Re: Estimating the Effect of School Water, Sanitation, and Hygiene Improvements on Pupil Health Outcomes.
Re: Estimating the Effect of School Water, Sanitation, and Hygiene Improvements on Pupil Health Outcomes.
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回复：估计学校用水、环境卫生和个人卫生改善对学生健康结果的影响。
DOI：
10.1097/ede.0000000000000616
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Arnold,BenjaminF
中科院分区：
文献类型：
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作者：
Arnold,BenjaminF
在对一项为肯尼亚农村学校提供水、卫生设施和洗手(洗手)改善组合的整群随机试验的出色重新分析中，Garn及其同事1展示了不完美的遵从性如何可能通过将其与编撰者的平均因果效应估计进行比较来削弱一些意向治疗估计--遵守干预任务的学校子组中的干预效果。由于在平行ARM试验中不能观察到合并者的子组，2 Garn和他的同事1使用工具变量(IV)技术来估计合并者的平均因果效应，这是值得称赞的，因为它扩展了原始试验的推理。首先，希望使用IV技术来估计编制者对感染结果的平均因果影响的社区试验应该在随机水平上定义遵从性--个人水平的定义通常是有问题的(图)。其次，多方面干预的合规定义是集中的
In their excellent re-analysis of a cluster-randomized trial that delivered combinations of water, sanitation, and handwashing (WASH) improvements to schools in rural Kenya, Garn and colleagues1 showed how imperfect compliance likely attenuated some intention-to-treat estimates by comparing them with complier average causal effect estimates—the effect of the intervention among the subgroup of schools that complied with their intervention assignment. Because the subgroup of compliers cannot be observed in a parallel arm trial, 2 Garn and colleagues1 used an instrumental variables (IV) technique to estimate complier average causal effects, and should be commended for extending the original trial’s inference.The article illustrates two more general issues related to compliance definitions in community intervention trials. First, community trials that wish to use IV techniques to estimate complier average causal effects for infectious outcomes should define compliance at the level of randomization—individual-level definitions are generally problematic (Figure). Second, the definition of compliance for a multifaceted intervention is centrally