Department of Environmental Health, Rollins School of Public Health, Emory University, 1516 Clifton Road, Atlanta, GA 30306, United States.
Department of Public Health, the Environment and Social Determinants of Health, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Int J Hyg Environ Health. 2016 Nov;219(8):709-723. doi: 10.1016/j.ijheh.2016.09.021. Epub 2016 Oct 1.
Fecal-oral transmission of enteric and other pathogens due to poor sanitation is a major cause of morbidity and mortality, especially in low- or middle-income settings. Few studies have investigated the impact of sanitation on indicators of transmission, a prerequisite to achieving health gains. This review attempts to summarize the literature to date.
We searched leading databases to identify studies that address the effect of sanitation on various transmission pathways including fecal pathogens or indicator bacteria in drinking water, hand contamination, sentinel toys, food, household and latrine surfaces and soil, as well as flies and observations of human feces. This also included studies that assessed the impact of fecal contamination of water supplies based on distance from sanitation facilities. We identified 29 studies that met the review's eligibility criteria.
Overall, the studies found little to no effect from sanitation interventions on these transmission pathways. There was no evidence of effects on water quality (source or household), hand or sentinel toy contamination, food contamination, or contamination of surfaces or soil. There is some evidence that sanitation was associated with reductions in flies and a small effect on observations of feces (Risk Difference -0.03, 95%CI -0.06 to 0.01). Studies show an inverse relationship between the distance of a water supply from a latrine and level of fecal contamination of such water supply. Future evaluations of sanitation interventions should include assessments of effects along transmission pathways in order to better understand the circumstances under which interventions may be effective at preventing disease.
由于卫生条件差导致的肠道和其他病原体经粪-口传播，是发病率和死亡率的主要原因，尤其是在低收入和中等收入国家。很少有研究调查卫生条件对传播指标的影响，而这是实现健康收益的前提。本综述试图对现有文献进行总结。
我们检索了主要数据库，以确定研究卫生条件对各种传播途径的影响的研究，包括饮用水中的粪便病原体或指示菌、手部污染、哨兵玩具、食物、家庭和厕所表面及土壤、苍蝇以及人类粪便的观察。这也包括了根据距离卫生设施评估供水受粪便污染影响的研究。我们确定了 29 项符合审查标准的研究。
总体而言，这些研究发现卫生干预措施对这些传播途径几乎没有影响。卫生干预措施对水质（水源或家庭）、手部或哨兵玩具污染、食物污染或表面或土壤污染没有影响。有一些证据表明，卫生条件与苍蝇数量减少和粪便观察结果的微小影响相关（风险差异 -0.03，95%CI -0.06 至 0.01）。研究表明，供水距离厕所的距离与该供水的粪便污染程度呈反比关系。未来对卫生干预措施的评估应包括对传播途径影响的评估，以便更好地了解干预措施在哪些情况下可能有效预防疾病。
