204 lines
6.9 KiB
YAML
204 lines
6.9 KiB
YAML
abstract: 'Author summary Why was this study done? The biggest contributor to the
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global burden of infectious disease in childhood in developing countries
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is mortality due to respiratory and diarrhoeal infections, both of which
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are closely linked to deficient water, sanitation, and hygiene (WASH)
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availability and use by households.Multiple systematic reviews and
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meta-analyses of WASH-related morbidity have been conducted, but there
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is a shortage of rigorous, systematic evidence on the effectiveness of
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WASH interventions in reducing mortality. What did the researchers do
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and find? We conducted a systematic review and meta-analysis of the
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impacts of WASH interventions on all-cause and diarrhoea-related
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mortality in L\&MICs, incorporating evidence from 35 studies comprising
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48 distinct WASH intervention arms.We found significant effects on
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all-cause mortality among children aged under 5 of interventions to
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improve the quantity of water available (34\% reduction), hygiene
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promotion when water supplies were accessible to households (29\%
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reduction), and community-wide sanitation (21\% reduction).We also found
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significant effects of WASH interventions on diarrhoea mortality among
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under 5s (45\% reduction), which were significantly larger when provided
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to communities that were at the lowest rungs of the sanitation ladder,
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compared to those that already had improved WASH. What do these findings
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mean? Interventions to prevent water-related mortality in childhood in
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endemic disease circumstances provide adequate water supplies to
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households, enabling domestic hygiene and safe excreta disposal in the
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household and community.Systematic reviews can provide new evidence for
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decision making, but the approach we present is reliant on trial authors
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and journals adhering to agreed standards of reporting.
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BackgroundIn low- and middle-income countries (L\&MICs), the biggest
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contributing factors to the global burden of disease in childhood are
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deaths due to respiratory illness and diarrhoea, both of which are
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closely related to use of water, sanitation, and hygiene (WASH) services
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by households. However, current estimates of the health impacts of WASH
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interventions use self-reported morbidity, which may fail to capture
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longer-term or more severe impacts. Reported mortality is thought to be
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less prone to bias than other reported measures. This study aimed to
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answer the question: What are the impacts of WASH interventions on
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reported childhood mortality in L\&MICs? Methods and findingsWe
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conducted a systematic review and meta-analysis, using a published
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protocol. Systematic searches of 11 academic databases and trial
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registries, plus organisational repositories, were undertaken to locate
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studies of WASH interventions, which were published in peer review
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journals or other sources (e.g., organisational reports and working
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papers). Intervention studies of WASH improvements implemented under
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endemic disease circumstances in L\&MICs were eligible, which reported
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findings at any time until March 2020. We used the participant flow data
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supplied in response to journal editors'' calls for greater transparency.
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Data were collected by two authors working independently.We included
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evidence from 24 randomized and 11 nonrandomized studies of WASH
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interventions from all global regions, incorporating 2,600 deaths.
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Effects of 48 WASH treatment arms were included in analysis. We
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critically appraised and synthesised evidence using meta-analysis to
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improve statistical power. We found WASH interventions are associated
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with a significant reduction of 17\% in the odds of all-cause mortality
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in childhood (OR = 0.83, 95\% CI = 0.74, 0.92, evidence from 38
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interventions), and a significant reduction in diarrhoea mortality of
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45\% (OR = 0.55, 95\% CI = 0.35, 0.84; 10 interventions).Further
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analysis by WASH technology indicated interventions providing improved
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water in quantity to households were most consistently associated with
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reductions in all-cause mortality. Community-wide sanitation was most
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consistently associated with reductions in diarrhoea mortality. Around
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one-half of the included studies were assessed as being at ``moderate
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risk of bias{''''} in attributing mortality in childhood to the WASH
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intervention, and no studies were found to be at ``low risk of bias.{''''}
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The review should be updated to incorporate additional published and
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unpublished participant flow data. ConclusionsThe findings are congruent
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with theories of infectious disease transmission. Washing with water
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presents a barrier to respiratory illness and diarrhoea, which are the
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two biggest contributors to all-cause mortality in childhood in L\&MICs.
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Community-wide sanitation halts the spread of diarrhoea. We observed
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that evidence synthesis can provide new findings, going beyond the
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underlying data from trials to generate crucial insights for policy.
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Transparent reporting in trials creates opportunities for research
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synthesis to answer questions about mortality, which individual studies
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of interventions cannot be reliably designed to address.'
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affiliation: 'Waddington, HS (Corresponding Author), London Int Dev Ctr LIDC, London
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Sch Hyg \& Trop Med LSHTM, Dept Dis Control, Environm Hlth Grp, London, England.
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Waddington, Hugh Sharma, London Int Dev Ctr LIDC, London Sch Hyg \& Trop Med LSHTM,
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Dept Dis Control, Environm Hlth Grp, London, England.
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Masset, Edoardo, LSHTM, Ctr Excellence Dev Impact \& Learning CEDIL, LIDC, Dept
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Publ Hlth Environm \& Soc, London, England.
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Bick, Sarah; Cairncross, Sandy, LSHTM, Dept Dis Control, Environm Hlth Grp, London,
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England.'
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article-number: e1004215
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author: Waddington, Hugh Sharma and Masset, Edoardo and Bick, Sarah and Cairncross,
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Sandy
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author-email: Hugh.waddington@lshtm.ac.uk
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author_list:
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- family: Waddington
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given: Hugh Sharma
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- family: Masset
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given: Edoardo
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- family: Bick
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given: Sarah
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- family: Cairncross
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given: Sandy
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da: '2023-09-28'
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doi: 10.1371/journal.pmed.1004215
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eissn: 1549-1676
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files: []
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issn: 1549-1277
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journal: PLOS MEDICINE
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keywords-plus: 'DIARRHEAL DISEASE; NUTRITIONAL INTERVENTIONS; SOLAR DISINFECTION;
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CONTROLLED-TRIALS; INFANT-MORTALITY; RANDOMIZED-TRIAL; YOUNG-CHILDREN;
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WESTERN KENYA; HEALTH; GROWTH'
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language: English
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month: APR
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number: '4'
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number-of-cited-references: '106'
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orcid-numbers: 'Sharma Waddington, Hugh/0000-0003-3859-3342
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Bick, Sarah/0000-0001-6870-5320
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Masset, Edoardo/0000-0002-8826-0776'
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papis_id: 27bdb30ce5f9f747bd99a903cea5aedd
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ref: Waddington2023impactchildhood
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tags:
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- review
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times-cited: '1'
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title: 'Impact on childhood mortality of interventions to improve drinking water,
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sanitation, and hygiene (WASH) to households: Systematic review and meta-analysis'
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type: Review
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unique-id: WOS:000971493100001
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usage-count-last-180-days: '8'
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usage-count-since-2013: '8'
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volume: '20'
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web-of-science-categories: Medicine, General \& Internal
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year: '2023'
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