Author:
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Troeger C et al.2018. Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrheal diseases in children younger than 5 years. Lancet Glob Health, 6: e255–e69.
-
2.
GBD 2017 Risk Factor Collaborators, 2018. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392: 1923–1994.
-
3.
GBD 2017 Causes of Death Collaborators, 2018. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Glob Health 392: 1736–1788.
-
4.
UN , 2015. Transforming Our World: The 2030 Agenda for Sustainable Development. New York, NY: United Nations.
-
5.
WHO/UNICEF , 2019. Progress on Household Drinking Water, Sanitation and Hygiene 2000–2017: Special Focus on Inequalities. Geneva, Switzerland: World Health Organization.
-
6.
Liu L , Oza S , Hogan D , Chu Y , Perin J , Zhu J , Lawn JE , Cousens S , Mathers C , Black RE , 2016. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 388: 3027–3035.
-
7.
Wolf J et al., 2018. Impact of drinking water, sanitation and handwashing with soap on childhood diarrheal disease: updated meta-analysis and meta-regression. Trop Med Int Health 23: 508–525.
-
8.
Freeman MC et al., 2017. The impact of sanitation on infectious disease and nutritional status: a systematic review and meta-analysis. Int J Hyg Environ Health 220: 928–949.
-
9.
Null C et al., 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhea and child growth in rural Kenya: a cluster-randomized controlled trial. Lancet Glob Health 6: e316–e329.
-
10.
Clasen T et al., 2014. Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. Lancet Glob Health 2: e645–e653.
-
11.
Pickering AJ , Djebbari H , Lopez C , Coulibaly M , Alzua ML , 2015. Effect of a community-led sanitation intervention on child diarrhea and child growth in rural Mali: a cluster-randomized controlled trial. Lancet Glob Health 3: e701–e711.
-
12.
Patil SR , Arnold BF , Salvatore AL , Briceno B , Ganguly S , Colford JM , Gertler PJ , 2014. The effect of India’s total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial. PLoS Med 11: e1001709.
-
13.
Humphrey JH et al., 2019. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomized trial. Lancet Glob Health 7: e132–e47.
-
14.
Luby SP et al., 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhea and child growth in rural Bangladesh: a cluster randomized controlled trial. Lancet Glob Health 6: e302–e15.
-
15.
Hammer J , Spears D , 2016. Village sanitation and child health: effects and external validity in a randomized field experiment in rural India. J Health Econ 48: 135–148.
-
16.
Venkataramanan V , Crocker J , Karon A , Bartram J , 2018. Community-led total sanitation: a mixed-methods systematic review of evidence and its quality. Environ Health Perspect 126: 026001.
-
18.
Bongartz P , Vernon N , Fox J , 2016. Sustainable Sanitation for All. Rugby, United Kingdom: Practical Action.
-
19.
FMOH , 2012. Implementing Guideline for CLTSH Programming. Addis Ababa, Ethiopia: Federal Ministry of Health.
-
20.
Kar K , 2019. Scaling-up Community Led Total Sanitation: From Village to Nation. Rugby, United Kingdom: Practical Action.
-
21.
Dickinson KL , Patil SR , Pattanayak SK , Poulos C , Yang J-H , 2015. Nature’s call: Impacts of sanitation choices in Orissa, India. Econ Dev Cult Change 64: 1–29.
-
22.
Briceño B , Coville A , Martinez S , 2015. Promoting Handwashing and Sanitation: Evidence from a Large-Scale Randomized Trial in Rural Tanzania. Policy Research Working Paper 7164. Washington, DC: World Bank.
-
23.
Borja-Vega C , 2014. The effects of the Total Sanitation and Sanitation Marketing programme on gender and ethnic groups in Indonesia. Waterlines 33: 55–70.
-
24.
Cameron L , Shah M , Olivia S , 2013. Impact Evaluation of a Large-scale Rural Sanitation Project in Indonesia. Policy Research Working Paper 6360. Washington, DC: World Bank.
-
25.
Crocker J , Geremew A , Atalie F , Yetie M , Bartram J , 2016. Teachers and sanitation promotion: an assessment of community-led total sanitation in Ethiopia. Environ Sci Technol 50: 6517–6525.
