Larsen David A, Grisham Thomas, Slawsky Erik, Narine Lutchmie
Syracuse University Department of Public Health, Food Studies and Nutrition; Syracuse, NY; United States of America.
PLoS Negl Trop Dis. 2017 Jun 8;11(6):e0005591. doi: 10.1371/journal.pntd.0005591. eCollection 2017 Jun.
A lack of access to sanitation is an important risk factor child health, facilitating fecal-oral transmission of pathogens including soil-transmitted helminthes and various causes of diarrheal disease. We conducted a meta-analysis of cross-sectional surveys to determine the impact that community-level sanitation access has on child health for children with and without household sanitation access.
METHODOLOGY/PRINCIPAL FINDINGS: Using 301 two-stage demographic health surveys and multiple indicator cluster surveys conducted between 1990 and 2015 we calculated the sanitation access in the community as the proportion of households in the sampled cluster that had household access to any type of sanitation facility. We then conducted exact matching of children based on various predictors of living in a community with high access to sanitation. Using logistic regression with the matched group as a random intercept we examined the association between the child health outcomes of stunted growth, any anemia, moderate or severe anemia, and diarrhea in the previous two weeks and the exposure of living in a community with varying degrees of community-level sanitation access. For children with household-level sanitation access, living in a community with 100% sanitation access was associated with lowered odds of stunting (adjusted odds ratio [AOR] = 0.97, 95%; confidence interval (CI) = 0.94-1.00; n = 14,153 matched groups, 1,175,167 children), any anemia (AOR = 0.73; 95% CI = 0.67-0.78; n = 5,319 matched groups, 299,033 children), moderate or severe anemia (AOR = 0.72, 95% CI = 0.68-0.77; n = 5,319 matched groups, 299,033 children) and diarrhea (AOR = 0.94; 95% CI = 0.91-0.97); n = 16,379 matched groups, 1,603,731 children) compared to living in a community with < 30% sanitation access. For children without household-level sanitation access, living in communities with 0% sanitation access was associated with higher odds of stunting (AOR = 1.04, 95% CI = 1.02-1.06; n = 14,153 matched groups, 1,175,167 children), any anemia (AOR = 1.05, 95% CI = 1.00-1.09; n = 5,319 matched groups, 299,033 children), moderate or severe anemia (AOR = 1.04, 95% CI = 1.00-1.09; n = 5,319 matched groups, 299,033 children) but not diarrhea (AOR = 1.00, 95% CI = 0.98-1.02; n = 16,379 matched groups, 1,603,731 children) compared to children without household-level sanitation access living in communities with 1-30% sanitation access.
CONCLUSIONS/SIGNIFICANCE: Community-level sanitation access is associated with improved child health outcomes independent of household-level sanitation access. The proportion of children living in communities with 100% sanitation access throughout the world is appallingly low. Ensuring sanitation access to all by 2030 will greatly improve child health.
缺乏卫生设施是影响儿童健康的一个重要风险因素，它会促进包括土壤传播的蠕虫和各种腹泻病病因在内的病原体的粪口传播。我们进行了一项横断面调查的荟萃分析，以确定社区层面的卫生设施可及性对有或没有家庭卫生设施可及性的儿童健康的影响。
方法/主要发现：利用1990年至2015年间进行的301项两阶段人口与健康调查和多指标类集调查，我们将社区的卫生设施可及性计算为抽样群组中可使用任何类型卫生设施的家庭比例。然后，我们根据生活在卫生设施可及性高的社区的各种预测因素对儿童进行精确匹配。以匹配组作为随机截距，使用逻辑回归分析，我们研究了发育迟缓、任何贫血、中度或重度贫血以及前两周腹泻等儿童健康结果与生活在社区层面卫生设施可及性程度不同的社区之间的关联。对于有家庭卫生设施可及性的儿童，生活在卫生设施可及率为100%的社区与发育迟缓几率降低相关（调整优势比[AOR]=0.97，95%；置信区间[CI]=0.94-1.00；n=14,153个匹配组，1,175,167名儿童），任何贫血（AOR=0.73；95%CI=0.67-0.78；n=5,319个匹配组，299,033名儿童），中度或重度贫血（AOR=0.72，95%CI=0.68-0.77；n=5,319个匹配组，299,033名儿童）以及腹泻（AOR=0.94；95%CI=0.91-0.97；n=16,379个匹配组，1,603,731名儿童），相比生活在卫生设施可及率低于30%的社区。对于没有家庭卫生设施可及性的儿童，生活在卫生设施可及率为0%的社区与发育迟缓几率较高相关（AOR=1.04，95%CI=1.02-
