Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis.
OBJECTIVE
To assess the effectiveness of interventions to improve the microbial quality of drinking water for preventing diarrhoea.


METHODS
Systematic review.


METHODS
Cochrane Infectious Diseases Group's trials register, CENTRAL, Medline, Embase, LILACS; hand searching; and correspondence with experts and relevant organisations.


METHODS
Randomised and quasirandomised controlled trials of interventions to improve the microbial quality of drinking water for preventing diarrhoea in adults and in children in settings with endemic disease.


METHODS
Allocation concealment, blinding, losses to follow-up, type of intervention, outcome measures, and measures of effect. Pooled effect estimates were calculated within the appropriate subgroups.


RESULTS
33 reports from 21 countries documenting 42 comparisons were included. Variations in design, setting, and type and point of intervention, and variations in defining, assessing, calculating, and reporting outcomes limited the comparability of study results and pooling of results by meta-analysis. In general, interventions to improve the microbial quality of drinking water are effective in preventing diarrhoea. Effectiveness was not conditioned on the presence of improved water supplies or sanitation in the study setting and was not enhanced by combining the intervention with instructions on basic hygiene, a water storage vessel, or improved sanitation or water supplies--other common environmental interventions intended to prevent diarrhoea.


CONCLUSIONS
Interventions to improve water quality are generally effective for preventing diarrhoea in all ages and in under 5s. Significant heterogeneity among the trials suggests that the level of effectiveness may depend on a variety of conditions that research to date cannot fully explain.
Clasen
Thomas
T
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT. thomas.clasen@lshtm.ac.uk
Schmidt
Wolf-Peter
WP
Rabie
Tamer
T
Roberts
Ian
I
Cairncross
Sandy
S
D003967:Diarrhea / Q000517:prevention & control*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D018570:Risk Assessment; D014871:Water Microbiology / Q000592:standards*; D018508:Water Purification / Q000592:standards*; D014881:Water Supply / Q000592:standards*