Department of Environmental Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia.
Department of Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
PLoS One. 2024 May 16;19(5):e0303754. doi: 10.1371/journal.pone.0303754. eCollection 2024.
INTRODUCTION: Improved sanitation refers to those that effectively avoid human contact with excreta in a hygienic manner. Having improved latrines is a key factor in adopting safe ways of disposing of child feces. However, previous studies in Africa that examined how owning improved latrine facilities associated with household child feces disposal practices has shown inconsistent results, and no systematic review of these findings has been done. Therefore, this study aims to synthesize the evidence on the significance of households having improved latrine facilities for safe child feces disposal practices among households with under five-year-old children in Africa. METHODS: The searched databases include: PubMed/Medline, Ovid/Embase, ScienceDirect, AJOL and the Cochrane Library. In the search process, Google Scholar and references of other studies were considered. This review included studies that were published in English without any time restrictions. The outcome of this study was an estimate of the association between the ownership of an improved latrine and the disposal practices of children's feces. Two reviewers used the Excel data extraction tool to extract the relevant data from the studies that were included in the review. Using Stata version 16, a meta-analysis was performed with a random effects statistical model. The inverse index of variance (I2) was used to assess heterogeneity. Forest plots were used to show the pooled estimate with a 95% confidence interval. Publication bias was assessed using Egger's test and a funnel plot. RESULTS: Out of the 616 studies that were retrieved, 15 were included in the systematic review analysis and 10 were included in the meta-analysis. All studies that were included are cross-sectional studies done in Ethiopia, Nigeria, Gambia, Malawi, Eswatini, Ghana, Zambia, and a study used data from sub-Saharan Africa. Improved latrine facilities significantly enhanced the practice of safe child feces disposal, as shown by the overall effect size (OR = 2.74; 95% CI = 1.24-1.35, I2 = 99.95%). In the subgroup analysis by sample size, the presence of improved latrines significantly enhanced safe child feces disposal in studies with sample sizes less than 1000 (OR = 3.24; 95% CI = 2.86-3.62, I2 = 61.38%), while there was no significant difference in studies with sample sizes greater than 1000 (OR = 2.67; 95% CI = 0.69-4.64, I2 = 99.97%). However, studies that involved children under 5 years old indicated that improved latrine facilities significantly enhanced the practice of safe child feces disposal (OR = 4.02; 95% CI = 2.03-6.09; I2 = 99.96%). CONCLUSIONS: In this research study, we examined the ownership of improved latrine facilities among households with five-year-old children to enhance the disposal of child feces in a safer manner in Africa. The high heterogeneity among the studies and the cross-sectional design of the included studies limit the causal inference and generalizability of the findings. Therefore, meta-analyses of longitudinal and experimental studies are needed to confirm the causal relationship between improved latrine facilities and safe child feces disposal practices in Africa.
简介:改良卫生是指以卫生的方式有效避免人与粪便接触。拥有改良厕所是采用安全方式处理儿童粪便的关键因素。然而,非洲以前研究检查了拥有改良厕所设施与家庭处理儿童粪便做法之间的关联,结果不一致,也没有对这些发现进行系统综述。因此,本研究旨在综合有关家庭拥有改良厕所设施对五岁以下儿童家庭安全处理儿童粪便做法的重要性的证据。
方法:检索的数据库包括:PubMed/Medline、Ovid/Embase、ScienceDirect、AJOL 和 Cochrane 图书馆。在搜索过程中,还考虑了 Google Scholar 和其他研究的参考文献。本综述包括发表在英语期刊上且没有时间限制的研究。本研究的结果是评估拥有改良厕所与儿童粪便处理做法之间关联的估计值。两位审查员使用 Excel 数据提取工具从纳入综述的研究中提取相关数据。使用 Stata 版本 16,采用随机效应统计模型进行荟萃分析。使用方差倒数指数(I2)评估异质性。森林图用于显示具有 95%置信区间的汇总估计值。使用 Egger 检验和漏斗图评估发表偏倚。
结果:在检索到的 616 项研究中,有 15 项被纳入系统综述分析,10 项被纳入荟萃分析。所有纳入的研究均为横断面研究,在埃塞俄比亚、尼日利亚、冈比亚、马拉维、斯威士兰、加纳、赞比亚进行,一项研究使用了撒哈拉以南非洲的数据。改良厕所设施显著提高了安全处理儿童粪便的做法,总体效应量(OR=2.74;95%CI=1.24-1.35,I2=99.95%)。在按样本量进行的亚组分析中,在样本量小于 1000 的研究中,改良厕所的存在显著提高了安全处理儿童粪便的做法(OR=3.24;95%CI=2.86-3.62,I2=61.38%),而在样本量大于 1000 的研究中没有显著差异(OR=2.67;95%CI=0.69-4.64,I2=99.97%)。然而,涉及 5 岁以下儿童的研究表明,改良厕所设施显著提高了安全处理儿童粪便的做法(OR=4.02;95%CI=2.03-6.09;I2=99.96%)。
结论:在这项研究中,我们研究了五岁以下儿童家庭拥有改良厕所设施的情况,以提高非洲以更安全的方式处理儿童粪便。研究之间的高度异质性和纳入研究的横断面设计限制了发现的因果推断和推广。因此,需要对纵向和实验研究进行荟萃分析,以确认改良厕所设施与非洲安全处理儿童粪便做法之间的因果关系。
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