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Cited by 375Child Nutrition and Water AccessPoverty, Education, and Child WelfareGlobal Maternal and Child Health

The DOI matches its Crossref record; 79 of the 84 references it cites were found in a registry or an index.

Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children

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Dangour, Alan D, Watson, Louise, Cumming, Oliver, Boisson, Sophie, Che, Yan, Velleman, Yael, Cavill, Sue, Allen, Elizabeth, Uauy, Ricardo·2013·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd009382.pub2PMC PMC11608819
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Abstract

BACKGROUND: Water, sanitation and hygiene (WASH) interventions are frequently implemented to reduce infectious diseases, and may be linked to improved nutrition outcomes in children. OBJECTIVES: To evaluate the effect of interventions to improve water quality and supply (adequate quantity to maintain hygiene practices), provide adequate sanitation and promote handwashing with soap, on the nutritional status of children under the age of 18 years and to identify current research gaps. SEARCH METHODS: We searched 10 English-language (including MEDLINE and CENTRAL) and three Chinese-language databases for published studies in June 2012. We searched grey literature databases, conference proceedings and websites, reviewed reference lists and contacted experts and authors. SELECTION CRITERIA: Randomised (including cluster-randomised), quasi-randomised and non-randomised controlled trials, controlled cohort or cross-sectional studies and historically controlled studies, comparing WASH interventions among children aged under 18 years. DATA COLLECTION AND ANALYSIS: Two review authors independently sought and extracted data on childhood anthropometry, biochemical measures of micronutrient status, and adherence, attrition and costs either from published reports or through contact with study investigators. We calculated mean difference (MD) with 95% confidence intervals (CI). We conducted study-level and individual-level meta-analyses to estimate pooled measures of effect for randomised controlled trials only. MAIN RESULTS: Fourteen studies (five cluster-randomised controlled trials and nine non-randomised studies with comparison groups) from 10 low- and middle-income countries including 22,241 children at baseline and nutrition outcome data for 9,469 children provided relevant information. Study duration ranged from 6 to 60 months and all studies included children under five years of age at the time of the intervention. Studies included WASH interventions either singly or in combination. Measures of child anthropometry were collected in all 14 studies, and nine studies reported at least one of the following anthropometric indices: weight-for-height, weight-for-age or height-for-age. None of the included studies were of high methodological quality as none of the studies masked the nature of the intervention from participants.Weight-for-age, weight-for-height and height-for-age z-scores were available for five cluster-randomised controlled trials with a duration of between 9 and 12 months. Meta-analysis including 4,627 children identified no evidence of an effect of WASH interventions on weight-for-age z-score (MD 0.05; 95% CI -0.01 to 0.12). Meta-analysis including 4,622 children identified no evidence of an effect of WASH interventions on weight-for-height z-score (MD 0.02; 95% CI -0.07 to 0.11). Meta-analysis including 4,627 children identified a borderline statistically significant effect of WASH interventions on height-for-age z-score (MD 0.08; 95% CI 0.00 to 0.16). These findings were supported by individual participant data analysis including information on 5,375 to 5,386 children from five cluster-randomised controlled trials.No study reported adverse events. Adherence to study interventions was reported in only two studies (both cluster-randomised controlled trials) and ranged from low (< 35%) to high (> 90%). Study attrition was reported in seven studies and ranged from 4% to 16.5%. Intervention cost was reported in one study in which the total cost of the WASH interventions was USD 15/inhabitant. None of the studies reported differential impacts relevant to equity issues such as gender, socioeconomic status and religion. AUTHORS' CONCLUSIONS: The available evidence from meta-analysis of data from cluster-randomised controlled trials with an intervention period of 9-12 months is suggestive of a small benefit of WASH interventions (specifically solar disinfection of water, provision of soap, and improvement of water quality) on length growth in children under five years of age. The duration of the intervention studies was relatively short and none of the included studies is of high methodological quality. Very few studies provided information on intervention adherence, attrition and costs. There are several ongoing trials in low-income country settings that may provide robust evidence to inform these findings.

