Integrating disease control strategies: Balancing water sanitation and hygiene interventions to reduce diarrheal disease burden
Integrating disease control strategies: Balancing water sanitation and hygiene interventions to reduce diarrheal disease burden
复制标题
DOI：
10.2105/ajph.2006.086207
复制
发表时间：
2007-05-01
影响因子：
12.7
通讯作者：
Porco, Travis
中科院分区：
文献类型：
--
作者：
Eisenberg, Joseph N. S.;Scott, James C.;Porco, Travis
目标。尽管水质、卫生做法和个人卫生不足造成的腹泻病负担仍然很高，但人们对这些环境控制战略的整合知之甚少。我们测试了一个旨在捕捉肠道病原体相互依赖的传播途径的建模框架。我们建立了一个家庭水平的随机模型，考虑了5种不同的传播途径。我们通过比较两种情况：所有家庭完全接触受污染的饮用水和所有接受水质干预的家庭，来评估通过水处理可以预防的疾病。我们发现，水质干预的益处取决于卫生和卫生条件。当卫生条件较差时，无论水污染程度如何，改善水质的影响可能微乎其微。如果每条传播途径本身足以维持腹泻疾病，单途径干预的益处将微乎其微，最终，只有消除所有足够的途径，干预才会成功。然而，当一条途径对维持疾病至关重要时，公共卫生努力应该集中在这条关键途径上。我们的发现为理解如何通过综合控制策略最好地减少和消除腹泻疾病提供了指导。
Objectives. Although the burden of diarrheal disease resulting from inadequate water quality, sanitation practices, and hygiene remains high, there is little understanding of the integration of these environmental control strategies. We tested a modeling framework designed to capture the interdependent transmission pathways of enteric pathogens.Methods. We developed a household-level stochastic model accounting for 5 different transmission pathways. We estimated disease preventable through water treatment by comparing 2 scenarios: all households fully exposed to contaminated drinking water and all households receiving the water quality intervention.Results. We found that the benefits of a water quality intervention depend on sanitation and hygiene conditions. When sanitation conditions are poor, water quality improvements may have minimal impact regardless of amount of water contamination. If each transmission pathway alone is sufficient to maintain diarrheal disease, single-pathway interventions will have minimal benefit, and ultimately an intervention will be successful only if all sufficient pathways are eliminated. However, when 1 pathway is critical to maintaining the disease, public health efforts should focus on this critical pathway.Conclusions. Our findings provide guidance in understanding how to best reduce and eliminate diarrheal disease through integrated control strategies.