Mäusezahl Daniel, Christen Andri, Pacheco Gonzalo Duran, Tellez Fidel Alvarez, Iriarte Mercedes, Zapata Maria E, Cevallos Myriam, Hattendorf Jan, Cattaneo Monica Daigl, Arnold Benjamin, Smith Thomas A, Colford John M
Department of Public Health and Epidemiology, Swiss Tropical Institute (STI), University of Basel, Switzerland.
PLoS Med. 2009 Aug;6(8):e1000125. doi: 10.1371/journal.pmed.1000125. Epub 2009 Aug 18.
Solar drinking water disinfection (SODIS) is a low-cost, point-of-use water purification method that has been disseminated globally. Laboratory studies suggest that SODIS is highly efficacious in inactivating waterborne pathogens. Previous field studies provided limited evidence for its effectiveness in reducing diarrhoea.
We conducted a cluster-randomized controlled trial in 22 rural communities in Bolivia to evaluate the effect of SODIS in reducing diarrhoea among children under the age of 5 y. A local nongovernmental organisation conducted a standardised interactive SODIS-promotion campaign in 11 communities targeting households, communities, and primary schools. Mothers completed a daily child health diary for 1 y. Within the intervention arm 225 households (376 children) were trained to expose water-filled polyethyleneteraphtalate bottles to sunlight. Eleven communities (200 households, 349 children) served as a control. We recorded 166,971 person-days of observation during the trial representing 79.9% and 78.9% of the total possible person-days of child observation in intervention and control arms, respectively. Mean compliance with SODIS was 32.1%. The reported incidence rate of gastrointestinal illness in children in the intervention arm was 3.6 compared to 4.3 episodes/year at risk in the control arm. The relative rate of diarrhoea adjusted for intracluster correlation was 0.81 (95% confidence interval 0.59-1.12). The median length of diarrhoea was 3 d in both groups.
Despite an extensive SODIS promotion campaign we found only moderate compliance with the intervention and no strong evidence for a substantive reduction in diarrhoea among children. These results suggest that there is a need for better evidence of how the well-established laboratory efficacy of this home-based water treatment method translates into field effectiveness under various cultural settings and intervention intensities. Further global promotion of SODIS for general use should be undertaken with care until such evidence is available.
www.ClinicalTrials.govNCT00731497 Please see later in the article for Editors' Summary.
太阳能饮用水消毒（SODIS）是一种低成本的家庭用水净化方法，已在全球推广。实验室研究表明，SODIS在灭活水源性病原体方面非常有效。先前的现场研究为其在减少腹泻方面的有效性提供了有限的证据。
我们在玻利维亚的22个农村社区进行了一项整群随机对照试验，以评估SODIS对5岁以下儿童腹泻的影响。一个当地非政府组织在11个社区针对家庭、社区和小学开展了标准化的互动式SODIS推广活动。母亲们记录孩子1年的每日健康状况。在干预组中，225户家庭（376名儿童）接受了培训，将装满水的聚对苯二甲酸乙二酯瓶暴露在阳光下。11个社区（200户家庭，349名儿童）作为对照组。在试验期间，我们记录了166,971人日的观察数据，分别占干预组和对照组儿童可能观察总人日数的79.9%和78.9%。SODIS的平均依从率为32.1%。干预组儿童报告的胃肠道疾病发病率为每年3.6例，而对照组为4.3例/年。调整集群内相关性后的腹泻相对发生率为0.81（95%置信区间0.59 - 1.12）。两组腹泻的中位数持续时间均为3天。
尽管开展了广泛的SODIS推广活动，但我们发现对该干预措施的依从性仅为中等，且没有充分证据表明儿童腹泻率有实质性降低。这些结果表明，需要更好的证据来证明这种成熟的家庭水处理方法在不同文化背景和干预强度下，如何从实验室有效性转化为现场有效性。在获得此类证据之前，应谨慎地进一步在全球推广SODIS以供普遍使用。
www.ClinicalTrials.govNCT00731497 有关编辑总结，请参阅本文后面内容。
