Interventions to improve water quality for preventing diarrhoea

Clasen, Thomas F; Roberts, Ian G; Rabie, Taber; Schmidt, Wolf-Peter; Cairncross, Sandy

doi:10.1002/14651858.cd004794.pub2

Cited by 192Child Nutrition and Water AccessFecal contamination and water qualityWater Treatment and Disinfection

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Interventions to improve water quality for preventing diarrhoea

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Clasen, Thomas F, Roberts, Ian G, Rabie, Taber, Schmidt, Wolf-Peter, Cairncross, Sandy·2006·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd004794.pub2

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Abstract

BACKGROUND: Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in developing countries. While many of the infectious agents associated with diarrhoeal disease are potentially waterborne, the evidence for reducing diarrhoea in settings where it is endemic by improving the microbiological quality of drinking water has been equivocal. OBJECTIVES: To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (December 2005), CENTRAL (The Cochrane Library 2005, Issue 4), MEDLINE (December 2005), EMBASE (December 2005), and LILACS (December 2005). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults living in settings where diarrhoeal disease is endemic. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. MAIN RESULTS: Thirty trials (including 38 independent comparisons) covering over 53,000 participants met the inclusion criteria. Differences between the trials limited the comparability of results and pooling by meta-analysis. In general, the evidence suggests that interventions to improve the microbiological quality of drinking water are effective in preventing diarrhoea both for populations of all ages and children less than five years old. Subgroup analyses suggest that household interventions are more effective in preventing diarrhoea than interventions at the water source. Effectiveness was positively associated with compliance. Effectiveness was not conditioned on the presence of improved water supplies or sanitation in the study setting, and was not enhanced by combining the intervention to improve water quality with other common environmental interventions intended to prevent diarrhoea. AUTHORS' CONCLUSIONS: Interventions to improve water quality are generally effective in preventing diarrhoea, and interventions to improve water quality at the household level are more effective than those at the source. Significant heterogeneity among the trials suggests that the actual level of effectiveness may depend on a variety of conditions that research to date cannot fully explain. Rigorous, blinded, multi-arm randomized controlled trials conducted over a longer duration in a variety if settings may help clarify the potential effectiveness.

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There are several reviews (not limited to slum settings) that support our review findings that interventions including water and sanitation improvements could increase both health and socio‐economic wellbeing.
“There are several reviews (not limited to slum settings) that support our review findings that interventions including water and sanitation improvements could increase both health and socio‐economic wellbeing.”
From Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socio-economic outcomes (2013) · cites this paper as Clasen 2006
The Authors’ Conclusions (page not provided) say that improving drinking-water quality can prevent diarrhoea, supporting the health part of the claim. The review mentions improved sanitation as another environmental approach, but does not establish that water and sanitation interventions increase socio-economic wellbeing; its discussion of cost-effectiveness is not evidence of that outcome. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Several systematic reviews have evaluated the impact of water and sanitation interventions on health outcomes, but these have not focused on the complex setting of slums and do not cover the range of slum upgrading interventions beyond water and sanitation.
“Whilst several systematic reviews have evaluated the impact of water and sanitation interventions on health outcomes (Clasen 2006; Clasen 2010; Waddington 2009), these have not focused on the complex setting of slums and do not cover the range of slum upgrading interventions that exist beyond water and sanitation.”
From Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socio-economic outcomes (2013) · cites this paper as Clasen 2006
Systematic reviews report reductions in rates of diarrhoeal diseases following improved water supply.
“Systematic reviews (not limited to slum settings) report reductions in rates of diarrhoeal diseases following improved water supply (Clasen 2006; Waddington 2009)”
From Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socio-economic outcomes (2013) · cites this paper as Clasen 2006
The reports reveal reductions in diarrhoeal diseases following improved water supply and excreta disposal.
“The reports reveal reductions in diarrhoeal diseases following improved water supply (Clasen 2006; Waddington 2009) and excreta disposal (Clasen 2010).”
From Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socio-economic outcomes (2013) · cites this paper as Clasen 2006

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Authors: Clasen, T. F., Roberts, I. G., Rabie, T., Schmidt, W.-P., & Cairncross, S.
Affiliations: London School of Hygiene & Tropical Medicine (GB)
ORCID: Clasen, Thomas F
Roberts, Ian G
Schmidt, Wolf-Peter
Cairncross, Sandy
Venue: Cochrane Database of Systematic Reviews
Publisher: John Wiley & Sons, Ltd
Published: 2006-07-19
Issue: 3
Pages: CD004794-CD004794
ISSN: 1361-6137 (ISSN-L)
DOI: 10.1002/14651858.cd004794.pub2
OpenAlex: W4236271789
Cited by: 190
References: 102
Citations by year: 2026: 2 · 2025: 2 · 2024: 8 · 2023: 8 · 2022: 6 · 2021: 13 · 2020: 8 · 2019: 13 · 2018: 17 · 2017: 13 · 2016: 10 · 2015: 15 · 2014: 9 · 2013: 14 · 2012: 9
Type: reference entry
Language: en
Update notices: new_version (2015-10-20)
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Physical Sciences › Environmental Science › Water Science and Technology › Fecal contamination and water quality
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Water Treatment and Disinfection
Keywords: diarrhea prevention, drinking water quality, microbiological water quality, household water treatment, young children, compliance, waterborne pathogens, diarrhoeal diseases
MeSH terms: Adult, Child, Diarrhea, Humans, Water Supply, Randomized Controlled Trials as Topic, Water Purification

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