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

Wolf, Jennyfer, Hunter, Paul R., Freeman, Matthew C., Cumming, Oliver, Clasen, Thomas, Bartram, Jamie, Higgins, Julian P. T., Johnston, Richard, Medlicott, Kate, Boisson, Sophie and Prüss-Ustün, Annette (2018) Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta‐analysis and meta‐regression. Tropical Medicine & International Health, 23 (5). pp. 508-525. ISSN 1360-2276

[thumbnail of Published manuscript]
PDF (Published manuscript) - Published Version
Available under License Other licence.

Download (476kB) | Preview


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.

Item Type: Article
Additional Information: This article is protected by copyright. All rights reserved.
Uncontrolled Keywords: diarrhoea,hygiene,meta‐analysis,sanitation,review,water,diarrhée,hygiène,méta‐analyse,sanitaires,revue,eau,sdg 3 - good health and well-being,sdg 6 - clean water and sanitation ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: Pure Connector
Date Deposited: 09 Mar 2018 16:30
Last Modified: 21 Oct 2022 18:33
DOI: 10.1111/tmi.13051

Actions (login required)

View Item View Item