Systematic review: Assessing the impact of drinking water and sanitation on diarrhoeal disease in low‐ and middle‐income settings: systematic review and meta‐regression
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OBJECTIVE: To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings. METHODS: The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa-Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates. RESULTS: Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12,515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions. CONCLUSIONS: The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented.
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Self-citation
- Authors
- Wolf, J., Prüss‐Ustün, A., Cumming, O., Bartram, J., Bonjour, S., Cairncross, S., Clasen, T., Colford, J. M., Curtis, V., De France, J., Fewtrell, L., Freeman, M. C., Gordon, B., Hunter, P. R., Jeandron, A., Johnston, R. B., Mäusezahl, D., Mathers, C., Neira, M., & Higgins, J. P. T.
- Affiliations
- Swiss Tropical and Public Health Institute (CH)
- Department of Public Health and Environment World Health Organization Geneva Switzerland
- London School of Hygiene & Tropical Medicine (GB)
- University of North Carolina at Chapel Hill (US)
- World Health Organization (CH)
- Emory University (US)
- University of California, Berkeley (US)
- Aberystwyth University (GB)
- University of East Anglia (GB)
- London School of Hygiene and Tropical Medicine London UK
- University of Bristol (GB)
- Corresponding author
- Wolf, Jennyfer
- ORCID
- Venue
- Tropical Medicine & International Health
- Publisher
- Wiley
- Published
- 2014-05-08
- Volume
- 19
- Issue
- 8
- Pages
- 928-942
- ISSN
- 1360-2276 (ISSN-L)
- 1365-3156
- OpenAlex
- W2149966611
- Cited by
- 461
- References
- 82
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 23 · 2023: 44 · 2022: 43 · 2021: 33 · 2020: 46 · 2019: 48 · 2018: 58 · 2017: 55 · 2016: 38 · 2015: 28 · 2014: 8
- FWCI
- 4.89
- Type
- journal article
- Language
- en
- Open access
- green
- ueaeprints.uea.ac.uk
- Locations
- Tropical Medicine & International Health (publishedVersion)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- DORA Eawag (Swiss Federal Institute of Aquatic Science and Technology (Eawag)) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- World Health Organization
- London School of Hygiene and Tropical Medicine
- Department for International Development
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
- Physical Sciences › Environmental Science › Water Science and Technology › Fecal contamination and water quality
- Keywords
- diarrhoeal diseases, drinking water, sanitation, water filters, piped water, sewer connection, low- and middle-income settings, diarrhea prevention
- MeSH terms
- Developing Countries, Diarrhea, Humans, Income, Sanitation, Water Supply, Water Quality, Drinking Water
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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