-
26.
Guiteras R , Levinsohn J , Mobarak AM , 2015. Encouraging sanitation investment in the developing world: a cluster-randomized trial. Science 348: 903–906.
-
27.
Pattanayak SK et al., 2009. Shame or subsidy revisited: social mobilization for sanitation in Orissa, India. Bull World Health Organ 87: 580–587.
-
28.
Jung S , Doh YA , Bizuneh DB , Beyene H , Seong J , Kwon H , Kim Y , Habteyes GN , Tefera Y , Cha S , 2016. The effects of improved sanitation on diarrheal prevalence, incidence, and duration in children under five in the SNNPR State, Ethiopia: study protocol for a randomized controlled trial. Trials 17: 204.
-
29.
SNNPR , 2014. Demographic and Health Statistics Report of SNNPR. Hawassa: Southern Nations, Nationalities, and Peoples' Regional Office.
-
30.
BDS-CDR , 2015. Baseline Survey Report: The Project of Improvement of Water Supply and Sanitation in Gurage Zone, SNNPR, Ethiopia. Addis Ababa: BDS-Center for Development Research.
-
31.
Hayes RJ , Bennett S , 1999. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol 28: 319–326.
-
32.
Schmidt WP , Arnold BF , Boisson S , Genser B , Luby SP , Barreto ML , Clasen T , Cairncross S , 2011. Epidemiological methods in diarrhea studies–an update. Int J Epidemiol 40: 1678–1692.
-
33.
Sima LC , Reuben NG , Elimelech M , 2013. Modeling risk categories to predict the longitudinal prevalence of childhood diarrhea in Indonesia. Am J Trop Med Hyg 89: 884–891.
-
34.
Chavasse DC , Shier RP , Murphy OA , Huttly SR , Cousens SN , Akhtar T , 1999. Impact of fly control on childhood diarrhoea in Pakistan: community-randomised trial. Lancet 353: 22–25.
-
35.
Carr R , 2001. Excreta-related infections and the role of sanitation in the control of transmission. In: Fewtrall L and Bartram J, eds. Water Quality Guidelines, Standards and Health. London, United Kingdom: IWA Publishing.
-
36.
Nakagiri A , Niwagaba CB , Nyenje PM , Kulabako RN , Tumuhairwe JB , Kansiime F , 2016. Are pit latrines in urban areas of Sub-Saharan Africa performing? A review of usage, filling, insects and odour nuisances. BMC Public Health 16: 120.
-
37.
Nakagiri A , Kulabako R , Nyenje P , Tumuhairwe J , Niwagaba C , Kansiime F , 2015. Performance of pit latrines in urban poor areas: a case of Kampala, Uganda. Habitat Int 49: 529–537.
-
38.
Ngure FM , Reid BM , Humphrey JH , Mbuya MN , Pelto G , Stoltzfus RJ , 2014. Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links. Ann N Y Acad Sci 1308: 118–128.
-
39.
Harris M , Alzua ML , Osbert N , Pickering A , 2017. Community-level sanitation coverage more strongly associated with child growth and household drinking water quality than access to a private toilet in rural Mali. Environ Sci Technol 51: 7219–7227.
-
40.
Fuller JA , Eisenberg JN , 2016. Herd protection from drinking water, sanitation, and hygiene interventions. Am J Trop Med Hyg 95: 1201–1210.
-
41.
Carlton EJ , Eisenberg JN , Goldstick J , Cevallos W , Trostle J , Levy K , 2014. Heavy rainfall events and diarrhea incidence: the role of social and environmental factors. Am J Epidemiol 179: 344–352.
-
42.
Bandyopadhyaya S , Kanji S , Wang L , 2012. The impact of rainfall and temperature variation on diarrheal prevalence in Sub-Saharan Africa. Appl Geogr 33: 63–72.
-
43.
Crocker J , Saywell D , Bartram J , 2017. Sustainability of community-led total sanitation outcomes: evidence from Ethiopia and Ghana. Int J Hyg Environ Health 220: 551–557.
-
44.
