Taylor Dawn L, Kahawita Tanya M, Cairncross Sandy, Ensink Jeroen H J
Environmental Health Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Medecins Sans Frontieres/Artsen Zonder Grenzen, Plantage Middenlaan 14, 1001 EA, Amsterdam, The Netherlands.
Environmental Health Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
PLoS One. 2015 Aug 18;10(8):e0135676. doi: 10.1371/journal.pone.0135676. eCollection 2015.
Cholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often missing. This paper presents a systematic literature review investigating the function, use and impact of WASH interventions implemented to control cholera.
The review yielded eighteen studies and of the five studies reporting on health impact, four reported outcomes associated with water treatment at the point of use, and one with the provision of improved water and sanitation infrastructure. Furthermore, whilst the reporting of function and use of interventions has become more common in recent publications, the quality of studies remains low. The majority of papers (>60%) described water quality interventions, with those at the water source focussing on ineffective chlorination of wells, and the remaining being applied at the point of use. Interventions such as filtration, solar disinfection and distribution of chlorine products were implemented but their limitations regarding the need for adherence and correct use were not fully considered. Hand washing and hygiene interventions address several transmission routes but only 22% of the studies attempted to evaluate them and mainly focussed on improving knowledge and uptake of messages but not necessarily translating this into safer practices. The use and maintenance of safe water storage containers was only evaluated once, under-estimating the considerable potential for contamination between collection and use. This problem was confirmed in another study evaluating methods of container disinfection. One study investigated uptake of household disinfection kits which were accepted by the target population. A single study in an endemic setting compared a combination of interventions to improve water and sanitation infrastructure, and the resulting reductions in cholera incidence.
This review highlights a focus on particular routes of transmission, and the limited number of interventions tested during outbreaks. There is a distinct gap in knowledge of which interventions are most appropriate for a given context and as such a clear need for more robust impact studies evaluating a wider array of WASH interventions, in order to ensure effective cholera control and the best use of limited resources.
霍乱仍然是对全球公共卫生的重大威胁，估计每年有10万人死亡。水、环境卫生和个人卫生（WASH）干预措施经常被用于控制疫情，但其有效性的证据往往缺失。本文进行了一项系统的文献综述，以调查为控制霍乱而实施的WASH干预措施的功能、使用情况和影响。
该综述产生了18项研究，在报告健康影响的5项研究中，4项报告了与使用点水处理相关的结果，1项报告了改善水和环境卫生基础设施的结果。此外，虽然干预措施的功能和使用情况在最近的出版物中报告得越来越普遍，但研究质量仍然很低。大多数论文（>60%）描述了水质干预措施，水源处的干预措施主要集中在井水的无效氯化处理上，其余的则应用于使用点。实施了过滤、太阳能消毒和氯产品分发等干预措施，但没有充分考虑到它们在遵守和正确使用方面的局限性。洗手和卫生干预措施解决了多种传播途径，但只有22%的研究试图对其进行评估，且主要集中在提高信息的知晓率和接受度上，而不一定将其转化为更安全的做法。安全储水容器的使用和维护仅在一项研究中进行了评估，低估了收集和使用之间相当大的污染可能性。另一项评估容器消毒方法的研究证实了这一问题。一项研究调查了家庭消毒包的接受情况，目标人群接受了这些消毒包。在一个地方病流行环境中进行的一项研究比较了改善水和环境卫生基础设施的综合干预措施以及由此导致的霍乱发病率下降情况。
本综述强调了对特定传播途径的关注，以及疫情期间测试的干预措施数量有限。对于哪种干预措施最适合特定情况的知识存在明显差距，因此显然需要进行更有力的影响研究，评估更广泛的WASH干预措施，以确保有效控制霍乱并最佳利用有限资源。
