The effect of interventions to improve water quality and supply, provide sanitation and promote handwashing with soap on physical growth in children (Cochrane review)

Alan D Dangour et al.

Cochrane Library 2013, Issue 7 Available online http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0057931/

In low-income countries an estimated 165 million children under the age of five years suffer from stunting causing them to be short in height and 52 million children suffer from wasting causing them to be very thin. Poor growth in early life increases the risks of illness and death in childhood. The two immediate causes of childhood undernutrition are inadequate dietary intake and infectious diseases such as diarrhoea. Water, sanitation and hygiene (WASH) interventions are frequently implemented to reduce infectious diseases; this review evaluates the effect that WASH interventions may have on nutrition outcomes in children. The review includes evidence from randomised and non-randomised interventions designed to (i) improve the microbiological quality of drinking water or protect the micro- biological quality of water prior to consumption; (ii) introduce new or improved water supply or improve distribution; (iii) introduce or expand the coverage and use of facilities designed to improve sanitation; or (iv) promote hand washing with soap after defecation and disposal of child faeces, and prior to preparing and handling food, or a combination of these interventions, in children aged under 18 years.

The authors identified 14 studies of such interventions involving 22,241 children at baseline and nutrition outcome data for 9469 children. Meta-analyses of the evidence from the cluster-randomised trials suggest that WASH interventions confer a small benefit on linear growth in children under five years of age. While potentially important, this conclusion is based on relatively short-term studies, none of which is of high methodological quality, and should therefore be treated with caution. There are several large, robust studies underway in low- income country settings that should provide evidence to inform these findings.