Interventions to improve disposal of human excreta for preventing diarrhoea

• Type of Material: Article
• Authors: Thomas Clasen, Emory University; Kristof Bostoen, London School of Hygiene and Tropical Medicine; Wolf-Peter Schmidt, London School of Hygiene and Tropical Medicine; Sophie Boisson, London School of Hygiene and Tropical Medicine; Isaac C-H Fung, Imperial College London; Marion W. Jenkins, Univeristy of California, Davis; Beth Scott, London School of Hygiene and Tropical Medicine; Steven Sugden, London School of Hygiene and Tropical Medicine; Sandy Cairncross, London School of Hygiene and Tropical Medicine
• Language: English
• Date: 2010-06-16
• Publisher: Cochrane Collaboration
• Publication Version: Final Published Version
• Copyright Statement: © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
• Final Published Version (URL): http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007180.pub2/abstract
• Title of Journal or Parent Work: Cochrane Database of Systematic Reviews
• ISSN: 1469-493X
• Issue: 6
• Start Page: 1
• End Page: 30
• Grant/Funding Information: UNICEF, USA.; WaterAid, UK.; The editorial base for the Cochrane Infectious Diseases Group is funded by the UK Department for International Development (DFID) for the benefit of low- and middle-income countries.
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 6. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review. Clasen TF, Bostoen K, Schmidt WP, Boisson S, Fung ICH, Jenkins MW, Scott B, Sugden S, Cairncross S. Interventions to improve disposal of human excreta for preventing diarrhoea. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007180. DOI: 10.1002/14651858.CD007180.pub2. (http://dx.doi.org/10.1002/14651858.CD007180) ABSTRACT Background Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in low-income countries, and are associated with exposure to human excreta. Objectives To assess the effectiveness of interventions to improve the disposal of human excreta for preventing diarrhoeal diseases. Search methods We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; LILACS; the metaRegister of Controlled Trials (mRCT); and Chinese-language databases available under the Wan Fang portal, and the China National Knowledge Infrastructure (CNKI-CAJ). We also handsearched relevant conference proceedings, and contacted researchers and organizations working in the field, as well as checking references from identified studies. Selection criteria Randomized, quasi-randomized, and non-randomized controlled trials (RCTs) were selected, comparing interventions aimed at improving the disposal of human excreta to reduce direct or indirect human contact with no such intervention. Cluster (eg at the level of household or community) controlled trials were included. Data collection and analysis We determined study eligibility, extracted data, and assessed methodological quality in accordance with the methods prescribed by the protocol. We described the results and summarized the information in tables. Due to substantial heterogeneity among the studies in terms of study design and type of intervention, no pooled effects were calculated. Main results Thirteen studies from six countries covering over 33,400 children and adults in rural, urban, and school settings met the review's inclusion criteria. In all studies the intervention was allocated at the community level. While the studies reported a wide range of effects, 11 of the 13 studies found the intervention was protective against diarrhoea. Differences in study populations and settings, in baseline sanitation levels, water, and hygiene practices, in types of interventions, study methodologies, compliance and coverage levels, and in case definitions and outcome surveillance limit the comparability of results of the studies included in this review. The validity of most individual study results are further compromised by the non-random allocation of the intervention among study clusters, an insufficient number of clusters, the lack of adjustment for clustering, unclear loss to follow-up, potential for reporting bias and other methodological shortcomings. Authors' conclusions This review provides some evidence that interventions to improve excreta disposal are effective in preventing diarrhoeal disease. However, this conclusion is based primarily on the consistency of the evidence of beneficial effects. The quality of the evidence is generally poor and does not allow for quantification of any such effect. The wide range of estimates of the effects of the intervention may be due to clinical and methodological heterogeneity among the studies, as well as to other important differences, including exposure levels, types of interventions, and different degrees of observer and respondent bias. Rigorous studies in multiple settings are needed to clarify the potential effectiveness of excreta disposal on diarrhoea.