Evidence map›Paper›PMID 39705040›Full record

Trial reportEnvironmental health perspectives2024

Understanding the Effectiveness of Water, Sanitation, and Hygiene Interventions: A Counterfactual Simulation Approach to Generalizing the Outcomes of Intervention Trials.

Andrew F Brouwer, Mondal H Zahid, Marisa C Eisenberg, Benjamin F Arnold, Sania Ashraf, Jade Benjamin-Chung, John M Colford, Ayse Ercumen, Stephen P Luby, Amy J Pickering and 4 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Environmental health perspectives, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
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.

Andrew F BrouwerDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.ORCID 0000-0002-3779-5287
Mondal H ZahidDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Marisa C EisenbergDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Benjamin F ArnoldFrancis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA.
Sania AshrafEnvironmental Interventions Unit, Infectious Disease Division, The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Jade Benjamin-ChungDepartment of Epidemiology and Population Health, Stanford University, Stanford, California, USA.
John M ColfordSchool of Public Health, University of California Berkeley, Berkeley, California, USA.
Ayse ErcumenDepartment of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, USA.
Stephen P LubyDivision of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA.
Amy J PickeringDepartment of Civil and Environmental Engineering, University of California Berkeley, Berkeley, California, USA.
Mahbubur RahmanEnvironmental Health and WASH, Health System and Population Studies Division, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Alicia N M KraayInstitute for Disease Modeling, Global Health Division of the Bill & Melinda Gates Foundation, Seattle, Washington, USA.
Joseph N S EisenbergDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Matthew C FreemanRollins School of Public Health, Emory University, Atlanta, Georgia, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhile water, sanitation, and hygiene (WASH) interventions can reduce diarrheal disease, many large-scale trials have not found the expected health gains for young children in low-resource settings. Evidence-based guidance is needed to improve interventions and remove barriers to diarrheal disease reduction.

objectivesWe aimed to estimate how sensitive WASH intervention effectiveness was to underlying contextual and intervention factors in the WASH Benefits (WASH-B) Bangladesh cluster-randomized controlled trial.

methodsThe investigators measured diarrheal prevalence in children enrolled in the WASH-B trial at three time points approximately 1 year apart (

resultsIncreasing community coverage had the greatest impact on intervention effectiveness (e.g., median increases in effectiveness of 34.0 and 45.5 percentage points in the WSH and WSHN intervention arms when increasing coverage to 20%). The effect of community coverage on effectiveness depended on how much transmission was along pathways not modified by the interventions. Intervention effectiveness was reduced by lower levels of preexisting WASH conditions or increased baseline disease burden. Individual interventions had complementary but not synergistic effects when combined. DISCUSSION: To realize the expected health gains, future WASH interventions must address community coverage and transmission along pathways not traditionally covered by WASH. The effectiveness of individual-level WASH improvements is reduced more the further the community is from achieving the coverage needed for herd protection. https://doi.org/10.1289/EHP15200.

Indexed as

DiarrheaHygieneSanitationBangladeshBayes TheoremChild, PreschoolFemaleHumansInfantMaleWater Supply

Identifiers

PMID39705040
PMCPMC11661469

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.