The relationship between water, sanitation and schistosomiasis: a systematic review and meta-analysis.
The relationship between water, sanitation and schistosomiasis: a systematic review and meta-analysis.
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DOI：
10.1371/journal.pntd.0003296
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发表时间：
2014-12
影响因子：
3.8
通讯作者：
Templeton MR
中科院分区：
文献类型：
--
作者：
Grimes JE;Croll D;Harrison WE;Utzinger J;Freeman MC;Templeton MR
强调获得“安全”水和“充足”卫生设施是控制血吸虫病的重要措施。事实上，血吸虫的生命周期表明，通过安全用水和适当的卫生设施可以减少其传播。然而，这些证据之前并未经过系统审查。我们对报告能够或无法获得安全饮用水和足够卫生设施的人群血吸虫感染率的研究进行了系统回顾和荟萃分析。 PubMed、Web of Science、Embase 和 Cochrane 图书馆的检索时间从建库到 2013 年 12 月 31 日，不受出版年份或语言的限制。研究的标题和摘要由两名独立评估员筛选。被认为感兴趣的论文被完整阅读，适当的研究被纳入荟萃分析。通过漏斗图的目视检查和艾格测试来评估发表偏倚。荟萃分析中数据集的异质性使用 Higgins' I2 进行量化。安全供水与血吸虫病发病率显着降低相关（优势比 (OR) = 0.53，95% 置信区间 (CI)：0.47–0.61）。充足的卫生设施与曼氏血吸虫（OR = 0.59，95% CI：0.47–0.73）和埃及血吸虫（OR = 0.69，95% CI：0.57–0.84）的发病率较低相关。纳入的研究主要是横断面研究，质量很差。我们的系统回顾和荟萃分析表明，增加获得安全饮用水和适当卫生设施的机会是降低血吸虫感染几率的重要措施。然而，大多数研究都是观察性的，质量较差。因此，迫切需要进行充分有力的整群随机试验，比较血吸虫感染风险与获得安全水和适当卫生设施的情况，进行更多严格定义水和卫生设施的研究，以及对水、卫生设施、个人卫生、人类行为和血吸虫传播之间关系的新研究。血吸虫病是许多发展中国家的严重疾病，血吸虫病的控制依赖于吡喹酮的大规模给药。然而，这一策略未能解决血吸虫病的根本原因，血吸虫病是人们在接触含有受感染蜗牛的淡水水体时感染的。建议改善清洁水和卫生设施的获取可降低血吸虫病传播的风险。此外，使用肥皂、清洁剂和endod（一种有时用作肥皂替代品的浆果）可能会杀死蜗牛及其排泄的寄生虫幼虫。我们系统地回顾了文献并进行了荟萃分析，以研究人们获得清洁水、卫生设施和良好个人卫生与血吸虫病风险之间的关系。能够获得清洁水和足够卫生设施的人患血吸虫病的风险较低。没有研究探索卫生与血吸虫病风险之间的关系。不同研究之间，获得和无法获得清洁水和卫生设施的人之间的感染率差异很大，这表明水和卫生设施对血吸虫病传播的影响是由许多其他社会和环境因素介导的。需要进一步研究水、环境卫生和个人卫生干预措施对血吸虫病控制的影响。
Access to “safe” water and “adequate” sanitation are emphasized as important measures for schistosomiasis control. Indeed, the schistosomes' lifecycles suggest that their transmission may be reduced through safe water and adequate sanitation. However, the evidence has not previously been compiled in a systematic review. We carried out a systematic review and meta-analysis of studies reporting schistosome infection rates in people who do or do not have access to safe water and adequate sanitation. PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to 31 December 2013, without restrictions on year of publication or language. Studies' titles and abstracts were screened by two independent assessors. Papers deemed of interest were read in full and appropriate studies included in the meta-analysis. Publication bias was assessed through the visual inspection of funnel plots and through Egger's test. Heterogeneity of datasets within the meta-analysis was quantified using Higgins' I2. Safe water supplies were associated with significantly lower odds of schistosomiasis (odds ratio (OR) = 0.53, 95% confidence interval (CI): 0.47–0.61). Adequate sanitation was associated with lower odds of Schistosoma mansoni, (OR = 0.59, 95% CI: 0.47–0.73) and Schistosoma haematobium (OR = 0.69, 95% CI: 0.57–0.84). Included studies were mainly cross-sectional and quality was largely poor. Our systematic review and meta-analysis suggests that increasing access to safe water and adequate sanitation are important measures to reduce the odds of schistosome infection. However, most of the studies were observational and quality was poor. Hence, there is a pressing need for adequately powered cluster randomized trials comparing schistosome infection risk with access to safe water and adequate sanitation, more studies which rigorously define water and sanitation, and new research on the relationships between water, sanitation, hygiene, human behavior, and schistosome transmission. Schistosomiasis is a serious disease in many developing countries, and the control of schistosomiasis relies on the large-scale administration of praziquantel. However, this strategy fails to address the root causes of schistosomiasis, which people acquire during contact with freshwater bodies that contain infected snails. It is suggested that improving access to clean water and sanitation reduces the risk of schistosomiasis transmission. Moreover, the use of soap, detergent, and endod (a berry sometimes used as a substitute for soap) might kill snails and the parasite larvae they excrete. We systematically reviewed the literature and performed a meta-analysis to study the association between people's access to clean water, sanitation, and good hygiene and the risk of schistosomiasis. People with access to clean water and adequate sanitation were at lower risks of schistosomiasis. No studies were found to explore the relationship between hygiene and risk of schistosomiasis. The difference in infection rates between people with and without access to clean water and sanitation varies widely between studies, suggesting that the impact of water and sanitation on schistosomiasis transmission is mediated by many other social and environmental factors. Further research is needed on the impact of water, sanitation and hygiene interventions for schistosomiasis control.
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DOI：
10.1098/rstb.2012.0144
发表时间：
2013-08-05
期刊：
Philosophical transactions of the Royal Society of London. Series B, Biological sciences
影响因子：
--
作者：
Bockarie MJ;Kelly-Hope LA;Rebollo M;Molyneux DH
通讯作者：
Molyneux DH
影响因子：
3.2
作者：
Abou-Zeid, Alaa Hammad Ali;Abkar, Tigani Abdullah;Mohamed, Rashid Osman
通讯作者：
Mohamed, Rashid Osman
DOI：
10.1590/s0037-86822010000300020
发表时间：
2010-06-01
影响因子：
2
作者：
Palmeira, Danylo César Correia;Carvalho, Adriano Gonçalves de;Couto, Janira Lúcia Assumpção
通讯作者：
Couto, Janira Lúcia Assumpção
影响因子：
2.8
作者：
Coura, P;Rocha, RS;Katz, N
通讯作者：
Katz, N
影响因子：
4
作者：
Balen, Julie;Raso, Giovanna;McManus, Donald P.
通讯作者：
McManus, Donald P.