Systematic review: Assessing the impact of drinking water and sanitation on diarrhoeal disease in low‐ and middle‐income settings: systematic review and meta‐regression

Abstract

Abstractobjective To assess the impact of inadequate water and sanitation on diarrhoeal disease in lowand middle-income settings.methods The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low-and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified OttawaNewcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates.results Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12 515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions.conclusions The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented.keywords water, sanitation, diarrhoea, global burden of disease, risk estimates 928

On-plot drinking water supplies and health: A systematic review

“…Continuous supply, water quality, and storage emerged as mediating factors for health benefits of piped on-plot water, consistent with recent review findings (Wolf et al, 2014). A recent multi-country study found differences in water quality by water source type (Evans et al, 2013), but included studies reported little data on water quality by source type.…”

Do low-cost ceramic water filters improve water security in rural South Africa?

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User preferences and willingness to pay for safe drinking water: Experimental evidence from rural Tanzania

“…Rural areas of Sub-Saharan Africa suffer from limited access to improved water sources and high risk of fecal contamination in drinking water. Household water treatment and safe storage (HWTS) has been proposed as an intermediate solution to provide safer drinking water and reduce the burden of disease (WHO/UNICEF, 2008;Wolf et al, 2014).…”