Clasen Thomas F, Bostoen Kristof, Schmidt Wolf-Peter, Boisson Sophie, Fung Isaac C-H, Jenkins Marion W, Scott Beth, Sugden Steven, Cairncross Sandy
Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK, WC1E 7HT.
Cochrane Database Syst Rev. 2010 Jun 16;2010(6):CD007180. doi: 10.1002/14651858.CD007180.pub2.
Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in low-income countries, and are associated with exposure to human excreta.
To assess the effectiveness of interventions to improve the disposal of human excreta for preventing diarrhoeal diseases.
We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; LILACS; the metaRegister of Controlled Trials (mRCT); and Chinese-language databases available under the Wan Fang portal, and the China National Knowledge Infrastructure (CNKI-CAJ). We also handsearched relevant conference proceedings, and contacted researchers and organizations working in the field, as well as checking references from identified studies.
Randomized, quasi-randomized, and non-randomized controlled trials (RCTs) were selected, comparing interventions aimed at improving the disposal of human excreta to reduce direct or indirect human contact with no such intervention. Cluster (eg at the level of household or community) controlled trials were included.
We determined study eligibility, extracted data, and assessed methodological quality in accordance with the methods prescribed by the protocol. We described the results and summarized the information in tables. Due to substantial heterogeneity among the studies in terms of study design and type of intervention, no pooled effects were calculated.
Thirteen studies from six countries covering over 33,400 children and adults in rural, urban, and school settings met the review's inclusion criteria. In all studies the intervention was allocated at the community level. While the studies reported a wide range of effects, 11 of the 13 studies found the intervention was protective against diarrhoea. Differences in study populations and settings, in baseline sanitation levels, water, and hygiene practices, in types of interventions, study methodologies, compliance and coverage levels, and in case definitions and outcome surveillance limit the comparability of results of the studies included in this review. The validity of most individual study results are further compromised by the non-random allocation of the intervention among study clusters, an insufficient number of clusters, the lack of adjustment for clustering, unclear loss to follow-up, potential for reporting bias and other methodological shortcomings.
AUTHORS' CONCLUSIONS: This review provides some evidence that interventions to improve excreta disposal are effective in preventing diarrhoeal disease. However, this conclusion is based primarily on the consistency of the evidence of beneficial effects. The quality of the evidence is generally poor and does not allow for quantification of any such effect. The wide range of estimates of the effects of the intervention may be due to clinical and methodological heterogeneity among the studies, as well as to other important differences, including exposure levels, types of interventions, and different degrees of observer and respondent bias. Rigorous studies in multiple settings are needed to clarify the potential effectiveness of excreta disposal on diarrhoea.
腹泻病是导致死亡和发病的主要原因，在低收入国家的幼儿中尤为如此，并且与接触人类排泄物有关。
评估改善人类排泄物处理以预防腹泻病的干预措施的有效性。
我们检索了Cochrane传染病小组专业注册库；发表在《Cochrane图书馆》中的Cochrane对照试验中央注册库（CENTRAL）；MEDLINE；EMBASE；拉丁美洲及加勒比卫生科学数据库（LILACS）；对照试验元注册库（mRCT）；以及万方门户和中国知网（CNKI-CAJ）下的中文数据库。我们还手工检索了相关会议论文集，并联系了该领域的研究人员和组织，以及检查已识别研究的参考文献。
选择随机、半随机和非随机对照试验（RCT），比较旨在改善人类排泄物处理以减少直接或间接人际接触的干预措施与无此类干预措施。纳入整群（如家庭或社区层面）对照试验。
我们根据方案规定的方法确定研究的合格性，提取数据，并评估方法学质量。我们描述了结果并在表格中总结了信息。由于研究在研究设计和干预类型方面存在很大异质性，未计算合并效应。
来自六个国家的13项研究涵盖了农村、城市和学校环境中的33400多名儿童和成人，符合综述的纳入标准。在所有研究中，干预措施是在社区层面分配的。虽然研究报告了广泛的效果，但13项研究中有11项发现干预措施对腹泻有预防作用。研究人群和环境、基线卫生水平、水和卫生习惯、干预类型、研究方法、依从性和覆盖率以及病例定义和结局监测方面的差异限制了本综述中纳入研究结果的可比性。大多数个体研究结果的有效性因干预措施在研究整群中的非随机分配、整群数量不足、缺乏对整群的调整、随访失访情况不明、报告偏倚的可能性以及其他方法学缺陷而进一步受到损害。
本综述提供了一些证据表明改善排泄物处理的干预措施在预防腹泻病方面是有效的。然而，这一结论主要基于有益效果证据的一致性。证据质量总体较差，无法对任何此类效果进行量化。干预效果的广泛估计范围可能是由于研究之间临床和方法学的异质性，以及其他重要差异，包括暴露水平、干预类型以及不同程度的观察者和应答者偏倚。需要在多种环境中进行严格研究，以阐明排泄物处理对腹泻的潜在有效性。
