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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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Crossref · 10.1371/journal.pntd.0003296

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110 of 110 references verified0 citation errors · 0 not checkable

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Figures

Figure 1 Flow diagram demonstrating identification, inclusion and exclusion of studies.
Figure 1 Flow diagram demonstrating identification, inclusion and exclusion of studies.CC BY · PubMed Central
Figure 2 Forest plot for Schistosoma infection according to availability or use of a safe water source. Studies on S. haematobium are grouped at the top in blue, followed by those on S. japonicum in red, and those on S. mansoni in green. The square sizes represent the weight given to each dataset, and the black horizontal lines represent 95% confidence intervals. For each species the rhombus is centred on the combined effect size, and its width represents the 95% confidence interval. I2 estimates are presented beneath each combined effect size (except for S. japonicum, since two studies is insufficient for the I2 calculation). The combined effect size for all human schistosome species is presented at the bottom.
Figure 2 Forest plot for Schistosoma infection according to availability or use of a safe water source. Studies on S. haematobium are grouped at the top in blue, followed by those on S. japonicum in red, and those on S. mansoni in green. The square sizes represent the weight given to each dataset, and the black horizontal lines represent 95% confidence intervals. For each species the rhombus is centred on the combined effect size, and its width represents the 95% confidence interval. I2 estimates are presented beneath each combined effect size (except for S. japonicum, since two studies is insufficient for the I2 calculation). The combined effect size for all human schistosome species is presented at the bottom.CC BY · PubMed Central
Figure 3 Forest plot for S. mansoni infection according to access to adequate sanitation. The square sizes represent the weight given to each dataset, and the black horizontal lines represent 95% confidence intervals. The rhombus is centred on the combined effect size, and its width represents the 95% confidence interval. The I2 estimate is presented beneath the combined effect size.
Figure 3 Forest plot for S. mansoni infection according to access to adequate sanitation. The square sizes represent the weight given to each dataset, and the black horizontal lines represent 95% confidence intervals. The rhombus is centred on the combined effect size, and its width represents the 95% confidence interval. The I2 estimate is presented beneath the combined effect size.CC BY · PubMed Central
Figure 4 Forest plot for S. haematobium infection according to access to adequate sanitation. The square sizes represent the weight given to each dataset, and the black horizontal lines represent 95% confidence intervals. The rhombus is centred on the combined effect size, and its width represents the 95% confidence interval. The I2 estimate is presented beneath the combined effect size.
Figure 4 Forest plot for S. haematobium infection according to access to adequate sanitation. The square sizes represent the weight given to each dataset, and the black horizontal lines represent 95% confidence intervals. The rhombus is centred on the combined effect size, and its width represents the 95% confidence interval. The I2 estimate is presented beneath the combined effect size.CC BY · PubMed Central

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Citations

Cites

Research works printed but not linked: 3

  1. MD Guimarães, 1985, [Clinico-epidemiological study of schistosomiasis mansoni in school children of Ilha, municipality of Arcos, MG (Brazil) 1983], Rev Saude Publica, 19, 8
  2. MFF de Lima e Costa, 1994, [A hierarchical model for analysis of socio-economic variables and water contact patterns associated with the hepatosplenic form of schistosomiasis], Cad Saúde Pública, 10 Suppl 2, 241
  3. DCC Palmeira, 2010, [Prevalence of Schistosoma mansoni infection in two municipalities of the State of Alagoas, Brazil], Rev Soc Bras Med Trop, 43, 313

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Metadata

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
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
Licence
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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