Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies
Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies
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DOI：
10.1016/s0140-6736(07)61638-9
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发表时间：
2007-11-10
期刊：
影响因子：
168.9
通讯作者：
Caimcross, Sandy
中科院分区：
文献类型：
--
作者：
Barreto, Mauricio L.;Genser, Bernd;Caimcross, Sandy
背景 1997 年，巴西萨尔瓦多启动了全市范围的卫生干预措施，将污水处理系统覆盖率从 26% 的家庭提高到 80%。我们的目的是调查这项全市卫生计划对 3 岁以下儿童腹泻发病率的流行病学影响。 方法 这项调查由 1997-98 年干预前（卫生计划）和 2003-04 年干预完成后进行的两项纵向研究组成。每项研究均由一组儿童组成（干预前研究为 841 名，干预后研究为 1007 名；基线年龄为 0-36 个月），随访时间最长为 8 个月。儿童样本是从 24 个哨点区域随机选择的，代表研究地点的环境条件范围。在每项研究开始时，受过培训的实地工作人员都会对个人或家庭进行问卷调查；在实施环境卫生方案之前和之后，对每个地区进行了环境调查，以评估基本的社区和家庭卫生条件。每周两次家访期间获得每日腹泻数据。干预效果通过拟合一系列多元回归模型的分层建模方法进行评估。 结果 腹泻患病率下降了 21% (95% CI 18-25%)，从干预前的每儿童年 9.2 (9-0-9-5) 天下降到干预后的每儿童年 7.3 (7.0-7.5) 天。在对基线污水覆盖率和潜在混杂变量进行调整后，我们估计总体患病率下降了 22% (19-26%)。 解释 我们的结果表明，城市环境卫生是一项不再被忽视的高效健康措施，它们为启动 2008 年国际环境卫生年提供了及时的支持。
Background A city-wide sanitation intervention was started in Salvador, Brazil, in 1997 to improve sewerage coverage from 26% of households to 80%. Our aim was to investigate the epidemiological effect of this city-wide sanitation programme on diarrhoea morbidity in children less than 3 years of age.Methods The investigation was composed of two longitudinal studies done in 1997-98 before the intervention (the sanitation programme) and in 2003-04 after the intervention had been completed. Each study consisted of a cohort of children (841 in the preintervention study and 1007 in the postintervention. study; age 0-36 months at baseline) who were followed up for a maximum of 8 months. Children were sampled from 24 sentinel areas that were randomly chosen to represent the range of environmental conditions in the study site. At the start of each study an individual or household questionnaire was applied by trained fieldworkers; an environmental survey was done in each area before and after introduction of the sanitation programme to assess basic neighbourhood and household sanitation conditions. Daily diarrhoea data were obtained during home visits twice per week. The effect of the intervention was estimated by a hierarchical modelling approach fitting a sequence of multivariate regression models.Findings Diarrhoea prevalence fell by 21% (95% CI 18-25%)-from 9.2 (9-0-9-5) days per child-year before the intervention to 7.3 (7.0-7.5) days per child-year afterwards. After adjustment for baseline sewerage coverage and potential confounding variables, we estimated an overall prevalence reduction of 22% (19-26%).Interpretation Our results show that urban sanitation is a highly effective health measure that can no longer be ignored, and they provide a timely support for the launch of 2008 as the International Year of Sanitation.