Tag Archives: mortality

Effect of water quality, hygiene and sanitation in preventing diarrhoea deaths

Researchers propose diarrhoea risk reductions of 48, 17 and 36%, associated respectively, with handwashing with soap, improved water quality and excreta disposal as the estimates of effect for the Lives Saved Tool (LiST) model [1].

LiST is a new computer-based planning tool to help estimate the impact of scaling-up maternal, newborn and child health interventions. LiST was developed by a consortium of academic and international organizations, led by Institute of International Programs at the Johns Hopkins Bloomberg School.

Researchers led by Prof. Sandy Cairncross of the London School of Hygiene & Tropical Medicine, drew on three systematic reviews, two of them for the Cochrane Collaboration, to determine the estimated effect on diarrhoea mortality of the three interventions.

The striking effect of handwashing with soap (48% reduction) was found to be consistent across various study designs and pathogens, though it depended on access to water. The effect of (household) water treatment appeared similarly large, but was not found in few blinded studies, suggesting that it might be partly due to the placebo effect. The researchers found very little rigorous evidence for the health benefit of sanitation; four intervention studies were eventually identified, though they were all quasi-randomized, had morbidity as the outcome, and were in Chinese.

While most of the evidence was found to be of poor quality and more trials were required, the evidence was nonetheless strong enough to support the provision of water supply, sanitation and hygiene for all.

[1] Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I.C. and Schmidt, W.P. (2010). Water, sanitation and hygiene for the prevention of diarrhoea. International journal of epidemiology ; vol. 39 (Suppl. 1) ; p. i193-i205. DOI:10.1093/ije/dyq035

The complete issue of the April 2010 supplement of the International journal of epidemiology is devoted to the development and use of the Lives Saved Tool (LiST). Other articles deal with rotavirus vaccine, zinc treatment for diarrhoea, antibiotics for dysentery, and oral rehydration solution. All articles are free to download.

Cholera under-reported, infects millions a year – WHO

Cholera infects millions of people each year, 10 times the number of cases reported by countries who fear losing tourist or trade income by acknowledging the real scale of an outbreak, experts said

Claire-Lise Chaignat, cholera coordinator at the World Health Organisation, said [in the Feb 2009 issue of WHO Bulletin] the diarrhoeal disease that is spreading fast in Zimbabwe is also under-reported because the stigma attached to it means people often fail to seek treatment.

[...] In 2007, governments reported just 178,000 cases of cholera, which is spread mostly through contaminated food and water. According to Chaignat, about 120,000 people most likely died of cholera that year, compared to the 4,031 official toll reported to the WHO.

Angola, Sudan, Ethiopia, Afghanistan, Liberia, South Africa and Madagascar have all had large outbreaks in the past decade, and Iraq had more than 4,000 cases last year.

[...] WHO disease control expert Francesco Checchi said: “Unfortunately, the cholera epidemic [in Zimbabwe] has struck at a time when most Zimbabweans are unable to purchase salt and sugar [needed for oral rehydration solutions (ORS)]“.

[...] Major hotspots for cholera and other diarrhoeal diseases include Bangladesh, China, India, Indonesia, Pakistan, the Philippines, and much of Africa.

Source: Laura MacInnis, Reuters, 02 Feb 2009