Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea

Waddington, Hugh; Snilstveit, Birte

doi:10.1080/19439340903141175

Cited by 157 publications

(147 citation statements)

References 74 publications

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“…Of these, 170 households were randomly assigned to be surveyed about health status biweekly [to accord with common practice in surveys of child diarrhea in epidemiology (9,10) More than 97% of both the biweekly and low-frequency groups completed at least one of their survey rounds; 90% of the biweekly group completed at least 17 of the 19 surveys, and 90% of the lowfrequency group completed at least 2 of the 3 surveys. Dataset S1 (panel 1) presents some descriptive statistics.…”

Section: Resultsmentioning

confidence: 99%

“…An outcome measurement strategy that relied exclusively on frequent surveying would have led to the erroneous conclusion that the source water quality intervention was ineffective. This result suggests that much of the existing evidence on the effects of various environmental health interventions on diarrhea may be biased, because high-frequency measurement of health outcomes is the standard approach used in the epidemiology literature (9,10).…”

mentioning

confidence: 90%

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Being surveyed can change later behavior and related parameter estimates

Zwane

Zinman

Dusen

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

234

173

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Does completing a household survey change the later behavior of those surveyed? In three field studies of health and two of microlending, we randomly assigned subjects to be surveyed about health and/or household finances and then measured subsequent use of a related product with data that does not rely on subjects' selfreports. In the three health experiments, we find that being surveyed increases use of water treatment products and take-up of medical insurance. Frequent surveys on reported diarrhea also led to biased estimates of the impact of improved source water quality. In two microlending studies, we do not find an effect of being surveyed on borrowing behavior. The results suggest that limited attention could play an important but context-dependent role in consumer choice, with the implication that researchers should reconsider whether, how, and how much to survey their subjects. measurement effects | question-behavior effects | Hawthorne effects | survey methodology | models of attention M any data collection efforts in the social and clinical sciences rely on surveys. Psychologists and marketing and survey experts have long held that surveying a subject can draw attention to risks or choices with ordinarily little salience and thereby induce changes in subsequent behavior (1, 2), but conclusive evidence on this question from which a causal relationship can be clearly established has been limited. We provide evidence from a variety of settings that the act of being surveyed can affect behavior and confound estimates of parameters that initially motivated the data collection."Survey" or "interview" effects may occur even when the survey does not ask specifically about intent to engage in the behavior of interest or provide new information, and even when subjects do not know that their later behavior is being observed by researchers. Hence survey effects are conceptually distinct from, but closely related to, "question-behavior" (i.e., mere measurement or self-prophecy) and Hawthorne effects. Question-behavior effects arise when behavior changes as a result of asking subjects for intentions or predictions regarding future behavior effects (3-6). Hawthorne effects occur when behavior changes as a result of a subject responding to being treated and observed, as part of an experiment (7). These effects are also related to "push polling" and other efforts to manipulate subject behavior by posing hypothetical questions (8).We describe results from five different field experiments, in four developing countries, on whether being surveyed affects subsequent behavior. The first experiment randomizes the frequency of surveys on health behavior and diarrhea incidence, in a context in which other water quality interventions are also randomly provided. More-frequent surveying leads to lower reported child diarrhea and cleaner water (as measured by the presence of detectable chlorine in household drinking water). We posit that frequent surveying serves as a reminder to invest in water purification, although because sub...

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 90%

Being surveyed can change later behavior and related parameter estimates

Zwane

Zinman

Dusen

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

234

173

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“…6 Improving household drinking water quality through household water treatment and safe storage (HWTS) has been shown to have the potential to significantly reduce diarrheal disease. [7][8][9] However, although research has shown the need for consistent use of these interventions, 10,11 there are questions about whether HWTS interventions are used correctly and consistently over an extended period of time. 12,13 Overall, there is limited follow-up data on randomized controlled trials (RCTs), and existing evidence suggests that HWTS use and health impact may decline over time.…”

Section: Introductionmentioning

confidence: 99%

“…12,13 Overall, there is limited follow-up data on randomized controlled trials (RCTs), and existing evidence suggests that HWTS use and health impact may decline over time. 7,14 We previously undertook a 1-year RCT in Chongwe District, Zambia, to assess the HWTS filtration technology LifeStraw Family Filter (Vestergaard-Frandsen SA, Suzhou, Jingsu, China) combined with two 5-L local jerry cans for safe storage. 15 In the RCT, filter use was high, with 96% of household visits meeting the criteria for users.…”

Section: Introductionmentioning

confidence: 99%

Follow-Up Study to Assess the Use and Performance of Household Filters in Zambia

Peletz¹,

Simuyandi²,

Simunyama³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Effective household water treatment can improve drinking water quality and prevent disease if used correctly and consistently over time. One year after completion of a randomized controlled study of water filters among households in Zambia with children 2 years old and mothers who were human immunodeficiency virus (HIV)-positive, we conducted a follow-up study to assess use and performance of new filters distributed at the conclusion of the study; 90% of participating households met the criteria for current users, and 75% of participating households had stored water with lower levels of fecal contamination than source water. Microbiologically, the filters continued to perform well, removing an average of 99.0% of fecal indicator bacteria. Although this study provides some encouraging evidence about the potential to maintain high uptake and filter performance, even in the absence of regular household visits, additional research is necessary to assess whether these results can be achieved over longer periods and with larger populations.

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“…All Central Asian countries except for Turkmenistan (no data) achieved 93%-100% improved sanitation. Reviews indicate that improved sanitation can reduce diarrhoeal diseases by 32%-37% [30][31][32]. However, improved sanitation needs to be combined with good operation and maintenance of water supply systems.…”

Section: Human Wastementioning

confidence: 99%

Water Related Health Problems in Central Asia—A Review

Bekturganov

Tussupova

Berndtsson

et al. 2016

Water

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Abstract:The present paper provides an extensive literature review on water related health issues in Central Asia. Even though the per capita amount of available freshwater is substantial in all Central Asian states the uneven distribution in time and space creates problems for water availability. Due to this, the Central Asian economies are developing under increasing water deficiency. The degradation of water supply systems and sewage treatment plants is often severe leading to potentially high water loss rates and inadequate accessibility to safe water supply. In this context, rural areas are the most affected. Low tariffs in combination with absent metering and low collection rates for water fees mean that operation and maintenance costs for basic services of water supply and sanitation are not covered. Unsafe water supply contains both microbiological and non-microbiological contaminants. Helminthiasis and intestinal protozoa infections are of considerable public health importance in Central Asia. Agricultural and industrial pollution is especially affecting downstream areas of Amu Darya and Syr Darya rivers. In large areas copper, zinc, and chromium concentrations in water exceed maximum permissible concentration. Thus, there is an urgent need to strengthen the environmental monitoring system. Small-scale water supply and sanitation systems need to be developed in line with more efficient public spending on these.

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Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea

Cited by 157 publications

References 74 publications

Being surveyed can change later behavior and related parameter estimates

Being surveyed can change later behavior and related parameter estimates

Follow-Up Study to Assess the Use and Performance of Household Filters in Zambia

Water Related Health Problems in Central Asia—A Review

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