The impact of sanitation interventions on latrine coverage and latrine use: A systematic review and meta-analysis.

doi:10.1016/J.IJHEH.2016.10.001

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The impact of sanitation interventions on latrine coverage and latrine use: A systematic review and meta-analysis.

Journal Article•DOI•

The impact of sanitation interventions on latrine coverage and latrine use: A systematic review and meta-analysis.

Joshua V. Garn¹, Gloria D. Sclar¹, Matthew C. Freeman¹, Gauthami Penakalapati¹, Kelly T. Alexander¹, Patrick Brooks¹, Eva Rehfuess², Sophie Boisson³, Kate Medlicott³, Thomas Clasen¹ - Show less +6 more•Institutions (3)

Emory University¹, Ludwig Maximilian University of Munich², World Health Organization³

01 Apr 2017-International Journal of Hygiene and Environmental Health (Int J Hyg Environ Health)-Vol. 220, Iss: 2, pp 329-340

TL;DR: A further understanding of how different sanitation characteristics and sanitation interventions impact coverage and use is essential in order to more effectively attain sanitation access for all, eliminate open defecation, and ultimately improve health.

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About: This article is published in International Journal of Hygiene and Environmental Health.The article was published on 2017-04-01 and is currently open access. It has received 183 citations till now. The article focuses on the topics: Latrine & Improved sanitation.

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Journal Article•DOI•

Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta-analysis and meta-regression

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Jennyfer Wolf, Paul R. Hunter¹, Paul R. Hunter², Matthew C. Freeman³, Oliver Cumming⁴, Thomas Clasen³, James K Bartram⁵, Julian P T Higgins⁶, Richard B. Johnston, Kate Medlicott, Sophie Boisson, Annette Prüss-Ustün - Show less +8 more•Institutions (6)

Tshwane University of Technology¹, University of East Anglia², Emory University³, University of London⁴, University of North Carolina at Chapel Hill⁵, University of Bristol⁶

01 May 2018-Tropical Medicine & International Health

TL;DR: The main objective was an updated assessment of the impact of unsafe water, sanitation and hygiene (WaSH) on childhood diarrhoeal disease.

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Abstract: OBJECTIVES: Safe drinking water, sanitation and hygiene are protective against diarrhoeal disease; a leading cause of child mortality. The main objective was an updated assessment of the impact of unsafe water, sanitation and hygiene (WaSH) on childhood diarrhoeal disease. METHODS: We undertook a systematic review of articles published between 1970 and February 2016. Study results were combined and analysed using meta-analysis and meta-regression. RESULTS: A total of 135 studies met the inclusion criteria. Several water, sanitation and hygiene interventions were associated with lower risk of diarrhoeal morbidity. Point-of-use filter interventions with safe storage reduced diarrhoea risk by 61% (RR = 0.39; 95% CI: 0.32, 0.48); piped water to premises of higher quality and continuous availability by 75% and 36% (RR = 0.25 (0.09, 0.67) and 0.64 (0.42, 0.98)), respectively compared to a baseline of unimproved drinking water; sanitation interventions by 25% (RR = 0.75 (0.63, 0.88)) with evidence for greater reductions when high sanitation coverage is reached; and interventions promoting handwashing with soap by 30% (RR = 0.70 (0.64, 0.77)) vs. no intervention. Results of the analysis of sanitation and hygiene interventions are sensitive to certain differences in study methods and conditions. Correcting for non-blinding would reduce the associations with diarrhoea to some extent. CONCLUSIONS: Although evidence is limited, results suggest that household connections of water supply and higher levels of community coverage for sanitation appear particularly impactful which is in line with targets of the Sustainable Development Goals.

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267 citations

Cites background from "The impact of sanitation interventi..."

