Skip to main content

Advertisement

SpringerLink
Log in

Impact of Water, Sanitation and Hygiene Interventions on Growth, Non-diarrheal Morbidity and Mortality in Children Residing in Low- and Middle-income Countries: A Systematic Review

  • Systematic Review
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To evaluate the impact of water, sanitation and hygiene (WASH) interventions in children (age <18 y) on growth, non-diarrheal morbidity and mortality in children.

Design

Systematic review of randomized controlled trials, non-randomized controlled trials and controlled before-after studies.

Setting

Low- and middle-income countries.

Participants

41 trials with WASH intervention, incorporating data on 113055 children.

Intervention

Hygiene promotion and education (15 trials), water intervention (10 trials), sanitation improvement (7 trials), all three components of WASH (4 trials), combined water and sanitation (1 trial), and sanitation and hygiene (1 trial).

Outcome Measures

(i) Anthropometry: weight, height, weight-for-height, mid-arm circumference; (ii) Prevalence of malnutrition; (iii) Non-diarrheal morbidity; and (iv) mortality.

Results

There may be little or no effect of hygiene intervention on most anthropometric parameters (low- to very-low quality evidence). Hygiene intervention reduced the risk of developing Acute respiratory infections by 24% (RR 0.76; 95% CI 0.59, 0.98; moderate quality evidence), cough by 10% (RR 0.90; 95% CI 0.83, 0.97; moderate quality evidence), laboratory-confirmed influenza by 50% (RR 0.5; 95% CI 0.41, 0.62; very low quality evidence), fever by 13% (RR 0.87; 95% CI 0.74, 1.02; moderate quality evidence), and conjunctivitis by 51% (RR 0.49; 95% CI 0.45, 0.55; low quality evidence). There was low quality evidence to suggest no impact of hygiene intervention on mortality (RR 0.65; 95% CI 0.25, 1.7). Improvement in water supply and quality was associated with slightly higher weight-for-age Z-score (MD 0.03; 95% CI 0, 0.06; low quality evidence), but no significant impact on other anthropometric parameters or infectious morbidity (low to very low quality evidence). There was very low quality evidence to suggest reduction in mortality (RR 0.45; 95% CI 0.25, 0.81). Improvement in sanitation had a variable effect on the anthropometry and infectious morbidity. Combined water, sanitation and hygiene intervention improved height-for-age Z scores (MD 0.22; 95% CI 0.12, 0.32) and decreased the risk of stunting by 13% (RR 0.87; 95% CI 0.81, 0.94) (very low quality of evidence). There was no evidence of significant effect of combined WASH interventions on non-diarrheal morbidity (fever, respiratory infections, intestinal helminth infection and school absenteeism) (low- to very-low quality of evidence). Any WASH intervention (considered together) resulted in lower risk of underweight (RR 0.81; 95% CI 0.69, 0.96), stunting (RR 0.77; 95% CI 0.68, 0.86) and wasting (RR 0.12, 0.85) (low- to very-low quality of evidence).

Conclusion

Available evidence suggests that there may be little or no effect of WASH interventions on the anthropometric indices in children from low- and middle-income countries. There is low- to very-low quality of evidence to suggest decrease in prevalence of wasting, stunting and underweight. WASH interventions (especially hygiene intervention) were associated with lower risk of non-diarrheal morbidity (very low to moderate quality evidence). There was very low quality evidence to suggest some decrease to no change in mortality. These potential health benefits lend support to the ongoing efforts for provision of safe and adequate water supply, sanitation and hygiene.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organisation (WHO)/United Nations Children's Fund (UNICEF). Global water supply and sanitation assessment 2000 report. Geneva: Water Supply and Sanitation Collaborative Council, WHO/UNICEF, 2000.

  2. Clasen TF, Bostoen K, Schmidt WP, Boisson S, Fung ICH, Jenkins MW, et al. Interventions to improve disposal of human excreta for preventing diarrhoea. Cochrane Database Syst Rev. 2010;6:CD007180.

    Google Scholar 

  3. Fewtrell L, Kauffman B, Kay D, Enanoria W, Haller L, Colford JM. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis. 2005;5:42–52.

    Article  PubMed  Google Scholar 

  4. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: A systematic review. Lancet Infect Dis. 2003;3:275–81.

