A systematic review of water treatment strategies for childhood diarrhoea in low and middle income settings

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


During the year 2015 in, 525,977 under 5 deaths occurred due to diarrhea in low middle income. III In the same year in Pakistan, there are 39,484 deaths of Under 5 children due to diarrhea. Child hood diarrhea is one of the underlying cause of malnutrition. Diarrhea is primarily .a water born disease. Contaminated drink water is the main source of harmful microbes in the human body. However, evidence on the effectiveness of intervention on improved water supply are sparse and not conclusive. Objectives: To identify water treatment interventions that effect on reduction of diarrhea in children under five in low and middle-income settings. Methods: We searched published literature in PubMed, Cochrane, Health System Evidence and grey literature, World Health Organization database, Water and Sanitation Programs, Water Aid and United Nation Children Funds database. Our objective was to identify water treatment interventions at supply source and at point of use. To review the effect of identified water treatment interventions on reducing diarrhea in children under five in low and middle-income settings. Selection Criteria: We included those studies that evaluated the effect of water treatment interventions such as chlorination, flocculent and water filters (solar disinfection, bio-sand ceramic filters in reducing of diarrhea in children under five. The included studies conducted in low and middle-income settings. Randomized Control Trails (RCTs) and quasi-experiment or before after designs considered. Data Collection and analysis: Two researchers individually assessed trials eligibility, extracted data, assessed results and quality of evidences of included studies. We graded analysis of water treatment interventions at supply source and at point of use of different types of water treatment interventions. Quantitative analysis conducted to know the heterogeneity and pool results of different interventions at supply source and point of use on reduction of diarrhea. Qualitative analysis also conducted to know the quality of evidence of included studies. Results: We included 32 studies in the systematic- review and Meta-analysis. Out of these, 26 were RCTs and 6 were Quasi-Experiments. Pooled analysis showed reduction of diarrhea by water treatment interventions of point-of-use. Water filtration diarrhea risk reduction ratio is 0.47 (95% Cl: 0.36,0.62) and water disinfection is 0.69 (95% CI: 0.60,0.79). Supply source water treatment interventions, handpump diarrhea risk reduction ratio is 0.97 (95% CI:0.67, 1.41) and Chlorination & Improved supply diarrhea risk reduction ratio is 0.95 (95% CI: 0.35,2.60) & (0.47, 1.94) respectively. Quality ratings were low or very low for most studies, and heterogeneity was high in pooled analysis. Improvements to the water filtration and water disinfection at source did not show significant effects on diarrhea risk which again is a matter to be studied further to explore its authenticity. Conclusion: We provided evidence that point-of-use water treatment interventions have significant effect on reduction of childhood diarrhea. This would help policy makers for makirig choices in different identified point of use interventions and taking appropriate decision for areas where pipe water supply is not feasible in low and middle-income settings of Pakistan.

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