Interventions to improve water quality for preventing diarrhoea
Editorial Group: Cochrane Infectious Diseases Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 21 JAN 2006
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Clasen TF, Roberts IG, Rabie T, Schmidt WP, Cairncross S. Interventions to improve water quality for preventing diarrhoea. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004794. DOI: 10.1002/14651858.CD004794.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in developing countries. While many of the infectious agents associated with diarrhoeal disease are potentially waterborne, the evidence for reducing diarrhoea in settings where it is endemic by improving the microbiological quality of drinking water has been equivocal.
To assess the effectiveness of interventions to improve water quality for preventing diarrhoea.
We searched the Cochrane Infectious Diseases Group Specialized Register (December 2005), CENTRAL (The Cochrane Library 2005, Issue 4), MEDLINE (December 2005), EMBASE (December 2005), and LILACS (December 2005). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies.
Randomized and quasi-randomized controlled trials comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults living in settings where diarrhoeal disease is endemic.
Data collection and analysis
Two authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses.
Thirty trials (including 38 independent comparisons) covering over 53,000 participants met the inclusion criteria. Differences between the trials limited the comparability of results and pooling by meta-analysis. In general, the evidence suggests that interventions to improve the microbiological quality of drinking water are effective in preventing diarrhoea both for populations of all ages and children less than five years old. Subgroup analyses suggest that household interventions are more effective in preventing diarrhoea than interventions at the water source. Effectiveness was positively associated with compliance. Effectiveness was not conditioned on the presence of improved water supplies or sanitation in the study setting, and was not enhanced by combining the intervention to improve water quality with other common environmental interventions intended to prevent diarrhoea.
Interventions to improve water quality are generally effective in preventing diarrhoea, and interventions to improve water quality at the household level are more effective than those at the source. Significant heterogeneity among the trials suggests that the actual level of effectiveness may depend on a variety of conditions that research to date cannot fully explain. Rigorous, blinded, multi-arm randomized controlled trials conducted over a longer duration in a variety if settings may help clarify the potential effectiveness.
Plain language summary
Interventions to improve water quality, particularly when implemented at the household level, are effective in preventing diarrhoea in settings where it is endemic
Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. Loss of fluid (dehydration) is the major threat, though diarrhoea also reduces the absorption of the nutrients, causing poor growth in children, reduced resistance to infection, and potentially long-term gut disorders. This review examined trials of interventions to improve the microbiological quality of drinking water. These include conventional improvements at the water source (eg protected wells, bore holes, and stand posts) and point-of-use interventions at the household level (eg chlorination, filtration, solar disinfection, and combined flocculation and disinfection). The review covered 38 independent comparisons from 30 trials that involved more than 53,000 people. In general, such interventions were effective in reducing episodes of diarrhoea. Household interventions were more effective in preventing diarrhoea than those at the source. However, differences in the interventions and the settings in which they were introduced, as well as the methods and measurements of effect, limit the extent to which generalizations can be made. Further research, including blinded trials and longer-term assessments, is necessary to understand the full impact of these interventions.
我們搜尋Cochrane Infectious Diseases Group Specialized Register (2005年12月)、 CENTRAL (Cochrane Library 2005, Issue 4)、 MEDLINE (2005年12月)、 EMBASE (2005年12月)、以及LILACS (2005年12月)。我們人工搜尋相關研討會手冊、聯絡本領域研究人員以及組織，並檢查所找到的研究的參考文獻。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。