Intervention Review

You have free access to this content

Interventions to improve disposal of human excreta for preventing diarrhoea

  1. Thomas F Clasen1,*,
  2. Kristof Bostoen1,
  3. Wolf-Peter Schmidt1,
  4. Sophie Boisson1,
  5. Isaac C-H Fung2,
  6. Marion W Jenkins3,
  7. Beth Scott1,
  8. Steven Sugden1,
  9. Sandy Cairncross1

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 16 JUN 2010

Assessed as up-to-date: 17 MAR 2010

DOI: 10.1002/14651858.CD007180.pub2


How to Cite

Clasen TF, Bostoen K, Schmidt WP, Boisson S, Fung ICH, Jenkins MW, Scott B, Sugden S, Cairncross S. Interventions to improve disposal of human excreta for preventing diarrhoea. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007180. DOI: 10.1002/14651858.CD007180.pub2.

Author Information

  1. 1

    London School of Hygiene & Tropical Medicine, Department of Infectious and Tropical Diseases, London, UK

  2. 2

    Imperial College London, Department of Infectious Disease Epidemiology, Faculty of Medicine, London, UK

  3. 3

    Univeristy of California, Davis, Department of Civil & Environmental Engineering, California, USA

*Thomas F Clasen, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. thomas.clasen@lshtm.ac.uk.

