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Water, sanitation and hygiene interventions to prevent diarrhoea

Intervention | Last updated: 26 April 2023


Diarrhoea remains a leading cause of death globally among children under five years of age. Diarrhoea contributes to nutritional deficiencies, reduced resistance to infections and impaired growth and development. Severe diarrhoea leads to fluid loss, and may be life-threatening, particularly in young children and people who are already malnourished or have impaired immunity.

Diarrhoea mostly results from lack of safe drinking-water, adequate sanitation and hygiene. A number of interventions are effective in preventing diarrhoeal diseases, thereby positively impacting the nutritional status of those most vulnerable. These are:

  • Access to safe drinking water (e.g. water safety planning (the management of water from the source to tap); household water treatment and safe storage)
  • Access to improved sanitation facilities
  • Hand washing with soap at critical times (e.g. after toilet use and before the preparation of food)

Hygiene promotion, along with access to safe drinking water and adequate sanitation should be accessible by all.

WHO Recommendations


Guidance information can be found in the guidelines and guidance documents below.



Evidence


Systematic reviews used to develop the guidelines


Hand washing promotion for preventing diarrhoea

Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Cochrane Database of Systematic Reviews. 2015; Issue 9. Art. No.: CD004265.

Summary of this review Alternate Text

Exploring the relationship between sanitation and mental and social well-being: A systematic review and qualitative synthesis

Sclar GD, Penakalapati G, Caruso BA, Rehfuess EA, Garn JV, Alexander KT, et al. Soc Sci Med. 2018;217:121-134.


The Impact of Water, Sanitation, and Hygiene Interventions on the Health and WellBeing of People Living With HIV: A Systematic Review

Yates T, Lantagne D, Mintz E, Quick R. J Acquir Immune Defic Syndr. 2015;68 Suppl 3:S318-30.


Effect of sanitation and water treatment on intestinal protozoa infection: a systematic review and meta-analysis

Speich B, Croll D, Fürst T, Utzinger J, Keiser J. Lancet Infect Dis. 2016;16(1):87-99.


Effects of sanitation on cognitive development and school absence: A systematic review

Sclar GD, Garn JV, Penakalapati G, Alexander KT, Krauss J, Freeman MC, et al. Int J Hyg Environ Health. 2017;220(6):917-927.


Assessing the impact of sanitation on indicators of faecal exposure along principal transmission pathways: A systematic review

Sclar GD, Penakalapati G, Amato HK, Garn JV, Alexander K, Freeman MC, et al. Int J Hyg Environ Health. 2016;219(8):709-723.


Community-Led Total Sanitation: A Mixed-Methods Systematic Review of Evidence and Its Quality

Venkataramanan V, Crocker J, Karon A, Bartram J. Environ Health Perspect. 2018;126(2):026001.


Unsafe return of human excreta to the environment: A literature review

Williams AR, Overbo A. Chapel Hill: The Water Institute at UNC, Chapel Hill; 2015.


The impact of sanitation interventions on latrine coverage and latrine use: A systematic review and metaanalysis

Garn JV, Sclar GD, Freeman MC, Penakalapati G, Alexander KT, Brooks P, et al. Int J Hyg Environ Health. 2017;220(2 Pt B):329-340.


The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis

Freeman MC, Garn JV, Sclar GD, Boisson S, Medlicott K, Alexander KT, et al. Int J Hyg Environ Health. 2017;220(6):928-949.


Interventions to improve disposal of child faeces for preventing diarrhoea and soil‐transmitted helminth infection (protocol)

Majorin F, Torondel B, Ka Seen Chan G, Clasen TF. Cochrane Database of Systematic Reviews. 2014; Issue 4. Art. No.: CD011055.


What factors affect sustained adoption of safe water, hygiene and sanitation technologies? A systematic review of literature

Hulland K, Martin N, Dreibelbis R, DeBruicker Valliant J, Winch P. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London; 2015.


Related Cochrane reviews


Interventions to improve water quality for preventing diarrhoea

Clasen TF, Alexander KT, Sinclair D, Boisson S, Peletz R, Chang HH, et al. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD004794.

