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Water and sanitation interventions for better child health: Evidence from a synthetic review

Water and sanitation interventions for better child health: Evidence from a synthetic review. Hugh Waddington Birte Snilstveit Howard White Lorna Fewtrell 3ie. Contents. Objectives Methodology Results: effectiveness Results: sustainability Conclusions.

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Water and sanitation interventions for better child health: Evidence from a synthetic review

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  1. Water and sanitation interventions for better child health: Evidence from a synthetic review Hugh Waddington Birte Snilstveit Howard White Lorna Fewtrell 3ie

  2. Contents • Objectives • Methodology • Results: effectiveness • Results: sustainability • Conclusions

  3. 1. Objectives of the synthetic review • Conduct review to Cochrane/Campbell standards • Mixed methods: analysis of quantitative and qualitative information • Synthesise quantitative information using meta-analysis: assess whether existing ‘consensus’ stands up to inclusion of new studies, and internal and external validity criteria • Theory-based: draw out behavioural and contextual factors shaping success/failure and (likely) sustainability

  4. 2. Methodology • Extensive search (published and unpublished sources) • Inclusion criteria: impact of WSH on diarrhoea; experimental and quasi-experimental methods • Coding of studies: • Internal validity: study design; data quality • External validity: contextual information • Quantitative and qualitative information relating to process, context, behaviour, confounding, moderation • Effectiveness of interventions assessed using: • Meta-analysis (fixed/random effects models; impact heterogeneity, publication bias) • Meta-regression • Sustainability of interventions assessed using quantitative and qualitative information relating to process (outputs), study length and size, replicability

  5. 3. Results: about the interventions

  6. Effectiveness: Water supply interventions

  7. Effectiveness: Water treatment interventions

  8. Effectiveness: Sanitation interventions

  9. Effectiveness: Hygiene interventions

  10. Heterogeneity – ‘high quality’

  11. A closer look at water treatment

  12. 4. Sustainability • Water supply and sanitation: sustainability/scalability assessed • Water treatment and hygiene: replicability demonstrated; sustainability and scalability not => only 5 follow-up studies assessing compliance + health impact over one year after intervention completed • Most studies assess adoption/compliance with intervention => success / failure • Contextual factors identified, often through use of moderator (interaction variable) in analysis: e.g. age, carer’s education level, income, time. • Behavioural factors identified: individual preferences (e.g. taste) and agency (intra-household effects), intra-community ownership + interpersonal networks

  13. Sustainability: quantitative

  14. Sustainability: qualitative (water treatment) • 3 follow-up studies of successful trials were conducted over one year after the initial intervention ended: • Brown et al (2007): ceramic filter provision in Cambodia; 3 years later only 31% compliance • Iijima et al (2001):pasteurisation in Kenya; 4 years later only 30% compliance • Luby et al (2008): water disinfectant in Guatemala; compliance (repeated use) only 5%. • One study evaluated the reasons for low compliance of unsuccessful intervention: source water treatment (UV filtration) in rural Mexico (de Wilde et al 2008): • Community capacity to manage, physical faults or under-valuing of safe water by users were NOT found to be limiting the intervention’s effectiveness • Constraints (money & time) and availability of other sources, meant households chose more convenient water sources

  15. 5. Conclusions • No one single intervention for improving global access to water and sanitation for reducing diarrhoeal disease: • the ‘right’ solution is the one that fits the (social, economic, political) context • emphasise behavioural factors, particularly where these are of overriding importance to adoption (water quality + hygiene interventions)

  16. 5. Conclusions (cont’d) • Effectiveness: • Water supply interventions least effective, excl household connection • Water treatment at point-of-use very effective, but concerns about study quality (blinding) and conflict of interest • Water treatment at source less effective but few high quality studies • Sanitation effective – more studies needed • Hygiene interventions are effective (at least in short term) but resource intensive • Interventions substitutes (results not reported) • Evidence on sustainability + scalability of water treatment and hygiene interventions limited

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