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Research works printed but not linked: 17

  1. Luby, 2006, Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial, Tropical Medicine and International Health, 11, 479, 10.1111/j.1365-3156.2006.01592.x · DOI · Paper page
  2. Luby, 2006, Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial, Tropical Medicine and International Health, 11, 479, 10.1111/j.1365-3156.2006.01592.x · DOI · Paper page
  3. Luby, 2006, Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial, Tropical Medicine and International Health, 11, 479, 10.1111/j.1365-3156.2006.01592.x · DOI · Paper page
  4. Chiang, 1991, Effect of the water supply on the nutritional state of children under 5 years old in rural locations, Revista Cubana de Alimentacion y Nutricion, 5, 56
  5. Farah, 2007, Effects of water and sanitation on childhood nutrition in Pakistan, Pakistan Paediatric Journal, 31, 69
  6. Hartinger, 2011, Integrating home-based environmental interventions (IHIP): A community-randomised trial to improve indoor air pollution, drinking water quality and child nutrition in rural Peru, Tropical Medicine and International Health. Conference: 7th European Congress on Tropical Medicine and International Health Barcelona Spain, 6, 354
  7. Li, 1996, A study on prevention of diarrhoeal diseases and improvement of case management in children of Hunan province, Disease Surveillance, 12, 87
  8. Parent, 2002, Are large-scale water facilities in Burkina Faso helping to improve child nutrition?, Cahiers Agricultures, 11, 51
  9. Yang, 2006, Hygiene evaluation of the program of child environment and environmental sanitation in Gansu province, Health, Occupation and Education, 24, 135
  10. Yao, 2000, Studies on the levels of iron, magnesium, copper and zinc in serum among population after water improvement for 10 years in areas with endemic Fluorosis-Arsenism, Journal of Environment & Health, 17, 98
  11. Zhang, 1999, Evaluation of the effect of health education intervention to prevent diarrhoea among children under 5 years old, Chinese Journal of Health Education, 15, 19
  12. Zhu, 1997, Macro effects of improving lavatories to prevent diseases in population of trial rural areas, Chinese Journal of Public Health, 13, 420
  13. Zhu, 1997, Assessment of effects of disease prevention by intervention measures of school environmental hygiene in rural areas, Journal of Hygiene Research, 6, 378
  14. Pruss-Ustun, 2006, Preventing disease through healthy environments
  15. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan) 2012
  16. United Nations Children’s, 2012, UNICEF-WHO-World Bank joint child malnutrition estimates
  17. WHO/UNICEF, 2012, WHO/UNICEF Joint Monitoring Programme (JMP) Report 2012 update. Joint Monitoring Programme for Water Supply and Sanitation (http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-report-2012-en.pdf)

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Metadata

Authors
Dangour, A. D., Watson, L., Cumming, O., Boisson, S., Che, Y., Velleman, Y., Cavill, S., Allen, E., & Uauy, R.
Affiliations
  • London School of Hygiene & Tropical Medicine (GB)
  • Shanghai Institute of Planned Parenthood Research (CN)
  • WaterAid (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2013-08-01
Volume
2013
Issue
8
Pages
CD009382-CD009382
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd009382.pub2
PMC
PMC11608819
OpenAlex
W1886885898
Cited by
374
References
84
Citations by year
2026: 5 · 2025: 12 · 2024: 14 · 2023: 21 · 2022: 30 · 2021: 34 · 2020: 35 · 2019: 39 · 2018: 45 · 2017: 37 · 2016: 37 · 2015: 31 · 2014: 24 · 2013: 8
FWCI
3.76
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (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
  • Social Sciences › Development › Poverty, Education, and Child Welfare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
water, sanitation and hygiene interventions, child nutritional status, child anthropometry, handwashing with soap, sanitation, micronutrient status, weight-for-age z-score, height-for-age z-score, weight-for-height z-score, children under five, low- and middle-income countries, cost-effectiveness, research gaps, diarrhea prevention
MeSH terms
Age Factors, Body Height, Body Weight, Child, Preschool, Developing Countries, Hand Disinfection, Humans, Hygiene, Infant, Nutritional Status, Sanitation, Water Supply, Randomized Controlled Trials as Topic, Malnutrition, Water Quality

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