Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Haidian District, Beijing, China.
Public Health. 2024 Oct;235:202-210. doi: 10.1016/j.puhe.2024.07.004. Epub 2024 Aug 16.
Globally, billions of people do not have access to safely managed drinking water and sanitation services. Interventions to improve drinking water, sanitation and hygiene could reduce the incidence of diarrhoea in low- and middle-income countries. This study aimed to investigate the association between these services and the incidence of diarrhoea.
Worldwide, ecological observational study, utilising cross-sectional data.
Data from the Global Burden of Disease Study 2019 and World Bank were used in this study. Diarrhoeal disease episodes were defined as three or more loose bowel movements within 24 h. Estimated Annual Percentage Change was used to quantify trends in disease incidence over a specific time interval. Quasi-Poisson Generalised Linear Model was introduced to analyse the influence of basic drinking water and sanitation services on the incidence of diarrhoea. Subgroup analyses were carried out to determine potential variations in the incidence of diarrhoeal diseases according to sex, age and sociodemographic index (SDI) region.
Between 2000 and 2019, the incidence rate of global diarrhoea remained consistent, with regional variations linked to SDIs. A 1% increase in access to basic drinking water was associated with a 0.41% (95% confidence interval [CI], 0.33%-0.50%) increase in the age-standardised incidence rate of diarrhoea; meanwhile, a 1% increase in sanitation service usage was associated with a 0.47% (95% CI, 0.40%-0.54%) reduction in the age-standardised incidence rate of diarrhoea. The correlation differed across SDI regions. The use of safely managed drinking water was associated with a reduction in diarrhoeal disease rates, but the effect was non-significant in High SDI regions. Higher diarrhoeal disease incidence was seen in younger and older populations. Individuals in the age groups 55-59 years and 10-14 years showed the greatest association of water service usage with diarrhoea, while an increase in sanitation service usage was related to decreased diarrhoea rates in most age groups, excluding children aged 5-14 years.
Emphasising initiatives to enhance water quality, elevate the standards of drinking water safety management, and strengthening related infrastructure development in global health policies and development plans could have a positive impact on overall global health. Such comprehensive interventions have the potential to not only prevent waterborne diseases but also elevate the general health status of societies worldwide.
在全球范围内，数十亿人无法获得安全管理的饮用水和环境卫生服务。改善饮用水、环境卫生和个人卫生的干预措施可降低中低收入国家腹泻的发病率。本研究旨在调查这些服务与腹泻发病率之间的关系。
这是一项全球性的、基于观察的生态学研究，利用了横断面数据。
本研究使用了 2019 年全球疾病负担研究和世界银行的数据。腹泻病发作定义为 24 小时内出现 3 次或以上稀便。使用估计年百分变化来量化特定时间段内疾病发病率的变化趋势。引入了拟泊松广义线性模型来分析基本饮用水和环境卫生服务对腹泻发病率的影响。进行了亚组分析，以确定根据性别、年龄和社会人口指数（SDI）区域的变化，腹泻疾病发病率的潜在变化。
2000 年至 2019 年期间，全球腹泻发病率保持稳定，地区差异与 SDI 有关。基本饮用水获得率每增加 1%，腹泻发病率的年龄标准化发生率相应增加 0.41%（95%置信区间 [CI]，0.33%-0.50%）；而环境卫生服务使用率每增加 1%，腹泻发病率的年龄标准化发生率相应降低 0.47%（95% CI，0.40%-0.54%）。这种相关性在不同 SDI 区域有所不同。安全管理饮用水的使用与腹泻病发病率的降低有关，但在高 SDI 区域，这种关联不显著。在年轻和老年人群中，腹泻病发病率更高。55-59 岁和 10-14 岁年龄组的人群中，水服务使用与腹泻的关联最大，而环境卫生服务使用率的增加与大多数年龄组（14 岁以下儿童除外）腹泻率的降低有关。
在全球卫生政策和发展计划中强调改善水质、提高饮用水安全管理标准以及加强相关基础设施建设的倡议，可能对全球整体健康状况产生积极影响。这些综合干预措施不仅有潜力预防水传播疾病，还可以提高全球社会的整体健康水平。
