Effect of water, sanitation and hygiene interventions alone and combined with nutrition on child growth in low and middle income countries: a systematic review and meta-analysis
Open accessAbstract
OBJECTIVE: This study aimed to provide clarification on the benefits of water, sanitation and hygiene (WASH) alone separately and combined with nutrition in improving child growth outcomes. DESIGN: Systematic review and meta-analysis. METHODS: We conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed, MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science and Science Direct were searched in May 2018 and last updated in April 2019. We included studies that reported WASH interventions alone separately or combined with nutrition. Fixed and random-effects models were used to estimate pooled effect in mean difference (MD). Heterogeneity and publication bias statistics were performed. RESULTS: A total of 18 studies were included: 13 cluster randomised controlled trials (RCTs) and 5 non-randomised controlled trials (non-RCTs). Non-RCTs showed effect of WASH interventions alone on height-for-age z-score (HAZ) (MD=0.14; 95% CI 0.08 to 0.21) but RCTs did not. WASH alone of non-RCTs and RCTs that were delivered over 18-60 months indicated an effect on HAZ (MD=0.04; 95% CI 0.01 to 0.08). RCTs showed an effect for children <2 years (MD=0.07; 95% CI 0.01 to 0.13). Non-RCTs of WASH alone and those that included at least two components, improved HAZ (MD=0.15; 95% CI 0.07 to 0.23) but RCTs did not. WASH alone of non-RCTs and RCTs separately or together showed no effect on weight-for-age z-score (WAZ) and weight-for-height z-score (WHZ). Combined WASH with nutrition showed an effect on HAZ (MD=0.13; 95% CI 0.08 to 0.17) and on WAZ (MD=0.09; 95% CI 0.05 to 0.13) and was borderline on WHZ. CONCLUSIONS: WASH interventions alone improved HAZ when delivered over 18-60 months and for children <2 years. Combined WASH with nutrition showed a strong effect on HAZ and WAZ and a borderline effect on WHZ. Integrated WASH with nutrition interventions may be effective inimproving child growth outcomes.
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References 54 · Cited by 51
Research works printed but not linked: 2
- [20]EPOC Cochrane effective practice and organisation of care (EPOC). suggested risk of bias criteria for EPOC reviews, 2017 Available: http://epoc.cochrane.org/resources/epoc-resources-review-authors [Accessed 15 May 2018].
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- Authors
- Bekele, T., Rawstorne, P., & Rahman, B.
- Affiliations
- UNSW Sydney (AU)
- Corresponding author
- Bekele, Tolesa
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2020-07
- Volume
- 10
- Issue
- 7
- Pages
- e034812
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC7359184
- OpenAlex
- W3040694627
- Cited by
- 51
- References
- 54
- Citations by year
- 2026: 13 · 2025: 6 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 10 · 2020: 1
- FWCI
- 0.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- University of New South Wales
- 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 nutrition, height-for-age z-score, weight-for-age z-score, weight-for-height z-score, low- and middle-income countries, intervention duration, children under 2 years, stunting, underweight, diarrhea, anthelmintic treatment
- MeSH terms
- Child, Developing Countries, Humans, Hygiene, Nutritional Status, Sanitation, Water
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