Tiwari Amy, Russpatrick Scott, Hoehne Alexandra, Matimelo Selma M, Mazimba Sharon, Nkhata Ilenga, Osbert Nicolas, Soloka Geoffrey, Winters Anna, Winters Benjamin, Larsen David A
Akros, Lusaka, Zambia.
United Nations Children's Emergency Fund Water and Sanitation Unit, Lusaka, Zambia.
Am J Trop Med Hyg. 2017 Nov;97(5):1355-1361. doi: 10.4269/ajtmh.16-0612. Epub 2017 Oct 10.
Open defecation is practiced by more than one billion people throughout the world and leads to significant public health issues including infectious disease transmission and stunted growth in children. Zambia implemented community-led total sanitation (CLTS) as an intervention to eliminate open defecation in rural areas. To support CLTS and the attainment of open defecation free communities, chiefs were considered key agents of change and were empowered to drive CLTS and improve sanitation for their chiefdom. Chiefs were provided with data on access to sanitation in the chiefdom during chiefdom orientations prior to the initiation of CLTS within each community and encouraged to make goals of universal sanitation access within the community. Using a survival regression, we found that where chiefs were orientated and mobilized in CLTS, the probability that a village would achieve 100% coverage of adequate sanitation increased by 23% (hazard ratio = 1.263, 95% confidence interval = 1.080-1.478, = 0.003). Using an interrupted time series, we found a 30% increase in the number of individuals with access to adequate sanitation following chiefdom orientations (95% confidence interval = 28.8-32.0%). The mobilization and support of chiefs greatly improved the uptake of CLTS, and empowering them with increased CLTS knowledge and authority of the program in their chiefdom allowed chiefs to closely monitor village sanitation progress and follow-up with their headmen/headwomen. These key agents of change are important facilitators of public health goals such as the elimination of open defecation in Zambia by 2020.
全世界有超过10亿人有露天排便的习惯，这导致了重大的公共卫生问题，包括传染病传播和儿童发育迟缓。赞比亚实施了社区主导的全面卫生（CLTS）措施，作为消除农村地区露天排便的一项干预措施。为了支持CLTS并实现无露天排便社区的目标，酋长们被视为变革的关键推动者，并被赋予权力推动CLTS，改善其酋长领地的卫生状况。在每个社区启动CLTS之前的酋长领地情况介绍会上，向酋长们提供了有关该酋长领地卫生设施使用情况的数据，并鼓励他们制定社区内普及卫生设施的目标。通过生存回归分析，我们发现，在CLTS中对酋长进行了情况介绍和动员的地方，村庄实现100%适当卫生设施覆盖率的概率提高了23%（风险比=1.263，95%置信区间=1.080-1.478，P=0.003）。通过中断时间序列分析，我们发现，在酋长领地情况介绍会后，有适当卫生设施的人数增加了30%（95%置信区间=28.8-32.0%）。对酋长的动员和支持极大地提高了CLTS的接受程度，赋予他们更多关于CLTS的知识以及在其酋长领地内对该项目的权力，使酋长们能够密切监测村庄的卫生进展情况，并与其村长进行跟进。这些变革的关键推动者是实现公共卫生目标的重要促进因素，例如到2020年在赞比亚消除露天排便。
