Environmental Health Sciences, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, 1212, Bangladesh; SID Foundation, Dhaka, 1216, Bangladesh.
Environmental Health Sciences, BRAC James P. Grant School of Public Health, BRAC University, Dhaka, 1212, Bangladesh.
Int J Hyg Environ Health. 2019 Sep;222(8):1098-1108. doi: 10.1016/j.ijheh.2019.08.006. Epub 2019 Aug 20.
Diarrhoea, the most common disease directly related to water, sanitation, and hygiene (WASH), still remains one of the most significant health problems among children under-five worldwide. In this reality, BRAC, the largest NGO in the world initiated a comprehensive WASH intervention in 50 upazilas (sub-districts) of Bangladesh in 2007 which was later scaled up to cover 150 upazilas in two subsequent phases. The intervention period of the programme was 2007-2011. The present study encompassed 30 upazilas of the first phase of intervention. The aim of the study was to investigate the effectiveness of this intervention on reduction of diarrhoea among under-five children, and to identify the factors associated with childhood diarrhoea. A repeated cross-sectional study design was followed, and a population-based survey was carried out on four occasions: baseline (2007), midline (2009), endline (2011), and post-endline (2015) among 4,775 households. This analysis considers only households having at least one under-five children. Absence of handwashing practice with soap after defecation and before eating food, unclean latrine condition, and unsafe disposal of child faeces were identified as significant risk factors associated with under-five diarrhoea from Log-binomial regression. The prevalence of under-five diarrhoea within the past 2 weeks of the survey declined from 13.7% at baseline to 3.6% at end-line (p < 0.001) in the WASH intervention area. However, the progress seemingly stalled after 2011, which may have occurred due to the lack of improvement in unsafe disposal of child faeces and unclean latrine condition after the intervention period. Study findings suggest that, to reduce the prevalence of childhood diarrhoea it is important to promote safe disposal of child faeces, maintaining cleanliness of latrines, and washing hand with soap at critical times, beyond merely increasing the sanitation coverage. Findings also underline the necessity of maintaining a small-scale monitoring component involving local community, such as a WatSan committee (a local committee comprising the user communities for supervising WASH related activities) for periodic monitoring at household level for a certain period after the program intervention works to make the behavioural change more sustainable and to keep the reduction rate of under-five diarrhoeal prevalence steady.
腹泻是与水、环境卫生和个人卫生（WASH）最直接相关的最常见疾病，仍然是全球五岁以下儿童面临的最严重健康问题之一。在这种情况下，BRAC 作为全球最大的非政府组织，于 2007 年在孟加拉国的 50 个县（相当于中国的乡镇）启动了一项全面的 WASH 干预措施，随后在两个后续阶段扩大到覆盖 150 个县。该项目的干预期为 2007 年至 2011 年。本研究涵盖了干预措施第一阶段的 30 个县。研究的目的是调查该干预措施对减少五岁以下儿童腹泻的效果，并确定与儿童腹泻相关的因素。采用重复的横断面研究设计，在四个时间点（基线 2007 年、中期 2009 年、结束线 2011 年和结束线后 2015 年）对 4775 户家庭进行了基于人群的调查。本分析仅考虑至少有一名五岁以下儿童的家庭。在食用食物前未用肥皂洗手，便后未用肥皂洗手，厕所卫生条件差，儿童粪便处理不安全，这些都被认为是与五岁以下儿童腹泻相关的重要危险因素。从 Log-binomial 回归分析来看，在调查前两周内，五岁以下儿童腹泻的患病率从基线时的 13.7%下降到干预区的 3.6%（p<0.001）。然而，2011 年后，进展似乎停滞不前，这可能是由于干预期后儿童粪便处理不安全和厕所卫生条件改善不明显所致。研究结果表明，要降低儿童腹泻的患病率，除了增加卫生设施的覆盖率外，还必须促进儿童粪便的安全处理，保持厕所的清洁卫生，在关键时间用肥皂洗手。研究结果还强调了保持小规模监测组件的必要性，包括 WatSan 委员会（由监督与 WASH 相关活动的用户社区组成的地方委员会），以便在项目干预后一段时间内，定期在家庭层面进行监测，使行为改变更加可持续，并保持五岁以下儿童腹泻患病率的降低率稳定。
