Department of Population Health Sciences, King's College London, Guy's Campus, London, England, UK.
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
J Glob Health. 2024 Jun 28;14:04018. doi: 10.7189/jogh.14.04018.
Diarrhoeal disease disproportionately affects children <5 years in low- and middle-income countries (LMICs). The pathogens responsible for diarrhoea are commonly transmitted through faecally-contaminated drinking water. Lifestraw Family point-of-use water filters have been the subject of intervention studies for over a decade and were the first filters evaluated by the World Health Organization in its water treatment evaluation scheme to provide comprehensive protection against many diarrhoea-causing pathogens. This systematic review aimed to: 1) report on aspects related to physical environment and implementation and 2) conduct an updated meta-analysis on Lifestraw Family filter effectiveness against childhood diarrhoea based on studies with ≥12 months of follow-up.
We conducted a literature search in November 2022 using MEDLINE, Embase, Cochrane, and CINAHL databases. Inclusion criteria were: 1) RCTs, cluster-RCTs, quasi-experimental, or matched cohort studies on 2) Lifestraw Family 1.0 or 2.0 filters 3) conducted in LMICs 4) that evaluated filter effectiveness against diarrhoea in children <5 and 5) analysed ≥12 months of follow-up data on clinical effectiveness against diarrhoea and were 6) published from 2010 with 7) full-text availability in English. A modified Newcastle-Ottawa Scale was used to assess risk of bias. Relative risk (RR) and 95% confidence intervals (CIs) were extracted and analysed using a random-effects meta-analysis.
We included 6 studies in LMICs involving 4740 children <5. Of the four clinically-effective interventions, common characteristics were access to improved water sources (75%), the 2.0 version of the filter or the 1.0 version with additional water storage (100%), use of behaviour change theory, community engagement, and health messaging (75%), local filter repair-and-replace mechanisms (75%), and specially-trained local interventionists (100%). The meta-analysis showed a 30% reduction in diarrhoea risk in the intervention group (RR = 0.69; 95% CI = 0.52-0.91, P = 0.01).
Lifestraw Family water filters can be effective interventions to reduce diarrhoea in vulnerable paediatric populations for at least one year, though certain aspects related to physical environment and implementation may increase their public health impact. The findings of this study suggest considerations for scale-up that can be applied in settings in need of longer-term interim solutions until universal access to safe drinking water is achieved.
腹泻病在中低收入国家（LMICs）中不成比例地影响 5 岁以下儿童。导致腹泻的病原体通常通过粪便污染的饮用水传播。Lifestraw Family 即食式水过滤器已成为干预研究的主题超过十年，并且是世界卫生组织在其水处理评估方案中评估的第一批过滤器，可提供针对许多腹泻病原体的全面保护。本系统评价旨在：1）报告与物理环境和实施相关的方面；2）根据具有≥12 个月随访的研究，对 Lifestraw Family 过滤器对儿童腹泻的有效性进行更新的荟萃分析。
我们于 2022 年 11 月在 MEDLINE、Embase、Cochrane 和 CINAHL 数据库中进行了文献检索。纳入标准为：1）RCTs、集群 RCTs、准实验或匹配队列研究；2）Lifestraw Family 1.0 或 2.0 过滤器；3）在 LMICs 中进行；4）评估过滤器对 5 岁以下儿童腹泻的有效性；5）分析≥12 个月的临床有效性随访数据；6）2010 年以后发表，且全文为英文。使用改良的 Newcastle-Ottawa 量表评估偏倚风险。提取相对风险（RR）和 95%置信区间（CI），并使用随机效应荟萃分析进行分析。
我们纳入了 4740 名<5 岁儿童的 6 项 LMIC 研究。在四项临床有效的干预措施中，共同特征包括获得改良水源（75%）、过滤器为 2.0 版本或 1.0 版本但具有额外的水储存（100%）、使用行为改变理论、社区参与和健康信息传递（75%）、当地的过滤器修复和更换机制（75%）以及经过专门培训的当地干预者（100%）。荟萃分析显示，干预组腹泻风险降低 30%（RR=0.69；95%CI=0.52-0.91，P=0.01）。
Lifestraw Family 水过滤器可作为减少弱势儿科人群腹泻的有效干预措施，至少持续一年，但与物理环境和实施相关的某些方面可能会增加其公共卫生影响。本研究的结果表明，在普遍获得安全饮用水之前，需要考虑扩大规模的问题，这些问题可以在需要长期临时解决方案的环境中应用。