Orgill-Meyer J et al., 2019. Long-term impact of a community-led sanitation campaign in India, 2005–2016. Bull World Health Organ 97: 523–533A.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2562 | 1180 | 121 |
| Full Text Views | 349 | 20 | 2 |
| PDF Downloads | 244 | 30 | 6 |
Effect of a Community-led Total Sanitation Intervention on the Incidence and Prevalence of Diarrhea in Children in Rural Ethiopia: A Cluster-randomized Controlled Trial
Seungman Cha
Seungman Cha
Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom;
Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, South Korea;
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Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, South Korea;
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Sunghoon Jung
Sunghoon Jung
Good Neighbors International, Mozambique, Maputo, Mozambique;
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Dawit Belew Bizuneh
Dawit Belew Bizuneh
Independent Consultant, Addis Ababa, Ethiopia;
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Tadesse Abera
Tadesse Abera
Public Health Institute, Addis Ababa, Ethiopia;
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Young-Ah Doh
Young-Ah Doh
Korea International Cooperation Agency, Seongnam-si, South Korea
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Jieun Seong
Jieun Seong
Korea International Cooperation Agency, Seongnam-si, South Korea
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Wolf-Peter Schmidt
Wolf-Peter Schmidt
Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom;
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ABSTRACT.
We conducted a cluster-randomized trial in 48 rural villages of Ethiopia to assess the effect of community-led total sanitation (CLTS) on the diarrhea incidence of children. Twenty-four villages were randomly assigned to the intervention group and the other 24 were assigned to the control group. A CLTS intervention was implemented from January 2016 through January 2017. Baseline data collection was conducted during October and November 2015. At baseline, 906 children were recruited and followed-up until January 2017. These 906 children were randomly selected among all children in the 48 villages. To determine the 7-day period prevalence of diarrhea, four household-based surveys were conducted by independent data collectors at 3, 5, 9, and 10 months after the CLTS was initiated. To determine the incidence and longitudinal prevalence, the presence of daily diarrhea presence was recorded for 140 days using diary methods. The follow-up rates were 95% for period prevalence and 93% for incidence and longitudinal prevalence. The incidence ratio and longitudinal prevalence ratio were 0.66 (95% confidence interval [CI], 0.45–0.97; P = 0.03) and 0.70 (95% CI, 0.52–0.95; P = 0.02) after adjusting for clustering and stratification. The relative risk of period prevalence was 0.66 (95% CI, 0.45–0.98; P = 0.04) at 3 months after initiation. Improved toilet coverage increased from 0.0% at baseline to 35.0% at 10 months in the intervention villages, whereas it increased from 0.7% to 2.8% in the control villages. Adherence to the intervention was comparable with that of previous studies; therefore, we suggest that the findings of this study are replicable.
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Author Notes
Authors’ addresses: Seungman Cha and Wolf-Peter Schmidt, Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom, E-mails: seungman.cha@lshtm.ac.uk and wolf-peter.schmidt@lshtm.ac.uk. Seungman Cha, Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, 558 Handong-ro Buk-gu, Pohang Gyeongbuk 37554 Republic of Korea, E-mail: seungman.cha@handong.edu. Sunghoon Jung, Good Neighbors International, Mozambique, Maputo, Mozambique, E-mail: hoonie12@gmail.com. Dawit Belew Bizuneh, Independent Consultant, Addis Ababa, Ethiopia, E-mail: belewbizuneh@gmail.com. Tadesse Abera, Public Health Institute, Addis Ababa, Ethiopia, E-mail: tade842@gmail.com. Young-Ah Doh and Jieun Seong, Korea International Cooperation Agency, 825 Daewangpangyo-ro, Sujeong-gu, Seongnam-si, Gyeonggi-do, Republic of Korea, E-mails: yadoh@koica.go.kr and sje0115@koica.go.kr.
Financial support: This study was supported by the Korea International Cooperation Agency (KOICA) under “the Integrated Water and Sanitation project in Gurage zone, SNNPR state, Ethiopia (P2013-00139-2)”. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Troeger C et al.2018. Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrheal diseases in children younger than 5 years. Lancet Glob Health, 6: e255–e69.
-
2.
GBD 2017 Risk Factor Collaborators, 2018. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392: 1923–1994.