Publication History

  1. Publication Status: New
  2. Published Online: 16 JUN 2010

SEARCH

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Aziz 1990 {published data only}
  • Aziz KMA, Hoque BA, Hasan KZ, Patwary MY, Huttly SRA, Rahman MM, et al. Reduction in diarrhoeal diseases in children in rural Bangladesh by environmental and behavioural modifications. Transactions of the Royal Society of Tropical Medicine and Hygiene 1990;84(3):433-8.
  • Hasan KZ, Briend A, Aziz KMA, Hoque BA, Patwary My, Huttly SRA. Lack of impact of a water and sanitation intervention on the nutritional status of children in rural Bangladesh. European Journal of Clinical Nutrition 1989;43(12):837-43.
  • Hoque BA, Juncker T, Sack RB, Ali M, Aziz KMA. Sustainability of a water, sanitation and hygiene education project in rural Bangladesh: a 5-year follow-up. Bulletin World Health Organization 1995;74(4):431-37.
Garrett 2008 {published data only}
  • Garrett V, Ogutu P, Mabonga P, Ombeki S, Mwaki A, Aluoch G, et al. Diarrhoea prevention in a high-risk rural Kenyan population through point-of-use chlorination, safe water storage, sanitation, and rainwater harvesting. Epidemiology and Infection 2008;136(11):1463-71.
Hu 1988 {published data only}
  • Hu X-R, Liu G, Liu S-P, Yan-Xin H, Zhang X-M, Fan Y-Y, et al. [Field evaluation of the effect of diarrhoea control of methanogenesis treatment of human and animal faeces and rubbish of cellulose nature in the rural areas of Xiang Cheng]. Henan Yu Fang Yi Xue Za Zhi [Henan Journal of Preventative Medicine] 1988;1988:11-13.
Huttly 1990 {published data only}
  • Blum D, Emeh R. Evaluation of the UNICEF-assisted Imo State water supply and sanitation project: epidemiological and fieldwork methods. In: Briscoe J, Feachem RG, Rahaman MM editor(s). Evaluating Health Impacts: Water Supply, Sanitation and Hygiene Education. Toronto: International Development Research Centre Canada, 1986.
  • Huttly SR, Blum D, Kirkwood BR, Emeh RN, Feachem RG. The epidemiology of acute diarrhoea in a rural community in Imo State, Nigeria. Transactions of the Royal Society of Tropical Medicine and Hygiene 1987;81(5):865-70.
  • Huttly SR, Blum D, Kirkwood BR, Emeh RN, Okeke N, Ajala M, et al. The Imo State (Nigeria) drinking water supply and sanitation project, 2: impact on dracunculiasis, diarrhoea and nutritional status. Transactions of the Royal Society of Tropical Medicine and Hygiene 1990;84(2):316-21.
  • The Imo State Evaluatin Team. Evaluating water and sanitation projects: lessons from Imo State, Nigeria. Health Policy and Planning 1989;4(1):40-9.
McCabe 1957 {published data only}
Messou 1997 {published data only}
  • Messou E, Sangare SV, Josseran R, Le Corre C, Guelain J. [Effect of hygiene and water sanitation and oral rehydration on diarrhoea and mortality of children children less than five years old in the south of Ivory Coast]. Bulletin de la Société de Pathologie Exotique 1997;90(1):44-7.
  • Messou E, Sangare SV, Josseran R, Le Corre C, Guelain J. [Effect of improvement in sanitary conditions and domestic hygiene on incidence of ascaridiasis and ankylostomiasis of children aged 2-4 years in rural zones of Ivory Coaste]. Bulletin de la Société de Pathologie Exotique 1997;90(1):48-50.
Rubenstein 1965 {published data only}
Wei 1998 {published data only}
  • Wei X-N, Shao B-C, Fang Z-H, Gao M, Zhu X-L. [Evaluation of the effect of prevention of diarrhoea and ascariasis among students of health intervetion measures in schools in rural areas. Zhongguo Gong Gong Wei Sheng [China Journal of Public Health] 1998;14:228.
Xu 1990 {published data only}
  • Xu J-Z. [Observation on the efficacy of three squares septic tank lavatory for disease prevention]. Huan Jing Yu Jian Kang Za Zhi [Journal of Environment and Health] 1990;1990:250-2.
Xu 1994 {published data only}
  • Xu G-X, Zhu X-L. [The assessment of the effects for prevention of diseases by non-hazardous treatment of night soil at experimental spots in rural areas]. Wei Sheng Yan Jiu [Journal of Hygiene Research] 1994;23:23-7.
Yan 1986 {published data only}
  • Yan Z-S, Wang G-F, Cui C, Yin L-S, Su C-H, Liu F, et al. [An observation of the effect on reducing the fly density and diarrhoea of the use of double urn funnel lavatory in faeces management]. Henan Yu Fang Yi Xue Za Zhi [Henan Journal of Preventive Medicine] 1986;1986(3):73-6.
Zhang 2000 {published data only}
  • Zhang W-P, Liu M-X, Yin W-H, Zhang H-J, Li G-P, Liu L-P, et al. [Evaluation of a long-term effect on improving drinking water and lavatories in rural areas for prevention of diseases]. Ji Bing Kong Ji Za Zhi [Chinese Journal of Disease Control & Prevention] 2000;4(1):76-8.
Zhu 1997 {published data only}
