[EQ] Water, Sanitation and Hygiene Interventions to Combat Childhood Diarrhoea in Developing Countries

Water, Sanitation and Hygiene Interventions to Combat Childhood Diarrhoea in Developing Countries

 

Hugh Waddington, International Initiative for Impact Evaluation (3ie), Birte Snilstveit, 3ie, Howard White, 3ie

Lorna Fewtrell, Aberystwyth University

The International Initiative for Impact Evaluation (3ie)

Available online PDF [119p.] at: http://bit.ly/dmHbhI

“…..This report is a synthetic review of impact evaluations examining effectiveness of water, sanitation and hygiene (WSH) interventions in reducing childhood diarrhoea.

 

The review has been conducted to Campbell/Cochrane Collaboration standards of systematic review, as well as employing mixed methods of data analysis to assess not only which interventions are effective, or not, but why and under what circumstances. The review provides an update of previous reviews conducted in this area, notably Fewtrell and Colford (2004).

 

A comprehensive search was conducted of published and unpublished materials. Studies were identified for inclusion which employed rigorous impact evaluation

techniques, using experimental (randomised assignment) and quasi-experimental methods, and which evaluated the impact of water, sanitation and/or hygiene

interventions on diarrhoea morbidity among children in low- and middle-income countries. 65 rigorous impact evaluations were identified for quantitative synthesis,

covering 71 distinct interventions assessed across 130,000 children in 35 developing countries during the past three decades.

 

Each study was coded for a range of variables relating to type of intervention, effect size and precision, internal validity (relating to evaluation quality) and external validity (relating to context and behavioural mechanisms). Interventions were grouped into five categories: water supply improvements, water quality, sanitation, hygiene and multiple interventions involving a combination of water and sanitation and/or hygiene. Data were collected and synthesised on both quantitative and qualitative information presented in the evaluations.

 

The results challenge the notion that water quality treatment in the household (at point-of-use) and sanitation ‘software’ (hygiene) interventions are necessarily the

most efficacious and sustainable interventions for promoting reduction of diarrhoea.

While point-of-use water quality interventions appear to be highly effective – and indeed, more effective than water supply or source treatment in reducing diarrhoea – much of the evidence is from trials conducted over small populations and short time periods. More evidence is needed on sustainability, as water quality interventions conducted over longer periods tend to show smaller effectiveness, while compliance rates, and therefore impact, appear to fall markedly over time.

 

Hygiene interventions, particularly provision of soap for hand-washing, are effective in reducing diarrhoea morbidity, and there does not appear to be evidence that compliance falls over time. The analysis suggests that sanitation ‘hardware’ interventions are also highly effective. However, relatively few studies have been conducted in this area to-date and studies are particularly needed that quantify the possible environmental spillovers from sanitation provision…”

 

CONTENTS

SUMMARY

1. INTRODUCTION AND OBJECTIVES

2. BACKGROUND

3. INTERVENTIONS AND THEORETICAL MODEL

4. METHODS

4.1. Inclusion criteria

4.2. Search methods for identification of studies

4.3. Data collection and coding

Interventions

Effect sizes

Internal validity

External validity

5. SEARCH RESULTS

6. EFFECTIVENESS

6.1. Pooled estimates

6.2. Impact heterogeneity

6.3. Publication bias

7. BEHAVIOUR CHANGE

8. SUSTAINABILITY

9. CONCLUSION

 

REFERENCES: INCLUDED STUDIES

REFERENCES: EXCLUDED STUDIES

ADDITIONAL REFERENCES

 

ANNEX 1: SEARCH RESULTS

ANNEX 2: STUDY CODES

ANNEX 3: INCLUDED INTERVENTIONS

ANNEX 4: FOREST PLOTS

 

http://www.research4development.info/PDF/Articles/SR_Sanitation.pdf

 

 

*      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho

IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission. 

Thank you.