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Maybe this mod will help you. Check comments for possible mod conflicts.
Also seem to recall some of the WRE town churches giving +sanitation bonuses.
You lose more with every additional Christian technology.
Save the techs until after the buildings you need are fully built.
It represents the degradation of the East as Orthodoxy rose up. Education became less common and being unclean became a sign that you were a better Christian.
It was mostly an infrastructure problem but there's a reason that medieval holy men and crusaders never bathed and it was not because they didn't have access to water or sap. They took the idea of rejecting vanity to an extreme.