The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement
The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement
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DOI：
10.1186/s12916-019-1410-x
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发表时间：
2019-08-28
期刊：
影响因子：
9.3
通讯作者：
Colford, John M., Jr.
中科院分区：
文献类型：
--
作者：
Cumming, Oliver;Arnold, Benjamin F.;Colford, John M., Jr.
背景：三个规模和成本空前的新大型试验，包括新的析因设计，发现基本的水、环境卫生和个人卫生（WASH）干预措施对儿童发育迟缓没有影响，对儿童腹泻只有混合作用。随着联合国可持续发展目标的启动，以及到2030年人人享有安全管理的水、环境卫生和个人卫生的大胆新目标的提出，这些成果值得研究人员、政策制定者和实践者的关注。在此，我们报告由世界卫生组织和比尔及梅林达·盖茨基金会召集的一次专家会议的结论，以讨论这些发现，并提出五个关键的共识信息，作为在讲卫生运动和营养部门进行更广泛讨论和辩论的基础。我们判断这些试验具有很高的内部效度，构成了很好的证据，证明这些特定的干预措施对儿童线性生长没有影响，对儿童腹泻的影响是混合的。这些结果表明，在这样的环境中，可能需要更全面或更雄心勃勃的讲卫生干预措施，才能对儿童健康产生重大影响。这些结果很重要，因为这些基本干预措施通常在低收入农村环境中部署，期望改善儿童健康，尽管这很少是唯一的理由。我们的观点是，这三个新的试验并没有表明WASH总体上不能影响儿童的线性生长，但它们确实表明，在发育迟缓仍然是一个重要的公共卫生挑战的环境中，这些特定的干预措施没有影响。我们支持呼吁进行变革性的讲卫生运动，因为它包含了一项指导原则，即在任何情况下都需要针对当地接触情况和肠道疾病负担量身定制的一整套讲卫生运动干预措施。
Background Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations' Sustainable Development Goals, and the bold new target of safely managed water, sanitation and hygiene for all by 2030, these results warrant the attention of researchers, policy-makers and practitioners. Main body Here we report the conclusions of an expert meeting convened by the World Health Organization and the Bill and Melinda Gates Foundation to discuss these findings, and present five key consensus messages as a basis for wider discussion and debate in the WASH and nutrition sectors. We judge these trials to have high internal validity, constituting good evidence that these specific interventions had no effect on childhood linear growth, and mixed effects on childhood diarrhea. These results suggest that, in settings such as these, more comprehensive or ambitious WASH interventions may be needed to achieve a major impact on child health. Conclusion These results are important because such basic interventions are often deployed in low-income rural settings with the expectation of improving child health, although this is rarely the sole justification. Our view is that these three new trials do not show that WASH in general cannot influence child linear growth, but they do demonstrate that these specific interventions had no influence in settings where stunting remains an important public health challenge. We support a call for transformative WASH, in so much as it encapsulates the guiding principle that - in any context - a comprehensive package of WASH interventions is needed that is tailored to address the local exposure landscape and enteric disease burden.