-
3.
GBD 2017 Causes of Death Collaborators, 2018. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Glob Health 392: 1736–1788.
-
4.
UN , 2015. Transforming Our World: The 2030 Agenda for Sustainable Development. New York, NY: United Nations.
-
5.
WHO/UNICEF , 2019. Progress on Household Drinking Water, Sanitation and Hygiene 2000–2017: Special Focus on Inequalities. Geneva, Switzerland: World Health Organization.
-
6.
Liu L , Oza S , Hogan D , Chu Y , Perin J , Zhu J , Lawn JE , Cousens S , Mathers C , Black RE , 2016. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 388: 3027–3035.
-
7.
Wolf J et al., 2018. Impact of drinking water, sanitation and handwashing with soap on childhood diarrheal disease: updated meta-analysis and meta-regression. Trop Med Int Health 23: 508–525.
-
8.
Freeman MC et al., 2017. The impact of sanitation on infectious disease and nutritional status: a systematic review and meta-analysis. Int J Hyg Environ Health 220: 928–949.
-
9.
Null C et al., 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhea and child growth in rural Kenya: a cluster-randomized controlled trial. Lancet Glob Health 6: e316–e329.
-
10.
Clasen T et al., 2014. Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. Lancet Glob Health 2: e645–e653.
-
11.
Pickering AJ , Djebbari H , Lopez C , Coulibaly M , Alzua ML , 2015. Effect of a community-led sanitation intervention on child diarrhea and child growth in rural Mali: a cluster-randomized controlled trial. Lancet Glob Health 3: e701–e711.
-
12.
Patil SR , Arnold BF , Salvatore AL , Briceno B , Ganguly S , Colford JM , Gertler PJ , 2014. The effect of India’s total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial. PLoS Med 11: e1001709.
-
13.
Humphrey JH et al., 2019. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomized trial. Lancet Glob Health 7: e132–e47.
-
14.
Luby SP et al., 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhea and child growth in rural Bangladesh: a cluster randomized controlled trial. Lancet Glob Health 6: e302–e15.
-
15.
Hammer J , Spears D , 2016. Village sanitation and child health: effects and external validity in a randomized field experiment in rural India. J Health Econ 48: 135–148.
-
16.
Venkataramanan V , Crocker J , Karon A , Bartram J , 2018. Community-led total sanitation: a mixed-methods systematic review of evidence and its quality. Environ Health Perspect 126: 026001.
-
18.
Bongartz P , Vernon N , Fox J , 2016. Sustainable Sanitation for All. Rugby, United Kingdom: Practical Action.
-
19.
FMOH , 2012. Implementing Guideline for CLTSH Programming. Addis Ababa, Ethiopia: Federal Ministry of Health.
-
20.
Kar K , 2019. Scaling-up Community Led Total Sanitation: From Village to Nation. Rugby, United Kingdom: Practical Action.
-
21.
Dickinson KL , Patil SR , Pattanayak SK , Poulos C , Yang J-H , 2015. Nature’s call: Impacts of sanitation choices in Orissa, India. Econ Dev Cult Change 64: 1–29.
-
22.
Briceño B , Coville A , Martinez S , 2015. Promoting Handwashing and Sanitation: Evidence from a Large-Scale Randomized Trial in Rural Tanzania. Policy Research Working Paper 7164. Washington, DC: World Bank.
-
23.
Borja-Vega C , 2014. The effects of the Total Sanitation and Sanitation Marketing programme on gender and ethnic groups in Indonesia. Waterlines 33: 55–70.
-
24.
Cameron L , Shah M , Olivia S , 2013. Impact Evaluation of a Large-scale Rural Sanitation Project in Indonesia. Policy Research Working Paper 6360. Washington, DC: World Bank.
-
25.
Crocker J , Geremew A , Atalie F , Yetie M , Bartram J , 2016. Teachers and sanitation promotion: an assessment of community-led total sanitation in Ethiopia. Environ Sci Technol 50: 6517–6525.
-
26.
Guiteras R , Levinsohn J , Mobarak AM , 2015. Encouraging sanitation investment in the developing world: a cluster-randomized trial. Science 348: 903–906.
