Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Environmental Health Group, London School of Hygiene and Tropical Medicine, London, UK.
Int J Epidemiol. 2019 Dec 1;48(6):1757-1767. doi: 10.1093/ije/dyz157.
Open defecation is widespread in rural India, and few households have piped water connections. While government and other efforts have increased toilet coverage in India, and evaluations found limited immediate impacts on health, longer-term effects have not been rigorously assessed.
We conducted a matched cohort study to assess the longer-term effectiveness of a combined household-level piped water and sanitation intervention implemented by Gram Vikas (an Indian NGO) in rural Odisha, India. Forty-five intervention villages were randomly selected from a list of those where implementation was previously completed at least 5 years before, and matched to 45 control villages. We conducted surveys and collected stool samples between June 2015 and October 2016 in households with a child <5 years of age (n = 2398). Health surveillance included diarrhoea (primary outcome), acute respiratory infection (ARI), soil-transmitted helminth infection, and anthropometry.
Intervention villages had higher improved toilet coverage (85% vs 18%), and increased toilet use by adults (74% vs 13%) and child faeces disposal (35% vs 6%) compared with control villages. There was no intervention association with diarrhoea [adjusted OR (aOR): 0.94, 95% confidence interval (CI): 0.74-1.20] or ARI. Compared with controls, children in intervention villages had lower helminth infection (aOR: 0.44, 95% CI: 0.18, 1.00) and improved height-for-age z scores (HAZ) (+0.17, 95% CI: 0.03-0.31).
This combined intervention, where household water connections were contingent on community-wide household toilet construction, was associated with improved HAZ, and reduced soil-transmitted helminth (STH) infection, though not reduced diarrhoea or ARI. Further research should explore the mechanism through which these heterogenous effects on health may occur.
在印度农村，露天排便现象普遍存在，很少有家庭拥有管道供水连接。尽管政府和其他方面的努力已经增加了印度的厕所覆盖率，并且评估发现对健康的直接影响有限，但长期影响尚未得到严格评估。
我们进行了一项匹配队列研究，以评估 Gram Vikas（一家印度非政府组织）在印度奥里萨邦实施的家庭层面管道供水和卫生综合干预的长期效果。从之前至少完成 5 年实施的村庄名单中随机选择了 45 个干预村庄，并与 45 个对照村庄相匹配。我们于 2015 年 6 月至 2016 年 10 月期间在 5 岁以下儿童家庭中进行了调查和粪便样本采集（n=2398）。健康监测包括腹泻（主要结局）、急性呼吸道感染（ARI）、土壤传播性蠕虫感染和人体测量学。
与对照村庄相比，干预村庄的改良厕所覆盖率更高（85%对 18%），成人厕所使用率更高（74%对 13%），儿童粪便处理率更高（35%对 6%）。干预与腹泻（调整后的 OR（aOR）：0.94，95%置信区间（CI）：0.74-1.20）或 ARI 无关。与对照组相比，干预组的儿童寄生虫感染率较低（aOR：0.44，95%CI：0.18，1.00），身高年龄 z 分数（HAZ）提高（0.17，95%CI：0.03-0.31）。
这种联合干预措施，即将家庭供水与社区范围内的家庭厕所建设挂钩，与改善 HAZ 以及减少土壤传播性蠕虫（STH）感染有关，尽管与腹泻或 ARI 无关。进一步的研究应该探索这些对健康的异质影响发生的机制。
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