    Article  PubMed  Google Scholar 

  5. Schmidt WP, Cairncross S. Household water treatment in poor populations: is there enough evidence for scaling up now? Environ Sci Technol. 2009;43:986–92.

    Article  PubMed  CAS  Google Scholar 

  6. Dangour AD, Watson L, Cumming O, Boisson S, Che Y, Velleman Y, et al. Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children. Cochrane Database Syst Rev. 2013;8:CD009382.

    Google Scholar 

  7. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011.

    Google Scholar 

  8. Cochrane Community. Editorial and Publishing Policy Resource: Review Manager (RevMan). Available from: http://community.cochrane.org/editorial-and-publishingpolicy-resource/information-technology/review-managerrevman. Accessed September 19, 2017.

  9. Gradepro. GRADE's software for Summary of Findings Tables, Health Technology Assessment and Guidelines. Available from: https://gradepro.org/. Accessed September 19, 2017.

  10. Abdou A, Munoz BE, Nassirou B, Kadri B, Moussa F, Baarè I, et al. How much is not enough? A community randomized trial of a Water and Health Education programme for Trachoma and Ocular C. trachomatis infection in Niger. Trop Med Int Health. 2010;15:98–104.

    Article  PubMed  Google Scholar 

  11. Ahmed NU, Zeitlin MF, Beiser AS, Super CM, Gershoff SN, Ahmed MA. Assessment of the impact of a hygiene intervention on environmental sanitation, childhood diarrhoea, and the growth of children in rural Bangladesh. Food Nutr Bull. 1994;15:40–52.

    Google Scholar 

  12. Ahmed NU, Zeitlin MF, Beiser AS, Super CM, Gershoff SN. A longitudinal study of the impact of behavioural change intervention on cleanliness, diarrhoeal morbidity and growth of children inrural Bangladesh. Soc Sci Med. 1993;37:159–71.

    Article  PubMed  CAS  Google Scholar 

  13. Belizario Jr VY, Liwanag HJC, Naig JRA, Chua PLC, Madamba MI, Dahildahil RO. Parasitological and nutritional status of school-age and preschool-age children in four villages in Southern Leyte, Philippines: Lessons for monitoring the outcome of Community-Led Total Sanitation. Acta Tropica. 2015;141:16–24.

    Article  PubMed  Google Scholar 

  14. Boisson S, Kiyombo M, Sthreshley L, Tumba S, Makambo J, Clasen T. Field assessment of a novel household-based water filtration device: A randomised, placebo-controlled trial in the democratic republic of congo. PloS One. 2010;5:e12613.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Boisson S, Stevenson M, Shapiro L, Kumar V, Singh LP, Ward D, et al. Effect of household-based drinking water chlorination on diarrhoea among children under five in Orissa, India: A double-blind randomised placebocontrolled trial. PloS Med. 2013;10:e1001497.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Bowen A, Ma H, Ou J, Billhimer W, Long T, Mintz E, et al. A cluster randomized trial evaluating the effect of a hand washing-promotion program in Chinese primary schools. Am J Trop Med Hyg. 2007;76:1166–73.

    Article  PubMed  Google Scholar 

  17. Bowen A, Agboatwalla M, Luby S, Tobery T, Ayers T, Hoekstra RM. Association between intensive hand washing promotion and child development in Karachi, Pakistan: A cluster randomized controlled trial. Arch Pediatr Adolesc Med. 2012;166:1037–44.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer W, Keswick B, et al. Combining drinking water treatment and hand washing for diarrhoea prevention: A cluster randomised controlled trial. Trop Med Int Health. 2006;11:479–89.

    Article  PubMed  Google Scholar 

  19. Caruso BA, Freeman MC, Garn JV, Driebelbis R, Saboori S, Muga R, et al. Assessing the impact of a school-based latrine cleaning and hand washing program on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial. Trop Med Int Health. 2014;19:1185–97.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Christensen G, Dentz HN, Pickering AJ, Bourdier T, Arnold BF, Colford JM, et al. Pilot cluster randomized controlled trials to evaluate adoption of water, sanitation and hygiene interventions and their combination in rural Western Kenya. Am J Trop Med Hyg. 2015;92:437–47.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Boisson S, Sosai P, Ray S, Routray P, Torondel B, Schmidt W, et al. Promoting latrine construction and use in rural villages practicing open defecation: Process evaluation in connection with a randomised controlled trial in Orissa, India. BMC Research Notes 2014;7:486.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Clasen T, Boisson S, Routray P, Ensink J, Jenkins M, Freeman M, et al. Assessing the health impact of improved rural sanitation: Designing and carrying out a cluster randomized, controlled trial in Orissa, India. Am J Trop Med Hyg. 2012;87(Suppl 1):231.

