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Does suboptimal household flooring increase the risk of diarrhoea and intestinal parasite infection in low and middle income endemic settings? A systematic review and meta-analysis protocol

  • Sartorius, Benn1, 2, 3
  • Legge, Hugo1
  • Pullan, Rachel1
  • 1 London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK , London (United Kingdom)
  • 2 University of Washington, Seattle, WA, USA , Seattle (United States)
  • 3 University of KwaZulu-Natal, Durban, South Africa , Durban (South Africa)
Published Article
Systematic Reviews
BioMed Central
Publication Date
May 20, 2020
DOI: 10.1186/s13643-020-01384-9
Springer Nature


BackgroundWater, sanitation, and hygiene interventions often fail to show long-term impact on diarrhoeal and/or intestinal parasite risk in many low- and middle-income countries. Less attention has been paid to wider contextual factors that may contribute to high levels of contamination in the domestic environment such as household flooring. The purpose of this study will be to assess the association between diarrhoeal and/or intestinal parasite infection status and unimproved/unfinished flooring in low- and middle-income countries.MethodsWe will conduct a comprehensive search of published studies (randomized controlled trials, non-randomized controlled trials, and observational studies) that examined the association between unimproved/unfinished household flooring and diarrhoeal and/or intestinal parasite infection status from January 1, 1980, onwards with no language restriction. The primary outcome will include diarrhoeal and/or intestinal parasite infection status. Databases to be searched include EMBASE, MEDLINE, Web of Science, and Google Scholar. The secondary outcome will be the association between specific pathogens (laboratory confirmed) and unimproved/unfinished household flooring. Independent screening for eligible studies using defined criteria and data extraction will be completed in duplicate and independently. Any discrepancies between the two reviewers will be resolved by consensus and/or arbitration by a third researcher. If data permits, random effects models will be used where appropriate. Subgroup and additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. age group, geographical region) and potential risk of bias of included studies.DiscussionThis review will provide a comprehensive examination of a possible association between suboptimal household flooring and increased risk of enteric pathogen infection, highlight gaps for future research in high risk areas, and inform intervention design for future planned studies in Kenya and/or elsewhere in the region.Systematic review registrationPROSPERO registration number: CRD42019156437

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