Case Study about the Effect of Environmental Sanitation on Diarrhoea Morbidity in Malawi
Abstract: A case-control design has been applied in the evaluation of improved environmental sanitation on diarrhea diseases in rural Malawi. The study demonstrates the feasibility of using such an approach to evaluate two levels of water supply and sanitation service quickly and at moderate cost. Sample sizes would need to be increased substantially to evaluate multiple levels of service or to investigate interactions between water supply and sanitation. The results indicate that children living in families who use good quality water supplies and latrines experience 20% less diarrhea as reported to the health clinics during the warm, rainy season.
Many studies on the health effects of improved water supplies and excreta disposal facilities have methodological problems which cast doubt on the validity of their conclusions. Blum and Feacham cite eight of these problems which include study design, validity of information, and analytical issues. They draw attention to the need for studies on existing water supply and sanitation programmes which are functioning satisfactorily and properly used. Recently, arguments have been presented for applying a case control study design to diarrhea impact evaluations of environmental interventions in order to overcome many of these methodological problems.
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