    Google Scholar 

  23. Clasen T, Boisson S, Routray P, Torondel B, Bell M, Cumming O, et al. Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: A cluster-randomised trial. Lancet Glob Health 2014;2: e645–53.

    Article  PubMed  Google Scholar 

  24. Clasen T, Boisson S, Routray P, Torondel B, Jenkins M, Freeman M. The effectiveness of a rural sanitation on health and Orissa, India: A cluster-randomized, controlled trial. Am J Trop Med Hyg. 2014;91(Suppl 1):215.

    Google Scholar 

  25. Conroy RM, Meegan ME, Joyce T, McGuigan K, Barnes J. Solar disinfection of water reduces diarrhoeal disease: an update. Arch Dis Child. 1999;81:337–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Correa JC, Pinto D, Salas LA, Camacho JC, Rondón M, Quintero J. A cluster-randomized controlled trial of hand rubs for prevention of infectious diseases among children in Colombia. Rev Panam Salud Publica. 2012;31:476–484.

    Article  PubMed  Google Scholar 

  27. Crump JA, Oteino PO, Slutsker L, Keswick BH, Rosen DH, Hoekstra RM, et al. Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: Cluster randomised controlled trial. BMJ. 2005;331:478–81.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dumba R, Kaddu JB, Wabwire-Mangen F. Design and implementation of participatory hygiene and sanitation transformation (PHAST) as a strategy to control soiltransmitted helminth infections in Luweero, Uganda. African Health Sci. 2013;13:512–7.

    CAS  Google Scholar 

  29. du Preez M, Conroy R, Ligondo S, Hennessy J, Elmore-Meegan M, Soita A, et al. Randomized intervention study of solar disinfection of drinking water in the prevention of dysentery in Kenyan children aged under 5 Years. Environ Sci Tech. 2011;45:9315–23.

    Article  CAS  Google Scholar 

  30. Emerson PM, Lindsay SW, Alexander N, Bah M, Dibba SM, Faal HB, et al. Role of flies and provision of latrines in trachoma control: Cluster-randomised controlled trial. Lancet. 2004;363:1093–8.

    Article  PubMed  Google Scholar 

  31. Emerson PM, Lindsay SW, Walraven GEL, Dibba SM, Lowe KO, Bailey RL. The Flies and Eyes Project Design and methods of a cluster-randomised intervention study to confirm the importance of flies as trachoma vectors in The Gambia and to test a sustainable method of fly control using pit latrines. Opthalmic Epidemiology. 2002;9:105–17.

    Article  Google Scholar 

  32. Ercumen A, Naser AM, Unicomb L, ArnoldBF, Colford Jr. JM, Luby SP. Effects of source-versus household contamination of tubewell water on child diarrhea in rural Bangladesh: A randomized controlled trial. PLoS One. 2015;10:e0121907.

    PubMed  Google Scholar 

  33. Fenn B, Bulti AT, Nduna T, Duffield A, Watson F. An evaluation of an operations research project to reduce childhood stunting in a food-insecure area in Ethiopia. Public Health Nutr. 2012;15:1746–54.

    Article  PubMed  Google Scholar 

  34. Dreibelbis R, Freeman MC, Greene LE, Saboori S, Rheingans R. Reductions in diarrhea and clinic visits for diarrhea among children under the age of five associated with a school-based water supply, sanitation and hygiene intervention in western Kenya: A cluster-randomized trial. Am J Trop Med Hyg. 2012;87(suppl 1):382.

    Google Scholar 

  35. Freeman M, Clasen T, Dreibelbis R, Greene L, Saboori S, Rheingans R. The impact of improved school water, sanitation and hygiene access on pupil diarrhea: A cluster randomized trial. Am J Trop Med Hyg. 2012;87(Suppl 1):428.

