Lamichhane Prabhat, Sharma Anurag, Mahal Ajay
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, Australia.
School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.
Int Health. 2018 Jul 1;10(4):277-284. doi: 10.1093/inthealth/ihy030.
Improper disposal of child faeces is a major source of faecal pathogens that cause diarrhoeal disease. However, this has received relatively less attention in sanitation evaluation literature, which has tended to focus on sanitation provision, implicitly assuming that child faeces disposal behaviour also improves with sanitation. We examined the impact of improved sanitation without safe disposal (households with improved sanitation but not disposing of child faeces in improved sanitation) and improved sanitation with safe disposal (households with improved sanitation and disposal of child faeces in improved sanitation) on diarrhoeal prevalence in rural Nepal.
Data from the Nepal Demographic Health Survey 2011 for 3377 children <5 y of age were used to answer the research question using quasi-experimental methods.
Improved sanitation with safe disposal was associated with a 3.3 percentage point (standard error [SE] 0.016) to 6.6 percentage point (SE 0.023) lower prevalence of diarrhoea among children <5 y of age compared with matched households without access to improved sanitation. No effect was observed for households having improved sanitation without safe disposal compared with matched households without access to improved sanitation. Improved sanitation with safe disposal was also associated with a 4.0 percentage point (SE 0.023) lower prevalence of diarrhoea in low economic status households (bottom two quintiles).
Our results suggest that sanitation programmes need to focus on behavioural interventions as well as increasing access to sanitation facilities.
儿童粪便处理不当是导致腹泻病的粪便病原体的主要来源。然而，这在卫生设施评估文献中受到的关注相对较少，这些文献往往侧重于卫生设施的提供，隐含地假设儿童粪便处理行为也会随着卫生设施的改善而改善。我们研究了无安全处理措施的改善卫生设施情况（卫生设施得到改善但未在改善后的卫生设施中处理儿童粪便的家庭）和有安全处理措施的改善卫生设施情况（卫生设施得到改善且在改善后的卫生设施中处理儿童粪便的家庭）对尼泊尔农村地区腹泻患病率的影响。
使用2011年尼泊尔人口与健康调查中3377名5岁以下儿童的数据，采用准实验方法回答研究问题。
与未获得改善卫生设施的匹配家庭相比，有安全处理措施的改善卫生设施使5岁以下儿童腹泻患病率降低了3.3个百分点（标准误[SE]0.016）至6.6个百分点（SE 0.023）。与未获得改善卫生设施的匹配家庭相比，无安全处理措施的改善卫生设施家庭未观察到效果。有安全处理措施的改善卫生设施在经济地位较低的家庭（最底层两个五分位数）中也与腹泻患病率降低4.0个百分点（SE 0.023）相关。
我们的结果表明，卫生设施项目需要关注行为干预以及增加卫生设施的可及性。
