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Cited by 77Child Nutrition and Water AccessGlobal Maternal and Child HealthPoverty, Education, and Child Welfare

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

Gera, Tarun, Shah, Dheeraj, Sachdev, Harshpal Singh·2018·Indian Pediatrics
DOI 10.1007/s13312-018-1279-3
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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).Conclusions 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.

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Authors
Gera, T., Shah, D., & Sachdev, H. S.
Affiliations
  • Jain hospital (IN)
  • University of Delhi (IN)
  • Sitaram Bhartia Institute of Science and Research (IN)
Corresponding author
Sachdev, Harshpal Singh
ORCID
Venue
Indian Pediatrics
Publisher
Springer Science and Business Media LLC
Published
2018-02-09
Volume
55
Issue
5
Pages
381-393
ISSN
  • 0019-6061 (ISSN-L)
  • 0974-7559
DOI
10.1007/s13312-018-1279-3
OpenAlex
W2883748497
Cited by
77
References
77
Citations by year
2026: 2 · 2025: 6 · 2024: 7 · 2023: 11 · 2022: 13 · 2021: 18 · 2020: 12 · 2019: 5 · 2018: 2
FWCI
1.18
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Indian Pediatrics (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Social Sciences › Safety Research › Poverty, Education, and Child Welfare
Keywords
water, sanitation and hygiene, child growth, child mortality, hygiene promotion, water supply, sanitation improvement, acute respiratory infections, conjunctivitis, influenza, fever, malnutrition, anthropometry, low- and middle-income countries, child health interventions, diarrheal disease, anthelmintic treatment
MeSH terms
Adolescent, Child, Child, Preschool, Developing Countries, Growth Disorders, Health Promotion, Humans, Hygiene, Infant, Infant Mortality, Infant, Newborn, Sanitation, Malnutrition, Child Mortality, Water Quality

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