Evaluating the effectiveness of sanitation and hygiene interventions on waterborne diarrheal diseases: A literature review

Tania Asda Jaina; Triana Srisantyorin; Suherman  Jaksa

doi:10.56922/mchc.v5i3.3470

Authors

Tania Asda Jaina Universitas Muhammadiyah Jakarta
Triana Srisantyorin Universitas Muhammadiyah Jakarta
Suherman Jaksa Universitas Muhammadiyah Jakarta

Diarrheal Disease Prevention Hygiene Sanitation WASH Waterborne Diarrhea

Abstract

Background: Waterborne diarrhea remains a major global public health problem closely associated with water quality, sanitation conditions, and hygiene practices. Various interventions have been implemented to reduce the incidence of diarrheal diseases; however, their effectiveness needs to be comprehensively evaluated to provide evidence for environmental health policy and program development.

Purpose: To evaluating the effectiveness of sanitation and hygiene interventions on waterborne diarrheal diseases.

Method: This study employed a literature review design using a descriptive-analytical approach. Relevant articles were retrieved from Google Scholar, PubMed, ScienceDirect, and nationally accredited SINTA-indexed journals. Articles were selected based on predefined inclusion and exclusion criteria. A total of 10 articles published between 2020 and 2025 were included and analyzed to identify the types of interventions, study findings, and the effectiveness of sanitation and hygiene programs.

Results: The findings indicated that all reviewed studies reported a significant association between sanitation and hygiene interventions and a reduction in diarrheal incidence (p< 0.05). Effective interventions included the provision of safe drinking water, the use of improved sanitation facilities, household waste management, handwashing with soap, and integrated Water, Sanitation, and Hygiene (WASH) programs. Integrated WASH interventions demonstrated greater effectiveness than single-component interventions.

Conclusion: Sanitation interventions and hygiene practices are effective in reducing the incidence of waterborne diarrheal diseases, particularly when implemented through an integrated WASH approach.

Suggestion: Strengthening WASH programs and promoting sustainable behavior change interventions are recommended to support long-term diarrhea prevention efforts.

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References

Adria, B. P., Wulandari, R. A., & Kurniasari, F. (2023). Spatial analysis of diarrhea incidences, environmental influences, and behavioral factors in an ecological study. Media Kesehatan Masyarakat Indonesia, 19(4), 185-192.

Aristi, I. P. S., & Sulistyowati, M. (2020). Analisis teori Health Belief Model terhadap tindakan personal hygiene siswa Sekolah Dasar. Journal of Health Science and Prevention, 4(1), 7-13.

Bauza, V., Ye, W., Liao, J., Majorin, F., & Clasen, T. (2023). Interventions to improve sanitation for preventing diarrhoea. Cochrane Database of Systematic Reviews, (1).

Bushen, G., Merga, H., & Tessema, F. (2022). Effects of community-led total sanitation and hygiene implementation on diarrheal diseases prevention in children less than five years of age in South Western Ethiopia: A quasi-experimental study. PloS one, 17(4), e0265804.

Contreras, J. D., Islam, M., Mertens, A., Pickering, A. J., Arnold, B. F., Benjamin-Chung, J., & Ercumen, A. (2022). Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: extended follow-up of a cluster-randomized controlled trial in rural Bangladesh. PLoS Medicine, 19(8), e1004041.

Darvesh, N., Das, J. K., Vaivada, T., Gaffey, M. F., Rasanathan, K., Bhutta, Z. A. (2017). Water, sanitation and hygiene interventions for acute childhood diarrhea: a systematic review to provide estimates for the Lives Saved Tool. Bmc public health, 17(Suppl 4), 776.

de Wit, S., Luseka, E., Bradley, D., Brown, J., Bhagwan, J., Evans, B., & Chandler, C. I. (2024). Water, sanitation and hygiene (WASH): the evolution of a global health and development sector. Bmj global health, 9(10).

Ejemot‐Nwadiaro, R. I., Ehiri, J. E., Arikpo, D., Meremikwu, M. M., & Critchley, J. A. (2015). Hand washing promotion for preventing diarrhoea. Cochrane database of systematic reviews, (9).

Ekhoragbon, C. (2024). Public health implications of open defecation practices in rural Nigeria. Authorea Preprints.

Freeman, M. C., Stocks, M. E., Cumming, O., Jeandron, A., Higgins, J. P., Wolf, J., & Curtis, V. (2014). Systematic review: hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Tropical Medicine & International Health, 19(8), 906-916.

Irjayanti, A., Irmanto, M., & Wibowo, T. F. (2024). Analisis faktor risiko diare pada balita di wilayah kerja Puskesmas Jayapura Utara. Jurnal Kesehatan Lingkungan Indonesia, 23(1), 1-9.

Jubayer, A., Islam, M. H., Nowar, A., & Islam, S. (2022). Exploring household water, sanitation, and hygiene and acute diarrhea among children in St. Martin’s Island, Bangladesh: A cross-sectional study. The American Journal of Tropical Medicine and Hygiene, 107(2), 441.

