Interpreting the Global Enteric Multicenter Study (GEMS) findings on sanitation, hygiene, and diarrhea

The Global Enteric Multicenter Study (GEMS) reported on the associations between sanitation and hygiene indicators and moderate-to-severe diarrhea. We argue that while GEMS provides the best dataset yet on diarrheal disease associated with sanitation and hygiene, its sanitation and hygiene indicators have a number of limitations and therefore the data should be interpreted with caution. For example, GEMS sanitation and hygiene indicators are at the household, not individual, level and are indicators of access. Access does not equal use and behaviors within a household often vary by age and gender. Survey best practice should ask about individual behaviors both at and away from home.

Interpreting the Global Enteric Multicenter Study (GEMS) findings on sanitation, hygiene, and diarrhea. Jonny Crocker and Jamie Bartram. 2016. PLoS Medicine 13(5): e1002011. doi:10.1371/journal.pmed.1002011.