Child Health Outcomes Associated With Failing Wastewater Management in the Black Belt Region of Alabama

Poor rural communities, such as those in the Alabama Black Belt region, face major challenges in managing household wastewater. Our study examined if children in the Alabama Black Belt experience higher rates of health conditions associated with environmental exposure to fecal pathogens. A retrospective cohort study using Alabama Medicaid administrative claims data (2012–2020) compared the prevalence of selected health conditions between rural Alabama counties within and outside the Black Belt region, which is known for its widespread wastewater failures. Children in the Black Belt region had a significantly higher prevalence of anemia (1.6% versus 0.6%, p =.006), sepsis (0.6% versus 0.2%, p <.0001), and asthma (15.6% versus 10.3%, p <.0001), but no significant difference was observed in rates of gastroenteritis, malnutrition, or pneumonia. Inadequate wastewater management in the Alabama Black Belt might contribute to higher rates of asthma, sepsis, and anemia in children. Our study findings suggest that gastrointestinal disease outcomes alone might be insufficient to evaluate the detrimental health effect of wastewater failures, especially within high-income countries such as the U.S.