  • Zhu X-L, Xia Q-Y, Meng Z-Y, Wang X-C, Shao B-C, Yang S-Y, et al. [Assessment of effects of disease prevention by intervention measures of school environmental hygiene in rural areas]. Wei Sheng Yan Jiu [Journal of Hygiene Research] 1997;26:378-80.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Asaolu 2002 {published data only}
  • Asaolu SO, Ofoezie IE, Odumuyiwa PA, Sowemimo OA, Oguniyi TA. Effect of water supply and sanitation on the prevalence and intensity of Ascaris lumbricodes among pre-school-age children in Ajebandele and Ifewara, Osun State, Nigeria. Tranactions of the Royal Society of Tropical Medicine and Hygiene 2002;96(6):600-4.
Azurin 1974 {published data only}
Baltazar 2002 {published data only}
  • Baltazar JC, Nadera DP, Victora CG. Evaluation of the National Control of Diarrhoeal Diseases Programme in the Philippines, 1980-93. Bulletin of the World Health Organization 2002;80(6):637-43.
Beck 1957 {published data only}
  • Beck MD, Munoz JA, Scrimshaw NS. Studies on diarrheal diseases in Central America I: preliminary findings on cultural surveys of normal populations groups in Guatemala. The American Journal of Tropical Medicine and Hygiene 1957;6(1):62-71.
Butz 1984 {published data only}
  • Butz WP, Habicht J-P, DaVanzo J. Environmental factors in the relationship between breast-feeding and infant mortality: the role of sanitation and water in Malaysia. American Journal of Epidemiology 1984;119(4):516-25.
Cao 2007 {published data only}
  • Cao D-Q, Zhang R. [A survey of the effect of the intervention measures of water and latrine improvement in rural areas on diarrhoea prevention]. Zhonngguo Nong Cun Wei Sheng Shi Ye Guan Li [Chinese Rural Health Service Administration] 2007;27:466.
Daniels 1990 {published data only}
  • Daniels DL, Cousens SN, Makoae LN, Feachem RG. A case-control study of the impact of improved sanitation on diarrhoea morbidity in Lesotho. Bulletin of the World Health Organization 1990;68(4):455-63.
Gross 1989 {published data only}
  • Gross R, Schell B, Bisi Molina MC, Cuelho Leao MA, Strack U. The impact of improvement of water supply and sanitation facilities on diarrhea and intestinal parasites: a Brazilian experience with children in two low-income urban communities. Revista de saúde pública 1989;23(3):214-20.
Guerrant 1983 {published data only}
  • Guerrant RL, Kirchhoff LV, Shield DS, Natons MK, Leslie J, de Sousa MA, et al. Prospective study of diarrheal illnesses in northeastern Brazil: patterns of disease, nutritional impact, etiologies, and risk factors. Journal of Infectious Diseases 1983;148(6):986-99.
Gutierrez 1999 {published data only}
  • Guiterrez G, Reyes H, Fernandez S, Perez L, Perez-Cuevas R, Guiscafre H. Impact of health care services, sanitation and education on mortality rates of children under five years of age [Impacto de los servicios de salud, el saneamiento y las alfabetizacion en la mortalidad de menores de cinco anos]. Salud Pública de México 1999;41(5):368-75.
Henry 1981 {published data only}
  • Henry FJ. Environmental sanitation, infection and nutritional status of infants in rural St Lucia, West Indies. Transactions of the Royal Society of Tropical Medicine and Hygiene 1981;75(4):507-13.
Koopman 1978 {published data only}
Kumar 1968 {published data only}
  • Kumar P, Singh R, Sehgal BS. Fly control and diarrheal morbidity in a rural community in U.P. Indian Journal of Medical Sciences 1968:285-91.
Lou 1990 {published data only}
  • Lou H, Liu M-X, Song S-M, Li Q-M, Zhang W-P, Xu G-X, et al. [Effectiveness evaluation and cost-effectiveness estimate for diarrhea control by environmental improvement in rural area]. Henan Yu Fang Yi Xue Za Zhi [Henan Journal of Preventive Medicine] 1989;1989:25-9.
Makoni 2004 {published data only}
  • Makoni FS, Ndamba J, Mbati PA, Manase G. Impact of waste disposal on health of a poor urban community in Zimbambwe. East African Medical Journal 2004;81(8):422-6.
Meddings 2004 {published data only}
  • Meddings DR, Ronald LA, Marion S, Pinera JF, Oppliger A. Cost effectiveness of a latrine revision programme in Kabul, Afghanistan. Bulletin of the World Health Organization 2004;82(4):281-8.
Moore 1965 {published data only}
  • Moore HA, de la Cruz E, Vargas-Mendez O. Diarreal disease studies in Costa Rica. IV. The influence of sanitation upon the prevalence of intestinal infection and diarrheal disease. American Journal of Epidemiology 1965;82(2):162-184.
Nanan 2003 {published data only}
  • Nanan D, White F, Azam I, Afsar H, Hozhari S. Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan. Bulletin of the World Health Organization 2003;81(3):160-5.
Pickering 1985 {published data only}
Pokhrel 2004 {published data only}