-
27.
Pattanayak SK et al., 2009. Shame or subsidy revisited: social mobilization for sanitation in Orissa, India. Bull World Health Organ 87: 580–587.
-
28.
Jung S , Doh YA , Bizuneh DB , Beyene H , Seong J , Kwon H , Kim Y , Habteyes GN , Tefera Y , Cha S , 2016. The effects of improved sanitation on diarrheal prevalence, incidence, and duration in children under five in the SNNPR State, Ethiopia: study protocol for a randomized controlled trial. Trials 17: 204.
-
29.
SNNPR , 2014. Demographic and Health Statistics Report of SNNPR. Hawassa: Southern Nations, Nationalities, and Peoples' Regional Office.
-
30.
BDS-CDR , 2015. Baseline Survey Report: The Project of Improvement of Water Supply and Sanitation in Gurage Zone, SNNPR, Ethiopia. Addis Ababa: BDS-Center for Development Research.
-
31.
Hayes RJ , Bennett S , 1999. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol 28: 319–326.
-
32.
Schmidt WP , Arnold BF , Boisson S , Genser B , Luby SP , Barreto ML , Clasen T , Cairncross S , 2011. Epidemiological methods in diarrhea studies–an update. Int J Epidemiol 40: 1678–1692.
-
33.
Sima LC , Reuben NG , Elimelech M , 2013. Modeling risk categories to predict the longitudinal prevalence of childhood diarrhea in Indonesia. Am J Trop Med Hyg 89: 884–891.
-
34.
Chavasse DC , Shier RP , Murphy OA , Huttly SR , Cousens SN , Akhtar T , 1999. Impact of fly control on childhood diarrhoea in Pakistan: community-randomised trial. Lancet 353: 22–25.
-
35.
Carr R , 2001. Excreta-related infections and the role of sanitation in the control of transmission. In: Fewtrall L and Bartram J, eds. Water Quality Guidelines, Standards and Health. London, United Kingdom: IWA Publishing.
-
36.
Nakagiri A , Niwagaba CB , Nyenje PM , Kulabako RN , Tumuhairwe JB , Kansiime F , 2016. Are pit latrines in urban areas of Sub-Saharan Africa performing? A review of usage, filling, insects and odour nuisances. BMC Public Health 16: 120.
-
37.
Nakagiri A , Kulabako R , Nyenje P , Tumuhairwe J , Niwagaba C , Kansiime F , 2015. Performance of pit latrines in urban poor areas: a case of Kampala, Uganda. Habitat Int 49: 529–537.
-
38.
Ngure FM , Reid BM , Humphrey JH , Mbuya MN , Pelto G , Stoltzfus RJ , 2014. Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links. Ann N Y Acad Sci 1308: 118–128.
-
39.
Harris M , Alzua ML , Osbert N , Pickering A , 2017. Community-level sanitation coverage more strongly associated with child growth and household drinking water quality than access to a private toilet in rural Mali. Environ Sci Technol 51: 7219–7227.
-
40.
Fuller JA , Eisenberg JN , 2016. Herd protection from drinking water, sanitation, and hygiene interventions. Am J Trop Med Hyg 95: 1201–1210.
-
41.
Carlton EJ , Eisenberg JN , Goldstick J , Cevallos W , Trostle J , Levy K , 2014. Heavy rainfall events and diarrhea incidence: the role of social and environmental factors. Am J Epidemiol 179: 344–352.
-
42.
Bandyopadhyaya S , Kanji S , Wang L , 2012. The impact of rainfall and temperature variation on diarrheal prevalence in Sub-Saharan Africa. Appl Geogr 33: 63–72.
-
43.
Crocker J , Saywell D , Bartram J , 2017. Sustainability of community-led total sanitation outcomes: evidence from Ethiopia and Ghana. Int J Hyg Environ Health 220: 551–557.
-
44.
Orgill-Meyer J et al., 2019. Long-term impact of a community-led sanitation campaign in India, 2005–2016. Bull World Health Organ 97: 523–533A.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2562 | 1180 | 121 |
| Full Text Views | 349 | 20 | 2 |
| PDF Downloads | 244 | 30 | 6 |