Kolsky P J
London School of Hygiene and Tropical Medicine, UK.
Trans R Soc Trop Med Hyg. 1993 Dec;87 Suppl 3:43-6. doi: 10.1016/0035-9203(93)90537-z.
This paper reviews the application of epidemiological understanding of diarrhoeal disease to interventions in water and sanitation. Over the past 20 years, great efforts have been made to elucidate the relationships between water supply, sanitation and diarrhoeal disease. At the outset, it was hoped that improved understanding of these relations could provide a rational framework for the planning of public health engineering interventions. This paper also reviews historical and recent perceptions of water, sanitation, and diarrhoeal disease, and summarizes progress to date. On the one hand, some fundamental ideas about the relative importance of water quality and quantity in the transmission of diarrhoeal disease have changed, and there is increased recognition of the complex interrelationships between interventions, hygiene behaviour and health. On the other hand, our understanding of the impact of interventions is painfully incomplete, and is unlikely to improve dramatically in the near future. While further research can usefully illustrate a variety of interactions in specific contexts, globally applicable planning guidelines and design criteria appear a dangerous will-o'-the-wisp. While we know more than ever before about water, sanitation and diarrhoea, much remains unknown, and is perhaps unknowable.
本文回顾了腹泻病流行病学知识在水与环境卫生干预措施中的应用。在过去20年里，人们付出了巨大努力来阐明供水、环境卫生与腹泻病之间的关系。一开始，人们希望对这些关系的深入理解能够为公共卫生工程干预措施的规划提供一个合理的框架。本文还回顾了对水、环境卫生和腹泻病的历史及近期认知，并总结了迄今为止取得的进展。一方面，关于水质和水量在腹泻病传播中的相对重要性的一些基本观念已经发生了变化，人们越来越认识到干预措施、卫生行为与健康之间复杂的相互关系。另一方面，我们对干预措施影响的理解极其不完整，而且在不久的将来也不太可能有显著改善。虽然进一步的研究能够有效地阐明特定背景下的各种相互作用，但全球适用的规划指南和设计标准似乎是难以实现的海市蜃楼。虽然我们对水、环境卫生和腹泻病的了解比以往任何时候都多，但仍有许多未知之处，甚至可能是不可知的。
