Effect of home-based water chlorination and safe storage on diarrhea among persons with human immunodeficiency virus in Uganda
Effect of home-based water chlorination and safe storage on diarrhea among persons with human immunodeficiency virus in Uganda
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DOI：
10.4269/ajtmh.2005.73.926
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发表时间：
2005-11-01
影响因子：
3.3
通讯作者：
Quick, R
中科院分区：
文献类型：
--
作者：
Lule, JR;Mermin, J;Quick, R
腹泻在人类免疫缺陷病毒（HIV）感染者中很常见，但非洲人很少有干预措施。我们进行了一项随机对照试验，对生活在乌干达农村的艾滋病毒感染者中腹泻的发生率和严重程度进行了以家庭为基础的安全饮用水干预。在2001年4月至2002年11月期间，509名艾滋病毒感染者和1521名艾滋病毒阴性家庭成员的家庭获得了一个闭口塑料容器、稀释氯溶液和卫生教育（安全用水系统[SWS]）或单纯的卫生教育。5个月后，hiv阳性参与者每天接受复方新诺明预防治疗（160毫克甲氧苄啶和800毫克磺胺甲恶唑），并随访1.5年。使用SWS的HIV感染者腹泻发作减少25%（校正发病率比[IRR] = 0.75, 95%可信区间[CI] = 0.59-0.94, P = 0.015），腹泻天数减少33% (IRR = 0.67, 95% CI = 0.48-0.94, P = 0.021)，粪便中可见血液或粘液较少（28%对39%，P < 0.0001）。SWS在有或没有复方新诺明预防的情况下同样有效（相互作用的P = 0.73），它们共同减少了67%的腹泻发作（IRR = 0.33, 95% CI = 0.24-0.46, P < 0.0001），减少了54%的腹泻天数（IRR = 0.46, 95% CI = 0.32-0.66, P < 0.0001），减少了47%的因腹泻而旷课或旷课的天数（IRR = 0.53, 95% CI = 0.34-0.83 P < 0.0056）。应考虑建立以家庭为基础的安全饮水系统，以减少非洲艾滋病毒感染者腹泻的频率和严重程度，并大规模实施。
Diarrhea is frequent among persons infected with human immunodeficiency virus (HIV) but few interventions are available for people in Africa. We conducted a randomized controlled trial of a home-based, safe water intervention on the incidence and severity of diarrhea among persons with HIV living in rural Uganda. Between April 2001 and November 2002, households of 509 persons with HIV and 1,521 HIV-negative household members received a closed-mouth plastic container, a dilute chlorine solution, and hygiene education (safe water system [SWS]) or simply hygiene education alone. After five months, HIV-positive participants received daily cotrimoxazole prophylaxis (160 mg of trimethoprim and 800 mg of sulfamethoxazole) and were followed for an additional 1.5 years. Persons with HIV using SWS had 25% fewer diarrhea episodes (adjusted incidence rate ratio [IRR] = 0.75, 95% confidence interval [CI] = 0.59-0.94, P = 0.015), 33% fewer days with diarrhea (IRR = 0.67, 95% CI = 0.48-0.94, P = 0.021), and less visible blood or mucus in stools (28% versus 39%; P < 0.0001). The SWS was equally effective with or without cotrimoxazole prophylaxis (P = 0.73 for interaction), and together they reduced diarrhea episodes by 67% (IRR = 0.33, 95% CI = 0.24-0.46, P < 0.0001), days with diarrhea by 54% (IRR = 0.46, 95% CI = 0.32-0.66, P < 0.0001), and days of work or school lost due to diarrhea by 47% (IRR = 0.53, 95% CI = 0.34-0.83 P < 0.0056). A home-based safe water system reduced diarrhea frequency and severity among persons with HIV living in Africa and large scale implementation should be considered.