Abstract:
A systematic review of published literature (2000–2019) evaluating the impact of sanitation
interventions on the prevalence of disease, parasite infestation, and/or child growth using randomized
controlled trials (RCTs) was done according to the PRISMA checklist. Earlier reviews indicated
mixed evidence citing relatively poor quality evidence from mixed designs. Public health policy and
practice appear to rely on evidence from RCTs. Records were searched in six electronic databases.
The methodological quality of RCTs was assessed using the Cochrane collaboration risk of bias tool.
Fifteen records (2.0%) were included for review. Impact trials were done in rural communities of
African and Asian countries. The significant effect of sanitation-focus interventions was found in
one trial for the prevalence of childhood diarrhea (14.3%), three trials for parasite infestation (37.5%),
and two trials (25.0%) for child growth. Results indicate mixed quality evidence from RCT designs.
Evidence is limited and suggestive of the impact of sanitation on parasite infestation and child
growth. Further rigorous sanitation intervention trials under varying settings are needed to show
what really works and under what settings. Future work may explore sanitation behavior change
strategies and latrine options to address the challenges of poor latrine use under high sanitation
coverage.
