Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea
Abstract
This paper presents a synthetic review of impact evaluations examining effectiveness of water, sanitation, and hygiene interventions in reducing diarrhoea among children. The evaluations were conducted in 35 low- and middle-income countries during the past three decades. The paper challenges the existing consensus that water treatment at point-of-use and hygiene interventions are necessarily the most effective and sustainable interventions for promoting reduction of diarrhoea. The analysis suggests that sanitation ‘hardware’ interventions are highly effective in reducing diarrhoea morbidity. Moreover, while there is a wealth of trials documenting the effectiveness of water treatment interventions, studies conducted over longer periods tend to show smaller effectiveness and evidence suggests compliance rates and therefore impact may fall markedly over time.
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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 Waddington 2009
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 Waddington 2009
Recall of up to two weeks is considered a generally reliable period in reporting disease morbidity before significant bias sets in.
“Recall of up to two weeks is considered a generally reliable period in reporting disease morbidity before significant bias sets in (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 Waddington 2009
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 Waddington 2009
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 Waddington 2009
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References 116 · Cited by 179
- Authors
- Waddington, H., & Snilstveit, B.
- Affiliations
- International Initiative for Impact Evaluation (US)
- Corresponding author
- Waddington, Hugh
- ORCID
- Waddington, Hugh
- Venue
- Journal of Development Effectiveness
- Publisher
- Informa UK Limited
- Published
- 2009-09-15
- Volume
- 1
- Issue
- 3
- Pages
- 295-335
- ISSN
- 1943-9342 (ISSN-L)
- 1943-9407
- OpenAlex
- W2007695924
- Cited by
- 179
- References
- 116
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 8 · 2023: 9 · 2022: 10 · 2021: 11 · 2020: 10 · 2019: 10 · 2018: 16 · 2017: 14 · 2016: 12 · 2015: 14 · 2014: 15 · 2013: 15 · 2012: 13
- FWCI
- 10.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Development Effectiveness (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Social Sciences › Safety Research › Poverty, Education, and Child Welfare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- water, sanitation and hygiene, diarrhea, childhood diarrhea, impact evaluation, household water treatment, hygiene interventions, intervention sustainability, compliance, low- and middle-income countries
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