Rego 2005 {published data only}
Van Zil 1966 {published data only}
  • Van Zijl WJ. Studies on diarrhoeal diseases in seven countries by the WHO Diarrhoeal Diseases Advisory Team. Bulletin of the World Health Organization 1966;35:249-61.
Xiao 1995 {published data only}
  • Xiao S-S, Lin L-Y, Shi X-Q, Lin C-S, Chen K-C. [A discussion on the control measures of diarrhoeal diseases in rural villages of eastern Fujian]. Zhongguo Gong Gong Wei Sheng [China Journal of Public Health] 1995;11:257.
Xiao 1997 {published data only}
  • Xiao S, Lin C, Chen K. [Evaluation of effectiveness of comprehensive control for diarrhea diseases in rural areas of East Fujian and analysis of its cost-benefit]. [Zhonghua Yu Fang Yi Xue Za Zhi] Chinese Journal of Preventive Medicine 1997;31(1):40-1.
Zhou 1995 {published data only}
  • Zhou TK, Wang CS, Gu BK, Tan JD, Su ZL, Fan PH. [Evaluation of effectiveness and cost-effectiveness analysis of faeces management measures upon diarrhoea control]. Shanghai Yu Fang Yi Xue Za Zhi [Shanghai Journal of Preventive Medicine] 1995;7(9):388-91.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Baqui 1993
  • Baqui AH, Black RE, Sack RB, Chowdhury HR, Yunus M, Siddique AK. Malnutrition, cell-mediated immune deficiency, and diarrhea: a community-based longitudinal study in rural Bangladeshi children. American Journal of Epidemiology 1993;137(3):355-65.
Barreto 2007
  • Barreto ML, Genser B, Strina A, Teixeira MG, Assis AM, Rego RF, et al. Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies. Lancet 2007;370(9599):1622-8.
Bartram 2003
Bennett 2002
Blum 1983
Byers 2001
  • Byers KE, Guerrant RL, Farr BM. Fecal-oral transmission. In: Thomas JC, Webber DJ editor(s). Epidemiologic Methods for the Study of Infectious Diseases. Oxford: Oxford University Press, 2001:228-48.
Clasen 2006
Curtis 2003
Deeks 2001
  • Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG editor(s). Systematic Reviews in Health Care. 2nd Edition. London: BMJ Books, 2001:285-312.
Donner 2000
  • Donner A, Klar N. Design and Analysis of Cluster Randomisation Trials in Health Research. London: Arnold, 2000.
Egger 2001
  • Egger M, Davey Smith G. Principles of and procedures for systematic reviews. In: Egger M, Davey Smith G, Altman DG editor(s). Systematic Reviews in Health Care: Meta-analysis in Context. 2nd Edition. London: BMJ Books, 2001:23-42.
Ejemot 2008
  • Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD004265.pub2]
Emerson 2004
  • Emerson PM, Lindsay SW, Alexander N, Bah M, Dibba SM, Faal HB. Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial. Lancet 2004;363(9415):1093-8.
Esrey 1985
  • Esrey SA, Feachem RG, Hughes JM. Interventions for control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities. Bulletin of the World Health Organization 1985;63(4):757-72.
Esrey 1986
Esrey 1991
  • Esrey SA, Potash JB, Roberts L, Shiff C. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bulletin of the World Health Organization 1991;69(5):609-21.
Fewtrell 2005
  • Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infectious Diseases 2005;5(1):42-52.
Fung 2008
  • Fung ICH. Chinese journals: a guide for epidemiologists. Emerging Themes in Epidemiology 2008;5:20.
Genser 2008
  • Genser B, Strina A, dos Santos LA, Teles CA, Prado MS, Cairncross S, et al. Impact of a city-wide sanitationr intervention in a large urban centre on social, environmental and behavioural determinants of childhood diarrhoea: analysis of two cohort studies. International Journal of Epidemiology 2008;37(4):831-40.
Green 2009
Guerrant 1999
  • Guerrant DI, Moore SR, Lima AA, Patrick PD, Schorling JB, Guerrant RL. Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil. American Journal of Tropical Medicine and Hygiene 1999;61(5):707-13.
Gundry 2004
  • Gundry S, Wright J, Conroy R. A systematic review of the health outcomes related to household water quality in developing countries. Journal of Water and Health 2004;2(1):1-13.
Hayes 2008
  • Hayes RJ, Moulton LH. Cluster. Cluster Randomised Trials. London: Chapman & Hall/CRC Interdisciplinary Statistics Series, 2008.
Higgins 2003
Higgins 2006
  • Higgins J, Green S, editors. Highly sensitive search strategies for identifying reports of randomized controlled trials in MEDLINE. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [updated September 2006]; Appendix 5b. www.cochrane.org/resources/handbook/hbook.htm (accessed 1 December 2007).
Hoque 1996
  • Hoque BA, Juncker T, Sack RB, Ali M, Aziz KM. Sustainability of a water, sanitation and hygiene education project in rural Bangladesh: a 5-year follow-up. Bulletin of the World Health Organization 1996;74(4):431-7.
Humphrey 2009
Jenkins 2005
Kosek 2003
  • Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bulletin of the World Health Organization 2003;81(3):197-204.
Leclerc 2002
McNutt 2003
Millennium Project 2005
  • United Nations Millennium Project. UN Millennium Project Task Force on Water and Sanitation--Health, dignity and development: what will it take?. London: Earthscan, 2005.
Morris 1996
  • Morris SS, Cousens SN, Kirkwood BR, Arthur P, Ross DA. Is prevalence of diarrhoea a better predictor of subsequent mortality and weight gain than diarrhea incidence?. American Journal of Epidemiology 1996;144(6):582-8.
Moy 1991
Mulligan 2005
  • Mulligan J, Fox-Rushby J, Adam T, Johns B, Mills A. Unit costs of health care inputs in low- and middle-income regions. In: Jamison DT, Breman JG, Measham AR, Alleyn G, Claeson M, Evans DB, et al. editor(s). Disease Control Priorities in Developing Countries. Washington, DC: World Bank, 2006.
Petri 2008
  • Petri WA, Miller M, Binder HJ, Levine MM, Dillingham R, Guerrant RL. Enteri infections, diarrea, and their impact on function and development. Journal of Clinical Investigation 2008;118(4):1277-90.
Pickering 1987
  • Pickering H, Hayes RG, Tomkins AM, Carson D, Dunn DT. Alternative measures of diarrhoeal morbidity and their association with social and environmental factors in urban children in The Gambia. Transactions of the Royal Society of Tropical Medicine and Hygiene 1987;81(5):853-9.
Rabiu 2005
  • Rabiu M, Alhassan M, Ejere H. Environmental sanitary interventions for preventing active trachoma. Cochrane Database of Systematic Reviews 2005, Issue 2. [DOI: 10.1002/14651858.CD004003.pub2]
Review Manager 5 [Computer program]
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.
Schneider 1978
  • Schneider RE, Shiffman M, Faigenblum J. The potential effect of water on gastrointestinal infections prevalent in developing countries. American Journal of Clinical Nutrition 1978;31(11):2089-99.
Traore 1994
  • Traore E, Cousens S, Curtis V, Mertens T, Tall F, Traore A, Kanki B, Diallo I, Rochereau A, Chiron JP. Child defecation behaviour, stool disposal practices, and childhood diarrhoea in Burkina Faso: results from a case-control study. J Epidemiol Community Health 1994;48(270-275).
UNDP 2007
  • United Nations Development Programme. Human Development Report 2007: Power, Poverty and the Global Water Crisis. New York: United Nations Development Programme, 2007.
United Nations 2002
  • United Nations. Report of the World Summit on Sustainable Development: Johannesburg, South Africa, 26 August-4 September 2002 [A/CONF.199/20*]. www.unctad.org/en/docs/aconf199d20&c1_en.pdf (accessed 3 October 2007).
United Nations 2005
  • United Nations Statistics Division. Progress towards the Millennium Development Goals, 1990-2005: Goal 4. Reduce child mortality. unstats/un.org/unsd/mi/goals_2005/goal_4.pdf (accessed 15 November 2005).
United Nations 2006
  • United Nations. Resolution A/C.2/61/L.16/Rev.1 on the International Year of Sanitation 2008. United Nations General Assembly 4 December 2006.
Waddington 2009
  • Waddinton H, Snilstveit B, White H, Fewtrell L. Water, sanitation and hygiene interventions to combat childhood diarrhoea in developing countries. Journal of Development Effectiveness 2009; Vol. 1, issue 3:295-335.
WHO 1993
  • World Health Organization. The management and prevention of diarrhoea: practical guidelines. 3rd Edition. Geneva: World Health Organization, 1993.
WHO 2002
  • World Health Organization. The World Health Report : 2002 : Reducing the Risks, PromotingHealthy Life [WHO/WHR/02.1]. Geneva: World Health Organization, 2002.
WHO 2005
  • World Health Organization. The World Health Report: 2005: Make Every Mother and Child Count. Geneva: World Health Organization, 2005.
WHO/UNICEF 2002
  • World Health Organization, United Nations Childrens' Fund. Global Water Supply and Sanitation Assessment. Geneva: World Health Organization, 2002.
WHO/UNICEF 2005
  • World Health Organization, United Nations Childrens' Fund. Progress towards the Millennium Development Goals, 1990-2005. Geneva: World Health Organization, 2005.
WHO/UNICEF 2006
  • WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Meeting the MDG Drinking Water and Sanitation Target: The Urban and Rural Challenge of the Decade. Geneva and New York: World Health Organization and United Nations Children's Fund, 2006.
WHO/UNICEF 2010
  • WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Progress on Drinking Water and Sanitation: 2010 Update. Geneva and New York: World Health Organization and United Nations Children's Fund, 2010.
Wood 2008
  • Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG, et al. Emperical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes. BMJ 2008;336(7644):601-5.
Zhang 1998