Effect of Sanitation Interventions on Health Outcomes: A Systematic Review of Cluster-Randomized Controlled Trials in Rural Communities of Low- and Middle-Income Countries

Artwell Kanda, Esper Jacobeth Ncube and Kuku Voyi
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Artwell Kanda: Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Private Bag 323, Pretoria 0007, South Africa
Esper Jacobeth Ncube: Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Private Bag 323, Pretoria 0007, South Africa
Kuku Voyi: Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Private Bag 323, Pretoria 0007, South Africa

IJERPH, 2021, vol. 18, issue 16, 1-16

Abstract: A systematic review of published literature (2000–2019) evaluating the impact of sanitation interventions on the prevalence of disease, parasite infestation, and/or child growth using randomized controlled trials (RCTs) was done according to the PRISMA checklist. Earlier reviews indicated mixed evidence citing relatively poor quality evidence from mixed designs. Public health policy and practice appear to rely on evidence from RCTs. Records were searched in six electronic databases. The methodological quality of RCTs was assessed using the Cochrane collaboration risk of bias tool. Fifteen records (2.0%) were included for review. Impact trials were done in rural communities of African and Asian countries. The significant effect of sanitation-focus interventions was found in one trial for the prevalence of childhood diarrhea (14.3%), three trials for parasite infestation (37.5%), and two trials (25.0%) for child growth. Results indicate mixed quality evidence from RCT designs. Evidence is limited and suggestive of the impact of sanitation on parasite infestation and child growth. Further rigorous sanitation intervention trials under varying settings are needed to show what really works and under what settings. Future work may explore sanitation behavior change strategies and latrine options to address the challenges of poor latrine use under high sanitation coverage.

Keywords: basic sanitation; health outcome; low- and middle-income countries; randomized controlled trial (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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