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The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review

BACKGROUND AND METHODS: Cholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often missing. This paper p...

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Autores principales: Taylor, Dawn L., Kahawita, Tanya M., Cairncross, Sandy, Ensink, Jeroen H. J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540465/
https://www.ncbi.nlm.nih.gov/pubmed/26284367
http://dx.doi.org/10.1371/journal.pone.0135676
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author Taylor, Dawn L.
Kahawita, Tanya M.
Cairncross, Sandy
Ensink, Jeroen H. J.
author_facet Taylor, Dawn L.
Kahawita, Tanya M.
Cairncross, Sandy
Ensink, Jeroen H. J.
author_sort Taylor, Dawn L.
collection PubMed
description BACKGROUND AND METHODS: Cholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often missing. This paper presents a systematic literature review investigating the function, use and impact of WASH interventions implemented to control cholera. RESULTS: The review yielded eighteen studies and of the five studies reporting on health impact, four reported outcomes associated with water treatment at the point of use, and one with the provision of improved water and sanitation infrastructure. Furthermore, whilst the reporting of function and use of interventions has become more common in recent publications, the quality of studies remains low. The majority of papers (>60%) described water quality interventions, with those at the water source focussing on ineffective chlorination of wells, and the remaining being applied at the point of use. Interventions such as filtration, solar disinfection and distribution of chlorine products were implemented but their limitations regarding the need for adherence and correct use were not fully considered. Hand washing and hygiene interventions address several transmission routes but only 22% of the studies attempted to evaluate them and mainly focussed on improving knowledge and uptake of messages but not necessarily translating this into safer practices. The use and maintenance of safe water storage containers was only evaluated once, under-estimating the considerable potential for contamination between collection and use. This problem was confirmed in another study evaluating methods of container disinfection. One study investigated uptake of household disinfection kits which were accepted by the target population. A single study in an endemic setting compared a combination of interventions to improve water and sanitation infrastructure, and the resulting reductions in cholera incidence. DISCUSSION AND RECOMMENDATIONS: This review highlights a focus on particular routes of transmission, and the limited number of interventions tested during outbreaks. There is a distinct gap in knowledge of which interventions are most appropriate for a given context and as such a clear need for more robust impact studies evaluating a wider array of WASH interventions, in order to ensure effective cholera control and the best use of limited resources.
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spelling pubmed-45404652015-08-24 The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review Taylor, Dawn L. Kahawita, Tanya M. Cairncross, Sandy Ensink, Jeroen H. J. PLoS One Research Article BACKGROUND AND METHODS: Cholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often missing. This paper presents a systematic literature review investigating the function, use and impact of WASH interventions implemented to control cholera. RESULTS: The review yielded eighteen studies and of the five studies reporting on health impact, four reported outcomes associated with water treatment at the point of use, and one with the provision of improved water and sanitation infrastructure. Furthermore, whilst the reporting of function and use of interventions has become more common in recent publications, the quality of studies remains low. The majority of papers (>60%) described water quality interventions, with those at the water source focussing on ineffective chlorination of wells, and the remaining being applied at the point of use. Interventions such as filtration, solar disinfection and distribution of chlorine products were implemented but their limitations regarding the need for adherence and correct use were not fully considered. Hand washing and hygiene interventions address several transmission routes but only 22% of the studies attempted to evaluate them and mainly focussed on improving knowledge and uptake of messages but not necessarily translating this into safer practices. The use and maintenance of safe water storage containers was only evaluated once, under-estimating the considerable potential for contamination between collection and use. This problem was confirmed in another study evaluating methods of container disinfection. One study investigated uptake of household disinfection kits which were accepted by the target population. A single study in an endemic setting compared a combination of interventions to improve water and sanitation infrastructure, and the resulting reductions in cholera incidence. DISCUSSION AND RECOMMENDATIONS: This review highlights a focus on particular routes of transmission, and the limited number of interventions tested during outbreaks. There is a distinct gap in knowledge of which interventions are most appropriate for a given context and as such a clear need for more robust impact studies evaluating a wider array of WASH interventions, in order to ensure effective cholera control and the best use of limited resources. Public Library of Science 2015-08-18 /pmc/articles/PMC4540465/ /pubmed/26284367 http://dx.doi.org/10.1371/journal.pone.0135676 Text en © 2015 Taylor et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Taylor, Dawn L.
Kahawita, Tanya M.
Cairncross, Sandy
Ensink, Jeroen H. J.
The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review
title The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review
title_full The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review
title_fullStr The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review
title_full_unstemmed The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review
title_short The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review
title_sort impact of water, sanitation and hygiene interventions to control cholera: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540465/
https://www.ncbi.nlm.nih.gov/pubmed/26284367
http://dx.doi.org/10.1371/journal.pone.0135676
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