Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
PLoS One. 2019 Aug 21;14(8):e0221200. doi: 10.1371/journal.pone.0221200. eCollection 2019.
Program interventions like access to improved water supply, sanitation and hygiene do not have a systematic response to the aggregate health outcomes. Therefore, this is an attempt at recognising the concept of level sensitivity while verifying the association between prevalence of diarrhoea in under-five children in a district and its corresponding coverage of improved water supply and sanitation and hygiene. Information obtained in the DLHS-4 including 275 districts from 19 states and 2 union territories of India forms the database for this analysis. Universal access to safe drinking water, improving coverage of sanitation in a district beyond 71 percent across the country and beyond 78 percent among the non-south DLHS districts, has the potential to realise reductions in the prevalence of diarrhoea in under-five children in a district. The effect of improved sanitation seems to work synergistically with these indicators only at better levels of prevalence of diarrhoea in under-five children in a district. This offers lessons for the Clean India Mission in terms of universalising access to safe water and coverage up to three-fourths of households with sanitation in a district for the positive externalities to manifest in reduced prevalence of diarrhoea in under-five children.
项目干预措施，如获得改善的供水、卫生和个人卫生，并没有对总体健康结果做出系统的回应。因此，这是试图在验证一个地区五岁以下儿童腹泻患病率与其相应的改善供水、环境卫生和个人卫生覆盖范围之间的关联时，认识到水平敏感性概念。这项分析所使用的数据库来自印度四个国家抽样调查（DLHS-4），包括来自 19 个邦和 2 个联邦属地的 275 个地区。在全国范围内，实现安全饮用水的普及，将一个地区的卫生设施覆盖率提高到 71%以上，非南部地区的覆盖率提高到 78%以上，这有可能降低一个地区五岁以下儿童腹泻的患病率。改善卫生设施的效果似乎只有在一个地区五岁以下儿童腹泻的患病率处于较好水平时，才能与这些指标协同发挥作用。这为清洁印度使命提供了一些经验教训，即普及安全用水，使一个地区四分之三的家庭都能使用卫生设施，以实现减少五岁以下儿童腹泻患病率的积极外部效应。
