Are there 'before and after' studies that show impact of FSM practices on health?

  • dineshmehta100
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FSM impact on health

Are there 'before and after' studies that show impact of FSM practices on health?
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  • muench
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Re: FSM impact on health

Hi Dinesh,

I would say yes and no. We are seeing more and more studies where researchers are doing randomized controlled trials (RCTs) on figuring out health impacts from improved sanitation. But it's incredibly hard to prove anything. One reason is that in some of the trials sanitation interventions are not far reaching enough (e.g. not the entire community is covered, or handwashing is not covered etc.). We all know intuitively that hygiene and sanitation is super important for health, particularly when it comes to newborns, babies and young children. But to prove this with data, and for an entire community, is not easy. Even doing scientific trials (those RCTs) is not easy, for ethical reasons (e.g. can we "withhold" hygiene measures for young children just to prove the impact?)

I haven't seen any studies looking at FSM (fecal sludge management) in particular.

Could you tell us a bit more about the background to your question?

Please also see these forum threads, and feel free to contribute to them:
It's a grant funded by the BMGF: Benefits of water quality, sanitation, handwashing and nutritional interventions for health and child development (Kenya, Bangladesh)

"The trials are currently conducting their final round of outcome measurement. We anticipate primary results in late 2016 (Bangladesh) and mid 2017 (Kenya)."

and this one:
The elusive effect of water and sanitation on the global burden of disease

and this one:
No evidence that this sanitation programme in rural Odisha prevented diarrhoea, soil-transmitted helminth infection, or child malnutrition (study led by Emory University)


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  • zvig
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Re: FSM impact on health

I wanted to note, that while randomized clinical trials are indeed the 'golden standard' of epidemiological research, there are other methods that are easier to apply to such questions. Such methods are before/after studies (comparing changes to health before and after an intervention, compared to areas where the intervention was not performed based on historical data), ecological studies (comparing regions or countries with different rates of the behavior under study and the health outcomes), or even cross sectional studies which assess behavior and health at the same time.

I know not whether such designs have been tried, and regardless of the study design, impact of a single factor such as hand washing or open defecation on health outcome like diarrhea is going to be very difficult to demonstrate (because many of the health behaviors are going to be correlated with one another and because external factors - floods, droughts, wars, political unrest, etc. - make the data noisy and hard to analyze), but I am sure some of the data may be available for study.

BTW, I am also not sure about the ethics of the situation. Just because intuition tells us something should work, the proof is in the pudding. Economists make a living showing that most programs do not work (see the works of Angus Deaton and Esther Duflo). The point being that a program such as hand washing promotion can ethically be applied to some villages and not to others if we suspect the impact is insignificant. If we find out that although people wash hands properly and avoid fecal/oral contamination, they still have as many cases of diarrhea, we would look elsewhere for the cause (perhaps drinking water is contaminated at the source, or there is a breach between sewage and water pipes, or food source is contaminated), and in doing so will both reduce incidence of the disease, and direct the funds towards something (that is demonstrably more effective).

Just my two cents, as an MPH.
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