Do Piped Water and Flush Toilets Prevent Child Diarrhea in Rural Philippines?

Capuno, Joseph J.; Tan, Carlos Antonio R.; Fabella, Vigile Marie

doi:10.1177/1010539511430996

Cited by 23 publications

(11 citation statements)

References 21 publications

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“…35 There is also evidence from other studies that access to improved sanitation with a water seal is associated with lower diarrhea morbidity, compared with improved sanitation with no water seal. 23,26,27 This may suggest that access to sanitation facilities with a water seal provides better protection from fecal contamination compared with nonflush latrines.…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence from a small number of observational and intervention studies that access to flush or pour flush latrines connected to a piped sewer system or septic tank or pit and composting latrines is associated with a lower risk of diarrhea. [23][24][25][26][27][28] However, from these studies it is not known whether pit latrines with a slab (improved, as defined by JMP) provide similar protection from diarrhea.…”

Section: Introductionmentioning

confidence: 99%

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A Cross Sectional Study of the Association between Sanitation Type and Fecal Contamination of the Household Environment in Rural Bangladesh

Huda

Schmidt

Pickering

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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We conducted a cross sectional study to assess 1) the association between access to basic sanitation and fecal contamination of sentinel toy balls and 2) if other sanitation factors such as shared use and cleanliness are associated with fecal contamination of sentinel toy balls. We assessed sanitation facilities in 454 households with a child aged 6-24 months in rural Bangladesh. We defined "basic" sanitation as access to improved sanitation facilities (pit latrine with a slab or better) not shared with other households. In each household, an identical toy ball was given to the target child. After 24 hours, the balls were rinsed to enumerate fecal coliforms as an indicator of household fecal contamination. Households with basic sanitation had lower fecal coliform contamination than households with no access to basic sanitation (adjusted difference in means: -0.31 log colony forming units [CFU]/toy ball; 95% confidence interval [CI]: -0.61, -0.01). Shared sanitation facilities of otherwise improved type were more likely to have visible feces on the latrine slab compared with private facilities. Among households with access to improved sanitation, households with no visible feces on the latrine slab had less toy ball contamination than households with visible feces on the latrine slab (adjusted difference in means: -0.38 log CFU/toy ball; 95% CI: -0.77, 0.02). Access to basic sanitation may prevent fecal contamination of the household environment. An Improved sanitation facility used by an individual household may be better in preventing household fecal contamination compared with improved facilities shared with other households.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Cross Sectional Study of the Association between Sanitation Type and Fecal Contamination of the Household Environment in Rural Bangladesh

Huda

Schmidt

Pickering

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…(), Capuno et al . (), Fan and Mahal () and Kumar and Vollmer ()). A strength of this study is that it compares different types of sanitation intervention and different levels of coverage of those facilities, allows for a non‐linear relationship with health outcomes and pools data from multiple countries.…”

Section: Discussionmentioning

confidence: 98%

“…() and Capuno et al . () used DHS (or similar household level survey) data and propensity score matching methods to compare households with ‘improved sanitation’ (typically improved latrines) with households with unimproved sanitation. Komarulzaman et al .…”

Section: Introductionmentioning

confidence: 99%

Health Effects of Sanitation Facilities: A Bayesian Semiparametric Analysis of Compositional Data

Watson

Sartori

Uthman

et al. 2019

Journal of the Royal Statistical Society Series C: Applied Statistics

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Summary Diarrhoeal disease is one of the leading causes of illness and death in young children: a problem exacerbated by a lack of access to safe sanitation facilities. But the effects of different types of sanitation facilities, and the relationship between their levels of coverage in an area and disease risk, remain uncertain. We specify a hierarchical model that enables us to estimate the disease risk response surface across the multi‐dimensional space of the composition of sanitation facilities in an area. This permits a non‐linear relationship between coverage of improved sanitation, differential effects by sanitation type and unobserved differences between countries. The model is used to estimate the change in risk associated with different types of sanitation facility, from which it is estimated that only increases in the coverage of sewerage and private improved sanitation facilities will achieve clinically meaningful reductions in the risk of adverse outcomes.

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“…However, this estimate still includes school-based interventions, which likely follow unique transmission dynamics, and three sewerage studies that possibly drive the observed overall effect of sanitation interventions. In this update, eight new eligible sanitation studies were identified and added to the 11 studies from Wolf et al 2014 [19,21,22,24,[48][49][50][51][52][53]55,58,[77][78][79][87][88][89][90]. Four estimates were extracted from Interventions that led to sanitation coverage of <75% reduced diarrhea by an average of 24% (RR = 0.76, 95% CI = 0.51, 1.13), and those that led to coverage >75% reduced diarrhea by 45% (RR = 0.55, 95% CI 0.34, 0.91).…”

Section: Jung Et Al 2017mentioning

confidence: 99%

Does Basic Sanitation Prevent Diarrhea? Contextualizing Recent Intervention Trials through a Historical Lens

Contreras

Eisenberg

2019

IJERPH

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Three of four recent major sanitation intervention trials found no effect on diarrhea. These results conflicted with longstanding beliefs from decades of literature. To understand this discordance, we placed recent trials into the historical context that preceded them in two ways. First, we evaluated the history of published literature reviews on sanitation and diarrhea. Second, we conducted meta-analyses on studies from the most recent systematic review to uncover features that predict effectiveness. We found that 13 literature reviews dating to 1983 consistently estimated a significant protective effect of sanitation against diarrhea. However, these were marred by flawed studies and inappropriately averaged effects across widely heterogeneous interventions and contexts. Our meta-analyses highlight that the overall effect of sanitation on diarrhea was largely driven by sewerage and interventions that improved more than sanitation alone. There is no true overall effect of sanitation because variability between intervention types and implementation contexts is too complex to average. Ultimately, the null effects of recent latrine interventions are not surprising. Instead, the one trial that found a strong relative reduction in diarrhea is the historical outlier. The development of transformative sanitation interventions requires a better understanding of the social and environmental contexts that determine intervention effectiveness.

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Do Piped Water and Flush Toilets Prevent Child Diarrhea in Rural Philippines?

Cited by 23 publications

References 21 publications

A Cross Sectional Study of the Association between Sanitation Type and Fecal Contamination of the Household Environment in Rural Bangladesh

A Cross Sectional Study of the Association between Sanitation Type and Fecal Contamination of the Household Environment in Rural Bangladesh

Health Effects of Sanitation Facilities: A Bayesian Semiparametric Analysis of Compositional Data

Does Basic Sanitation Prevent Diarrhea? Contextualizing Recent Intervention Trials through a Historical Lens

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