Moraes L R, Cancio Jacira Azevedo, Cairncross Sandy, Huttly Sharon
Polytechnic School, Federal University of Bahia, Salvador, Brazil.
Trans R Soc Trop Med Hyg. 2003 Mar-Apr;97(2):153-8. doi: 10.1016/s0035-9203(03)90104-0.
A longitudinal prospective study of the effect of drainage and sewerage systems on diarrhoea in children aged < 5 years was conducted in 9 poor urban areas of the city of Salvador (population 2.44 million) in north-east Brazil in 1989-90. Due to complex political and administrative reasons, 3 areas had benefited from drainage improvements, 3 from both drainage and sewerage improvements, and 3 from neither. An extensive questionnaire was applied to collect information on each child and on the conditions of the household, and mothers recorded diarrhoea episodes in their children aged < 5 years daily for 1 year, using calendars. Fortnightly home visits were made to collect the data. The incidence of diarrhoea in children in neighbourhoods with drainage was less than two-thirds, and in neighbourhoods with drainage and sewerage less than one-third, of the incidence in neighbourhoods with neither. After controlling for potential confounders, the proportion of children with 'frequent diarrhoea' showed the same significant trend across the study groups. Though the groups were not exactly comparable, more than one child was monitored per household, and it was not possible to rotate fieldworkers between study groups, the study provides evidence that community sanitation can have an impact on diarrhoeal disease, even without measures to promote hygiene behaviour.
1989 - 1990年，在巴西东北部萨尔瓦多市（人口244万）的9个贫困城区，针对排水和污水处理系统对5岁以下儿童腹泻的影响开展了一项纵向前瞻性研究。由于复杂的政治和行政原因，3个地区受益于排水系统改善，3个地区同时受益于排水和污水处理系统改善，3个地区则两者均未受益。通过广泛的问卷调查收集每个儿童及其家庭状况的信息，母亲们使用日历记录其5岁以下孩子每日的腹泻发作情况，为期1年。每两周进行一次家访以收集数据。有排水系统社区的儿童腹泻发病率不到没有排水系统社区的三分之二，有排水和污水处理系统社区的儿童腹泻发病率不到没有排水系统社区的三分之一。在控制了潜在混杂因素后，“频繁腹泻”儿童的比例在各研究组中呈现相同的显著趋势。尽管各研究组并非完全可比，每户监测不止一名儿童，且不可能在各研究组之间轮换实地工作人员，但该研究提供了证据，表明即使没有促进卫生行为的措施，社区卫生设施也可对腹泻病产生影响。
