Next Article in Journal
Use of Information Sources on Vaccine-Preventable Diseases in Pregnant Women: An Experience in Ferrara, Italy
Next Article in Special Issue
Ruminant Fecal Contamination of Drinking Water Introduced Post-Collection in Rural Kenyan Households
Previous Article in Journal
Spatiotemporal Variations and Factors of Air Quality in Urban Central China during 2013–2015
Previous Article in Special Issue
Sanitation and Collective Efficacy in Rural Cambodia: The Value Added of Qualitative Formative Work for the Contextualization of Measurement Tools
Open AccessReview

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

Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109-2029, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(1), 230; https://doi.org/10.3390/ijerph17010230
Received: 27 November 2019 / Revised: 19 December 2019 / Accepted: 25 December 2019 / Published: 28 December 2019
(This article belongs to the Special Issue New Directions in Water, Sanitation and Hygiene Research)
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. View Full-Text
Keywords: sanitation; diarrhea; diarrhoea; WASH; sewerage; intervention; meta-analysis sanitation; diarrhea; diarrhoea; WASH; sewerage; intervention; meta-analysis
Show Figures

Figure 1

MDPI and ACS Style

Contreras, J.D.; Eisenberg, J.N. Does Basic Sanitation Prevent Diarrhea? Contextualizing Recent Intervention Trials through a Historical Lens. Int. J. Environ. Res. Public Health 2020, 17, 230.

Show more citation formats Show less citations formats
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Search more from Scilit
 
Search
Back to TopTop