...Effect estimates included in this review are usually based on intention-to-treat analysis which might again underestimate the true health impact of WaSH interventions which usually achieve low coverage and lower compliance [45, 51]....
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...Effectiveness trials of WaSH interventions have typically not achieved high coverage or high compliance [45]....
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Journal Article•DOI•

The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis

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Matthew C. Freeman¹, Joshua V. Garn¹, Gloria D. Sclar¹, Sophie Boisson², Kate Medlicott², Kelly T. Alexander¹, Gauthami Penakalapati¹, Darcy M. Anderson¹, Amrita G. Mahtani¹, Jack E. T. Grimes³, Eva Rehfuess⁴, Thomas Clasen¹, Thomas Clasen⁵ - Show less +9 more•Institutions (5)

Emory University¹, World Health Organization², Imperial College London³, Ludwig Maximilian University of Munich⁴, University of London⁵

01 Aug 2017-International Journal of Hygiene and Environmental Health

TL;DR: Overall, the evidence suggests that sanitation is protective against diarrhea, active trachoma, some STH infections, schistosomiasis, and height-for-age, with no protective effect for other anthropometric outcomes.

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214 citations

Cites background from "The impact of sanitation interventi..."

...We also assess how the health outcomes are associated with latrine coverage and latrine use levels (Garn et al., 2016) for all of the intervention studies where available that included information on both health and coverage/use, to better characterize latrine coverage and latrine use thresholds for improving health (Table S15)....
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...Another of our group’s reviews specifically addresses how different types of sanitation interventions impact coverage and use (Garn et al., 2016), but there is further need to identify how coverage and use impact health....
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...We also assess how the health outcomes are associated with latrine coverage and latrine use levels (Garn et al., 2016) for all of the intervention studies where available that included information on both health and coverage/use, to better characterize latrine coverage and latrine use thresholds…...
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Journal Article•DOI•

Exposure to Animal Feces and Human Health: A Systematic Review and Proposed Research Priorities

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Gauthami Penakalapati¹, Jenna Swarthout¹, Miranda J Delahoy¹, Lydia McAliley¹, Breanna K. Wodnik¹, Karen Levy¹, Matthew C. Freeman¹ - Show less +3 more•Institutions (1)

Emory University¹

09 Oct 2017-Environmental Science & Technology

TL;DR: The human health impacts of exposure to poorly managed animal feces transmitted via water, sanitation, and hygiene (WASH)-related pathways in low- and middle-income countries, where household livestock, small-scale animal operations, and free-roaming animals are common are examined.

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Abstract: Humans can be exposed to pathogens from poorly managed animal feces, particularly in communities where animals live in close proximity to humans. This systematic review of peer-reviewed and gray literature examines the human health impacts of exposure to poorly managed animal feces transmitted via water, sanitation, and hygiene (WASH)-related pathways in low- and middle-income countries, where household livestock, small-scale animal operations, and free-roaming animals are common. We identify routes of contamination by animal feces, control measures to reduce human exposure, and propose research priorities for further inquiry. Exposure to animal feces has been associated with diarrhea, soil-transmitted helminth infection, trachoma, environmental enteric dysfunction, and growth faltering. Few studies have evaluated control measures, but interventions include reducing cohabitation with animals, provision of animal feces scoops, controlling animal movement, creating safe child spaces, improving veterinary ca...

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206 citations

Journal Article•DOI•

Real-life effectiveness of ‘improved’ stoves and clean fuels in reducing PM2.5 and CO: Systematic review and meta-analysis

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Daniel Pope¹, Nigel Bruce¹, Mukesh Dherani¹, Kirstie Jagoe¹, Eva Rehfuess² - Show less +1 more•Institutions (2)

University of Liverpool¹, Ludwig Maximilian University of Munich²

01 Apr 2017-Environment International

TL;DR: In everyday use in LMIC, neither 'improved' solid fuel stoves nor clean fuels (probably due to neighbourhood contamination) achieve PM2.5 concentrations close to 24-hour AQG limit values, so household energy policy should prioritise community-wide use of clean fuels.

