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Systematic review: Assessing the impact of drinking water and sanitation on diarrhoeal disease in low‐ and middle‐income settings: systematic review and meta‐regression
Author(s) -
Wolf Jennyfer,
PrüssUstün Annette,
Cumming Oliver,
Bartram Jamie,
Bonjour Sophie,
Cairncross Sandy,
Clasen Thomas,
Colford John M.,
Curtis Valerie,
France Jennifer,
Fewtrell Lorna,
Freeman Matthew C.,
Gordon Bruce,
Hunter Paul R.,
Jeandron Aurelie,
Johnston Richard B.,
Mäusezahl Daniel,
Mathers Colin,
Neira Maria,
Higgins Julian P. T.
Publication year - 2014
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12331
Subject(s) - sanitation , observational study , medicine , environmental health , psychological intervention , meta analysis , propensity score matching , randomized controlled trial , systematic review , medline , psychiatry , pathology , political science , law
Objective To assess the impact of inadequate water and sanitation on diarrhoeal disease in low‐ and middle‐income settings. Methods The search strategy used C ochrane L ibrary, MEDLINE & P ub M ed, G lobal H ealth, E mbase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low‐ and middle‐income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi‐randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified O ttawa– N ewcastle scale. Study results were combined using meta‐analysis and meta‐regression to derive overall and intervention‐specific risk estimates. Results Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12 515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high‐quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions. Conclusions The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented.