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Water, Sanitation and Hygiene for the Prevention of Diarrhoea
International Journal of Epidemiology (2010)
  • Sandy Cairncross, London School of Hygiene and Tropical Medicine
  • Caroline Hunt, London School of Hygiene and Tropical Medicine
  • Sophie Boisson, London School of Hygiene and Tropical Medicine
  • Kristof Bostoen, London School of Hygiene and Tropical Medicine
  • Val Curtis, London School of Hygiene and Tropical Medicine
  • Isaac Chun-Hai Fung, Georgia Southern University
  • Wolf-Peter Schmidt, London School of Hygiene and Tropical Medicine
Abstract
Background: Ever since John Snow's intervention on the Broad St pump, the effect of water quality, hygiene and sanitation in preventing diarrhoea deaths has always been debated. The evidence identified in previous reviews is of variable quality, and mostly relates to morbidity rather than mortality.

Methods: We drew on three systematic reviews, two of them for the Cochrane Collaboration, focussed on the effect of handwashing with soap on diarrhoea, of water quality improvement and of excreta disposal, respectively. The estimated effect on diarrhoea mortality was determined by applying the rules adopted for this supplement, where appropriate.

Results: The striking effect of handwashing with soap is consistent across various study designs and pathogens, though it depends on access to water. The effect of water treatment appears similarly large, but is not found in few blinded studies, suggesting that it may be partly due to the placebo effect. There is very little rigorous evidence for the health benefit of sanitation; four intervention studies were eventually identified, though they were all quasi-randomized, had morbidity as the outcome, and were in Chinese.

Conclusion: We propose diarrhoea risk reductions of 48, 17 and 36%, associated respectively, with handwashing with soap, improved water quality and excreta disposal as the estimates of effect for the LiST model. Most of the evidence is of poor quality. More trials are needed, but the evidence is nonetheless strong enough to support the provision of water supply, sanitation and hygiene for all.
Keywords
  • Water,
  • Sanitation,
  • Hygiene,
  • Diarrhoea,
  • Mortality
Disciplines
Publication Date
March 23, 2010
DOI
10.1093/ije/dyq035
Publisher Statement
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Article obtained from International Journal of Epidemiology.
Citation Information
Sandy Cairncross, Caroline Hunt, Sophie Boisson, Kristof Bostoen, et al.. "Water, Sanitation and Hygiene for the Prevention of Diarrhoea" International Journal of Epidemiology Vol. 39 Iss. S1 (2010) p. i193 - i205 ISSN: 1464-3685
Available at: http://works.bepress.com/isaac_fung1/59/