Water, sanitation and hygiene interventions to prevent diarrhoea
Intervention | Last updated: 9 August 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.
Guidelines and guidance documents Learn More
GRC-approved guidelines
Other guidance documents
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 reviewSclar GD, Penakalapati G, Caruso BA, Rehfuess EA, Garn JV, Alexander KT, et al.Soc Sci Med. 2018;217:121-134.
Yates T, Lantagne D, Mintz E, Quick R.J Acquir Immune Defic Syndr. 2015;68 Suppl 3:S318-30.
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.
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.
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.
Freeman MC, Garn JV, Sclar GD, Boisson S, Medlicott K, Alexander KT, et al.Int J Hyg Environ Health. 2017;220(6):928-949.
Majorin F, Torondel B, Ka Seen Chan G, Clasen TF. Cochrane Database of Systematic Reviews. 2014; Issue 4. Art. No.: CD011055.
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 reviewDangour 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 reviewOther related systematic reviews
Waddington H & Snilstveit B. Journal of Development Effectiveness. 2009; Vol.1 No3:295-335.
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.
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
Systematic reviews
Yates T, Lantagne D, Mintz E, Quick R.J Acquir Immune Defic Syndr. 2015; 68 Suppl 3:S318-30.
Cost-effectiveness analyses
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.
Kern E, Verguet S, Yuhas K, Odhiambo FH, Kahn JG, Walson J.Trop Med Int Health. 2013; 18(8):916-24.
Clasen T, Haller L, Walker D, Bartram J, Cairncross S.J Water Health. 2007; 5(4):599-608.
Varley RC, Tarvid J, Chao DN.Bull World Health Organ. 1998; 76(6):617-31.
Kahn JG, Muraguri N, Harris B, Lugada E, Clasen T, Grabowsky M, et al.PLoS One. 2012; 7(2):e31316.
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.
Günther I, Fink G.Eur J Dev Res. 2013; 25(1):129–153.
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.
Category 2 intervention
Systematic review(s) have been conducted but no recent guidelines yet available that have been approved by the WHO Guidelines Review Committee