Global Access to Handwashing: Implications for COVID-19 Control in Low-Income Countries
Global Access to Handwashing: Implications for COVID-19 Control in Low-Income Countries
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DOI：
10.1289/ehp7200
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发表时间：
2020-05-01
影响因子：
10.4
通讯作者：
Stanaway, Jeffrey D.
中科院分区：
文献类型：
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作者：
Brauer, Michael;Zhao, Jeff T.;Stanaway, Jeffrey D.
背景技术背景：低收入国家降低了卫生保健系统的能力，因此面临的COVID-19病死率远高于目前高收入国家的风险。洗手是减少导致COVID-19大流行的SARS-CoV-2病毒传播指南的关键组成部分。先前的系统评价表明洗手对减少呼吸道病毒传播的有效性。在低收入国家，减少传播是至关重要的，但社会距离受到高人口密度的挑战，使用肥皂和水洗手的设施有限。结论：我们的目标是估计全球使用肥皂和水洗手的情况，以告知使用洗手预防COVID-19传播。方法：我们利用观察性调查和时空高斯过程回归模型，在全球疾病负担，伤害和风险因素研究的背景下，估计获得洗手站提供肥皂和水1，结果：尽管从1990年（33.6% [95%不确定性区间（UI）：31.5，35.6]无访问）到2019年总体有所改善，但2019年全球范围内，2.02（95% UI：1.91）。21.4）亿人，占全球人口的26.1%（95% UI：24.7，27.7），缺乏可用肥皂和水洗手的机会。2019年，撒哈拉以南非洲和大洋洲超过50%的人口无法获得洗手服务，在8个国家中，有5000万或更多的人无法获得洗手服务。对于无法获得洗手服务的人群，迫切需要立即改善获得洗手服务的机会或采取替代战略，在应用于低收入国家时，应将洗手机会的差异纳入COVID-19预测模型。
BACKGROUND: Low-income countries have reduced health care system capacity and are therefore at risk of substantially higher COVID-19 case fatality rates than those currently seen in high-income countries. Handwashing is a key component of guidance to reduce transmission of the SARS-CoV-2 virus, responsible for the COVID-19 pandemic. Prior systematic reviews have indicated the effectiveness of handwashing to reduce transmission of respiratory viruses. In low-income countries, reduction of transmission is of paramount importance, but social distancing is challenged by high population densities and access to handwashing facilities with soap and water is limited.OBJECTIVES: Our objective was to estimate global access to handwashing with soap and water to inform use of handwashing in the prevention of COVID-19 transmission.METHODS: We utilized observational surveys and spatiotemporal Gaussian process regression modeling in the context of the Global Burden of Diseases, Injuries, and Risk Factors Study to estimate access to a handwashing station with available soap and water for 1,062 locations from 1990 to 2019.RESULTS: Despite overall improvements from 1990 (33.6% [95% uncertainty interval (UI): 31.5, 35.6] without access) to 2019, globally in 2019, 2.02 (95% UI: 1.91. 2.14) billion people, 26.1% (95% UI: 24.7, 27.7) of the global population, lacked access to handwashing with available soap and water. More than 50% of the population in sub-Saharan Africa and Oceania were without access to handwashing in 2019, and in eight countries, 50 million or more persons lacked access.DISCUSSION: For populations without handwashing access, immediate improvements in access or alternative strategies arc urgently needed, and disparities in handwashing access should be incorporated into COVID-19 forecasting models when applied to low-income countries.