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The Relationship between Water, Sanitation and Schistosomiasis: A Systematic Review and Meta-analysis

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Grimes, Jack E. T., Croll, David, Harrison, Wendy E., Utzinger, Jürg, Freeman, Matthew C., Templeton, Michael R.·2014·PLoS neglected tropical diseases

DOI 10.1371/journal.pntd.0003296PMC PMC4256273

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Abstract

BACKGROUND: Access to "safe" water and "adequate" sanitation are emphasized as important measures for schistosomiasis control. Indeed, the schistosomes' lifecycles suggest that their transmission may be reduced through safe water and adequate sanitation. However, the evidence has not previously been compiled in a systematic review. METHODOLOGY: We carried out a systematic review and meta-analysis of studies reporting schistosome infection rates in people who do or do not have access to safe water and adequate sanitation. PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to 31 December 2013, without restrictions on year of publication or language. Studies' titles and abstracts were screened by two independent assessors. Papers deemed of interest were read in full and appropriate studies included in the meta-analysis. Publication bias was assessed through the visual inspection of funnel plots and through Egger's test. Heterogeneity of datasets within the meta-analysis was quantified using Higgins' I2. PRINCIPAL FINDINGS: Safe water supplies were associated with significantly lower odds of schistosomiasis (odds ratio (OR) = 0.53, 95% confidence interval (CI): 0.47-0.61). Adequate sanitation was associated with lower odds of Schistosoma mansoni, (OR = 0.59, 95% CI: 0.47-0.73) and Schistosoma haematobium (OR = 0.69, 95% CI: 0.57-0.84). Included studies were mainly cross-sectional and quality was largely poor. CONCLUSIONS/SIGNIFICANCE: Our systematic review and meta-analysis suggests that increasing access to safe water and adequate sanitation are important measures to reduce the odds of schistosome infection. However, most of the studies were observational and quality was poor. Hence, there is a pressing need for adequately powered cluster randomized trials comparing schistosome infection risk with access to safe water and adequate sanitation, more studies which rigorously define water and sanitation, and new research on the relationships between water, sanitation, hygiene, human behavior, and schistosome transmission.

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Authors: Grimes, J. E. T., Croll, D., Harrison, W. E., Utzinger, J., Freeman, M. C., & Templeton, M. R.
Affiliations: Imperial College London (GB)
Swiss Tropical and Public Health Institute (CH)
Emory University (US)
Corresponding author: Grimes, Jack E. T.
ORCID: Grimes, Jack E. T.
Harrison, Wendy E.
Utzinger, Jürg
Freeman, Matthew C.
Templeton, Michael R.
Venue: PLoS neglected tropical diseases
Publisher: Public Library of Science (PLoS)
Published: 2014-12-04
Volume: 8
Issue: 12
Pages: e3296
ISSN: 1935-2727 (ISSN-L)
1935-2735
DOI: 10.1371/journal.pntd.0003296
PMC: PMC4256273
OpenAlex: W2112225871
Cited by: 296
References: 110
Citations by year: 2026: 13 · 2025: 28 · 2024: 19 · 2023: 26 · 2022: 32 · 2021: 21 · 2020: 31 · 2019: 29 · 2018: 23 · 2017: 25 · 2016: 26 · 2015: 23
FWCI: 3.02
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS neglected tropical diseases (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
edoc (University of Basel) (acceptedVersion)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Figshare (submittedVersion, cc-by)
Spiral (Imperial College London) (submittedVersion, other-oa)
Funders: London School of Hygiene and Tropical Medicine
Wellcome Trust
Imperial College London
Department for International Development
Topics: Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Mollusks and Parasites Studies
Keywords: schistosomiasis, safe water supply, sanitation, Schistosoma mansoni, Schistosoma haematobium, water, sanitation and hygiene, neglected tropical diseases
MeSH terms: Cross-Sectional Studies, Humans, Sanitation, Schistosomiasis, Water Supply, Water Quality

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The Relationship between Water, Sanitation and Schistosomiasis: A Systematic Review and Meta-analysis

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