Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK.
Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA.
BMC Med. 2019 Aug 28;17(1):173. doi: 10.1186/s12916-019-1410-x.
Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations' Sustainable Development Goals, and the bold new target of safely managed water, sanitation and hygiene for all by 2030, these results warrant the attention of researchers, policy-makers and practitioners.
Here we report the conclusions of an expert meeting convened by the World Health Organization and the Bill and Melinda Gates Foundation to discuss these findings, and present five key consensus messages as a basis for wider discussion and debate in the WASH and nutrition sectors. We judge these trials to have high internal validity, constituting good evidence that these specific interventions had no effect on childhood linear growth, and mixed effects on childhood diarrhea. These results suggest that, in settings such as these, more comprehensive or ambitious WASH interventions may be needed to achieve a major impact on child health.
These results are important because such basic interventions are often deployed in low-income rural settings with the expectation of improving child health, although this is rarely the sole justification. Our view is that these three new trials do not show that WASH in general cannot influence child linear growth, but they do demonstrate that these specific interventions had no influence in settings where stunting remains an important public health challenge. We support a call for transformative WASH, in so much as it encapsulates the guiding principle that - in any context - a comprehensive package of WASH interventions is needed that is tailored to address the local exposure landscape and enteric disease burden.
三项规模空前、耗资巨大的新试验，包括新颖的析因设计，均未发现基本的水、环境卫生和个人卫生（WASH）干预措施对儿童发育迟缓有影响，仅对儿童腹泻有混合影响。在联合国可持续发展目标启动之际，以及到 2030 年实现人人享有安全管理的水、环境卫生和个人卫生的大胆新目标之时，这些结果值得研究人员、决策者和从业者关注。
本文报告了世界卫生组织和比尔及梅琳达·盖茨基金会召集的一次专家会议的结论，以讨论这些发现，并提出了五条关键共识信息，作为在 WASH 和营养部门更广泛讨论和辩论的基础。我们认为这些试验具有较高的内部有效性，充分证明这些特定干预措施对儿童线性生长没有影响，对儿童腹泻有混合影响。这些结果表明，在这些环境中，可能需要更全面或更具雄心的 WASH 干预措施，才能对儿童健康产生重大影响。
这些结果很重要，因为这些基本干预措施通常在预期改善儿童健康的低收入农村环境中部署，尽管这并非唯一理由。我们认为，这三项新试验并非表明 WASH 一般不能影响儿童线性生长，而是表明在发育迟缓仍然是一个重要公共卫生挑战的环境中，这些特定干预措施没有影响。我们支持呼吁进行变革性的 WASH，因为它包含了这样一个指导原则，即在任何情况下，都需要一整套有针对性的 WASH 干预措施，以解决当地的暴露状况和肠道疾病负担。