    Google Scholar 

  36. Freeman MC, Clasen T, Brooker SJ, Akoko DO, Rheingans R. The impact of a school-based hygiene, water quality and sanitation intervention on soil-transmitted helminth reinfection: A cluster-randomized trial. Am J Trop Med Hyg. 2013;89:875–83.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Freeman MC, Greene LE, Dreibelbis R, Saboori S, Muga R, Brumback B, Rheingans R. Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial. Trop Med Int Health. 2012;17:380–91.

    PubMed  Google Scholar 

  38. Gungoren B, Latipov R, Regallet G, Musabaev E. Effect of hygiene promotion on the risk of reinfection rate of intestinal parasites in children in rural Uzbekistan. Trans Roy Soc Trop Med Hyg. 2007;101:564–9.

    Article  PubMed  Google Scholar 

  39. Gyorkos TW, Maheu-Giroux M, Blouin B, Casapia M. Impact of health education on soil-transmitted helminth infections in schoolchildren of the peruvian amazon: A cluster-randomized controlled trial. PLoS Negl Trop Dis. 2013;7:e2397.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hammer J, Spears D. Village sanitation and children's human capital: Evidence from a randomized experiment by the Maharashtra government. Washington DC: World Bank, Sustainable Development Network, Water and Sanitation Program, 2013.

    Book  Google Scholar 

  41. Huda TN, Unicomb L, Johnston RB, Halder AK, Sharkar MAY, Luby SP. Interim evaluation of a large scale sanitation, hygiene and water improvement programme on childhood diarrhea and respiratory disease in rural Bangladesh. Soc Sci Med. 2012;75:604–11.

    Article  PubMed  Google Scholar 

  42. Langford R, Lunn P, Panter-Brick C. Hand-Washing, Subclinical Infections, and Growth: A Longitudinal Evaluation of an Intervention in Nepali Slums. Am J Human Biol. 2011;23:621–9.

    Article  Google Scholar 

  43. Anonymous. Hand washing with soap reduces the risk of diarrhoea in children. Evidence-Based Healthcare & Public Health. 2004;8:383-4.

  44. Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, Altaf A, et al. Effect of hand washing on child health: A randomised controlled trial. Lancet. 2005;366:225–33.

    Article  PubMed  Google Scholar 

  45. Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer WL, Hoekstra RM. Effect of intensive hand washing promotionon childhood diarrhea in high-risk communities in Pakistan: A randomized controlled trial. JAMA. 2004;291:2547–54.

    Article  PubMed  CAS  Google Scholar 

  46. Nnoaham KE. A handwashing intervention in a low income community in the developing world reduced disease incidence in children. Evidenc Based Med. 2006;11:88.

    Article  Google Scholar 

  47. Clasen TF. Efficacy of hand washing and nail clipping on parasitic infection. J Pediatr 2015;167:1170–1.

    Article  PubMed  Google Scholar 

  48. Mahmud MA, Spigt M, Bezabih AM, Pavon IL, Dinant GJ, Velasco RB. Efficacy of hand washing with soap and nail clipping on intestinal parasitic infections in school-aged children: A factorial cluster randomized controlled trial. PLoS Med. 2015;12:e1001837.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Morris J, Schneeberger C, Jaron P, Moke F, Juma J, Ochieng J, et al. Ceramic Water Filters and reducing the burden of diarrheal disease in infants-Western Kenya, 2013. Am J Trop Med Hyg. 2014;91(Suppl 1):384.

    Google Scholar 

  50. Nicholson JA, Naeeni M, Hoptroff M, Matheson JR, Roberts AJ, Taylor D, et al. An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities. Trop Med Int Health. 2014;19:284–92.

