What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review

• Published in: The World Bank Research Observer Vol. 22; no. 1; pp. 1 - 24
• Main Authors: Zwane, Alix Peterson, Kremer, Michael
• Format: Journal Article
• Language: Japanese; English
• Published: Cary Oxford University Press (OUP) 01.04.2007; Oxford University Press; World Bank; Oxford Publishing Limited (England)
• Subjects: breastfeeding; Child mortality; Children & youth; Childrens health; clinics; Developing countries; Development economics; Development studies; Diarrhea; Disease; Diseases; Drinking water; Epidemiology; families; Groundwater; health education; health interventions; health research; hepatitis a; hygiene; Immunization; infectious diseases; Infrastructure; intervention; LDCs; Malnutrition; mortality; nutrition; nutrition education; Observational research; Pathogens; Potable water; primary schools; Public health; randomized controlled trials; Rural areas; Sanitation; screening; sodium; Studies; Tropical diseases; Tropical medicine; vaccination; waste; Water pollution; Water quality; Water resources; Water supply; Water treatment; World Bank; Kenya; Kazakhstan; Pakistan; MORTALITY; INFECTIOUS DISEASES; SODIUM; HYGIENE; HEALTH RESEARCH; PRIMARY SCHOOLS; VACCINATION; HEALTH EDUCATION; CLINICS; HEPATITIS A; IMMUNIZATION; WASTE; FAMILIES; NUTRITION EDUCATION; HEALTH INTERVENTIONS; NUTRITION; SCREENING; BREASTFEEDING; INTERVENTION; RANDOMIZED CONTROLLED TRIALS
• ISSN: 0257-3032; 1564-6971; 1564-6971
• DOI: 10.1093/wbro/lkm002

The Millennium Development Goals call for reducing by half the proportion of people without sustainable access to safe drinking water. This goal was adopted in large part because clean water was seen as critical to fighting diarrheal disease, which kills 2 million children annually. There is compelling evidence that provision of piped water and sanitation can substantially reduce child mortality. However, in dispersed rural settlements, providing complete piped water and sanitation infrastructure to households is expensive. Many poor countries have therefore focused instead on providing community-level water infrastructure, such as wells. Various traditional child health interventions have been shown to be effective in fighting diarrhea. Among environmental interventions, handwashing and point-of-use water treatment both reduce diarrhea, although more needs to be learned about ways to encourage households to take up these behavior changes. In contrast, there is little evidence that providing community-level rural water infrastructure substantially reduces diarrheal disease or that this infrastructure can be effectively maintained. Investments in communal water infrastructure short of piped water may serve other needs, and may reduce diarrhea in particular circumstances, but the case for prioritizing communal infrastructure provision needs to be made rather than assumed.