Jung Youngmee Tiffany, Hum Ryan James, Lou Wendy, Cheng Yu-Ling
Centre for Global Engineering and the Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2017 Mar 15;12(3):e0173808. doi: 10.1371/journal.pone.0173808. eCollection 2017.
Sanitation in neighbourhood and household domains can provide primary protection against diarrhea morbidity, yet their distinct health benefits have not been succinctly distinguished and reviewed. We present here the first systematic review and meta-analysis of the distinct effect of neighbourhood and household sanitation conditions on diarrhea morbidity. We identified studies reporting the effect of neighbourhood-level exposure to wastewater or household sanitation facilities on diarrhea, by performing comprehensive search on five databases, namely the Cochrane library, PubMed, Embase, Scopus and Web of Science, from the earliest date available to February 2015. Twenty-one non-randomized studies and one randomized controlled trial met the pre-determined inclusion criteria, consisting of six datasets on neighbourhood sanitation conditions (total 8271 subjects) and 20 datasets on household sanitation (total 20021 subjects). We calculated the pooled effect estimates of neighbourhood and household sanitation conditions on diarrhea morbidity using the inverse variance random-effects model. The pooled effect estimates showed that both neighbourhood sanitation conditions (odds ratio = 0.56, 95%CI: 0.40-0.79) and household sanitation (odds ratio = 0.64, 95%CI: 0.55-0.75) are associated with reduced diarrheal illness, and that the magnitudes of the associations are comparable. Evidence of risk of bias and heterogeneity were found in the included studies. Our findings confirm that both neighbourhood sanitation conditions and household sanitation are associated with considerable reduction in diarrhea morbidity, in spite of a number of methodological shortcomings in the included studies. Furthermore, we find evidence that neighbourhood sanitation conditions is associated with similar magnitude of reduction in diarrhea morbidity as household sanitation. The findings suggest that, in addition to household sanitation provision, dual emphasis on neighbourhood sanitation through public sanitation infrastructure provision and community-wide sanitation adoption is advisable for effective reduction of diarrheal disease burden.
社区和家庭环境卫生可提供预防腹泻发病的一级保护，但它们独特的健康益处尚未得到明确区分和综述。我们在此呈现了第一项关于社区和家庭卫生条件对腹泻发病的独特影响的系统综述和荟萃分析。我们通过对五个数据库（即考克兰图书馆、PubMed、Embase、Scopus和Web of Science）进行全面检索，从最早可获取的日期至2015年2月，确定了报告社区层面接触废水或家庭卫生设施对腹泻影响的研究。21项非随机研究和1项随机对照试验符合预先确定的纳入标准，包括6个关于社区卫生条件的数据集（共8271名受试者）和20个关于家庭卫生的数据集（共20021名受试者）。我们使用逆方差随机效应模型计算了社区和家庭卫生条件对腹泻发病的合并效应估计值。合并效应估计值表明，社区卫生条件（比值比 = 0.56，95%可信区间：0.40 - 0.79）和家庭卫生（比值比 = 0.64，95%可信区间：0.55 - 0.75）均与腹泻疾病减少相关，且关联程度相当可比。在所纳入的研究中发现了偏倚风险和异质性的证据。我们的研究结果证实，尽管所纳入的研究存在一些方法学上的不足，但社区卫生条件和家庭卫生均与腹泻发病率的显著降低相关。此外，我们发现有证据表明，社区卫生条件与家庭卫生在降低腹泻发病率方面的程度相似。这些研究结果表明，除了提供家庭卫生设施外，通过提供公共卫生基础设施和采用社区范围的卫生措施，双重重视社区卫生对于有效减轻腹泻疾病负担是可取的。
