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Interventions to improve disposal of human excreta for preventing diarrhoea.

Cochrane Database Syst Rev, 2010; 6(6):CD007180
First online: 2010-06-16
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pub_id
20556776
pubmedid
20556776
ISI
278858300022
reference_type
author
Clasen, T.F. ; Bostoen, K. ; Schmidt, W.P. ; Boisson, S. ; Fung, I.C. ; Jenkins, M.W. ; Scott, B. ; Sugden, S. ; Cairncross, S. ;
title
Interventions to improve disposal of human excreta for preventing diarrhoea.
secondary_title
Cochrane Database Syst Rev
ISBNISSN
1469-493X
volume
6
number
6
pages
CD007180
year
2010
abstract
: Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in low-income countries, and are associated with exposure to human excreta.
: To assess the effectiveness of interventions to improve the disposal of human excreta for preventing diarrhoeal diseases.
: We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; LILACS; the metaRegister of Controlled Trials (mRCT); and Chinese-language databases available under the Wan Fang portal, and the China National Knowledge Infrastructure (CNKI-CAJ). We also handsearched relevant conference proceedings, and contacted researchers and organizations working in the field, as well as checking references from identified studies.
: Randomized, quasi-randomized, and non-randomized controlled trials (RCTs) were selected, comparing interventions aimed at improving the disposal of human excreta to reduce direct or indirect human contact with no such intervention. Cluster (eg at the level of household or community) controlled trials were included.
: We determined study eligibility, extracted data, and assessed methodological quality in accordance with the methods prescribed by the protocol. We described the results and summarized the information in tables. Due to substantial heterogeneity among the studies in terms of study design and type of intervention, no pooled effects were calculated.
: Thirteen studies from six countries covering over 33,400 children and adults in rural, urban, and school settings met the review's inclusion criteria. In all studies the intervention was allocated at the community level. While the studies reported a wide range of effects, 11 of the 13 studies found the intervention was protective against diarrhoea. Differences in study populations and settings, in baseline sanitation levels, water, and hygiene practices, in types of interventions, study methodologies, compliance and coverage levels, and in case definitions and outcome surveillance limit the comparability of results of the studies included in this review. The validity of most individual study results are further compromised by the non-random allocation of the intervention among study clusters, an insufficient number of clusters, the lack of adjustment for clustering, unclear loss to follow-up, potential for reporting bias and other methodological shortcomings.
: This review provides some evidence that interventions to improve excreta disposal are effective in preventing diarrhoeal disease. However, this conclusion is based primarily on the consistency of the evidence of beneficial effects. The quality of the evidence is generally poor and does not allow for quantification of any such effect. The wide range of estimates of the effects of the intervention may be due to clinical and methodological heterogeneity among the studies, as well as to other important differences, including exposure levels, types of interventions, and different degrees of observer and respondent bias. Rigorous studies in multiple settings are needed to clarify the potential effectiveness of excreta disposal on diarrhoea.
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secondary_author
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publisher
number_of_volumes
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tertiary_title
edition
date
type_of_work
subsidiary_author
alternate_title
call_number
accession_number
custom_1
WOS OK
custom_2
Unknown
custom_3
custom_4
10.1002/14651858.CD007180.pub2
custom_5
Subscription Required
custom_6
10
label
2016-10-18
notes
Journal Article
url
author_address
Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK, WC1E 7HT.
library
20556776 10.1002/14651858.CD007180.pub2
date_accepted
date_online
2010-06-16
created
2010-06-21 15:24:53
modified
2017-03-23 09:37:56
library

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<ArticleId IdType="doi">10.1002/14651858.CD007180.pub2</ArticleId>