Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Environmental Health Sciences, Jimma University, Jimma, Ethiopia.
PLoS One. 2020 Feb 19;15(2):e0229303. doi: 10.1371/journal.pone.0229303. eCollection 2020.
Diarrhea is one of the leading causes of child morbidity and mortality in low- and middle-income countries like Ethiopia. The use of safe drinking water and improved sanitation are important practices to prevent diarrhea. However, limited research has been done to link water supply, sanitation and hygiene practices and childhood diarrhea. Therefore, this study aimed at assessing the association between microbial quality of drinking water, sanitation and hygiene practices and childhood diarrhea.
Community-based matched case-control study design was applied on 198 paired children from June to July 2019 in Kersa and Omo Nada districts of Jimma Zone, Ethiopia. Cases are children < 5 years of age with diarrhea during the two weeks before the survey. The controls are children without diarrhea during the two weeks before the survey. Twenty-five percent matched pair samples of water were taken from households of cases and controls. Data were collected using structured questionnaire by interviewing mothers/caregivers. A sample of water was collected in nonreactive borosilicate glass bottles and analyzed by the membrane filtration method to count fecal indicator bacteria. A conditional logistic regression model was used; variables with p-value less than 0.05 were considered as significantly associated with childhood diarrhea.
A total of 396 (each case matched with control) under-five children with their mothers/caregivers were included in this study. In the analysis, variables like presence of under-five child in their home (AOR = 2.76; 95% CI: 1.33-5.71), wealth status (AOR = 5.39; 95% CI: 1.99-14.55), main sources of drinking water (AOR = 4.01; 95% CI: 1.40-11.44), hand washing practice before water collection (AOR = 4.28; 95% CI: 1.46-12.56), treating water at household level (AOR = 1.22; 95% CI: 0.48-3.09), latrine use all the times of the day and night (AOR = 0.22; 95% CI: 0.06-0.78), using pit as method of waste disposal (AOR = 4.91; 95% CI: 1.39-13.29) and use of soap for hand washing (AOR = 2.89; 95% CI: 1.35-6.15) were significantly associated with childhood diarrhea. Moreover, 30% of sampled water from cases and 26% of sampled water from controls families were free from Escherichia coli whereas all sampled water analyzed for Total coliforms were positive.
We conclude that the main sources of drinking water, hand washing before water drawing from a storage container, domestic waste disposal place and use of soap for hand washing were the most important factors for the prevention of childhood diarrhea.
腹泻是埃塞俄比亚等中低收入国家导致儿童发病和死亡的主要原因之一。使用安全饮用水和改善环境卫生是预防腹泻的重要措施。然而，对于水供应、环境卫生和个人卫生实践与儿童腹泻之间的关联，相关研究还很有限。因此，本研究旨在评估饮用水的微生物质量、环境卫生和个人卫生实践与儿童腹泻之间的关联。
采用基于社区的病例对照研究设计，于 2019 年 6 月至 7 月在埃塞俄比亚吉马地区的克萨和奥莫纳达区对 198 对 5 岁以下儿童进行了研究。病例为调查前两周内患有腹泻的 5 岁以下儿童。对照为调查前两周内无腹泻的儿童。从病例和对照家庭中抽取了 25%的 25%匹配样本的水。数据通过对母亲/照顾者进行访谈的结构化问卷收集。采集水样于非反应性硼硅酸盐玻璃瓶中，并采用膜过滤法分析以计数粪便指示菌。采用条件逻辑回归模型；p 值小于 0.05 的变量被认为与儿童腹泻显著相关。
本研究共纳入了 396 名（每个病例匹配 1 名对照）5 岁以下儿童及其母亲/照顾者。在分析中，家中有 5 岁以下儿童（OR = 2.76；95%CI：1.33-5.71）、家庭财富状况（OR = 5.39；95%CI：1.99-14.55）、主要饮用水来源（OR = 4.01；95%CI：1.40-11.44）、在收集水之前洗手的习惯（OR = 4.28；95%CI：1.46-12.56）、家庭水平水处理（OR = 1.22；95%CI：0.48-3.09）、所有时间都使用厕所（OR = 0.22；95%CI：0.06-0.78）、使用坑作为废物处理方法（OR = 4.91；95%CI：1.39-13.29）和使用肥皂洗手（OR = 2.89；95%CI：1.35-6.15）与儿童腹泻显著相关。此外，病例组 30%和对照组 26%的抽样水均未检出大肠埃希氏菌，但所有分析的总大肠菌群水样均为阳性。
我们得出结论，主要饮用水来源、从储存容器中取水前洗手、家庭废物处理场所以及使用肥皂洗手是预防儿童腹泻的最重要因素。
