SynthesisEnvironmental health perspectives2020
Understanding the Impact of Rainfall on Diarrhea: Testing the Concentration-Dilution Hypothesis Using a Systematic Review and Meta-Analysis.
Synthesis in Environmental health perspectives, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 5 of them syntheses that pooled 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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
57 citing papers in PubMed, 5 syntheses or guidelines pooled it, 111 citations in OpenAlex.
- Differential Effectiveness of Water, Sanitation, and Handwashing Interventions to Reduce Child Diarrhea in Dry and Rainy Seasons: A Systematic Review and Meta-Analysis of Intervention Trials.Environmental health perspectives · 2025Pooled it
- Impact of Climate Variability on Foodborne Diarrheal Disease: Systematic Review and Meta-Analysis.Public health reviews · 2025Pooled it
- Rainfall and Temperature Influences on Childhood Diarrhea and the Effect Modification Role of Water and Sanitation Conditions: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2024Pooled it
- Climate change impacts on child and adolescent health and well-being: A narrative review.Journal of global health · 2024Pooled it
- Global Health Impacts for Economic Models of Climate Change: A Systematic Review and Meta-Analysis.Annals of the American Thoracic Society · 2022Pooled it
- Influence of Temperature and Precipitation on the Effectiveness of Water, Sanitation, and Handwashing Interventions against Childhood Diarrheal Disease in Rural Bangladesh: A Reanalysis of the WASH Benefits Bangladesh Trial.Environmental health perspectives · 2024Trial
- Waterborne diseases and climate change.Nature reviews. Microbiology · 2026Review
- Vulnerability to climate-driven pathogen-specific diarrheal diseases: secondary analysis from the Global Enteric Multicenter Study and Vaccine Impact on Diarrhea in Africa follow-up.Nature communications · 2026Article
- Drinking water quality and enteric disease: a nationwide case-crossover study (2015-2019) in New Zealand.Journal of exposure science & environmental epidemiology · 2026Article
- Rainfall and temperature influence effectiveness of on-site sanitation intervention against E. coli contamination in Bangladeshi households.International journal of hygiene and environmental health · 2026Article
- Data Resource Profile: Climate and Enteric Diseases Research Project (ClimED).International journal of epidemiology · 2026Article
- Evaluation of Remotely Sensed Inundation Data Sets to Estimate Flood-Associated Emergency Department Visits After Hurricane Harvey.GeoHealth · 2026Article
- Unraveling meteorologically influenced recurrence and sequential infection risks among influenza, mumps, scarlet fever, and hand-foot-and-mouth disease: evidence from Shenzhen, China.Frontiers in public health · 2026Article
- Variability of enteric pathogen infections by season and meteorological conditions in a low-income, urban setting in Mozambique.PLOS global public health · 2026Article
- Cholera trends in the WHO African region and temporal co-occurrence with El Niño, tropical cyclones, floods and droughts: 2022-2023.BMJ public health · 2026Article
- Acute gastroenteritis in Trinidad and Tobago: identifying trend by season, geography, and demographics from 2006 to 2023.IJID regions · 2025Review
- A Review of Combined Sewer Overflows and Gastrointestinal Illness in a Changing Climate.Current epidemiology reports · 2025Article
- Review
- The association between total precipitation and diarrhea morbidity: A multicountry study across diverse climate zones.Environmental epidemiology (Philadelphia, Pa.) · 2025Article
- Using Spatial Technologies to Assess Risk Factors for Diarrheal Disease Under Environmental Variability in Bangladesh: A Machine Learning Study.International journal of environmental research and public health · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundProjected increases in extreme weather may change relationships between rain-related climate exposures and diarrheal disease. Whether rainfall increases or decreases diarrhea rates is unclear based on prior literature. The concentration-dilution hypothesis suggests that these conflicting results are explained by the background level of rain: Rainfall following dry periods can flush pathogens into surface water, increasing diarrhea incidence, whereas rainfall following wet periods can dilute pathogen concentrations in surface water, thereby decreasing diarrhea incidence.
objectivesIn this analysis, we explored the extent to which the concentration-dilution hypothesis is supported by published literature.
methodsTo this end, we conducted a systematic search for articles assessing the relationship between rain, extreme rain, flood, drought, and season (rainy vs. dry) and diarrheal illness.
resultsA total of 111 articles met our inclusion criteria. Overall, the literature largely supports the concentration-dilution hypothesis. In particular, extreme rain was associated with increased diarrhea when it followed a dry period [incidence rate ratio DISCUSSION: Our meta-analysis suggests that the effect of rainfall depends on the antecedent conditions. Future studies should use standard, clearly defined exposure variables to strengthen understanding of the relationship between rainfall and diarrheal illness. https://doi.org/10.1289/EHP6181.
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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.