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Abstract：
Estimates of the effectiveness of water, sanitation, and hygiene (WASH) interventions that provide high levels of service on childhood diarrhoea are scarce. We aimed to provide up-to-date estimates on the burden of disease attributable to WASH and on the effects of different types of WASH interventions on childhood diarrhoea in low-income and middle-income countries (LMICs).
In this systematic review and meta-analysis, we updated previous reviews following their search strategy by searching MEDLINE, Embase, Scopus, Cochrane Library, and BIOSIS Citation Index for studies of basic WASH interventions and of WASH interventions providing a high level of service, published between Jan 1, 2016, and May 25, 2021. We included randomised and non-randomised controlled trials conducted at household or community level that matched exposure categories of the so-called service ladder approach of the Sustainable Development Goal (SDG) for WASH. Two reviewers independently extracted study-level data and assessed risk of bias using a modified Newcastle-Ottawa Scale and certainty of evidence using a modified Grading of Recommendations, Assessment, Development, and Evaluation approach. We analysed extracted relative risks (RRs) and 95% CIs using random-effects meta-analyses and meta-regression models. This study is registered with PROSPERO, CRD42016043164.
19 837 records were identified from the search, of which 124 studies were included, providing 83 water (62 616 children), 20 sanitation (40 799 children), and 41 hygiene (98 416 children) comparisons. Compared with untreated water from an unimproved source, risk of diarrhoea was reduced by up to 50% with water treated at point of use (POU): filtration (n=23 studies; RR 0·50 [95% CI 0·41-0·60]), solar treatment (n=13; 0·63 [0·50-0·80]), and chlorination (n=25; 0·66 [0·56-0·77]). Compared with an unimproved source, provision of an improved drinking water supply on premises with higher water quality reduced diarrhoea risk by 52% (n=2; 0·48 [0·26-0·87]). Overall, sanitation interventions reduced diarrhoea risk by 24% (0·76 [0·61-0·94]). Compared with unimproved sanitation, providing sewer connection reduced diarrhoea risk by 47% (n=5; 0·53 [0·30-0·93]). Promotion of handwashing with soap reduced diarrhoea risk by 30% (0·70 [0·64-0·76]).
WASH interventions reduced risk of diarrhoea in children in LMICs. Interventions supplying either water filtered at POU, higher water quality from an improved source on premises, or basic sanitation services with sewer connection were associated with increased reductions. Our results support higher service levels called for under SDG 6. Notably, no studies evaluated interventions that delivered access to safely managed WASH services, the level of service to which universal coverage by 2030 is committed under the SDG.
WHO, Foreign, Commonwealth & Development Office, and National Institute of Environmental Health Sciences.
In this systematic review and meta-analysis, we updated previous reviews following their search strategy by searching MEDLINE, Embase, Scopus, Cochrane Library, and BIOSIS Citation Index for studies of basic WASH interventions and of WASH interventions providing a high level of service, published between Jan 1, 2016, and May 25, 2021. We included randomised and non-randomised controlled trials conducted at household or community level that matched exposure categories of the so-called service ladder approach of the Sustainable Development Goal (SDG) for WASH. Two reviewers independently extracted study-level data and assessed risk of bias using a modified Newcastle-Ottawa Scale and certainty of evidence using a modified Grading of Recommendations, Assessment, Development, and Evaluation approach. We analysed extracted relative risks (RRs) and 95% CIs using random-effects meta-analyses and meta-regression models. This study is registered with PROSPERO, CRD42016043164.
19 837 records were identified from the search, of which 124 studies were included, providing 83 water (62 616 children), 20 sanitation (40 799 children), and 41 hygiene (98 416 children) comparisons. Compared with untreated water from an unimproved source, risk of diarrhoea was reduced by up to 50% with water treated at point of use (POU): filtration (n=23 studies; RR 0·50 [95% CI 0·41-0·60]), solar treatment (n=13; 0·63 [0·50-0·80]), and chlorination (n=25; 0·66 [0·56-0·77]). Compared with an unimproved source, provision of an improved drinking water supply on premises with higher water quality reduced diarrhoea risk by 52% (n=2; 0·48 [0·26-0·87]). Overall, sanitation interventions reduced diarrhoea risk by 24% (0·76 [0·61-0·94]). Compared with unimproved sanitation, providing sewer connection reduced diarrhoea risk by 47% (n=5; 0·53 [0·30-0·93]). Promotion of handwashing with soap reduced diarrhoea risk by 30% (0·70 [0·64-0·76]).
WASH interventions reduced risk of diarrhoea in children in LMICs. Interventions supplying either water filtered at POU, higher water quality from an improved source on premises, or basic sanitation services with sewer connection were associated with increased reductions. Our results support higher service levels called for under SDG 6. Notably, no studies evaluated interventions that delivered access to safely managed WASH services, the level of service to which universal coverage by 2030 is committed under the SDG.
WHO, