The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review.
The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review.
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DOI：
10.1371/journal.pone.0135676
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Ensink JH
中科院分区：
文献类型：
--
作者：
Taylor DL;Kahawita TM;Cairncross S;Ensink JH
霍乱仍然是对全球公共卫生的重大威胁，估计每年有10万人死亡。水、环境卫生和个人卫生（WASH）干预措施经常被用来控制疫情，但有关其有效性的证据往往缺失。本文介绍了一个系统的文献综述调查的功能，使用和影响的WASH干预措施实施控制霍乱。审查产生了18项研究，其中5项研究报告了对健康的影响，4项研究报告了与用水点水处理有关的成果，1项研究报告了改善水和卫生基础设施的情况。此外，虽然在最近的出版物中，干预措施的功能和使用的报告越来越普遍，但研究的质量仍然很低。大多数论文（>60%）描述了水质干预措施，在水源处的干预措施侧重于对威尔斯的无效氯化，其余的则在使用点实施。实施了过滤、太阳能消毒和分发氯产品等干预措施，但没有充分考虑到这些措施在坚持和正确使用方面的局限性。洗手和卫生干预措施涉及几种传播途径，但只有22%的研究试图对其进行评估，主要侧重于提高知识和信息的吸收，但不一定将其转化为更安全的做法。对安全储水容器的使用和维护只进行了一次评价，低估了收集和使用之间相当大的污染可能性。在另一项评价容器消毒方法的研究中证实了这一问题。一项研究调查了目标人群接受的家庭消毒包的使用情况。一项在地方病流行环境中进行的研究比较了改善水和卫生基础设施的综合干预措施以及由此导致的霍乱发病率下降。这次审查强调了对特定传播途径的关注，以及在疫情爆发期间测试的有限数量的干预措施。在了解哪些干预措施最适合特定情况方面存在明显差距，因此显然需要进行更有力的影响研究，评估更广泛的讲卫生运动干预措施，以确保有效控制霍乱和最佳利用有限资源。
Cholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often missing. This paper presents a systematic literature review investigating the function, use and impact of WASH interventions implemented to control cholera. The review yielded eighteen studies and of the five studies reporting on health impact, four reported outcomes associated with water treatment at the point of use, and one with the provision of improved water and sanitation infrastructure. Furthermore, whilst the reporting of function and use of interventions has become more common in recent publications, the quality of studies remains low. The majority of papers (>60%) described water quality interventions, with those at the water source focussing on ineffective chlorination of wells, and the remaining being applied at the point of use. Interventions such as filtration, solar disinfection and distribution of chlorine products were implemented but their limitations regarding the need for adherence and correct use were not fully considered. Hand washing and hygiene interventions address several transmission routes but only 22% of the studies attempted to evaluate them and mainly focussed on improving knowledge and uptake of messages but not necessarily translating this into safer practices. The use and maintenance of safe water storage containers was only evaluated once, under-estimating the considerable potential for contamination between collection and use. This problem was confirmed in another study evaluating methods of container disinfection. One study investigated uptake of household disinfection kits which were accepted by the target population. A single study in an endemic setting compared a combination of interventions to improve water and sanitation infrastructure, and the resulting reductions in cholera incidence. This review highlights a focus on particular routes of transmission, and the limited number of interventions tested during outbreaks. There is a distinct gap in knowledge of which interventions are most appropriate for a given context and as such a clear need for more robust impact studies evaluating a wider array of WASH interventions, in order to ensure effective cholera control and the best use of limited resources.