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Interventions to improve water quality for preventing diarrhoea

Cochrane Database of Systematic Reviews, 2006; 3(3):CD004794
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Centre for Global Non-Communicable Diseases (NCDs)

pub_id
16856059
pubmedid
16856059
ISI
239141400058
reference_type
Journal Article
author
Clasen, T.; Roberts, I.; Rabie, T.; Schmidt, W.; Cairncross, S.
title
Interventions to improve water quality for preventing diarrhoea
secondary_title
Cochrane Database of Systematic Reviews
ISBNISSN
1469-493X
volume
3
number
3
pages
CD004794
year
2006
abstract
BACKGROUND: 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. OBJECTIVES: To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. SEARCH STRATEGY: 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. SELECTION CRITERIA: 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. MAIN RESULTS: 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. AUTHORS' CONCLUSIONS: 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.
keywords
Point-of-use; randomized controlled-trial; household drinking-water; developing-countries; childhood diarrhea; rural bangladesh; solar disinfection; safe storage; flocculant-disinfectant; young-children
secondary_author
place_published
publisher
number_of_volumes
tertiary_author
tertiary_title
edition
date
2006-07-19
type_of_work
subsidiary_author
alternate_title
Cochrane Database Syst Rev
call_number
accession_number
16856059
custom_1
WOS OK
custom_2
Unknown
custom_3
custom_4
10.1002/14651858.CD004794.pub2
custom_5
Subscription Required
custom_6
10
label
2016-10-18
notes
Journal Article
url
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=16856059
author_address
London School of Hygiene & Tropical Medicine, Department of Infectious and Tropical Diseases, Keppel Street, London, UK WC1E 7HT. thomas.clasen@lshtm.ac.uk
library
10.1002/14651858.CD004794.pub2 16856059
date_accepted
date_online
created
2006-09-07 13:35:29
modified
2016-07-08 00:00:00
library
<ArticleId IdType="doi">10.1002/14651858.CD004794.pub2</ArticleId>
<ArticleId IdType="pubmed">16856059</ArticleId>