小柯机器人

世界卫生组织气候变化与健康部Jennyfer Wolf团队研究了改善饮用水、环境卫生和用肥皂洗手对中低收入国家儿童腹泻病风险的干预效果。相关论文于2022年7月2日发表在《柳叶刀》杂志上。

目前为儿童腹泻提供高水平服务的水、环境卫生和个人卫生（WASH）干预措施的有效性缺乏估计。该研究旨在提供关于中低收入国家（LMICs）因WASH引起的疾病负担以及不同类型的WASH干预措施对儿童腹泻影响的最新估计。

在本系统综述和荟萃分析中，研究组根据通过在MEDLINE、Embase、Scopus、Cochrane Library和BIOSIS引文索引等数据库中检索2016年1月1日至2021年5月25日期间研究基础WASH干预措施和提供高水平服务的WASH干预措施的文献，更新了之前的综述。

这些文献包括在家庭或社区层面进行的随机和非随机对照试验，与所谓的可持续发展目标（SDG）的服务阶梯方法接触类别相匹配。由两名评审员独立提取研究水平数据，并使用改良的纽卡斯尔-渥太华量表评估偏倚风险，使用改良的建议、评估、开发和评定方法评估证据的确定性。使用随机效应荟萃分析和元回归模型分析了提取的相对风险（RRs）和95%CI。

从检索中确定了19837份记录，其中包括124项研究，提供了83份水（62616名儿童）、20份环境卫生设施（40799名儿童）和41份个人卫生设施（98416名儿童）的比较。与未经处理的水源水相比，在使用点（POU）处理水可将腹泻风险降低高达50%，处理方式包括：过滤（23项研究；RR为0.50）、太阳能处理（13项，0.63）和氯化（25项；0.66）。

与未经改善的水源相比，在水质较高的场所提供改进的饮用水供应可将腹泻风险降低52%（2项；0.48）。总体来说，卫生干预降低了24%的腹泻风险（0.76）。与未改善的卫生条件相比，提供下水道连接将腹泻风险降低了47%（5项；0.53）。提倡用肥皂洗手可将腹泻风险降低30%（0.70）。

研究结果表明，WASH干预措施降低了LMICs儿童的腹泻风险。提供POU过滤水、改善房屋内水源提供更高质量水或与下水道连接的基本卫生服务的干预措施均有助于降低腹泻风险。该结果支持可持续发展目标6要求的更高服务水平。值得注意的是，没有研究评估提供安全管理的讲卫生运动服务的干预措施，可持续发展目标承诺到2030年实现全民覆盖的服务水平。

附：英文原文

Title: Effectiveness of interventions to improve drinking water, sanitation, and handwashing with soap on risk of diarrhoeal disease in children in low-income and middle-income settings: a systematic review and meta-analysis

Author: Jennyfer Wolf, Sydney Hubbard, Michael Brauer, Argaw Ambelu, Benjamin F Arnold, Robert Bain, Valerie Bauza, Joe Brown, Bethany A Caruso, Thomas Clasen, John M Colford, Matthew C Freeman, Bruce Gordon, Richard B Johnston, Andrew Mertens, Annette Prüss-Ustün, Ian Ross, Jeffrey Stanaway, Jeff T Zhao, Oliver Cumming, Sophie Boisson

Issue&Volume: 2022/07/02

Abstract:

Background

Estimates of the effectiveness of water, sanitation, and hygiene (WASH) interventions that provide high levels of service on childhood diarrhoea are scarce. We aimed to provide up-to-date estimates on the burden of disease attributable to WASH and on the effects of different types of WASH interventions on childhood diarrhoea in low-income and middle-income countries (LMICs).

Methods

In this systematic review and meta-analysis, we updated previous reviews following their search strategy by searching MEDLINE, Embase, Scopus, Cochrane Library, and BIOSIS Citation Index for studies of basic WASH interventions and of WASH interventions providing a high level of service, published between Jan 1, 2016, and May 25, 2021. We included randomised and non-randomised controlled trials conducted at household or community level that matched exposure categories of the so-called service ladder approach of the Sustainable Development Goal (SDG) for WASH. Two reviewers independently extracted study-level data and assessed risk of bias using a modified Newcastle-Ottawa Scale and certainty of evidence using a modified Grading of Recommendations, Assessment, Development, and Evaluation approach. We analysed extracted relative risks (RRs) and 95% CIs using random-effects meta-analyses and meta-regression models. This study is registered with PROSPERO, CRD42016043164.

Findings

19837 records were identified from the search, of which 124 studies were included, providing 83 water (62616 children), 20 sanitation (40799 children), and 41 hygiene (98416 children) comparisons. Compared with untreated water from an unimproved source, risk of diarrhoea was reduced by up to 50% with water treated at point of use (POU): filtration (n=23 studies; RR 0·50 [95% CI 0·41–0·60]), solar treatment (n=13; 0·63 [0·50–0·80]), and chlorination (n=25; 0·66 [0·56–0·77]). Compared with an unimproved source, provision of an improved drinking water supply on premises with higher water quality reduced diarrhoea risk by 52% (n=2; 0·48 [0·26–0·87]). Overall, sanitation interventions reduced diarrhoea risk by 24% (0·76 [0·61–0·94]). Compared with unimproved sanitation, providing sewer connection reduced diarrhoea risk by 47% (n=5; 0·53 [0·30–0·93]). Promotion of handwashing with soap reduced diarrhoea risk by 30% (0·70 [0·64–0·76]).

Interpretation

WASH interventions reduced risk of diarrhoea in children in LMICs. Interventions supplying either water filtered at POU, higher water quality from an improved source on premises, or basic sanitation services with sewer connection were associated with increased reductions. Our results support higher service levels called for under SDG 6. Notably, no studies evaluated interventions that delivered access to safely managed WASH services, the level of service to which universal coverage by 2030 is committed under the SDG.

DOI: 10.1016/S0140-6736(22)00937-0

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00937-0/fulltext

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