wow-inequalities/02-data/intermediate/wos_sample/8d73575ad9f59f65ecbe54d5a22dcb2a-waddington-hugh-sha/info.yaml

abstract: 'Author summary Why was this study done? The biggest contributor to the

  global burden of infectious disease in childhood in developing countries

  is mortality due to respiratory and diarrhoeal infections, both of which

  are closely linked to deficient water, sanitation, and hygiene (WASH)

  availability and use by households.Multiple systematic reviews and

  meta-analyses of WASH-related morbidity have been conducted, but there

  is a shortage of rigorous, systematic evidence on the effectiveness of

  WASH interventions in reducing mortality. What did the researchers do

  and find? We conducted a systematic review and meta-analysis of the

  impacts of WASH interventions on all-cause and diarrhoea-related

  mortality in L\&MICs, incorporating evidence from 35 studies comprising

  48 distinct WASH intervention arms.We found significant effects on

  all-cause mortality among children aged under 5 of interventions to

  improve the quantity of water available (34\% reduction), hygiene

  promotion when water supplies were accessible to households (29\%

  reduction), and community-wide sanitation (21\% reduction).We also found

  significant effects of WASH interventions on diarrhoea mortality among

  under 5s (45\% reduction), which were significantly larger when provided

  to communities that were at the lowest rungs of the sanitation ladder,

  compared to those that already had improved WASH. What do these findings

  mean? Interventions to prevent water-related mortality in childhood in

  endemic disease circumstances provide adequate water supplies to

  households, enabling domestic hygiene and safe excreta disposal in the

  household and community.Systematic reviews can provide new evidence for

  decision making, but the approach we present is reliant on trial authors

  and journals adhering to agreed standards of reporting.

  BackgroundIn low- and middle-income countries (L\&MICs), the biggest

  contributing factors to the global burden of disease in childhood are

  deaths due to respiratory illness and diarrhoea, both of which are

  closely related to use of water, sanitation, and hygiene (WASH) services

  by households. However, current estimates of the health impacts of WASH

  interventions use self-reported morbidity, which may fail to capture

  longer-term or more severe impacts. Reported mortality is thought to be

  less prone to bias than other reported measures. This study aimed to

  answer the question: What are the impacts of WASH interventions on

  reported childhood mortality in L\&MICs? Methods and findingsWe

  conducted a systematic review and meta-analysis, using a published

  protocol. Systematic searches of 11 academic databases and trial

  registries, plus organisational repositories, were undertaken to locate

  studies of WASH interventions, which were published in peer review

  journals or other sources (e.g., organisational reports and working

  papers). Intervention studies of WASH improvements implemented under

  endemic disease circumstances in L\&MICs were eligible, which reported

  findings at any time until March 2020. We used the participant flow data

  supplied in response to journal editors'' calls for greater transparency.

  Data were collected by two authors working independently.We included

  evidence from 24 randomized and 11 nonrandomized studies of WASH

  interventions from all global regions, incorporating 2,600 deaths.

  Effects of 48 WASH treatment arms were included in analysis. We

  critically appraised and synthesised evidence using meta-analysis to

  improve statistical power. We found WASH interventions are associated

  with a significant reduction of 17\% in the odds of all-cause mortality

  in childhood (OR = 0.83, 95\% CI = 0.74, 0.92, evidence from 38

  interventions), and a significant reduction in diarrhoea mortality of

  45\% (OR = 0.55, 95\% CI = 0.35, 0.84; 10 interventions).Further

  analysis by WASH technology indicated interventions providing improved

  water in quantity to households were most consistently associated with

  reductions in all-cause mortality. Community-wide sanitation was most

  consistently associated with reductions in diarrhoea mortality. Around

  one-half of the included studies were assessed as being at ``moderate

  risk of bias{''''} in attributing mortality in childhood to the WASH

  intervention, and no studies were found to be at ``low risk of bias.{''''}

  The review should be updated to incorporate additional published and

  unpublished participant flow data. ConclusionsThe findings are congruent

  with theories of infectious disease transmission. Washing with water

  presents a barrier to respiratory illness and diarrhoea, which are the

  two biggest contributors to all-cause mortality in childhood in L\&MICs.

  Community-wide sanitation halts the spread of diarrhoea. We observed

  that evidence synthesis can provide new findings, going beyond the

  underlying data from trials to generate crucial insights for policy.

  Transparent reporting in trials creates opportunities for research

  synthesis to answer questions about mortality, which individual studies

  of interventions cannot be reliably designed to address.'
affiliation: 'Waddington, HS (Corresponding Author), London Int Dev Ctr LIDC, London
  Sch Hyg \& Trop Med LSHTM, Dept Dis Control, Environm Hlth Grp, London, England.

  Waddington, Hugh Sharma, London Int Dev Ctr LIDC, London Sch Hyg \& Trop Med LSHTM,
  Dept Dis Control, Environm Hlth Grp, London, England.

  Masset, Edoardo, LSHTM, Ctr Excellence Dev Impact \& Learning CEDIL, LIDC, Dept
  Publ Hlth Environm \& Soc, London, England.

  Bick, Sarah; Cairncross, Sandy, LSHTM, Dept Dis Control, Environm Hlth Grp, London,
  England.'
article-number: e1004215
author: Waddington, Hugh Sharma and Masset, Edoardo and Bick, Sarah and Cairncross,
  Sandy
author-email: Hugh.waddington@lshtm.ac.uk
author_list:
- family: Waddington
  given: Hugh Sharma
- family: Masset
  given: Edoardo
- family: Bick
  given: Sarah
- family: Cairncross
  given: Sandy
da: '2023-09-28'
doi: 10.1371/journal.pmed.1004215
eissn: 1549-1676
files: []
issn: 1549-1277
journal: PLOS MEDICINE
keywords-plus: 'DIARRHEAL DISEASE; NUTRITIONAL INTERVENTIONS; SOLAR DISINFECTION;

  CONTROLLED-TRIALS; INFANT-MORTALITY; RANDOMIZED-TRIAL; YOUNG-CHILDREN;

  WESTERN KENYA; HEALTH; GROWTH'
language: English
month: APR
number: '4'
number-of-cited-references: '106'
orcid-numbers: 'Sharma Waddington, Hugh/0000-0003-3859-3342

  Bick, Sarah/0000-0001-6870-5320

  Masset, Edoardo/0000-0002-8826-0776'
papis_id: 27bdb30ce5f9f747bd99a903cea5aedd
ref: Waddington2023impactchildhood
tags:
- review
times-cited: '1'
title: 'Impact on childhood mortality of interventions to improve drinking water,
  sanitation, and hygiene (WASH) to households: Systematic review and meta-analysis'
type: article
unique-id: WOS:000971493100001
usage-count-last-180-days: '8'
usage-count-since-2013: '8'
volume: '20'
web-of-science-categories: Medicine, General \& Internal
year: '2023'