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The joint effects of water and sanitation on diarrhoeal disease: a multicountry analysis of the Demographic and Health Surveys.


ABSTRACT: To assess whether the joint effects of water and sanitation infrastructure, are acting antagonistically (redundant services preventing the same cases of diarrhoeal disease), independently, or synergistically; and to assess how these effects vary by country and over time.We used data from 217 Demographic and Health Surveys conducted in 74 countries between 1986 and 2013. We used modified Poisson regression to assess the impact of water and sanitation infrastructure on the prevalence of diarrhoea among children under 5.The impact of water and sanitation varied across surveys, and adjusting for socio-economic status drove these estimates towards the null. Sanitation had a greater effect than water infrastructure when all 217 surveys were pooled; however, the impact of sanitation diminished over time. Based on survey data from the past 10 years, we saw no evidence for benefits in improving drinking water or sanitation alone, but we estimated a 6% reduction of both combined (prevalence ratio = 0.94, 95% confidence limit 0.91-0.98).Water and sanitation interventions should be combined to maximise the number of cases of diarrhoeal disease prevented in children under 5. Further research should identify the sources of variability seen between countries and across time. These national surveys likely include substantial measurement error in the categorisation of water and sanitation, making it difficult to interpret the roles of other pathways.

SUBMITTER: Fuller JA 

PROVIDER: S-EPMC4308567 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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The joint effects of water and sanitation on diarrhoeal disease: a multicountry analysis of the Demographic and Health Surveys.

Fuller James A JA   Westphal Joslyn A JA   Kenney Brooke B   Eisenberg Joseph N S JN  

Tropical medicine & international health : TM & IH 20141212 3


<h4>Objectives</h4>To assess whether the joint effects of water and sanitation infrastructure, are acting antagonistically (redundant services preventing the same cases of diarrhoeal disease), independently, or synergistically; and to assess how these effects vary by country and over time.<h4>Methods</h4>We used data from 217 Demographic and Health Surveys conducted in 74 countries between 1986 and 2013. We used modified Poisson regression to assess the impact of water and sanitation infrastruct  ...[more]

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