Morita Tomohiko, Godfrey Samuel, George Christine Marie
Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Water, Sanitation and Hygiene Section, UNICEF Ethiopia, Addis Ababa, Ethiopia.
Trop Med Int Health. 2016 Nov;21(11):1403-1419. doi: 10.1111/tmi.12773. Epub 2016 Sep 16.
To review and synthesise the available evidence on the effectiveness of interventions targeting unsafe child faeces disposal in reducing this behaviour and improving child health in low- and middle-income countries.
PubMed and EMBASE were systematically searched. Studies meeting the inclusion criteria were reviewed and key information on study methodologies and outcomes were extracted.
A total of 1048 articles were screened, and eight studies representing five countries were included for the review. Three were randomised controlled trials, and five were prospective cohort studies. There was wide variability across studies in the definition of 'safe disposal' of child faeces. Six studies reported the change in child faeces disposal practices associated with safe child faeces disposal interventions. However, only one study found a significant improvement in this behaviour. Two of the six studies that evaluated the health impact of delivered interventions found significant reductions in childhood diarrhoea associated with safe faeces disposal practices, and one study reported a positive effect on child growth and ascariasis. Only one study was identified that delivered a single intervention solely focused on safe child faeces disposal. Unfortunately, this study did not investigate the impact of this intervention on child health.
There are major methodological limitations in studies that assessed the impact of safe child faeces disposal interventions. The health impact of these interventions is inconclusive because the quality of the current evidence is poor. Randomised controlled trials are urgently needed to assess the impact of safe faeces disposal interventions on child health.
回顾并综合现有证据，以探讨针对不安全儿童粪便处理的干预措施在低收入和中等收入国家减少此类行为及改善儿童健康方面的有效性。
系统检索了PubMed和EMBASE。对符合纳入标准的研究进行了综述，并提取了有关研究方法和结果的关键信息。
共筛选了1048篇文章，纳入综述的有来自五个国家的八项研究。三项为随机对照试验，五项为前瞻性队列研究。关于儿童粪便“安全处理”的定义，各研究之间存在很大差异。六项研究报告了与安全儿童粪便处理干预措施相关的儿童粪便处理行为的变化。然而，只有一项研究发现这种行为有显著改善。在评估所实施干预措施对健康影响的六项研究中，两项发现与安全粪便处理措施相关的儿童腹泻显著减少，一项研究报告了对儿童生长和蛔虫病的积极影响。仅确定了一项仅专注于安全儿童粪便处理的单一干预措施的研究。遗憾的是，该研究未调查此干预措施对儿童健康的影响。
评估安全儿童粪便处理干预措施影响的研究存在重大方法学局限性。由于现有证据质量较差，这些干预措施对健康的影响尚无定论。迫切需要进行随机对照试验来评估安全粪便处理干预措施对儿童健康的影响。
