Comments
Hi Michael,
great post! We're currently looking into this more.
Diarrheal disease really is responsible for a lot of ill health. Here's a breakdown of the reasons for diarrhea taken from (http://ihmeuw.org/3oxy) with some observations on each of those risk factors in terms of highly effective interventions:
The associated risk are:
1.‘Behavioural’ risk factors:
1.1 Malnutrition
1.1.1 Childhood undernutrition
- Solutions: agricultural aid tries to work on this
- Givedirectly, because people buy more food
- deworming, because worms might have a little effect on weight (the effect might be small, but cost-effectiveness might still be high)
1.1.2 suboptimal breastfeeding
- there DMI is a good candidate, because they encourage breastfeeding, but the midline results were not significant.
1.1.3 Vitamin A and Zinc deficiency
- this is partly because we recommend Project Healthy Children
Living Goods also sells vitamins
'environmental' risk factors
2.1 'WASH' interventions:
2.1.1 Unsafe Water
Potential interventions:
- Dispensers for safe water is working on this but both Givewell and ourselves are still trying to make sense out of some methodological issues with the trials - see post in the comments, as well as this recent document: https://docs.google.com/document/d/1hyTyu5Ok-Zf6-4IuvRPlZSK1jGZygpksayD2s22ElPk/edit?usp=sharing Solar Water Disinfection:
2.1.2 unsafe sanitation
potential interventions:
- DMI tries to promote latrine ownership - no sig. results so far.
- I recently saw the folks from peepoople.com speak at a conference and this might be an innovative, high cost-effectiveness approach - but there is not enough evidence out yet. Generally, my sense is that toilets are very difficult.
Handwashing (can be done with ash, doesn't even have to be soap). DMI promotes handwashing, but the results for this are still out.
Treament:
Living Goods also sells an oral rehydration therapy product
- DMI, in the midline results of their trial, found that they significantly increased the number of people who sought help at a clinic for diarrhea.
New interesting research in this area:
very good recent cluster RCT on:
The Effect of Improved Water Supply on Diarrhea Prevalence of Children under Five in the Volta Region of Ghana: A Cluster-Randomized Controlled Trial.
Supplying clean water by drilling or rehabilitating boreholes reduced diarrheal prevalence by 11% in this study. The study convincingly gets around some methodological issues with self-reported diarrhea. http://www.ncbi.nlm.nih.gov/pubmed/26404337
- Effects of better WASH beyond health:
Effect of Early Life Exposure to a Clean Water Intervention on Health and Socioeconomic Status in Adulthood: Evidence from a Quasi-Experimental Cohort Study in Mexico*
“Early childhood diarrhea jeopardizes child development by diverting nutrition away from physical and mental growth towards fighting illness. Consequently, early exposure to clean water interventions, which reduce diarrhea risk, may confer positive effects on adult health and well-being that are typically not accounted for in resource allocation decisions. We found that early life exposure to a clean water intervention in Mexico in 1991 led to increases in adult height for men and completed schooling for women.” http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.363.1560&rep=rep1&type=pdf
I hope this helps.
Givewell published their findings on water treatment interventions in 2013 did you miss this page? I think it is very plausible that such interventions could be a highly effective cause area With more research though.
Interesting, I suppose I must have... Thanks for the link.
It seems that a lack of good evidence is rather crippling here. I wonder how much it would cost to set up a trial with a good chance of determining the effectiveness of water treatment and related interventions. It almost seems like a cop out to leave things at that point. Surely, if there's a chance that water treatments are more effective at saving lives than malaria interventions and the costs of setting up a good trial are not exorbitant, it would be worth funding such a study.
Yes potentially. I know that Evidence Action (the charity that runs Deworm the World) also has a water dispensing charity http://www.evidenceaction.org/dispensers/ .
GWWC has a good blog post from 2014 about them and the potential for research in this area. https://www.givingwhatwecan.org/blog/2014-01-28/dispensers-for-safe-water
As a general point, I think there are a whole host of potentially high impact charities (such as those that are "other outstanding charities") that have not received much attention in the EA community, and could be good targets for more research and highlighting in a similar way.