Understanding the Effectiveness of Water, Sanitation, and Hygiene Interventions
Background
Water, sanitation, and hygiene (WASH) interventions can help reduce diarrheal diseases. However, many large trials have not shown the expected health benefits for young children in low-resource areas. We need better guidance to improve these interventions and overcome challenges in reducing diarrheal diseases.
Objectives
Our goal was to assess how effective WASH interventions are based on different factors in the WASH Benefits (WASH-B) Bangladesh trial.
Methods
We tracked diarrheal cases in children from the WASH-B trial at three different times, involving 17,187 observations. We created a model to understand disease transmission and evaluated four interventions: water (W), sanitation (S), hygiene (H), and nutrition (N). We looked at how well people followed these interventions and the effects of those not in the study. Using advanced statistical methods, we simulated outcomes to see how changes in six WASH factors affected intervention effectiveness.
Results
Increasing community coverage significantly improved intervention effectiveness. For example, effectiveness increased by 34.0 and 45.5 percentage points in the WSH and WSHN groups when coverage reached 20%. The impact of community coverage varied based on how much disease spread occurred through pathways not addressed by the interventions. Lower preexisting WASH conditions or higher disease rates reduced effectiveness. Combining individual interventions showed complementary effects but not synergistic ones.
Discussion
To achieve the desired health benefits, future WASH interventions must focus on increasing community coverage and addressing disease transmission through unmodified pathways. The effectiveness of individual WASH improvements decreases as community coverage falls short of what is needed for herd protection.
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