Impact of a citywide sanitation program in Northeast Brazil on intestinal parasites infection in young children.
Impact of a citywide sanitation program in Northeast Brazil on intestinal parasites infection in young children.
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DOI：
10.1289/ehp.1002058
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发表时间：
2010-11
影响因子：
10.4
通讯作者：
Cairncross S
中科院分区：
文献类型：
--
作者：
Barreto ML;Genser B;Strina A;Teixeira MG;Assis AM;Rego RF;Teles CA;Prado MS;Matos S;Alcântara-Neves NM;Cairncross S
卫生影响健康，特别是幼儿的健康。巴西东北部萨尔瓦多的居民肠道寄生虫患病率很高。1996年开始的全市卫生干预措施旨在将下水道覆盖率从26%的家庭提高到80%。我们评估了这种干预措施对学龄前儿童蛔虫、鞭虫和贾第鞭毛虫感染患病率的影响。评价由两项横断面研究（1998年和2003-2004年）组成，每项研究的样本分别为681名和976名1-4岁儿童。儿童从24个哨点区域抽样，选择代表研究地点的环境条件范围。使用个人/家庭问卷收集数据，并在干预前后在每个区域进行环境调查，以评估家庭和社区的基本卫生条件。检查粪便样本是否存在肠道寄生虫。干预的效果是通过分层建模，拟合一系列多元回归模型来估计的。A.蛔虫感染率由24.4%降至12.0%;鞭虫为18.0%~ 5.0%;从14.1%降至5.3%。这一减少的大部分原因似乎是在干预期间建造的下水道系统在每个街区的覆盖面增加。因此，关键的解释变量是暴露的生态措施，而不是以家庭为基础的，这表明该计划预防的寄生虫传播主要是在公共（与国内）领域。这项研究，使用先进的统计模型来控制个人和生态潜在的混杂因素，证明了在大规模人群中实施的卫生改善对肠道寄生虫的影响。
Sanitation affects health, especially that of young children. Residents of Salvador, in Northeast Brazil, have had a high prevalence of intestinal parasites. A citywide sanitation intervention started in 1996 aimed to raise the level of sewer coverage from 26% to 80% of households. We evaluated the impact of this intervention on the prevalence of Ascaris lumbricoides, Trichuris trichuria, and Giardia duodenalis infections in preschool children. The evaluation was composed of two cross-sectional studies (1998 and 2003–2004), each of a sample of 681 and 976 children 1–4 years of age, respectively. Children were sampled from 24 sentinel areas chosen to represent the range of environmental conditions in the study site. Data were collected using an individual/household questionnaire, and an environmental survey was conducted in each area before and after the intervention to assess basic household and neighborhood sanitation conditions. Stool samples were examined for the presence of intestinal parasites. The effect of the intervention was estimated by hierarchical modeling, fitting a sequence of multivariate regression models. The prevalence of A. lumbricoides infection was reduced from 24.4% to 12.0%, T. trichuria from 18.0% to 5.0%, and G. duodenalis from 14.1% to 5.3%. Most of this reduction appeared to be explained by the increased coverage in each neighborhood by the sewage system constructed during the intervention. The key explanatory variable was thus an ecological measure of exposure and not household-based, suggesting that the parasite transmission prevented by the program was mainly in the public (vs. the domestic) domain. This study, using advanced statistical modeling to control for individual and ecological potential confounders, demonstrates the impact on intestinal parasites of sanitation improvements implemented at the scale of a large population.
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影响因子：
7.7
作者：
BLUM, D;FEACHEM, RG
通讯作者：
FEACHEM, RG
影响因子：
5.4
作者：
Genser, Bernd;Strina, Agostino;Barreto, Mauricio L.
通讯作者：
Barreto, Mauricio L.
影响因子：
10.4
作者：
Prüss, A;Kay, D;Bartram, J
通讯作者：
Bartram, J
影响因子：
168.9
作者：
Berkman, DS;Lescano, AG;Black, MM
通讯作者：
Black, MM
影响因子：
3.8
作者：
Mascarini-Serra, Luciene Maura;Telles, Carlos A.;Barreto, Mauricio L.
通讯作者：
Barreto, Mauricio L.