University of Ghana School of Public Health, Accra, Ghana.
PLoS One. 2024 May 24;19(5):e0302754. doi: 10.1371/journal.pone.0302754. eCollection 2024.
Good Water, Sanitation and Hygiene (WASH) practices, introduction of Rotavirus vaccination, zinc supplementation and improved nutrition have contributed significantly to the reduction of diarrhoea morbidity and mortality globally by 50%. In spite of these gains, diarrhoea still remains a leading cause of morbidity and mortality in children under-five. Causes of diarrhoea are multifaceted with many factors such as seasonality, behaviour, pathogenicity, epidemiology, etc. However, assessments on the causes of diarrhoea have generally been tackled in silos over the years focusing only on particular causes. In this study, we describe an integrated approach (evaluating WASH interventions implantation processes, assessing epidemiolocal risk factors, and identifying pathogens causing diarrhoea) for assessing determinants of diarrhoea.
The study has ethical approval from the Ghana Health Service Ethical Review Committee (GHSERC:020/07/22). It will employ three approaches; a process evaluation and a case-control study and laboratory analysis of diarrhoea samples. The process evaluation will assess the detailed procedures taken by the Anloga district to implement WASH interventions. A desk review and qualitative interviews with WASH stakeholders purposively sampled will be done. The evaluation will provide insight into bottlenecks in the implementation processes. Transcribed interviews will be analysed thematically and data triangulated with reviews. A 1:1 unmatched case-control study with 206 cases and 206 controls to determine risk factors associated with diarrhoea in children under-five will also be done. Odds ratios at 5.0% significance level would be calculated. Stool samples of cases will be taken and tested for diarrhoea pathogens using Standard ELISA and TAQMAN Array Card laboratory procedures.
It is expected that this framework proposed would become one of the robust approaches for assessing public health community interventions for diseases. Through the process evaluation, epidemiological case-control study and pathogen identification, we would be able to identify the gaps in the current diarrhoea assessments, come up with tailored recommendations considering the existing risk and assumptions and involve the relevant stakeholders in reducing the diarrhoea burden in a coastal setting in Ghana.
良好的水、环境卫生和个人卫生（WASH）措施、轮状病毒疫苗接种的引入、补锌和改善营养，这些措施共同使全球腹泻发病率和死亡率降低了 50%。尽管取得了这些进展，但腹泻仍然是五岁以下儿童发病和死亡的主要原因。腹泻的病因是多方面的，有许多因素，如季节性、行为、致病性、流行病学等。然而，多年来，对腹泻病因的评估一直是孤立进行的，只关注特定的病因。在这项研究中，我们描述了一种综合方法（评估 WASH 干预措施的实施过程、评估流行病学风险因素以及确定导致腹泻的病原体），用于评估腹泻的决定因素。
这项研究已获得加纳卫生局伦理审查委员会（GHSERC：020/07/22）的伦理批准。它将采用三种方法；过程评估、病例对照研究和腹泻样本的实验室分析。过程评估将评估阿纳洛区实施 WASH 干预措施所采取的详细程序。将进行桌面审查和对 WASH 利益攸关方的定性访谈，这些利益攸关方是经过有目的抽样的。评估将深入了解实施过程中的瓶颈。转录后的访谈将进行主题分析，并与评论进行数据三角剖分。还将进行 1:1 不匹配的病例对照研究，纳入 206 例病例和 206 例对照，以确定与五岁以下儿童腹泻相关的风险因素。将计算 5.0%显著性水平的比值比。还将采集病例的粪便样本，并使用标准 ELISA 和 TAQMAN 阵列卡实验室程序检测腹泻病原体。
预计所提出的这一框架将成为评估公共卫生社区干预疾病的强有力方法之一。通过过程评估、流行病学病例对照研究和病原体鉴定，我们将能够发现当前腹泻评估中的差距，根据现有风险和假设提出有针对性的建议，并让相关利益攸关方参与减少加纳沿海地区的腹泻负担。
