Relationships between shared sanitation facilities and diarrhoeal and soil-transmitted helminth infections: An analytical review

Abstract

Shared sanitation is widely proposed as a means to increase access to improved sanitation. There are few reports of a causal relationship between the use of shared sanitation and community-acquired diarrhoea. This paper presents an analytical review of studies that have investigated the relationship between the use of shared sanitation and the prevalence of (1) diarrhoeal disease and (2) soil-transmitted helminth (STH) infections. Data were extracted from the reviewed literature to calculate odds ratios (ORs) and confidence intervals (CIs). The use of shared sanitation showed a significant increase in diarrhoeal diseases, with an overall OR of 2.39 (85% CI 1.15–8.31). Children under 5 years were slightly less affected with a prevalence ratio of 1.09 (95% CI 1.06–1.12). The number of published reports on STH infections in relation to shared sanitation was limited, but the few that do exist report on ‘improved sanitation’, showing a positive and protective impact with an overall OR of 0.49 (95% CI 0.28–0.89), which is contrary to the negative impact related to diarrhoea. Despite the limited information on the direct link between shared sanitation and incidence of diarrhoeal/STH infections, this literature review demonstrates that the relationship deserves close attention in future practice and research.