I get height with a little help from my friends: herd protection from sanitation on child growth in rural Ecuador
I get height with a little help from my friends: herd protection from sanitation on child growth in rural Ecuador
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DOI：
10.1093/ije/dyv368
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发表时间：
2016-04-01
影响因子：
7.7
通讯作者：
Eisenberg, Joseph N. S.
中科院分区：
文献类型：
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作者：
Fuller, James A.;Villamor, Eduardo;Eisenberg, Joseph N. S.
背景：传染病干预措施，如疫苗和蚊帐，有可能为非接受者提供羊群保护。同样，如果改善一个家庭的卫生条件可以减少共享环境中的污染，那么它可能会带来整个社区的好处。家庭层面的卫生状况是儿童生长发育的重要预测指标，但对社区卫生状况的影响知之甚少。方法：从2008年到2013年，我们对厄瓜多尔24个农村村庄的1314名5岁以下儿童进行了重复的人体测量。结果：周围家庭卫生覆盖率与儿童身高密切相关，100%覆盖率的儿童发育迟缓患病率比0覆盖率低67%[患病率(PR)0.32，95%可信区间0.15~0.69]。卫生条件较好的家庭儿童发育迟缓的发生率较低(PR为0.86，95%CI为0.64~1.15)。当分析身高作为一个连续的结果时，卫生覆盖的保护作用主要体现在生命第二年的女孩身上，这是最有可能发生发育迟缓的时候。结论：我们的研究强调了家庭的卫生做法可以为整个社区提供牛群保护。没有考虑到卫生设施提供的积极外部性的研究将低估整体的保护效果。未来的研究可能寻求确定卫生覆盖率的门槛，类似于群体免疫门槛，以提供覆盖率和合规目标。
Background: Infectious disease interventions, such as vaccines and bed nets, have the potential to provide herd protection to non-recipients. Similarly, improved sanitation in one household may provide community-wide benefits if it reduces contamination in the shared environment. Sanitation at the household level is an important predictor of child growth, but less is known about the effect of sanitation coverage in the community.Methods: From 2008 to 2013, we took repeated anthropometric measurements on 1314 children under 5 years of age in 24 rural Ecuadorian villages. Using mixed effects regression, we estimated the association between sanitation coverage in surrounding households and child growth.Results: Sanitation coverage in the surrounding households was strongly associated with child height, as those with 100% coverage in their surroundings had a 67% lower prevalence of stunting [prevalence ratio (PR) 0.32, 95% CI 0.15-0.69] compared with those with 0% coverage. Children from households with improved sanitation had a lower prevalence of stunting (PR 0.86, 95% CI 0.64-1.15). When analysing height as a continuous outcome, the protective effect of sanitation coverage is manifested primarily among girls during the second year of life, the time at which growth faltering is most likely to occur.Conclusions: Our study highlights that a household's sanitation practices can provide herd protection to the overall community. Studies which fail to account for the positive externalities that sanitation provides will underestimate the overall protective effect. Future studies could seek to identify a threshold of sanitation coverage, similar to a herd immunity threshold, to provide coverage and compliance targets.