Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial
Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial
复制标题
DOI：
10.1016/s2214-109x(15)00144-8
复制
发表时间：
2015-11-01
影响因子：
34.3
通讯作者：
Laura Alzua, Maria
中科院分区：
文献类型：
--
作者：
Pickering, Amy J.;Djebbari, Habiba;Laura Alzua, Maria
社区主导的全面卫生（CLTS）采用参与性方法动员社区建造自己的厕所，并停止露天排便。我们的目的是进行CLTS的第一个随机试验，以评估其对儿童健康的影响在库利科罗，Mali.Methods我们做了一个集群随机试验，以评估由马里政府实施的CLTS计划。研究人群包括马里库利科罗区农村村庄（集群）的家庭;每个家庭必须至少有一个10岁以下的孩子。由研究人员按照计算机生成的序列将村庄随机分配（1：1），接受CLTS或不接受方案。健康结局包括腹泻（主要结局）、年龄别身高、年龄别体重、发育迟缓和体重不足。在5岁以下的儿童中，在干预分娩后1.5年（入学后2年）测量结果。参与者未对干预分配设盲。该试验在ClinicalTrials.gov注册，编号NCT 01900912。结果我们在2011年4月12日至6月23日期间招募了参与者。我们分配了60个村庄（2365户）接受CLTS干预，61个村庄（2167户）为对照组。在CLTS和对照村庄的儿童中没有观察到任何差异（3140名CLTS儿童中的706名[22%] vs 2872名对照儿童中的693名[24%];患病率[PR] 0.93，95%CI 0.76-1.14）。在采取干预措施的村庄，使用私人厕所的人数几乎是原来的两倍（2120户中的1373户[65%]对1911户中的661户[35%]），女性报告的露天排便减少（2086户中的198户[9%]对1869户中的608户[33%]）和男性（2004年的195户[10%]对1813户中的602户[33%]）成人。CLTS村庄的儿童比对照村庄的儿童更高（年龄别身高Z评分增加0.18，95% CI 0.03-0.32; 2415名儿童），发育迟缓的可能性更低（35% vs 41%，PR 0.86，95% CI 0.74-1.0）。CLTS中22%的儿童体重不足，而对照村庄为26%（PR 0.88，95% CI 0.71-1.08），两组之间年龄别平均体重Z评分的差异为0.09（95% CI -0.04至0.22）。在CLTS村庄，入学时年龄较小的儿童（
Background Community-led total sanitation (CLTS) uses participatory approaches to mobilise communities to build their own toilets and stop open defecation. Our aim was to undertake the first randomised trial of CLTS to assess its effect on child health in Koulikoro, Mali.Methods We did a cluster-randomised trial to assess a CLTS programme implemented by the Government of Mali. The study population included households in rural villages (clusters) from the Koulikoro district of Mali; every household had to have at least one child aged younger than 10 years. Villages were randomly assigned (1: 1) with a computer-generated sequence by a study investigator to receive CLTS or no programme. Health outcomes included diarrhoea (primary outcome), height for age, weight for age, stunting, and underweight. Outcomes were measured 1.5 years after intervention delivery (2 years after enrolment) among children younger than 5 years. Participants were not masked to intervention assignment. The trial is registered with ClinicalTrials.gov, number NCT01900912.Findings We recruited participants between April 12, and June 23, 2011. We assigned 60 villages (2365 households) to receive the CLTS intervention and 61 villages (2167 households) to the control group. No differences were observed in terms of diarrhoeal prevalence among children in CLTS and control villages (706 [22%] of 3140 CLTS children vs 693 [24%] of 2872 control children; prevalence ratio [PR] 0.93, 95% CI 0.76-1.14). Access to private latrines was almost twice as high in intervention villages (1373 [65%] of 2120 vs 661 [35%] of 1911 households) and reported open defecation was reduced in female (198 [9%] of 2086 vs 608 [33%] of 1869 households) and in male (195 [10%] of 2004 vs 602 [33%] of 1813 households) adults. Children in CLTS villages were taller (0.18 increase in height-for-age Z score, 95% CI 0.03-0.32; 2415 children) and less likely to be stunted (35% vs 41%, PR 0.86, 95% CI 0.74-1.0) than children in control villages. 22% of children were underweight in CLTS compared with 26% in control villages (PR 0.88, 95% CI 0.71-1.08), and the difference in mean weight-for-age Z score was 0.09 (95% CI -0.04 to 0.22) between groups. In CLTS villages, younger children at enrolment (