The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review.

Article English OPEN
Dawn L Taylor ; Tanya M Kahawita ; Sandy Cairncross ; Jeroen H J Ensink
  • Publisher: Public Library of Science (PLoS)
  • Journal: PLoS ONE, volume 10, issue 8 (issn: 1932-6203, eissn: 1932-6203)
  • Related identifiers: pmc: PMC4540465, doi: 10.1371/journal.pone.0135676
  • Subject: Q | R | Research Article | Science | Medicine

Background and Methods Cholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often missing. This paper presents a systematic literature review investigating the function, use and impact of WASH interventions implemented to control cholera. Results The review yielded eighteen studies and of the five studies reporting on health impact, four reported outcomes associated with water treatment at the point of use, and one with the provision of improved water and sanitation infrastructure. Furthermore, whilst the reporting of function and use of interventions has become more common in recent publications, the quality of studies remains low. The majority of papers (>60%) described water quality interventions, with those at the water source focussing on ineffective chlorination of wells, and the remaining being applied at the point of use. Interventions such as filtration, solar disinfection and distribution of chlorine products were implemented but their limitations regarding the need for adherence and correct use were not fully considered. Hand washing and hygiene interventions address several transmission routes but only 22% of the studies attempted to evaluate them and mainly focussed on improving knowledge and uptake of messages but not necessarily translating this into safer practices. The use and maintenance of safe water storage containers was only evaluated once, under-estimating the considerable potential for contamination between collection and use. This problem was confirmed in another study evaluating methods of container disinfection. One study investigated uptake of household disinfection kits which were accepted by the target population. A single study in an endemic setting compared a combination of interventions to improve water and sanitation infrastructure, and the resulting reductions in cholera incidence. Discussion and Recommendations This review highlights a focus on particular routes of transmission, and the limited number of interventions tested during outbreaks. There is a distinct gap in knowledge of which interventions are most appropriate for a given context and as such a clear need for more robust impact studies evaluating a wider array of WASH interventions, in order to ensure effective cholera control and the best use of limited resources.
  • References (56)
    56 references, page 1 of 6

    1. WHO. Cholera, Fact sheet No. 107. Geneva: 2012 Contract No.: 12 August 2013.

    2. WHO. Cholera Annual Report, 2013. Geneva: 2014 Contract No.: 31.

    3. Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung IC, et al. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol. 2010; 39 Suppl 1:i193-205. Epub 2010/04/02. dyq035 [pii] doi: 10.1093/ije/dyq035 PMID: 20348121; PubMed Central PMCID: PMC2845874.

    4. Clasen T, Bartram J, Colford J, Luby S, Quick R, Sobsey M. Comment on "Household water treatment in poor populations: is there enough evidence for scaling up now?". Environ Sci Technol. 2009; 43 (14):5542-4; author reply 5-6. PMID: 19708394.

    5. Schmidt WP, Cairncross S. Household water treatment in poor populations: is there enough evidence for scaling up now? Environ Sci Technol. 2009; 43(4):986-92. PMID: 19320147.

    6. Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM Jr. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis. 2005; 5(1):42-52. PMID: 15620560.

    7. Waddington H, Snilstveit, White H, Fewtrell L. Water, sanitation and hygiene interventions to combat childhood diarrhoea in developing countries. Delhi: International Initiative for Impact Evaluation, 2009.

    8. Hunter PR. Household water treatment in developing countries: comparing different intervention types using meta-regression. Environ Sci Technol. 2009; 43(23):8991-7. Epub 2009/12/01. doi: 10.1021/ es9028217 PMID: 19943678.

    9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine. 2009; 6(7):e1000100. doi: 10.1371/journal.pmed. 1000100 PMID: 19621070; PubMed Central PMCID: PMC2707010.

    10. DFID. Water, Sanitation and Hygiene, Evidence Paper, May 2013. London, UK: 2013.

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