Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts.
National Health Research Authority, Lusaka, Zambia.
Am J Trop Med Hyg. 2019 Apr;100(4):1005-1012. doi: 10.4269/ajtmh.18-0632.
In 2012, approximately 5.6 million Zambians did not have access to improved sanitation and around 2.1 million practiced open defecation. The Zambia Sanitation and Hygiene Program (ZSHP), featuring community-led total sanitation, began in November 2011 to increase the use of improved sanitation facilities and adopt positive hygiene practices. Using a pre- and post-design approach with a population-level survey, after 3 years of implementation, we evaluated the impact of ZSHP in randomly selected households in 50 standard enumeration areas (representing 26 of 65 program districts). We interviewed caregivers of children younger than 5 years old (1,204 and 1,170 female caregivers at baseline and end line, respectively) and inspected household toilet facilities and sites for washing hands. At end line, 80% of households had access to improved sanitation facilities versus 64.1% at baseline (prevalence ratio [PR] = 1.25; 95% CI: 1.18-1.31) and 14.1% did not have a toilet facility compared with 19.4% at baseline. At end line, 10.6% of households reported living in an open defecation-free certified village compared with 0.3% at baseline (PR = 32.0; 95% CI: 11.9-86.4). In addition, at end line, 33.4% of households had a specific place for washing hands and 61.4% of caregivers reported handwashing with a washing agent after defecation or before preparing food compared with 21.1% (PR = 1.59; 95% CI: 1.39-1.82) and 55.2% (PR = 1.11; 95% CI: 1.04-1.19) at baseline, respectively. Community-led total sanitation implementation in Zambia led to improvements in access to improved sanitation facilities, reduced open defecation, and better handwashing practices. There is however a need for enhanced investment in sanitation and hygiene promotion.
2012 年，约有 560 万赞比亚人无法获得改良的环境卫生设施，约 210 万人仍在露天排便。赞比亚环境卫生和个人卫生方案于 2011 年 11 月启动，以增加对改良环境卫生设施的使用，并采取积极的个人卫生习惯。我们采用了在人口层面进行预-后设计的调查方法，在实施 3 年后，评估了该方案在随机选择的 50 个标准普查区（代表 65 个方案区中的 26 个）中的家庭的影响。我们采访了 5 岁以下儿童的照顾者（基线时有 1204 名女性照顾者，终点时有 1170 名），并检查了家庭厕所设施和洗手地点。在终点时，80%的家庭获得了改良的环境卫生设施，而基线时为 64.1%（患病率比[PR] = 1.25；95%CI：1.18-1.31），与基线时的 19.4%相比，没有厕所设施的家庭比例为 14.1%。在终点时，有 10.6%的家庭报告生活在一个获得认证的无露天排便村庄，而基线时为 0.3%（PR = 32.0；95%CI：11.9-86.4）。此外，在终点时，33.4%的家庭有一个专门的洗手场所，61.4%的照顾者表示在排便后或准备食物前使用洗手剂洗手，而与基线时的 21.1%（PR = 1.59；95%CI：1.39-1.82）和 55.2%（PR = 1.11；95%CI：1.04-1.19）相比，有更多的人报告了这些行为。赞比亚的社区主导的全面环境卫生方案导致获得改良的环境卫生设施的机会增加，露天排便减少，以及更好的洗手习惯。然而，仍需要加强环境卫生和个人卫生促进方面的投资。