    Article  PubMed  Google Scholar 

  51. Odagiri M, Schriewer A, Daniels ME, Wuertz S, Smith WA, Clasen T, et al. Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage. Water Res. 2016;100:232–44.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  52. Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, Colford JM Jr, et al. The Effect of India's Total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: A cluster randomized controlled trial. PLoS Med. 2014;11:e1001709.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Peletz R, Simunyama M, Sarenje K, Baisley K, Filteau S, Kelly P, et al. Assessing water filtration and safe storage in households with young children of HIV-Positive mothers: A randomized, controlled trial in Zambia. PloS One. 2012;7:e46548.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  54. Pickering AJ, Davis J, Blum AG, Saclmanini J, Oyeir B, Okoth G, et al. Access to waterless hand sanitizer improves student hand hygiene behaviour in primary schools in Nairobi, Kenya. Am J Trop Med Hyg. 2013;89:411–18.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Pickering AJ, Alzua ML, Djebbari H. Impact of a community-led total sanitation intervention on child health in rural Mali: evidence from a cluster-randomised controlled trial. Am J Trop Med Hyg. 2014;91(Suppl1):215.

    Google Scholar 

  56. Pickering AJ, Djebbari H, Lopez C, Coulibaly M, Alzua ML. Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a clusterrandomised controlled trial. Lancet Glob Health 2015;3:e701–11.

    Article  PubMed  Google Scholar 

  57. Quick RE, Venczel LV, Mintz ED, Soleto L, Aparicio J, Kelly P, et al. Diarrhoea prevention in Bolivia through point-of-use water treatment and safe storage: A promising new strategy. Epidemiol Infect. 1999;122:83–90.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  58. Rosen L, Manor O, Engelhard D, Brudy D, Rosen B, Peleg H, et al. Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools. Prev Med. 2006;42:27–32.

    Article  PubMed  Google Scholar 

  59. Rosen L, Manor O, Engelhard D, Zucker D. Design of the jerusalem hand washing study: Meeting the challenges of a preschool-based public health intervention trial. Clin Trials. 2006;3:376–84.

    Article  PubMed  Google Scholar 

  60. Schlesinger L, Weinberger J, Figueroa G, Secure T, González N, Mónckeberg F. Environmental sanitation: a nutrition intervention. In: Nutrition Intervention Strategies in National Development. Underwood Academy. Academic Press Inc. 1981:241.

    Google Scholar 

  61. Shafique S, Jalal CS, Jolly SP, Shikder H, Sellen D, Zlotkin S. Prevention of linear growth faltering among low birth weight infants in rural Bangladesh: A community-based cluster randomized trial. Ann Nutr Metab. 2013;63:1127–28.

    Google Scholar 

  62. Shafique S, Jalal CS, Jolly SP, Shikder H, Sellen DW, Zlotkin S. Effects of water-based hand sanitizers and micronutrient powders along with nutrition and hygiene education to prevent infections and linear growth faltering among low birth weight infants in Bangladesh. Faseb J. 2013;27.

    Google Scholar 

  63. Shafique S, Sellen DW, Lou W, Jalal CS, Jolly SP, Zlotkin SH. Mineral-and vitamin-enhanced micronutrient powder reduces stunting in full-term low-birth-weight infants receiving nutrition, health, and hygiene education: a 2 3 2 factorial, cluster-randomized trial in Bangladesh. Am J Clin Nutr. 2016;103:1357–69.

    Article  PubMed  CAS  Google Scholar 

  64. Shafique S, Shikder H, Jolly, SP, Jalal CSB, Sellen DW, Zlotkin SH. Reducing infectious morbidity and accelerating linear growth among low birth weight infants with hand sanitizers and nutrition and hygiene education in rural Bangladesh. Faseb J. 2012;26.

    Google Scholar 

  65. Slayton RB, Murphy JL, Morris J, Faith SH, Oremo J, Odhiambo A, et al. A cluster randomized controlled evaluation of the health impact of a novel anti microbial hand towel on the health of children under 2 years old in rural communities in Nyanza Province, Kenya. Am J Trop Med Hyg. 2016;94:437–44.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  66. Stanton BF, Clemens JD, Khair T. Educational intervention for altering water-sanitation behavior to reduce childhood diarrhea in urban Bangladesh: impact on nutritional status. Am J Clin Nutr. 1988;48:1166–72.

    Article  PubMed  CAS  Google Scholar 

  67. Stanton BF, Clemens JD. An educational intervention for altering water sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. Am J Epidemiol. 1987;125:292–301.

