Rainfall and Temperature Influences on Childhood Diarrhea and the Effect Modification Role of Water and Sanitation Conditions: A Systematic Review and Meta-Analysis

Abstract

The latest report from the Intergovernmental Panel on Climate Change (IPCC) highlighted the worsening impacts of climate change. Two climate factors-temperature and rainfall uncertainties-influence the risk of childhood diarrhea, which remains a significant cause of morbidity and mortality in low- and middle-income countries. They create a conducive environment for diarrhea-causing pathogens and overwhelm environmental prevention measures. This study aimed to produce comprehensive evidence on the association of temperature and rainfall variability with the risk of childhood diarrhea and the influence of water and sanitation conditions on those associations. We conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) approach. Records published in English from 2006 to 2023 were searched on 8 January 2024 via PubMed, EMBASE, ScienceDirect, Scopus, the Cochrane Library, and Google/Google Scholar using comprehensive search terms. We assessed studies for any risk of bias using the Navigation Guide and rated the quality of the evidence using the GRADE approach. The heterogeneity among estimates was assessed using I-squared statistics (I²). The findings of the analysis were presented with forest plots using an incidence rate ratio (IRR). A meta-analysis was conducted on effect modifiers (water supply and sanitation conditions) using a random effects model with a 95% confidence interval (CI). The statistical analyses were conducted using R 4.3.2 software and Review Manager 5.3. A total of 2017 records were identified through searches, and only the 36 articles that met the inclusion criteria were included. The analysis suggests a small positive association between increased temperature and the occurrence of under-five diarrhea, with the pooled IRR = 1.04; 95% CI [1.03, 1.05], at I² = 56% and p-value < 0.01, and increased rainfall and U5 diarrhea, with IRR = 1.14; 95% CI [1.03, 1.27], at I² = 86% and p-value < 0.01. The meta-analysis indicated a positive association between unimproved latrine facilities and drinking water sources with a rainfall-modified effect on U5 diarrhea, with IRR = 1.21; 95% CI [0.95, 1.53], at I² = 62% and p-value = 0.03. We found that an increase in mean temperature and rainfall was associated with an increased risk of childhood diarrhea. Where there were unimproved latrine facilities and drinking water sources, the increase in mean rainfall or temperature would increase the incidence of childhood diarrhea. The results of this review help in assessing the effectiveness of current intervention programs, making changes as needed, or creating new initiatives to lower the prevalence of childhood diarrhea.

Keywords: diarrhea; drinking water source; rainfall; sanitation condition; temperature; under-five children.

Figure 1

Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.

Figure 2

The PRISMA diagram of the study selection for a systematic review and meta-analysis on the association between rainfall and temperature on childhood diarrhea and their influence on water and sanitation factors.

Figure 3

Forest plot of the systematic review of the association between temperature and childhood diarrhea after removing the articles that contributed to high heterogeneity (the funnel plot displaying the corresponding publication bias is shown in the Supplementary Materials; Figure S4) [24,26,27,32,33,35,37,39,41,43,45,47,50,51,52,53,54,55,58].

Figure 4

Forest plot of the systematic review of the association between rainfall and childhood diarrhea (the funnel plot of this analysis is shown in the Supplementary Materials; Figure S7) [23,26,27,28,29,34,36,39,44,45,46,49,54,55,58].

Figure 5

Forest plot of the meta-analysis on the modified association between temperature and childhood diarrhea due to water and sanitation conditions. Effect modifiers on temp-diarrhea association refers Effect modifiers on the temperature-diarrhea association [32,39,47].

Figure 6

Forest plot of the meta-analysis on the modified effect of the association of rainfall on childhood diarrhea by water and sanitation conditions (see the Supplementary Materials for funnel plot, Figure S11). Effect modifiers on Rainfall-diarrhea associa refers Effect modifiers on the Rainfall-diarrhea association [28,30,42,49].