Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Child Enteric Protozoan Infections in Rural Bangladesh: A Cluster-Randomized Controlled Trial.
Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Child Enteric Protozoan Infections in Rural Bangladesh: A Cluster-Randomized Controlled Trial.
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DOI：
10.1093/cid/ciy320
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发表时间：
2018-10-30
期刊：
影响因子：
--
通讯作者：
Luby SP
中科院分区：
文献类型：
--
作者：
Lin A;Ercumen A;Benjamin-Chung J;Arnold BF;Das S;Haque R;Ashraf S;Parvez SM;Unicomb L;Rahman M;Hubbard AE;Stewart CP;Colford JM Jr;Luby SP
该试验发现，个人洗手和卫生干预显著减少了儿童贾第鞭毛虫感染。联合干预没有提供额外的益处。为了减少贾第鞭毛虫感染，在类似的农村低收入环境中，单独的干预措施可能比联合干预措施更可行和更具成本效益。我们评估了单独和联合的水、卫生、洗手和营养干预对儿童原生动物感染的影响。我们将孟加拉国农村的孕妇随机分为氯化饮用水组、卫生设施组、洗手组、营养组、清洁卫生联合组、营养加清洁卫生组（N+WSH）组或对照组。参与者没有被蒙面。经过大约2.5年的干预，我们通过儿童粪便多重实时聚合酶链反应测量贾第鞭毛虫、隐孢子虫和溶组织内阿米巴原虫的患病率和感染强度。分析是意向治疗。在2012年5月至2013年7月期间，我们随机选取了5551名孕妇。在随访中，在4102名妇女中，我们招募了6694名儿童参加原生动物评估。我们分析了5933名儿童（年龄~31个月）的粪便中是否有原虫感染。与对照组的35.5%相比，卫生设施中的贾第鞭毛虫感染率较低（26.5%）；患病率[PR]为0.75[95%可信区间{CI}， 0.64 -。[88])，洗手(28.2%；PR, 0.80 [95% CI, 0.66 -]。[96]), WSH (29.7%; pr, 0.83 [95% ci, 0.72 -]。[96]), N+WSH (26.7%； PR, 0.75 [95% CI, 0.64 -]。88年])武器。水和营养干预没有效果。溶组织芽胞杆菌和隐孢子虫的低患病率（<2%）导致不精确的效果估计。个人洗手和个人卫生干预措施显著减少了儿童贾第鞭毛虫感染，在这种情况下，氯化饮用水和营养改善没有效果。WSH联合干预措施没有提供额外的益处。为了减少贾第鞭毛虫感染，在类似的农村低收入环境中，单独的水卫生干预措施可能比联合干预措施更可行和更具成本效益。NCT01590095。
The trial found that individual handwashing and sanitation interventions significantly reduced childhood Giardia infections. Combined interventions provided no additional benefit. To reduce Giardia infection, individual interventions may be more feasible and cost-effective than combined interventions in similar rural, low-income settings. We evaluated effects of individual and combined water, sanitation, handwashing (WSH), and nutritional interventions on protozoan infections in children. We randomized geographical clusters of pregnant women in rural Bangladesh into chlorinated drinking water, hygienic sanitation, handwashing, nutrition, combined WSH, nutrition plus WSH (N+WSH), or control arms. Participants were not masked. After approximately 2.5 years of intervention, we measured Giardia, Cryptosporidium, and Entamoeba histolytica prevalence and infection intensity by multiplex real-time polymerase chain reaction of child stool. Analysis was intention-to-treat. Between May 2012 and July 2013, we randomized 5551 pregnant women. At follow-up, among 4102 available women, we enrolled 6694 children into the protozoan assessment. We analyzed stool from 5933 children (aged ~31 months) for protozoan infections. Compared with 35.5% prevalence among controls, Giardia infection prevalence was lower in the sanitation (26.5%; prevalence ratio [PR], 0.75 [95% confidence interval {CI}, .64–.88]), handwashing (28.2%; PR, 0.80 [95% CI, .66–.96]), WSH (29.7%; PR, 0.83 [95% CI, .72–.96]), and N+WSH (26.7%; PR, 0.75 [95% CI, .64–.88]) arms. Water and nutrition interventions had no effect. Low prevalence of E. histolytica and Cryptosporidium (<2%) resulted in imprecise effect estimates. Individual handwashing and hygienic sanitation interventions significantly reduced childhood Giardia infections, and there were no effects of chlorinated drinking water and nutrition improvements in this context. Combined WSH interventions provided no additional benefit. To reduce Giardia infection, individual WSH interventions may be more feasible and cost-effective than combined interventions in similar rural, low-income settings. NCT01590095.
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影响因子：
4
作者：
Carmena, D.;Aguinagalde, X.;Ocio, J. A.
通讯作者：
Ocio, J. A.
DOI：
10.4269/ajtmh.2007.76.713
发表时间：
2007-04-01
影响因子：
3.3
作者：
Haque, Rashidul;Roy, Shantanu;Petri, William A., Jr.
通讯作者：
Petri, William A., Jr.
影响因子：
168.9
作者：
Kotloff, Karen L.;Nataro, James P.;Levine, Myron M.
通讯作者：
Levine, Myron M.
影响因子：
12.7
作者：
Eisenberg, Joseph N. S.;Scott, James C.;Porco, Travis
通讯作者：
Porco, Travis
影响因子：
11.8
作者：
Ortega, YR;Adam, RD
通讯作者：
Adam, RD