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Case-control studies of the effect of environmental sanitation on diarrhoea morbidity: methodological implications of field studies in Africa and Asia.

Abstract：

:The problems and prospects in the use of case-control studies to assess the effects of improvements in environmental sanitation on diarrhoea morbidity are discussed on the basis of two field studies. It is concluded that an adequate design is available for assessing the effects of a single improvement on diarrhoeal disease. The estimates of effect appear to be valid and sufficiently precise. For addressing more complex questions of interactions, sample sizes would have to be increased substantially. The experience with two field studies suggests that there is hope that a simpler protocol may be feasible, in which only limited information is collected, in which few home visits are made, and in which analytical techniques are simple. Until more field studies have been conducted definitive conclusions cannot be reached on the applicability of such a simple, rapid and inexpensive approach. :Only 2 field studies have been conducted on the effect of environmental sanitation interventions on diarrheal disease. Based on the validity, precision, the "simplification" of these 2 studies, researchers suggest that further studies follow a similar simple approach. In 1 study, the Government of Malawi evaluated the impact of the installation of gravity water supply systems in a rural area. In the Philippines, researchers compared the effect of the provision of piped and borehole water to that of springs and dug wells in a periurban area. In the Malawi study, geometric mean fecal coliform levels/100 ml for the piped water and water from unprotected sources stood at 12 and 540 respectively at the source and 16 and 760 in the house. As for the Philippines, the mean for piped and borehole water were almost 0, while the levels for springs and dug wells were 50. Both cases of diarrhea and controls with several diseases of similar severity were selected at clinics used by clients exposed to improved environmental conditions and by those not so exposed. The results suggested that improved environmental sanitation was associated with a reduction in diarrhea of about 20% in both locations. Further, in the Philippines study, health personnel took rectal swabs from cases and controls and analyzed them for all major diarrhea pathogens in which case, based on fecal microbiology, diarrhea reduction was about 40%. These studies have demonstrated advantages of the case control methods for assessing the impact of water supply and sanitation conditions on diarrheal disease.

journal_name

Int J Epidemiol

journal_title

International journal of epidemiology

authors

Briscoe J,Baltazar J,Young B

doi

10.1093/ije/17.2.441

subject

Has Abstract

pub_date

1988-06-01 00:00:00

pages

441-7

issue

eissn

0300-5771

issn

1464-3685

journal_volume

pub_type

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Case-control studies of the effect of environmental sanitation on diarrhoea morbidity: methodological implications of field studies in Africa and Asia.