A controlled, before-and-after trial of an urban sanitation intervention to reduce enteric infections in children: research protocol for the Maputo Sanitation (MapSan) study, Mozambique.
A controlled, before-and-after trial of an urban sanitation intervention to reduce enteric infections in children: research protocol for the Maputo Sanitation (MapSan) study, Mozambique.
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对城市卫生干预措施的受控，前后试验，以减少儿童肠道感染：莫桑比克的马普托卫生研究方案（Mapsan）研究。
DOI：
10.1136/bmjopen-2015-008215
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发表时间：
2015-06-18
期刊：
影响因子：
2.9
通讯作者：
Schmidt WP
中科院分区：
文献类型：
--
作者：
Brown J;Cumming O;Bartram J;Cairncross S;Ensink J;Holcomb D;Knee J;Kolsky P;Liang K;Liang S;Nala R;Norman G;Rheingans R;Stewart J;Zavale O;Zuin V;Schmidt WP
自1990年以来，撒哈拉以南非洲低收入非正规住区获得安全卫生设施的情况没有显著改善。与粪便有关的疾病负担高，基础设施不足，这两个因素表明，在人口密集的城市贫民窟投资扩大卫生设施，可以产生重要的公共卫生收益。没有严格的，受控的干预研究已经评估了分散（非污水）卫生设施在非正式城市环境中的健康影响，尽管这些技术可能会在扩大获得方面发挥作用。我们设计了一个对照，前后（CBA）试验，以估计在莫桑比克马普托的非正式社区的城市卫生干预的健康影响，包括评估暴露和健康结果是否因当地人口密度而异。干预措施包括由大院或住户群中的多户共用私人冲水厕所（至化粪池）。我们将在两个时间点测量约760名儿童的客观健康结果（380名家庭获得干预措施的儿童，380名使用卫生条件差的现有共用私人厕所的匹配对照）：干预前和12个月后的随访。 主要结果是5岁以下儿童中选定肠道感染的合并患病率。 次要结果指标包括基线驱虫后儿童的土源性蠕虫（STH）再感染和报告的肠道疾病患病率。我们将使用暴露评估，粪便源跟踪和微生物传播模型来研究引入有效卫生设施后，致病性病原体和STH的暴露途径是否以及如何发生变化。研究方案已经由伦敦卫生和热带医学学院、格鲁吉亚理工学院、查佩尔山的北卡罗来纳州大学和莫桑比克共和国卫生部的人类受试者审查委员会审查和批准。NCT 02362932。
Access to safe sanitation in low-income, informal settlements of Sub-Saharan Africa has not significantly improved since 1990. The combination of a high faecal-related disease burden and inadequate infrastructure suggests that investment in expanding sanitation access in densely populated urban slums can yield important public health gains. No rigorous, controlled intervention studies have evaluated the health effects of decentralised (non-sewerage) sanitation in an informal urban setting, despite the role that such technologies will likely play in scaling up access. We have designed a controlled, before-and-after (CBA) trial to estimate the health impacts of an urban sanitation intervention in informal neighbourhoods of Maputo, Mozambique, including an assessment of whether exposures and health outcomes vary by localised population density. The intervention consists of private pour-flush latrines (to septic tank) shared by multiple households in compounds or household clusters. We will measure objective health outcomes in approximately 760 children (380 children with household access to interventions, 380 matched controls using existing shared private latrines in poor sanitary conditions), at 2 time points: immediately before the intervention and at follow-up after 12 months. The primary outcome is combined prevalence of selected enteric infections among children under 5 years of age. Secondary outcome measures include soil-transmitted helminth (STH) reinfection in children following baseline deworming and prevalence of reported diarrhoeal disease. We will use exposure assessment, faecal source tracking, and microbial transmission modelling to examine whether and how routes of exposure for diarrhoeagenic pathogens and STHs change following introduction of effective sanitation. Study protocols have been reviewed and approved by human subjects review boards at the London School of Hygiene and Tropical Medicine, the Georgia Institute of Technology, the University of North Carolina at Chapel Hill, and the Ministry of Health, Republic of Mozambique. NCT02362932.
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