Summary of this review Alternate Text

Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children

Dangour AD, Watson L, Cumming O, Boisson S, Che Y, Velleman Y, et al. Cochrane Database of Systematic Reviews. 2013; Issue 8. Art. No.: CD009382.

Summary of this review Alternate Text

Other related systematic reviews


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

Waddington H & Snilstveit B. Journal of Development Effectiveness. 2009; Vol.1 No3:295-335.


Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta‐analysis and meta‐regression

Wolf J, Hunter PR, Freeman MC, Cumming O, Clasen T, Bartram J, et al. Trop Med Int Health. 2018;23(5):508-525.


Water, sanitation and hygiene for the prevention of diarrhoea

Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung ICH and Schmidt WP. International Journal of Epidemiology. 2010; 39 suppl 1:i193-i205.


Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis

Clasen T, Schmidt WP, Rabie T, Roberts I, Cairncross S. BMJ. 2007; 334(7597):782.


Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis

Aiello AE, Coulborn RM, Perez V, and Larson EL. American Journal of Public Health. 2008; 98(8):1372–1381.


Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis

Fewtrell l, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM Jr . The Lancet Infectious Diseases. 2005; Vol5, Issue1:42-52.


Cost-effectiveness Learn More Alternate Text


Systematic reviews


The impact of water, sanitation, and hygiene interventions on the health and well-being of people living with HIV: a systematic review

Yates T, Lantagne D, Mintz E, Quick R. J Acquir Immune Defic Syndr. 2015; 68 Suppl 3:S318-30.


Cost-effectiveness analyses


Cost-effectiveness of oral cholera vaccine in a stable refugee population at risk for epidemic cholera and in a population with endemic cholera

Murray J, McFarland DA, Waldman RJ. Bull World Health Organ. 1998; 76(4):343-52.


The cost-effectiveness of forty health interventions in Guinea

Jha P, Bangoura O, Ranson K. Health Policy Plan. 1998; 13(3):249-62.


Cost-benefit comparisons of investments in improved water supply and cholera vaccination programs

Jeuland M, Whittington D. Vaccine. 2009; 27(23):3109-20.


Provision of bednets and water filters to delay HIV-1 progression: cost-effectiveness analysis of a Kenyan multisite study

Kern E, Verguet S, Yuhas K, Odhiambo FH, Kahn JG, Walson J. Trop Med Int Health. 2013; 18(8):916-24.


Cost-effectiveness of water quality interventions for preventing diarrhoeal disease in developing countries

Clasen T, Haller L, Walker D, Bartram J, Cairncross S. J Water Health. 2007; 5(4):599-608.


A reassessment of the cost-effectiveness of water and sanitation interventions in programmes for controlling childhood diarrhoea

Varley RC, Tarvid J, Chao DN. Bull World Health Organ. 1998; 76(6):617-31.


Integrated HIV testing, malaria, and diarrhea prevention campaign in Kenya: modeled health impact and cost-effectiveness

Kahn JG, Muraguri N, Harris B, Lugada E, Clasen T, Grabowsky M, et al. PLoS One. 2012; 7(2):e31316.


Cost-effectiveness and benefit–cost analyses of some water interventions in Nigeria: the case of Bauchi State

Uneze E, Tajudeen I, Iweala O. Cost-effectiveness and benefit–cost analyses of some water interventions in Nigeria: the case of Bauchi State. Journal of Development Effectiveness. 2012; 4(4):497-514.


Saving a Life-Year and Reaching MDG 4 with Investments in Water and Sanitation: A Cost-Effective Policy?

Günther I, Fink G. Eur J Dev Res. 2013; 25(1):129–153.


Cost-effectiveness of home-based chlorination and safe water storage in reducing diarrhea among HIV-affected households in rural Uganda

Shrestha RK, Marseille E, Kahn JG, Lule JR, Pitter C, Blandford JM, et al. Am J Trop Med Hyg. 2006; 74(5):884-90.


Is hygiene promotion cost-effective? A case study in Burkina Faso

Borghi J, Guinness L, Ouedraogo J, Curtis V. Trop Med Int Health. 2002; 7(11):960-9.


Global costs and benefits of reaching universal coverage of sanitation and drinking-water supply

Hutton G. J Water Health. 2013; 11(1):1-12.