In this systematic review and meta-analysis, we showed that WASH interventions reduced risk of diarrhoea. Drinking water interventions, specifically drinking water of higher quality and water filtered at POU, reduced risk of diarrhoea up to around 50%. Basic sanitation services without sewer connection resulted in a 21% reduction in diarrhoea risk and basic sanitation services with sewer connection resulted in a 47% reduction, compared with unimproved or limited sanitation. Combining water or sanitation interventions with other WASH interventions did not substantially increase reduction in diarrhoea. Handwashing promotion with or without broader hygiene education reduced diarrhoea by 30%. Only five (4%) of 124 included studies reported results by sex, showing the extent to which reporting of sex-disaggregated data is specifically limited in this context.
Author(s): Wolf, Jennyfer; Hubbard, Sydney; Brauer, Michael; Ambelu, Argaw; Arnold, Benjamin F; Bain, Robert; Bauza, Valerie; Brown, Joe;
Caruso, Bethany A;
Clasen, Thomas;
Colford, John M Jr;
Freeman, Matthew C;
Gordon, Bruce;
Johnston, Richard B;
Mertens, Andrew;
Prüss-Ustün, Annette;
Ross, Ian;
Stanaway, Jeffrey;
Zhao, Jeff T;
Cumming, Oliver;
Boisson, Sophie
Published: 2022
Language: English
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Additional Information
This systematic review and meta-analysis examines the effect of different types of WASH intervention, matching the transitions envisaged under SDG 6. The study provides updated exposure–response relationships between higher levels of WASH services, such as safely managed drinking water, sewered sanitation, and handwashing with soap, and occurrence of diarrhoea. These new estimates for the effect of different WASH services on diarrhoeal disease provide new information to support policy and investment decisions. They are also essential for up-to-date assessments of the burden of diarrhoeal disease attributable to WASH. Pooled effect sizes for higher level WASH services are important because they allow for more ambitious minimum risk exposure levels, which have a direct influence on the size, accuracy, and relevance of the estimated disease burden attributable to unsafe WASH.