Improved household flooring is associated with lower odds of enteric and parasitic infections in low- and middle-income countries: A systematic review and meta-analysis.
Improved household flooring is associated with lower odds of enteric and parasitic infections in low- and middle-income countries: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pgph.0002631
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发表时间：
2023
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肠道和寄生虫感染，如土壤传播的蠕虫，在低收入和中等收入环境中造成相当大的死亡率和发病率。在许多这些环境中，土制家庭地板很常见，可能成为肠道和寄生虫病原体的储存库，这些病原体很容易通过直接或间接接触传播给新的宿主。我们进行了系统回顾和荟萃分析，以确定与居住在未改善地板的家庭中的居住者相比，改善家庭地板是否以及在多大程度上降低了居住者肠道和寄生虫感染的几率。根据PRISMA指南，我们全面检索了四个电子数据库，以了解在低收入和中等收入环境中进行的研究，这些研究将家庭地板作为暴露，并将自我报告的腹泻或任何类型的肠道或泌尿道寄生虫感染作为结果。从合格研究中提取元数据，并在导入R软件平台进行分析之前转移到研究数据库中。研究质量评估采用了一个改编版的纽卡斯尔-渥太华质量评估量表。共有110项研究符合纳入系统综述的条件，其中65项在应用研究质量截止值后符合纳入荟萃分析的条件。随机效应荟萃分析表明，与未改善地板的家庭相比，改善地板的家庭感染任何类型的肠道或寄生虫感染的几率为0.75倍（95 CI：0.67-0.83）。改良地板对蠕虫感染的合并保护性OR为0.68（95 CI：0.58-0.8），对细菌或原生动物感染的合并保护性OR为0.82（95 CI：0.75-0.9）。总体研究质量较差，迫切需要高质量的实验研究来调查这种关系。然而，这项研究表明，在低收入和中等收入环境中，家庭地板可能会对肠道和寄生虫感染的疾病负担产生重大影响。
Enteric and parasitic infections such as soil-transmitted helminths cause considerable mortality and morbidity in low- and middle-income settings. Earthen household floors are common in many of these settings and could serve as a reservoir for enteric and parasitic pathogens, which can easily be transmitted to new hosts through direct or indirect contact. We conducted a systematic review and meta-analysis to establish whether and to what extent improved household floors decrease the odds of enteric and parasitic infections among occupants compared with occupants living in households with unimproved floors. Following the PRISMA guidelines, we comprehensively searched four electronic databases for studies in low- and middle-income settings measuring household flooring as an exposure and self-reported diarrhoea or any type of enteric or intestinal-parasitic infection as an outcome. Metadata from eligible studies were extracted and transposed on to a study database before being imported into the R software platform for analysis. Study quality was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale. In total 110 studies were eligible for inclusion in the systematic review, of which 65 were eligible for inclusion in the meta-analysis after applying study quality cut-offs. Random-effects meta-analysis suggested that households with improved floors had 0.75 times (95CI: 0.67–0.83) the odds of infection with any type of enteric or parasitic infection compared with household with unimproved floors. Improved floors gave a pooled protective OR of 0.68 (95CI: 0.58–0.8) for helminthic infections and 0.82 OR (95CI: 0.75–0.9) for bacterial or protozoan infections. Overall study quality was poor and there is an urgent need for high-quality experimental studies investigating this relationship. Nevertheless, this study indicates that household flooring may meaningfully contribute towards a substantial portion of the burden of disease for enteric and parasitic infections in low- and middle-income settings.