Health impact of small-community water supply reliability
Health impact of small-community water supply reliability
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DOI：
10.1016/j.ijheh.2010.10.005
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发表时间：
2011-03-01
影响因子：
6
通讯作者：
Hunter, Paul R.
中科院分区：
文献类型：
--
作者：
Majuru, Batsirai;Mokoena, M. Michael;Hunter, Paul R.
关于社区供水干预措施的健康益处，文献中仍然存在争议和不确定性。本文报告了与实施两个社区供水有关的自我报告腹泻发病率的变化。我们对三个社区的腹泻病进行了前瞻性的每周记录。其中两个社区计划得到改善的供水，一个社区预计将在研究期间继续依靠没有改善的水源。每周从每个参与家庭收集自我报告的腹泻数据，时间长达56周，其中约17周是在实施新的供水系统之前。使用广义估计方程(GEE)对数据进行建模，以考虑家庭和村庄内可能的集群。对于研究中的两个干预社区，干预后所有年龄段的发病率比(IRR)为0.43(95%可信区间0.24-0.79)，与对照社区(未接受干预)相比，这意味着腹泻减少了57%。两个新的供水系统都不可靠，一个在4周内不运行，另一个在16周内不运行。与最不可靠的干预系统相比，两种干预系统中较可靠的干预系统与较少的疾病相关(IRR=0.41，95%CI 0.21~0.80)。我们还注意到坊间报道，在新系统供应中断期间，一些人开始使用家用水处理。改进供水系统的实施似乎确实与社区中腹泻疾病的减少有关。然而，对健康的影响在系统更可靠的社区最为明显。需要做进一步的研究，以确定社区供水干预措施是否可以通过在供水中断期间偶尔使用家庭水处理(HWT)来利用公共卫生收益。(C)2010年爱思唯尔股份有限公司。版权所有。
There is still debate and uncertainty in the literature about the health benefits of community water supply interventions. This paper reports on a changing incidence of self-reported diarrhoea associated with the implementation of two community water supplies. We conducted prospective weekly recording of diarrhoeal disease in three communities. Two of the communities were scheduled to receive an improved water supply and one was expected to continue to rely on an unimproved source during the study period. Data of self-reported diarrhoea was collected from each participating household on a weekly basis for up to 56 weeks, of which some 17 weeks were prior to implementation of the new water supply systems. Data was modelled using Generalized Estimating Equations (GEE) to account for possible clustering within households and within villages. For the two intervention communities in the study, the incidence rate ratio (IRR) for all ages after the intervention was 0.43 (95% CI 0.24-0.79) when compared to the control community (who did not receive an intervention), implying a 57% reduction of diarrhoea. Both of the new water systems were unreliable, one not operating on 4 weeks and the other on 16 weeks. The more reliable of the two intervention systems was also associated with less illness than in the least reliable system (IRR = 0.41, 95% CI 0.21-0.80). We also noted anecdotal reports that during supply failures in the new systems some people were starting to use household water treatment. The implementation of improved water systems does appear to have been associated with a reduction of diarrhoeal disease in the communities. However the health impact was most obvious in the community with the more reliable system. Further research needs to be done to determine whether public health gains from community water supply interventions can be leveraged by occasional use of household water treatment (HWT) during supply failures. (C) 2010 Elsevier GmbH. All rights reserved.