Evaluations of water, sanitation and hygiene interventions should not use diarrhoea as (primary) outcome.
Evaluations of water, sanitation and hygiene interventions should not use diarrhoea as (primary) outcome.
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DOI：
10.1136/bmjgh-2022-008521
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发表时间：
2022-05
影响因子：
8.1
通讯作者：
Lilford, Richard J.
中科院分区：
文献类型：
--
作者：
Watson, Samuel, I;Rego, Ryan T. T.;Hofer, Timothy;Lilford, Richard J.
近年来，水、环境卫生和个人卫生干预措施一直是规模、规模和成本都前所未有的集群试验的主题。然而，问题是“什么在水、环境卫生和个人卫生方面起作用？”仍然知之甚少。对预防传染病的社区干预措施的评估通常使用实验室确认的感染作为主要结果;然而，WASH试验主要使用报告的腹泻。虽然腹泻是发病率的一个重要来源，但由于存在非感染性腹泻和无症状感染，因此在肠道感染方面存在重大错误分类。我们展示了这可能导致WASH试验的干预措施的估计效果出现偏差。测量过程中的其他偏差使问题进一步复杂化。除了测试肠道感染外，对WASH干预措施背后的因果假设的研究还提出了其他几种可靠的替代和补充测量方法和结果。当代指导评价复杂的干预措施，要求研究人员采取广泛的观点的因果关系的影响，干预整个系统。报告的腹泻甚至不能作为衡量胃肠道健康变化的可靠指标，因此如果我们要进一步了解WASH的作用，就不应将其作为主要结局。
Water, sanitation and hygiene interventions have been the subject of cluster trials of unprecedented size, scale and cost in recent years. However, the question ‘what works in water, sanitation, hygiene (WASH)?’ remains poorly understood. Evaluations of community interventions to prevent infectious disease typically use lab-confirmed infection as a primary outcome; however, WASH trials mostly use reported diarrhoea. While diarrhoea is a significant source of morbidity, it is subjected to significant misclassification error with respect to enteric infection due to the existence of non-infectious diarrhoea and asymptomatic infection. We show how this may lead to bias of estimated effects of interventions from WASH trials towards no effect. The problem is further compounded by other biases in the measurement process. Alongside testing for infection of the gut, an examination of the causal assumptions underlying WASH interventions present several other reliable alternative and complementary measurements and outcomes. Contemporary guidance on the evaluation of complex interventions requires researchers to take a broad view of the causal effects of an intervention across a system. Reported diarrhoea can fail to even be a reliable measure of changes to gastrointestinal health and so should not be used as a primary outcome if we are to progress our knowledge of what works in WASH.
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DOI：
10.1016/s2214-109x(21)00316-8
发表时间：
2021-10
期刊：
The Lancet. Global health
影响因子：
--
作者：
Baker JM;Hasso-Agopsowicz M;Pitzer VE;Platts-Mills JA;Peralta-Santos A;Troja C;Archer H;Guo B;Sheahan W;Lingappa J;Jit M;Lopman BA
通讯作者：
Lopman BA
影响因子：
168.9
作者：
Kotloff, Karen L.;Nataro, James P.;Levine, Myron M.
通讯作者：
Levine, Myron M.
影响因子：
7.7
作者：
ALAM, N;HENRY, FJ;RAHAMAN, MM
通讯作者：
RAHAMAN, MM
影响因子：
12.7
作者：
Eisenberg, Joseph N. S.;Scott, James C.;Porco, Travis
通讯作者：
Porco, Travis
肯尼亚多次传入与急性感染和无症状携带有关的多重耐药伤寒。
影响因子：
7.7
作者：
Kariuki S;Dyson ZA;Mbae C;Ngetich R;Kavai SM;Wairimu C;Anyona S;Gitau N;Onsare RS;Ongandi B;Duchene S;Ali M;Clemens JD;Holt KE;Dougan G
通讯作者：
Dougan G