Abstract
IntroductionApproximately 1000 children die each year due to preventable water and sanitation-related diarrheal diseases. Six in 10 people lacked access to safely managed sanitation facilities in 2015. Numerous community- and school-based approaches have been implemented to eradicate open defecation practices, promote latrine ownership, improve situation sanitation, and reduce waterborne disease.ObjectiveGiven that current evidence for sanitation interventions seem promising, the aim of this study was to systematically summarize existing research on the effectiveness of community- and school-based randomized controlled sanitation intervention in improving (1) free open defecation (safe feces disposal), (2) latrine usage, (3) latrine coverage or access, and (4) improved latrine coverage or access.MethodsEight electronic databases were searched: PubMed, Scopus, WHO Global Health Library (GHL), Virtual Health Library (VHL), POPLINE, Web of Science, Cochrane, and Google Scholar up to 26 April 2019. Original randomized clinical trials addressing community-based or school-based intervention that reported feces disposal and latrine coverage were deemed eligible. More than two researchers independently contributed to screening of papers, data extraction, and bias assessment. We conducted a meta-analysis by random-effects model. The risk of bias was assessed by the Cochrane risk of bias tool.ResultsEighteen papers that matched all criteria and 16 studies were included in the final meta-analysis. Compared to the control, the sanitation intervention significantly increased safe feces disposal (OR 2.19, 95% CI 1.51–3.19, p < 0.05, I2 = 97.28), latrine usage (OR 3.72, 95% CI 1.71–8.11, p < 0.05, I2 = 91.52), latrine coverage or access (OR 3.95, 95% CI 2.08–7.50, p < 0.05, I2 = 99.07), and improved latrine coverage or access (OR 3.68, 95% CI 1.52–8.91, p < 0.05, I2 = 99.11). A combination of education and latrine construction was more effective compared to educational intervention alone.ConclusionOur study showed strong evidence for both community- and school-based sanitation interventions as effective for the safe disposal of human excreta. The finding suggests major implications for health policy and design of future intervention in developing countries.
Highlights
1000 children die each year due to preventable water and sanitation-related diarrheal diseases
The sanitation intervention significantly increased safe feces disposal, latrine usage, latrine coverage or access, and improved latrine coverage or access
The community-led total sanitation (CLTS) approach developed by Drs Kamal Kar and Robert Chambers [5] was launched in Bangladesh in 2000 and has been implemented in many developing countries
Summary
1000 children die each year due to preventable water and sanitation-related diarrheal diseases. Numerous community- and school-based approaches have been implemented to eradicate open defecation practices, promote latrine ownership, improve situation sanitation, and reduce waterborne disease. According to the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) Joint Monitoring Program for Water Supply, Sanitation, and Hygiene (JMP) report (2017), 6 in 10 people lacked access to safely managed sanitation facilities in 2015. There was a decrease in the number of people who practiced open defecation from 1229 million to 892 million with an average decline of 22 million people per year These people have received limited education on sanitation and hygiene conditions [4]. The average increase in latrine coverage was 27% (95% confidence interval 14–39) [6] Another major approach was the water, sanitation, and hygiene (WASH) intervention, designed to supply sufficiently safe water and affordable hygiene stations to improve the level of sanitation and prevent waterborne diseases. Wolf et al showed a large reduction of diarrheal disease risk through interventions through improved drinking water, sanitation, and hygiene [7]
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