Water, sanitation and hygiene for the prevention of diarrhoea
Water, sanitation and hygiene for the prevention of diarrhoea
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DOI：
10.1093/ije/dyq035
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发表时间：
2010-04-01
影响因子：
7.7
通讯作者：
Schmidt, Wolf-Peter
中科院分区：
文献类型：
--
作者：
Cairncross, Sandy;Hunt, Caroline;Schmidt, Wolf-Peter
背景自从约翰·斯诺对布罗德·ST水泵进行干预以来，水质、卫生和卫生在预防腹泻死亡方面的作用一直存在争议。以前的综述中发现的证据质量参差不齐，主要涉及发病率而不是死亡率。方法我们引用了三篇系统评价，其中两篇是Cochrane合作的，分别侧重于肥皂洗手对腹泻、水质改善和排泄物处理的影响。结果肥皂洗手的显著效果在不同的研究设计和病原体中是一致的，尽管它依赖于水的获取。水处理的效果似乎也很大，但在少数盲目研究中没有发现，这表明这可能部分是由于安慰剂效应。卫生设施的健康益处几乎没有严格的证据；最终确定了4项干预研究，尽管它们都是准随机的，结果是发病率，而且都是中文的。结论我们建议将腹泻风险分别降低48%、17%和36%，并用肥皂洗手、改善水质和排泄物处理作为LIST模型的效果估计。大多数证据的质量都很差。需要进行更多的试验，但证据仍然足够有力，足以支持为所有人提供供水、环境卫生和个人卫生。
Background Ever since John Snow's intervention on the Broad St pump, the effect of water quality, hygiene and sanitation in preventing diarrhoea deaths has always been debated. The evidence identified in previous reviews is of variable quality, and mostly relates to morbidity rather than mortality.Methods We drew on three systematic reviews, two of them for the Cochrane Collaboration, focussed on the effect of handwashing with soap on diarrhoea, of water quality improvement and of excreta disposal, respectively. The estimated effect on diarrhoea mortality was determined by applying the rules adopted for this supplement, where appropriate.Results The striking effect of handwashing with soap is consistent across various study designs and pathogens, though it depends on access to water. The effect of water treatment appears similarly large, but is not found in few blinded studies, suggesting that it may be partly due to the placebo effect. There is very little rigorous evidence for the health benefit of sanitation; four intervention studies were eventually identified, though they were all quasi-randomized, had morbidity as the outcome, and were in Chinese.Conclusion We propose diarrhoea risk reductions of 48, 17 and 36%, associated respectively, with handwashing with soap, improved water quality and excreta disposal as the estimates of effect for the LiST model. Most of the evidence is of poor quality. More trials are needed, but the evidence is nonetheless strong enough to support the provision of water supply, sanitation and hygiene for all.