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157 citations

Journal Article•DOI•

Community-Led Total Sanitation: A Mixed-Methods Systematic Review of Evidence and Its Quality.

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Vidya Venkataramanan¹, Jonny Crocker¹, Andrew J. Karon¹, James K Bartram¹•Institutions (1)

University of North Carolina at Chapel Hill¹

02 Feb 2018-Environmental Health Perspectives

TL;DR: The evidence base on CLTS effectiveness available to practitioners, policy makers, and program managers to inform their actions is weak and the importance of adaptability, structured posttriggering activities, appropriate community selection, and further research on combining and sequencing CLTS with other interventions is revealed.

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Abstract: Background: Community-led total sanitation (CLTS) is a widely applied rural behavior change approach for ending open defecation. However, evidence of its impact is unclear. Objectives: We conducted...

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99 citations

Additional excerpts

...Our synthesis of health outcomes from CLTS and related interventions supports findings of previous reviews (Garn et al. 2016; Sclar et al. 2016; Taylor et al. 2015; Wolf et al. 2014) and underscores the challenge of attributing health impacts to sanitation, particularly over a short followup....
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TL;DR: The Scoping meeting on collaboration between Regional Seas Programmes and Regional Fisheries Bodies in the Southwest Indian Ocean is described in this article, where the authors propose a framework for collaboration between regional sea programmes and regional fisheries bodies in the Indian Ocean.

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Abstract: Information document of the Scoping meeting on collaboration between Regional Seas Programmes and Regional Fisheries Bodies in the Southwest Indian Ocean

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Gordon H. Guyatt¹, Andrew D Oxman², Elie A. Akl³, Regina Kunz⁴, Gunn Elisabeth Vist², Jan Brozek¹, Susan L Norris⁵, Yngve Falck-Ytter⁶, Paul Glasziou⁷, Hans deBeer, Roman Jaeschke¹, David Rind⁸, Joerg J Meerpohl⁹, Philipp Dahm¹⁰, Holger J. Schünemann¹ - Show less +11 more•Institutions (10)

McMaster University¹, Norwegian Institute of Public Health², University at Buffalo³, University of Basel⁴, Oregon Health & Science University⁵, Case Western Reserve University⁶, Bond University⁷, Harvard University⁸, University of Freiburg⁹, University of Florida¹⁰

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McMaster University¹, Mayo Clinic², University Hospital of Basel³, Autonomous University of Barcelona⁴, University of South Florida⁵, United States Department of Veterans Affairs⁶, Case Western Reserve University⁷, Duke University⁸, University Medical Center Freiburg⁹, Oregon Health & Science University¹⁰, University at Buffalo¹¹

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Journal Article•DOI•

Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial

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Thomas Clasen¹, Thomas Clasen², Sophie Boisson¹, Parimita Routray¹, Belen Torondel¹, Melissa Bell¹, Oliver Cumming¹, Jeroen H. J. Ensink¹, Matthew C. Freeman², Marion W. Jenkins³, Mitsunori Odagiri³, Subhajyoti Ray⁴, Antara Sinha¹, Mrutyunjay Suar⁵, Wolf-Peter Schmidt¹ - Show less +11 more•Institutions (5)

University of London¹, Emory University², University of California, Davis³, Xavier University⁴, KIIT University⁵

01 Nov 2014-The Lancet Global Health

TL;DR: The intervention increased mean village-level latrine coverage from 9% of households to 63%, compared with an increase from 8% to 12% in control villages, and increased exposure to faecal pathogens and preventing disease.

