基于调查的水、环境卫生和动物相关因素对中重度腹泻的影响评估：2015-2018 年非洲疫苗对腹泻影响研究：冈比亚、马里和肯尼亚。
Survey-Based Assessment of Water, Sanitation, and Animal-Associated Risk Factors for Moderate-to-Severe Diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) Study: The Gambia, Mali, and Kenya, 2015-2018.
机构信息
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
出版信息
Clin Infect Dis. 2023 Apr 19;76(76 Suppl1):S132-S139. doi: 10.1093/cid/ciac911.
BACKGROUND
Pediatric exposures to unsafe sources of water, unsafely managed sanitation, and animals are prevalent in low- and middle-income countries. In the Vaccine Impact on Diarrhea in Africa case-control study, we examined associations between these risk factors and moderate-to-severe diarrhea (MSD) in children <5 years old in The Gambia, Kenya, and Mali.
METHODS
We enrolled children <5 years old seeking care for MSD at health centers; age-, sex-, and community-matched controls were enrolled at home. Conditional logistic regression models, adjusted for a priori confounders, were used to evaluate associations between MSD and survey-based assessments of water, sanitation, and animals living in the compound.
RESULTS
From 2015 to 2018, 4840 cases and 6213 controls were enrolled. In pan-site analyses, children with drinking water sources below "safely managed" (onsite, continuously accessible sources of good water quality) had 1.5-2.0-fold higher odds of MSD (95% confidence intervals [CIs] ranging from 1.0 to 2.5), driven by rural site results (The Gambia and Kenya). In the urban site (Mali), children whose drinking water source was less available (several hours/day vs all the time) had higher odds of MSD (matched odds ratio [mOR]: 1.4, 95% CI: 1.1, 1.7). Associations between MSD and sanitation were site-specific. Goats were associated with slightly increased odds of MSD in pan-site analyses, whereas associations with cows and fowl varied by site.
CONCLUSIONS
Poorer types and availability of drinking water sources were consistently associated with MSD, whereas the impacts of sanitation and household animals were context-specific. The association between MSD and access to safely managed drinking water sources post-rotavirus introduction calls for transformational changes in drinking water services to prevent acute child morbidity from MSD.
背景
在低收入和中等收入国家，儿童接触不安全水源、管理不善的环境卫生设施和动物的情况普遍存在。在疫苗对非洲腹泻影响病例对照研究中，我们研究了这些危险因素与冈比亚、肯尼亚和马里 5 岁以下儿童中度至重度腹泻（MSD）之间的关系。
方法
我们招募了在卫生中心寻求治疗 MSD 的 5 岁以下儿童；在家中招募了年龄、性别和社区匹配的对照。使用条件逻辑回归模型，根据预先设定的混杂因素进行调整，评估 MSD 与基于调查的水源、环境卫生和居住在大院中的动物之间的关系。
结果
在 2015 年至 2018 年期间，共招募了 4840 例病例和 6213 例对照。在全站点分析中，饮用低于“安全管理”（现场、持续获得良好水质的水源）的水源的儿童患 MSD 的几率高出 1.5-2.0 倍（95%置信区间范围为 1.0 至 2.5），这主要归因于农村地区的结果（冈比亚和肯尼亚）。在城市地区（马里），饮用水源可用性较低（每天数小时/而不是随时）的儿童患 MSD 的几率更高（匹配比值比 [mOR]：1.4，95%CI：1.1，1.7）。MSD 与环境卫生之间的关联具有特定站点的特征。山羊与全站点分析中的 MSD 略有增加的几率相关，而牛和家禽与 MSD 的关联因地点而异。
结论
较差的水源类型和可获得性与 MSD 始终相关，而环境卫生和家庭动物的影响则具有特定地点的特征。在轮状病毒疫苗接种后，与获得安全管理的饮用水源相关的 MSD 之间的关联呼吁对饮用水服务进行变革性的改变，以防止急性儿童发病率从 MSD 中得到预防。
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