Health impact: water, sanitation and hygiene interventions to combat childhood diarrhoea

The notion that water quality treatment in the household and hygiene interventions are necessarily the most efficacious and sustainable interventions for promoting reduction of diarrhoea is challenged by the results of a synthetic review of impact evaluations examining effectiveness of water, sanitation and hygiene interventions in reducing childhood diarrhoea [1].

The review finds that while point-of-use water quality interventions appear to be highly effective, 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. Evidence on the combined impact of multiple interventions is mixed.

The review provides an update of previous reviews conducted in this area, notably by Fewtrell and Colford in 2004 [2].

[1] Waddington , H. ... [et al.] (2009). Water, sanitation and hygiene interventions to combat childhood diarrhoea in developing countries. (Synthetic review; no. 001). New Delhi, India, International Initiative for Impact Evaluation (3ie). Full document

[2] Fewtrell, L. and Colford, J.M. (2004). Water, sanitation and hygiene : interventions and diarrhoea : a systematic review and meta-analysis. (Health, nutrition and population (HNP) discussion paper / WB). Washington, DC, USA, World Bank. Full document

Related news:

• Health impact: deaths associated with incomplete water and sanitation provision in African refugee camps, Source Weekly, 21 Sep 2009
• Health impact: estimating the effects of poor reliability of drinking water interventions in developing countries, Source Weekly, 04 Jun 2009
• Household water treatment: scaling-up is premature say researchers, Source Weekly, 13 Mar 2009

Contact: Hugh Waddington, Responsible for Synthetic Reviews, International Initiative for Impact Evaluation (3ie), hwaddington@3ieimpact.org, http://www.3ieimpact.org

Keywords

• Monitoring & evaluation
• Sanitation - Hygiene promotion
• Water quality
• Water supply - Water treatment
• Water-related diseases