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445 citations

"The impact of sanitation interventi..." refers background in this paper

...However, a number of recent rigorous sanitation trials have found either no impact or a mixed impact of the sanitation interventions on various health outcomes (Arnold et al., 2010; Briceño et al., 2015; Clasen et al., 2014; Fenn et al., 2012; Patil et al., 2014; Pickering et al., 2015)....
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...Controlled before-and-after 48% 15% 33% 23% 12% 11% HH does not practice OD Clasen et al. (2014) TSC India 3 yr....
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...However, a number of recent rigorous sanitation trials have found either no impact or a mixed impact of the sanitation interventions on various health outcomes (Arnold et al., 2010; Briceño et al., 2015; Clasen et al., 2014; Fenn et al., 2012; Patil et al., 2014; Pickering et al., 2015)....
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...…little if any health impact from sanitation interventions (Arnold et al., 2010; Barreto et al., 2007; Briceño et al., 2015; Cameron et al., 2013; Clasen et al., 2014; Dreibelbis et al., 2014; Fenn et al., 2012; Freeman et al., 2013a,b, 2014; Hammer and Spears, 2013; Jinadu et al., 2007; Moraes…...
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Journal Article•DOI•

The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial.

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Sumeet Patil¹, Benjamin F. Arnold¹, Alicia L. Salvatore², Bertha Briceno³, Sandipan Ganguly, John M. Colford¹, Paul Gertler¹ - Show less +3 more•Institutions (3)

University of California, Berkeley¹, Stanford University², World Bank³

26 Aug 2014-PLOS Medicine

TL;DR: A cluster randomized controlled trial is conducted to measure the effect of India's Total Sanitation Campaign in Madhya Pradesh on the availability of individual household latrines, defecation behaviors, and child health.

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Abstract: Poor sanitation is thought to be a major cause of enteric infections among young children. However, there are no previously published randomized trials to measure the health impacts of large-scale sanitation programs. India’s Total Sanitation Campaign (TSC) is one such program that seeks to end the practice of open defecation by changing social norms and behaviors, and providing technical support and financial subsidies. The objective of this study was to measure the effect of the TSC implemented with capacity building support from the World Bank’s Water and Sanitation Program in Madhya Pradesh on availability of individual household latrines (IHLs), defecation behaviors, and child health (diarrhea, highly credible gastrointestinal illness [HCGI], parasitic infections, anemia, growth). The authors conducted a cluster-randomized, controlled trial in 80 rural villages. The study enrolled a random sample of 5,209 children less than 5 years old from 3,039 households that had at least one child less than 24 months at the beginning of the study. A random subsample of 1,150 children less than 24 months at enrollment were tested for soil transmitted helminth and protozoan infections in stool. The randomization successfully balanced intervention and control groups, and the authors estimated differences between groups in an intention to treat analysis. The intervention led to modest increases in availability of IHLs and even more modest reductions in open defecation. These improvements were insufficient to improve child health outcomes (diarrhea, HCGI, parasite infection, anemia, growth). The results underscore the difficulty of achieving adequately large improvements in sanitation levels to deliver expected health benefits within large-scale rural sanitation programs.

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367 citations

"The impact of sanitation interventi..." refers background in this paper

...RCT nr nr 8% nr nr nr na Patil et al. (2014) TSC India 2 yr....
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...…et al., 2007; Briceño et al., 2015; Cameron et al., 2013; Clasen et al., 2014; Dreibelbis et al., 2014; Fenn et al., 2012; Freeman et al., 2013a,b, 2014; Hammer and Spears, 2013; Jinadu et al., 2007; Moraes et al., 2003; Patil et al., 2014; Pickering et al., 2015; Pradhan and Rawlings, 2002)....
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...However, a number of recent rigorous sanitation trials have found either no impact or a mixed impact of the sanitation interventions on various health outcomes (Arnold et al., 2010; Briceño et al., 2015; Clasen et al., 2014; Fenn et al., 2012; Patil et al., 2014; Pickering et al., 2015)....
[...]
...However, a number of recent rigorous sanitation trials have found either no impact or a mixed impact of the sanitation interventions on various health outcomes (Arnold et al., 2010; Briceño et al., 2015; Clasen et al., 2014; Fenn et al., 2012; Patil et al., 2014; Pickering et al., 2015)....
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