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Interventions to improve water quality for preventing diarrhoea
1London School of Hygiene & Tropical Medicine, Department of Infectious and Tropical Diseases, Keppel Street, London, UK WC1E 7HT. thomas.clasen@lshtm.ac.uk
The Cochrane Database of Systematic Reviews
|July 21, 2006
Summary
Improving drinking water quality effectively prevents diarrhoeal diseases, particularly with household-level interventions. Further research is needed to understand factors influencing effectiveness in diverse settings.
Area of Science:
- Public Health
- Environmental Health
- Infectious Disease Epidemiology
Background:
- Diarrhoeal diseases are a major global health burden, especially in developing countries, disproportionately affecting young children.
- While often waterborne, the impact of improving drinking water quality on endemic diarrhoeal disease has been inconsistent.
- This review assesses the efficacy of water quality interventions in reducing diarrhoeal disease incidence.
Purpose of the Study:
- To systematically evaluate the effectiveness of interventions aimed at improving the microbiological quality of drinking water for preventing diarrhoea.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Cochrane, MEDLINE, EMBASE, LILACS) and other sources up to December 2005.
- Included were randomized and quasi-randomized controlled trials comparing water quality interventions with no intervention in endemic settings.
- Data were independently extracted and analyzed using meta-analysis where appropriate, with subgroup analyses exploring heterogeneity.
Main Results:
- Thirty trials involving over 53,000 participants were analyzed, though heterogeneity limited direct pooling.
- Interventions to improve drinking water quality generally demonstrated effectiveness in preventing diarrhoea across all age groups, including children under five.
- Household-level interventions were more effective than source-level interventions, and effectiveness correlated with compliance; it was independent of existing water/sanitation improvements.
Conclusions:
- Improving drinking water quality is a generally effective strategy for diarrhoea prevention, with household interventions showing superior results.
- Significant heterogeneity exists, indicating that effectiveness is influenced by unmeasured factors.
- Future research should focus on rigorous, long-term, multi-arm trials in varied settings to elucidate these influencing factors.