Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta-analysis and meta-regression

Jennyfer Wolf, Paul R. Hunter, Matthew C. Freeman, Oliver Cumming, Thomas Clasen, Jamie Bartram, Julian P.T. Higgins, Richard Johnston, Kate Medlicott, Sophie Boisson, Annette Prüss-Ustün*

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)

68 Citations (Scopus)
283 Downloads (Pure)

Abstract

Objectives: Safe drinking water, sanitation and hygiene are protective against diarrhoeal disease; a leading cause of child mortality. The main objective was an updated assessment of the impact of unsafe water, sanitation and hygiene (WaSH) on childhood diarrhoeal disease. Methods: We undertook a systematic review of articles published between 1970 and February 2016. Study results were combined and analysed using meta-analysis and meta-regression. Results: A total of 135 studies met the inclusion criteria. Several water, sanitation and hygiene interventions were associated with lower risk of diarrhoeal morbidity. Point-of-use filter interventions with safe storage reduced diarrhoea risk by 61% (RR = 0.39; 95% CI: 0.32, 0.48); piped water to premises of higher quality and continuous availability by 75% and 36% (RR = 0.25 (0.09, 0.67) and 0.64 (0.42, 0.98)), respectively compared to a baseline of unimproved drinking water; sanitation interventions by 25% (RR = 0.75 (0.63, 0.88)) with evidence for greater reductions when high sanitation coverage is reached; and interventions promoting handwashing with soap by 30% (RR = 0.70 (0.64, 0.77)) vs. no intervention. Results of the analysis of sanitation and hygiene interventions are sensitive to certain differences in study methods and conditions. Correcting for non-blinding would reduce the associations with diarrhoea to some extent. Conclusions: Although evidence is limited, results suggest that household connections of water supply and higher levels of community coverage for sanitation appear particularly impactful which is in line with targets of the Sustainable Development Goals.

Original languageEnglish
Pages (from-to)508-525
Number of pages18
JournalTropical Medicine and International Health
Volume23
Issue number5
Early online date23 Apr 2018
DOIs
Publication statusPublished - 1 May 2018

Keywords

  • diarrhoea
  • hygiene
  • meta-analysis
  • review
  • sanitation
  • water

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    Wolf, J., Hunter, P. R., Freeman, M. C., Cumming, O., Clasen, T., Bartram, J., Higgins, J. P. T., Johnston, R., Medlicott, K., Boisson, S., & Prüss-Ustün, A. (2018). Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta-analysis and meta-regression. Tropical Medicine and International Health, 23(5), 508-525. https://doi.org/10.1111/tmi.13051