Korir, C., Ogendi, G. M., & Donde, O. O. (2025). The Influence of Socioeconomic Factors on Open Defecation and Fecal Oral diseases in Soin ward, Kericho County, Kenya. Environmental Health Insights, 19, 11786302251400072.

Liu, Q., Liu, M., & Liu, J. (2024). Global associations between the use of basic drinking water and sanitation services with diarrhoeal disease incidence in 200 countries and territories from 2000 to 2019. Public Health, 235, 202-210.

Luby, S. P., Halder, A. K., Huda, T. M., Unicomb, L., Islam, M. S., Arnold, B. F., & Johnston, R. B. (2015). Microbiological contamination of drinking water associated with subsequent child diarrhea. The American journal of tropical medicine and hygiene, 93(5), 904.

Marron, E. L., Mitch, W. A., von Gunten, U., & Sedlak, D. L. (2019). A tale of two treatments: the multiple barrier approach to removing chemical contaminants during potable water reuse. Accounts of chemical research, 52(3), 615-622.

Mekonnen, G. K., Alemu, B. M., Gebrie, G. S., Kloos, H., & Legesse, W. M. (2023). Impact of hygiene promotion intervention on acute childhood diarrhea: evidence from a cluster-randomized trial in refugee communities in Gambella Region, Ethiopia. Journal of Water, Sanitation and Hygiene for Development, 13(4), 235-249.

Ministry of Health of the Republic of Indonesia. (2023). Survei Kesehatan Indonesia 2023. Retrieved from: https://www.badankebijakan.kemkes.go.id/hasil-ski-2023/

Morse, T., Tilley, E., Chidziwisano, K., Malolo, R., & Musaya, J. (2020). Health outcomes of an integrated behaviour-centred water, sanitation, hygiene and food safety intervention–a randomised before and after trial. International Journal of Environmental Research and Public Health, 17(8), 2648.

Mwishingo, A., Endres, K., Bisimwa, L., Sanvura, P., Banywesize, B. M., Bisimwa, J. C., & George, C. M. (2024). Effect of a water, sanitation, and hygiene program on handwashing with a cleansing agent among diarrhea patients and attendants in healthcare facilities in the Democratic Republic of Congo: a randomized pilot of the PICHA7 program. International journal of environmental research and public health, 21(6), 659.

Nasrulah, N., Junaidi, J., Syahrizal, S., & Kartini, K. (2024). The Relationship Between Basic Household Sanitation and Diarrheal Diseases in Samalanga Subdistrict Bireuen Regency 2024. ASJo: Aceh Sanitation Journal, 3(1), 47-53.

Pickering, A. J., Null, C., Winch, P. J., Mangwadu, G., Arnold, B. F., Prendergast, A. J., & Humphrey, J. H. (2019). The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhoea. The Lancet Global Health, 7(8), e1139-e1146.

Prakoso, I. D. (2020). Correlation between access of drinking water and sanitation with diarrhea incidence in East Java. Jurnal Berkala Epidemiologi, 8(1), 42.

Rahim, F., Juliana, N., Liambana, E. S. M., Lisna, L., Naningsi, A., Saing, F. M., & Ahmad, I. (2025). Health Belief Model (HBM) dalam Perilaku Berisiko Praktik Hygiene Makanan dikalangan Mahasiswa Universitas Karya Persada Muna. Jurnal Promotif Preventif, 8(6), 1633-1642.

Ross, I., Bick, S., Ayieko, P., Dreibelbis, R., Wolf, J., Freeman, M. C., & Cumming, O. (2023). Effectiveness of handwashing with soap for preventing acute respiratory infections in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet, 401(10389), 1681-1690.

Sangalang, S. O., Lemence, A. L. G., Ottong, Z. J., Valencia, J. C., Olaguera, M., Canja, R. J. F., & Kistemann, T. (2022). School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines. BMC Public Health, 22(1), 2034.

Solomon, E. T., Robele, S., Kloos, H., & Mengistie, B. (2020). Effect of household water treatment with chlorine on diarrhea among children under the age of five years in rural areas of Dire Dawa, eastern Ethiopia: a cluster randomized controlled trial. Infectious Diseases of Poverty, 9(1), 64.

Tintle, N., Van De Griend, K., Ulrich, R., Wade, R. D., Baar, T. M., Boven, E., & Best, A. A. (2021). Diarrhea prevalence in a randomized, controlled prospective trial of point-of-use water filters in homes and schools in the Dominican Republic. Tropical Medicine and Health, 49(1), 1.

UNICEF. (2025). UNICEF Annual Report 2024. Retrieved from: https://www.unicef.org/reports/unicef-annual-report/2024

Wolf, J., Johnston, R., Hunter, P. R., Gordon, B., Medlicott, K., & Prüss-Ustün, A. (2019). A Faecal Contamination Index for interpreting heterogeneous diarrhoea impacts of water, sanitation and hygiene interventions and overall, regional and country estimates of community sanitation coverage with a focus on low-and middle-income countries. International journal of hygiene and environmental health, 222(2), 270-282.

World Health Organization. (2023). WHO global water, sanitation and hygiene: annual report 2023. Retrieved from: https://www.who.int/water_sanitation_health/publications/global-water-sanitation-and-hygiene-annual-report-2018/en/