孟加拉国农村地区管井水的水源污染与家庭污染对儿童腹泻的影响：一项随机对照试验
Effects of source- versus household contamination of tubewell water on child diarrhea in rural Bangladesh: a randomized controlled trial.
作者信息
Ercumen Ayse, Naser Abu Mohd, Unicomb Leanne, Arnold Benjamin F, Colford John M, Luby Stephen P
机构信息
Division of Epidemiology, School of Public Health, University of California, Berkeley, California, United States of America.
Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
出版信息
PLoS One. 2015 Mar 27;10(3):e0121907. doi: 10.1371/journal.pone.0121907. eCollection 2015.
BACKGROUND
Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh.
METHODS
We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants' source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions.
FINDINGS
Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias.
CONCLUSIONS
Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01350063.
背景
浅管井是大多数孟加拉国农村居民的主要饮用水源。已在管井中检测到粪便污染，水源处浓度较低，使用点处浓度较高。我们进行了一项随机对照试验，以评估通过家庭水处理和安全储存来改善管井饮用水的微生物质量是否会减少孟加拉国农村2岁以下儿童的腹泻情况。
方法
我们将1800户有6至18个月大儿童（指标儿童）的家庭随机分为三组之一：氯加安全储存组、安全储存组和对照组。我们每月走访这些家庭，为期一年，以推广干预措施、跟踪其采用情况、检测参与者的水源水和储存水的粪便污染情况，并记录照护者报告的儿童腹泻患病率（主要结局）。为评估报告偏倚，我们还收集了预计不会受到我们干预措施影响的健康结局数据。
结果
两种干预措施的采用率都很高。单独的安全储存或与氯化结合使用，都减少了储存水的重度污染。与对照组相比，氯加安全储存组的指标儿童腹泻减少了36%（患病率比，PR = 0.64，0.55 - 0.73），安全储存组减少了31%（PR = 0.69，0.60 - 0.80），两个干预组之间无差异。该研究的一个局限性是采用自我报告结局的非盲法设计。然而，预计不会受到水干预措施影响的健康结局患病率在各研究组之间没有差异，表明报告偏倚极小。
结论
安全储存显著改善了使用点的饮用水质量，并减少了孟加拉国农村儿童的腹泻情况。将安全储存与氯化结合使用没有额外益处。应努力在孟加拉国实施和评估安全储水的长期措施。
试验注册
ClinicalTrials.gov NCT01350063。
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