In a linked commentary Stephen Luby, research deputy director at the Centre for Innovation in Global Health, Stanford University, California, said, “This rigorous assessment is important because it provides the best evidence so far for the uncomfortable conclusion that well-funded, professionally delivered sanitation programmes, even when they reach coverage levels that are quite commendable for large scale interventions, do not necessarily improve health.”3
He added, “This absence of sound data for the health effect of sanitation results in a paucity of evidence to guide decisions about whether to invest scarce funds in the improvement of sanitation. Might communities be healthier if the funds were instead invested in water infrastructure, handwashing promotion, rotavirus vaccine, nutritional supplementation, or improvement of clinical management of diarrhoea with oral rehydration and zinc treatment?”