Evidence map›Paper›PMID 29616236›Full record

ArticleThe Lancet. Child & adolescent health2018

Effects of water quality, sanitation, handwashing, and nutritional interventions on child development in rural Kenya (WASH Benefits Kenya): a cluster-randomised controlled trial.

Christine P Stewart, Patricia Kariger, Lia Fernald, Amy J Pickering, Charles D Arnold, Benjamin F Arnold, Alan E Hubbard, Holly N Dentz, Audrie Lin, Theodora J Meerkerk and 4 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Child & adolescent health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01704105 (WASH Benefits Kenya), which is not on this map. Cited by 42 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01704105 nacompletednot on this map

WASH Benefits Kenya: A Cluster Randomized Controlled Trial of the Benefits of Sanitation, Water Quality, Handwashing, and Nutrition Interventions on Child Health and Development

TypeinterventionalSponsorInnovations for Poverty ActionRan2012 to 2016Enrolled8,246ConditionsMalnutrition, Diarrhea, Child DevelopmentArmsWater Quality, Sanitation, Handwashing, Nutrition
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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  2. Hand-washing promotion for preventing diarrhoea.The Cochrane database of systematic reviews · 2021
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Christine P StewartDepartment of Nutrition, University of California, Davis, CA, USA. Electronic address: cpstewart@ucdavis.edu.
Patricia KarigerSchool of Public Health, University of California, Davis, CA, USA.
Lia FernaldCommunity Health Sciences, University of California, Davis, CA, USA.
Amy J PickeringDepartment of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.
Charles D ArnoldDepartment of Nutrition, University of California, Davis, CA, USA.
Benjamin F ArnoldDivision of Epidemiology, University of California, Davis, CA, USA.
Alan E HubbardDivision of Biostatistics, University of California, Davis, CA, USA.
Holly N DentzDepartment of Nutrition, University of California, Davis, CA, USA.
Audrie LinDivision of Epidemiology, University of California, Davis, CA, USA.
Theodora J MeerkerkDepartment of Nutrition and Health, Wageningen University, Wageningen, Netherlands.
Erin MilnerEnvironmental Health Sciences, University of California, Davis, CA, USA.
Jenna SwarthoutInnovations for Poverty Action, New Haven, CT, USA.
John M ColfordDivision of Epidemiology, University of California, Davis, CA, USA.
Clair NullInnovations for Poverty Action, New Haven, CT, USA; Center for International Policy Research and Evaluation, Mathematica Policy Research, Washington DC, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPoor nutrition and infectious diseases can prevent children from reaching their developmental potential. We aimed to assess the effects of improvements in water, sanitation, handwashing, and nutrition on early child development in rural Kenya.

methodsIn this cluster-randomised controlled trial, we enrolled pregnant women in their second or third trimester from three counties (Kakamega, Bungoma, and Vihiga) in Kenya's western region, with an average of 12 households per cluster. Groups of nine geographically adjacent clusters were block-randomised, using a random number generator, into the six intervention groups (including monthly visits to promote target behaviours), a passive control group (no visits), or a double-sized active control group (monthly household visits to measure child mid-upper arm circumference). The six intervention groups were: chlorinated drinking water; improved sanitation; handwashing with soap; combined water, sanitation, and handwashing; improved nutrition through counselling and provision of lipid-based nutrient supplements; and combined water, sanitation, handwashing, and nutrition. Here we report on the prespecified secondary child development outcomes: gross motor milestone achievement assessed with the WHO module at year 1, and communication, gross motor, personal social, and combined scores measured by the Extended Ages and Stages Questionnaire (EASQ) at year 2. Masking of participants was not possible, but data assessors were masked. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01704105.

findingsBetween Nov 27, 2012, and May 21, 2014, 8246 women residing in 702 clusters were enrolled. No clusters were lost to follow-up, but 2212 households with 2279 children were lost to follow-up by year 2. 5791 (69%) children were measured at year 1 and 6107 (73%) at year 2. At year 1, compared with the active control group, the combined water, sanitation, handwashing, and nutrition group had greater rates of attaining the standing with assistance milestone (hazard ratio 1·23, 95% CI 1·09-1·40) and the walking with assistance milestone (1·32, 1·17-1·50), and the handwashing group had a greater rate of attaining the standing alone milestone (1·15, 1·01-1·31). There were no differences when comparing the other intervention groups with the active control group on any of the motor milestone measures at year 1. At year 2, there were no differences among groups for the communication, gross motor, personal social, or combined EASQ scores.

interpretationThe handwashing and combined water, sanitation, handwashing, and nutrition interventions might have improved child motor development after 1 year, although after 2 years there were no other differences between groups. Future research should examine ways to make community health and nutrition programmes more effective at supporting child development.

fundingBill & Melinda Gates Foundation.

Identifiers

PMID29616236
PMCPMC5859215

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.