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Meta-Analysis
. 2022 Mar 12:12:08003.
doi: 10.7189/jogh.12.08003. eCollection 2022.

Updating the assumptions on the impact of household water, sanitation and hygiene interventions on diarrhea morbidity in young children

Christa L Fischer Walker  1 , Neff Walker  1 , Robert E Black  1
Affiliations
Meta-Analysis

Updating the assumptions on the impact of household water, sanitation and hygiene interventions on diarrhea morbidity in young children

Christa L Fischer Walker et al. J Glob Health. .

Abstract

Background: The Lives Saved Tool (LiST) is a publicly available and widely used model used to estimate the impact of scaling up interventions on maternal and child health. A strength of the model is that it is continuously updated with country-specific information about intervention coverage, risk factors and causes of death. This paper reports an updated review and meta-analysis on the efficacy of water, sanitation and hygiene (WASH) interventions in reducing diarrhea morbidity among children under the age of five years.

Methods: We updated previous LiST systematic reviews for improved WASH interventions according to standard LiST criteria. We sought to identify more recent WASH studies to update LiST efficacy estimates for each WASH intervention on diarrhea morbidity. In addition, we conducted a search to identify studies that reported an effect size for combined improved WASH interventions. For interventions where we found new studies, we conducted a weighted meta-analysis to produce an updated effect size estimate.

Results: We did not find new studies demonstrating an effect of improved water source alone on diarrhea morbidity among children under 5 years of age. For improved sanitation, we conducted an updated meta-analysis among 4 studies and found no difference between intervention and control arms (weighted mean difference (WMD) = -5% (95% confidence interval (CI) = -11% to 2%). We identified four trials that assessed the effect of combined interventions targeting improved water, sanitation and hygiene. The weighted mean difference also showed no effect on diarrhea morbidity among children under 5 years of age (WMD = -6%, 95% CI = -15% to 4%). Our updated results for handwashing promotion estimate the effects to results in a 17% reduction in childhood diarrhea morbidity (95% CI = 7% to 27%).

Conclusions: Despite widespread acceptance that WASH interventions can improve diarrhea morbidity, the evidence supporting this specifically for children under 5 years of age remains weak. Children interact with the environment in ways that differ from adults and these constant exposures may limit the effect that these WASH interventions can have on diarrhea morbidity.

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Conflict of interest statement

Competing interests: The authors completed the ICMJE Unified Competing Interest Form (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of systematic review paper selection process.
Figure 2
Figure 2
Effect of improved sanitation on 7-day diarrhea prevalence.
Figure 3
Figure 3
Effect of handwashing promotion on 7-day diarrhea prevalence.
Figure 4
Figure 4
Effect of improved water, sanitation, and hygiene interventions on 7-day diarrhea prevalence.
See this image and copyright information in PMC

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