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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: A consensus statement
BMC Medicine, Volume 17, No. 1, Article 173, Year 2019
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Description
Background: Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations' Sustainable Development Goals, and the bold new target of safely managed water, sanitation and hygiene for all by 2030, these results warrant the attention of researchers, policy-makers and practitioners. Main body: Here we report the conclusions of an expert meeting convened by the World Health Organization and the Bill and Melinda Gates Foundation to discuss these findings, and present five key consensus messages as a basis for wider discussion and debate in the WASH and nutrition sectors. We judge these trials to have high internal validity, constituting good evidence that these specific interventions had no effect on childhood linear growth, and mixed effects on childhood diarrhea. These results suggest that, in settings such as these, more comprehensive or ambitious WASH interventions may be needed to achieve a major impact on child health. Conclusion: These results are important because such basic interventions are often deployed in low-income rural settings with the expectation of improving child health, although this is rarely the sole justification. Our view is that these three new trials do not show that WASH in general cannot influence child linear growth, but they do demonstrate that these specific interventions had no influence in settings where stunting remains an important public health challenge. We support a call for transformative WASH, in so much as it encapsulates the guiding principle that - in any context - a comprehensive package of WASH interventions is needed that is tailored to address the local exposure landscape and enteric disease burden. © 2019 The Author(s).
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC6712663/bin/12916_2019_1410_MOESM1_ESM.docx
Authors & Co-Authors
Cumming, Oliver
United Kingdom, London
London School of Hygiene & Tropical Medicine
Arnold, Benjamin F.
United States, Berkeley
University of California, Berkeley
Ban, Radu
Unknown Affiliation
Clasen, Thomas F.
United States, Atlanta
Emory University
Esteves-Mills, Joanna
United Kingdom, London
London School of Hygiene & Tropical Medicine
Freeman, Matthew Charles
United States, Atlanta
Emory University
Gordon, Bruce A.
Switzerland, Geneva
Organisation Mondiale de la Santé
Guiteras, Raymond P.
United States, Raleigh
Nc State University
Howard, Guy
United Kingdom, Bristol
University of Bristol
Hunter, Paul R.
United Kingdom, Norwich
University of East Anglia
Johnston, Richard Bart
Switzerland, Geneva
Organisation Mondiale de la Santé
Pickering, Amy J.
United States, Medford
Tufts University
Prendergast, Andrew J.
United Kingdom, London
Queen Mary University of London
Prüss-Üstün, Annette M.
Switzerland, Geneva
Organisation Mondiale de la Santé
Rosenboom, Jan Willem
Unknown Affiliation
Sundberg, Shelly
Unknown Affiliation
Wolf, Jennyfer
Switzerland, Geneva
Organisation Mondiale de la Santé
Null, Clair A.
United States, Princeton
Mathematica Policy Research Inc.
Luby, Stephen P.
United States, Palo Alto
Stanford University
Humphrey, Jean H.
United States, Baltimore
Johns Hopkins University
Colford, John Matthew
United States, Berkeley
University of California, Berkeley
Statistics
Citations: 134
Authors: 21
Affiliations: 13
Identifiers
Doi:
10.1186/s12916-019-1410-x
ISSN:
17417015
Research Areas
Environmental
Food Security
Health System And Policy
Maternal And Child Health