    Article  PubMed  CAS  Google Scholar 

  68. Gebre T, Ayele B, Zerihun B, House J, Stoller N, Zhou Z, et al. Latrine Promotion for Trachoma: Assessment of Mortality from a Cluster-Randomized Trial in Ethiopia. Am J Trop Med Hyg. 2011;85:518–23.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Stoller N, Gebre T, Ayele B, Zerihun M, Assefa Y, Habte D, et al. Efficacy of latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass antibiotic treatment: A cluster-randomized trial. Int Health. 2011;3:75–84.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, Kandeel A, et al. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Energ Infect Dis. 2011;17:619–25.

    Article  Google Scholar 

  71. West S, Munoz B, Lynch M, Kayongoya A, Chilangawa Z, Mmbaga BBO, et al. Impact of face-washing on trachoma in Kongwa, Tanzania. Lancet 1995;345:155–8.

    Article  PubMed  CAS  Google Scholar 

  72. Arnold BF, Null C, Luby SP, Unicomb L, Stewart CP, Dewey KG, et al. Cluster randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: The WASH Benefits study design and rationale. BMJ Open. 2013;3:e003476.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Brown J, Cumming O, Bartram J, Cairncross S, Ensink J, Holcomb D, et al. A controlled, before-and-after trial of an urban sanitation intervention to reduce enteric infections in children: research protocol for the Maputo Sanitation (MapSan) study, Mozambique. BMJ Open. 2015;5:e008215.

    Article  PubMed  PubMed Central  Google Scholar 

  74. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Rationale, design, and methods. Clin Infect Dis. 2015;61:S685-702.

  75. Jung S, Doh Y, Bizuneh DB, Beyene H, Seyong J, Kwon H, et al. The effects of improved sanitation on diarrheal prevalence, incidence, and duration in children under five in the SNNPR State, Ethiopia: Study protocol for a randomized controlled trial. Trials. 2016;17:204–13.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Nery SV, Campbell S, Llewllyn S, Andrews R, Gray D, Traub R, et al. Impact of WASH and Albendazole distribution on infection with soil transmitted helminths in Timor-Leste: initial results of a cluster randomized controlled trial. Am J Trop Med Hyg. 2014;91:179.

    Google Scholar 

  77. Nery SV, McCarthy JS, Traub R, Andrews RM, Black J, Gray D, et al. A cluster-randomised controlled trial integrating a community-based water, sanitation and hygiene programme, with mass distribution of albendazole to reduce intestinal parasites in Timor-Leste: the WASH for WORMS research protocol. BMJ Open. 2015;5:e009293.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Overgaard HJ, Alexander N, Mátiz MI, Jaramillo JF, Olano VA. Diarrhea and dengue control in rural primary schools in Colombia: Study protocol for a randomized controlled trial. Trials. 2012;13:182.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Overgaard, Mátiz MI, Jaramillo JF, Olano VA, Vargas SV, et al. Integrating dengue and diarrhea control in rural schools in Colombia: a cluster randomized controlled trial. Am J Trop Med Hyg. 2012;87(suppl 1):83–4.

    Google Scholar 

  80. Cumming O, Cairncross S. Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications. Maternal Child Nutr. 2016;12(suppl 1):91–105.

    Article  Google Scholar 

  81. Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health. 2008;98:1372–81.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Rabie T, Curtis V. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health. 2006;11:258–67.

    Article  PubMed  Google Scholar 

  83. Pruss A, Mariotti SP. Preventing trachoma through environmental sanitation: a review of the evidence base. Bull WHO. 2000;78:258–66.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, SL Jain Hospital, New Delhi, India

    Tarun Gera

  2. Department of Pediatrics, University College of Medical Sciences (University of Delhi) & GTB Hospital, New Delhi, India

    Dheeraj Shah

  3. Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India

    Harshpal Singh Sachdev

Authors
  1. Tarun Gera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dheeraj Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harshpal Singh Sachdev
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Harshpal Singh Sachdev.

Additional information

Systematic Review Registration: PROSPERO/CRD42017063779 (http://www.crd.york.ac.uk/PROSPERO)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gera, T., Shah, D. & Sachdev, H.S. Impact of Water, Sanitation and Hygiene Interventions on Growth, Non-diarrheal Morbidity and Mortality in Children Residing in Low- and Middle-income Countries: A Systematic Review. Indian Pediatr 55, 381–393 (2018). https://doi.org/10.1007/s13312-018-1279-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-018-1279-3

Keywords

Search

Navigation