The joint effects of water and sanitation on diarrhoeal disease: a multicountry analysis of the Demographic and Health Surveys
dc.contributor.author | Fuller, James A. | en_US |
dc.contributor.author | Westphal, Joslyn A. | en_US |
dc.contributor.author | Kenney, Brooke | en_US |
dc.contributor.author | Eisenberg, Joseph N. S. | en_US |
dc.date.accessioned | 2015-02-19T15:40:58Z | |
dc.date.available | 2016-05-10T20:26:29Z | en |
dc.date.issued | 2015-03 | en_US |
dc.identifier.citation | Fuller, James A.; Westphal, Joslyn A.; Kenney, Brooke; Eisenberg, Joseph N. S. (2015). "The joint effects of water and sanitation on diarrhoeal disease: a multicountry analysis of the Demographic and Health Surveys." Tropical Medicine & International Health 20(3): 284-292. | en_US |
dc.identifier.issn | 1360-2276 | en_US |
dc.identifier.issn | 1365-3156 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/110633 | |
dc.description.abstract | ObjectivesTo assess whether the joint effects of water and sanitation infrastructure, are acting antagonistically (redundant services preventing the same cases of diarrhoeal disease), independently, or synergistically; and to assess how these effects vary by country and over time.MethodsWe used data from 217 Demographic and Health Surveys conducted in 74 countries between 1986 and 2013. We used modified Poisson regression to assess the impact of water and sanitation infrastructure on the prevalence of diarrhoea among children under 5.ResultsThe impact of water and sanitation varied across surveys, and adjusting for socio‐economic status drove these estimates towards the null. Sanitation had a greater effect than water infrastructure when all 217 surveys were pooled; however, the impact of sanitation diminished over time. Based on survey data from the past 10 years, we saw no evidence for benefits in improving drinking water or sanitation alone, but we estimated a 6% reduction of both combined (prevalence ratio = 0.94, 95% confidence limit 0.91–0.98).ConclusionsWater and sanitation interventions should be combined to maximise the number of cases of diarrhoeal disease prevented in children under 5. Further research should identify the sources of variability seen between countries and across time. These national surveys likely include substantial measurement error in the categorisation of water and sanitation, making it difficult to interpret the roles of other pathways.ObjectifsEvaluer les effets conjoints des infrastructures de l'eau et d'assainissement afin de voir si elles sont des services redondants prévenant les mêmes cas de maladies diarrhéiques, si elles agissent indépendamment ou en synergie et d’évaluer comment ces effets varient selon les pays et au fil du temps.MéthodesNous avons utilisé les données de 217 enquêtes démographiques et santé menées dans 90 pays entre 1986 et 2013. Nous avons utilisé la régression de Poisson modifiée pour évaluer l'impact des infrastructures de l'eau et d'assainissement sur la prévalence de la diarrhée chez les enfants de moins de cinq ans.RésultatsL'impact de l'eau et de l'assainissement variait dans toutes les enquêtes et l'ajustement pour le statut socioéconomique conduisait ces estimations vers le néant. L'assainissement avait un effet plus important que l'infrastructure de l'eau lorsque toutes les 217 enquêtes ont été poolées. Toutefois, l'impact de l'assainissement a diminué au fil du temps. Basé sur des données d'enquêtes des dix dernières années, nous n'avons vu aucune preuve pour les bénéfices de l'amélioration de l'eau potable ou de l'assainissement seuls, mais nous avons estimé une réduction de 6% pour la combinaison des deux (rapport de prévalence = 0,94; IC95%: 0,91 à 0,98).ConclusionsLes interventions sur l'eau et l'assainissement devraient être combinées pour maximiser le nombre de cas de maladies diarrhéiques prévenus chez les enfants de moins de cinq ans. Des recherches supplémentaires devraient identifier les sources de variabilité observées entre les pays et dans le temps. Ces enquêtes nationales comportent probablement une erreur importante de mesure dans la catégorisation de l'eau et de l'assainissement, ce qui rend difficile l'interprétation des rôles des autres voies.ObjetivosEvaluar el efecto conjunto del agua e infraestructura sanitaria, y determinar si son servicios redundantes que previenen los mismos casos de enfermedad diarreica, actúan de forma independiente o actúan de forma sinérgica; y evaluar como dichos efectos varían según el país y a lo largo del tiempo.MétodosHemos utilizado los datos de 217 Censos Demográficos y de Salud realizados en 90 países entre 1986 y 2013. Hemos realizado una regresión de Poisson modificada para evaluar el impacto del agua y de la infraestructura sanitaria sobre la prevalencia de la diarrea en niños menores de cinco años.ResultadosEl impacto del agua y del saneamiento variaba a lo largo de los censos, y el ajustar según el estatus socioeconómico llevaba los resultados a cero. El saneamiento tenía un mayor efecto que la infraestructura para el agua si se agrupaban los 217 censos; sin embargo, el impacto del saneamiento disminuía a lo largo del tiempo. Basado en los datos censales de los últimos diez años, no encontramos evidencia de los beneficios de la mejora del agua para consumo o del saneamiento por sí solos, pero hemos estimado una reducción del 6% de las dos intervenciones combinadas (tasa de prevalencia = 0.94, IC 95% 0.91‐0.98).ConclusionesLas intervenciones en el agua o el saneamiento deberían combinarse para maximizar el número de casos de enfermedad diarréica prevenidas en niños menores de cinco años. Estudios futuros deberían identificar las fuentes de variabilidad observada entre países y a lo largo del tiempo. Es posible que los censos nacionales incluyan un error sustancial en la medición de las categorías de agua y saneamiento, lo cual complica la determinación del papel de vías alternativas. | en_US |
dc.publisher | Lippincott Williams & Wilkins | en_US |
dc.publisher | Wiley Periodicals, Inc. | en_US |
dc.subject.other | Interacción | en_US |
dc.subject.other | cross‐sectional analysis | en_US |
dc.subject.other | Demographic and Health Surveys | en_US |
dc.subject.other | diarrhoea | en_US |
dc.subject.other | interaction | en_US |
dc.subject.other | sanitation | en_US |
dc.subject.other | water | en_US |
dc.subject.other | analyse transversale | en_US |
dc.subject.other | enquêtes démographiques et de santé | en_US |
dc.subject.other | diarrhée | en_US |
dc.subject.other | interaction | en_US |
dc.subject.other | assainissement | en_US |
dc.subject.other | eau | en_US |
dc.subject.other | estudio croseccional | en_US |
dc.subject.other | Censo demográfico y sanitario | en_US |
dc.subject.other | Diarrea | en_US |
dc.subject.other | Saneamiento | en_US |
dc.subject.other | Agua | en_US |
dc.title | The joint effects of water and sanitation on diarrhoeal disease: a multicountry analysis of the Demographic and Health Surveys | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/110633/1/tmi12441.pdf | |
dc.identifier.doi | 10.1111/tmi.12441 | en_US |
dc.identifier.source | Tropical Medicine & International Health | en_US |
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dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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