Water Treatment And Child Mortality: A Meta-Analysis And Cost-effectiveness Analysis

Kremer, Michael; Luby, Stephen P.; Maertens, Ricardo; Tan, Brandon; Więcek, Witold

doi:10.3386/w30835

Cited by 6 publications

(3 citation statements)

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“…The contribution of this synthesis – to use participant flow data to provide estimates of changes in child mortality associated with WASH interventions – has been enabled by studies that use agreed standards of reporting such as CONSORT. There is potentially a large number of estimates of mortality in childhood from studies which do not use these methods of reporting, as a recent meta-analysis of household water treatment has indicated [101]. Going forward, the challenge will be for an author collaborative to provide sufficient incentives to obtain unpublished participant flow data, to ensure that future systematic reviews and meta-analyses are representative of the complete data available on mortality in WASH intervention studies.…”

Section: Conclusion and Suggested Research Directionsmentioning

confidence: 99%

Impact on childhood mortality of interventions to improve drinking water, sanitation and hygiene (WASH) to households: systematic review and meta-analysis

Waddington

Masset

Bick³

et al. 2023

Preprint

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Background In 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. However, current estimates of the health impacts of WASH improvements use self-reported morbidity, which may fail to capture longer-term or more severe impacts. Moreover, reported mortality is thought to be less prone to bias. This study aimed to answer the question: what are the impacts of WASH intervention improvements on reported childhood mortality in L&MICs? Methods and findings We 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 trials of WASH improvements implemented under endemic disease conditions in L&MICs were eligible, from studies 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 non-randomized 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 improvements are associated with a significant reduction of 17 percent 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 percent (OR=0.55, 95%CI=0.35, 0.84; 10 interventions). Further analysis by WASH technology suggested 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. Conclusions The findings are congruent with theories of infectious disease transmission. Washing with water presents a barrier to respiratory illness and diarrhoea, which are the two main components of 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.

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Section: Conclusion and Suggested Research Directionsmentioning

confidence: 99%

Impact on childhood mortality of interventions to improve drinking water, sanitation and hygiene (WASH) to households: systematic review and meta-analysis

Waddington

Masset

Bick³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…We join a growing number of meta-analyses of results from impact evaluations in economics and international education (Bandiera et al, 2021;Castaing and Gazeaud, 2022;Jackson and Mackevicius, 2021;Meager, 2019;Kremer et al, 2022;Vivalt, 2020). A meta-analysis allows us to rigorously aggregate effect sizes into a single average, boost the power of individual studies through pooling, and test important dimensions of heterogeneity.…”

Section: Introductionmentioning

confidence: 99%

Improving School Management in Low and Middle Income Countries: A Systematic Review

Anand,

Atluri,

Crawfurd

et al. 2023

SSRN Journal

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“…Randomized controlled trials are often criticized on the basis that their results are drawn from specific contexts and may therefore lack external validity. 9 A rapidly growing literature relies on Bayesian hierarchical models to aggregate information from multiple settings and assess external validity Romero et al, 2020;Vivalt, 2020;Bandiera et al, 2021;Jackson and Mackevicius, 2021;Kremer et al, 2022;Meager, 2022). 10 We add to this body of literature by applying the method to a new question -the effect of index insurance on productive investments -and by showing the scope for preregistration when data are not publicly available.…”

Section: Introductionmentioning

confidence: 99%

Do Index Insurance Programs Live Up to Their Promises? Aggregating Evidence from Multiple Experiments

Castaing

Gazeaud

2023

Preprint

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Water Treatment And Child Mortality: A Meta-Analysis And Cost-effectiveness Analysis

Cited by 6 publications

References 0 publications

Impact on childhood mortality of interventions to improve drinking water, sanitation and hygiene (WASH) to households: systematic review and meta-analysis

Impact on childhood mortality of interventions to improve drinking water, sanitation and hygiene (WASH) to households: systematic review and meta-analysis

Improving School Management in Low and Middle Income Countries: A Systematic Review

Do Index Insurance Programs Live Up to Their Promises? Aggregating Evidence from Multiple Experiments

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