单独和联合开展水、环境卫生和个人卫生干预措施以及营养改善对中低收入国家儿童生长的影响：系统评价和荟萃分析。
Effect of water, sanitation and hygiene interventions alone and combined with nutrition on child growth in low and middle income countries: a systematic review and meta-analysis.
机构信息
School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia, Ethiopia.
出版信息
BMJ Open. 2020 Jul 12;10(7):e034812. doi: 10.1136/bmjopen-2019-034812.
OBJECTIVE
This study aimed to provide clarification on the benefits of water, sanitation and hygiene (WASH) alone separately and combined with nutrition in improving child growth outcomes.
DESIGN
Systematic review and meta-analysis.
METHODS
We conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed, MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science and Science Direct were searched in May 2018 and last updated in April 2019. We included studies that reported WASH interventions alone separately or combined with nutrition. Fixed and random-effects models were used to estimate pooled effect in mean difference (MD). Heterogeneity and publication bias statistics were performed.
RESULTS
A total of 18 studies were included: 13 cluster randomised controlled trials (RCTs) and 5 non-randomised controlled trials (non-RCTs). Non-RCTs showed effect of WASH interventions alone on height-for-age z-score (HAZ) (MD=0.14; 95% CI 0.08 to 0.21) but RCTs did not. WASH alone of non-RCTs and RCTs that were delivered over 18-60 months indicated an effect on HAZ (MD=0.04; 95% CI 0.01 to 0.08). RCTs showed an effect for children <2 years (MD=0.07; 95% CI 0.01 to 0.13). Non-RCTs of WASH alone and those that included at least two components, improved HAZ (MD=0.15; 95% CI 0.07 to 0.23) but RCTs did not. WASH alone of non-RCTs and RCTs separately or together showed no effect on weight-for-age z-score (WAZ) and weight-for-height z-score (WHZ). Combined WASH with nutrition showed an effect on HAZ (MD=0.13; 95% CI 0.08 to 0.17) and on WAZ (MD=0.09; 95% CI 0.05 to 0.13) and was borderline on WHZ.
CONCLUSIONS
WASH interventions alone improved HAZ when delivered over 18-60 months and for children <2 years. Combined WASH with nutrition showed a strong effect on HAZ and WAZ and a borderline effect on WHZ. Integrated WASH with nutrition interventions may be effective inimproving child growth outcomes.
目的
本研究旨在阐明水、环境卫生和个人卫生（WASH）单独以及与营养相结合对改善儿童生长结果的益处。
设计
系统评价和荟萃分析。
方法
我们按照系统评价和荟萃分析的首选报告项目指南进行了系统评价。2018 年 5 月在 PubMed、MEDLINE、EMBASE、Scopus、Cochrane 图书馆、Web of Science 和 Science Direct 进行了检索，并于 2019 年 4 月进行了最新检索。我们纳入了单独报告 WASH 干预措施或与营养联合报告的研究。使用固定效应模型和随机效应模型估计均值差（MD）的汇总效应。进行了异质性和发表偏倚统计分析。
结果
共纳入 18 项研究：13 项群组随机对照试验（RCT）和 5 项非随机对照试验（非 RCT）。非 RCT 表明 WASH 单独干预措施对身高别年龄 Z 评分（HAZ）有影响（MD=0.14；95%CI 0.08 至 0.21），但 RCT 没有。非 RCT 的 WASH 单独干预措施以及持续 18-60 个月的 RCT 对 HAZ 有影响（MD=0.04；95%CI 0.01 至 0.08）。RCT 表明，WASH 对 2 岁以下儿童有影响（MD=0.07；95%CI 0.01 至 0.13）。非 RCT 的 WASH 单独干预措施和包含至少两个组成部分的 RCT 均提高了 HAZ（MD=0.15；95%CI 0.07 至 0.23），但 RCT 没有。非 RCT 的 WASH 单独干预措施以及单独或联合 RCT 对体重别年龄 Z 评分（WAZ）和体重别身高 Z 评分（WHZ）没有影响。WASH 与营养联合应用对 HAZ（MD=0.13；95%CI 0.08 至 0.17）和 WAZ（MD=0.09；95%CI 0.05 至 0.13）有影响，对 WHZ 有边缘影响。
结论
WASH 干预措施单独使用时，在持续 18-60 个月以及 2 岁以下儿童中可改善 HAZ。WASH 与营养联合应用对 HAZ 和 WAZ 有明显效果，对 WHZ 有边缘效果。WASH 与营养综合干预措施可能对改善儿童生长结果有效。
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