Safe Drinking Water and Its Impact on Children’s Growth and Development: A Systematic Review

Access to safe drinking water is critical for child growth and development. However, microbial contamination is a constant threat in many low- and middle-income countries. The current systematic review sets out to examine the evidence of drinking water quality and the physical and cognitive development of children aged 0 to 5 years. The review authors conducted a comprehensive search of SCOPUS, EBSCO, PubMed, the Cochrane Library, and Google Search for cohort studies and clinical trials conducted in English between the years 2010 and 2025. Of 222 studies, 15 were included in the review and the majority were conducted in low- and middle-income countries The findings consistently demonstrate that microbiological contamination, predominantly by <i>Escherichia coli</i> (the primary water quality indicator examined across studies), is associated with an increased risk of stunting (odds ratio up to 4.14) and reductions in height-for-age Z-scores (HAZ) (by 0.29-0.57). There is currently limited evidence in the studies reviewed that suggests a correlation between the presence of unsafe drinking water and a decrease in cognitive development; however, the evidence is insufficient and warrants further study. Integrated water, sanitation and hygiene (WASH) and nutrition programs had promising growth results, which varied depending on the initial sanitation coverage of the target population, adherence to the intervention, and the overall design of the program. To sum up, contaminated drinking water negatively affects physical and cognitive development during early childhood. Comprehensive WASH-nutrition strategies need to be implemented to reduce this impact and further progress towards Sustainable Development Goal (SDG) 6.