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Effect of Sanitation Interventions on Health Outcomes: A Systematic Review of Cluster-Randomized Controlled Trials in Rural Communities of Low- and Middle-Income Countries

Author

Listed:
  • Artwell Kanda

    (Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Private Bag 323, Pretoria 0007, South Africa)

  • Esper Jacobeth Ncube

    (Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Private Bag 323, Pretoria 0007, South Africa)

  • Kuku Voyi

    (Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Private Bag 323, Pretoria 0007, South Africa)

Abstract

A systematic review of published literature (2000–2019) evaluating the impact of sanitation interventions on the prevalence of disease, parasite infestation, and/or child growth using randomized controlled trials (RCTs) was done according to the PRISMA checklist. Earlier reviews indicated mixed evidence citing relatively poor quality evidence from mixed designs. Public health policy and practice appear to rely on evidence from RCTs. Records were searched in six electronic databases. The methodological quality of RCTs was assessed using the Cochrane collaboration risk of bias tool. Fifteen records (2.0%) were included for review. Impact trials were done in rural communities of African and Asian countries. The significant effect of sanitation-focus interventions was found in one trial for the prevalence of childhood diarrhea (14.3%), three trials for parasite infestation (37.5%), and two trials (25.0%) for child growth. Results indicate mixed quality evidence from RCT designs. Evidence is limited and suggestive of the impact of sanitation on parasite infestation and child growth. Further rigorous sanitation intervention trials under varying settings are needed to show what really works and under what settings. Future work may explore sanitation behavior change strategies and latrine options to address the challenges of poor latrine use under high sanitation coverage.

Suggested Citation

  • Artwell Kanda & Esper Jacobeth Ncube & Kuku Voyi, 2021. "Effect of Sanitation Interventions on Health Outcomes: A Systematic Review of Cluster-Randomized Controlled Trials in Rural Communities of Low- and Middle-Income Countries," IJERPH, MDPI, vol. 18(16), pages 1-16, August.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:16:p:8313-:d:609184
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    References listed on IDEAS

    as
    1. Katherine L. Dickinson & Sumeet R. Patil & Subhrendu K. Pattanayak & Christine Poulos & Jui-Hen Yang, 2015. "Nature's Call: Impacts of Sanitation Choices in Orissa, India," Economic Development and Cultural Change, University of Chicago Press, vol. 64(1), pages 1-29.
    2. Amy J. Pickering & Habiba Djebbari & Carolina Lopez & Massa Coulibaly & Maria Laura Alzua, 2015. "Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial," Post-Print hal-01456117, HAL.
    3. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
    4. Cameron, Lisa & Olivia, Susan & Shah, Manisha, 2019. "Scaling up sanitation: Evidence from an RCT in Indonesia," Journal of Development Economics, Elsevier, vol. 138(C), pages 1-16.
    5. World Health Organisation (WHO), 2015. "Progress on Sanitation and Drinking Water," Working Papers id:7119, eSocialSciences.
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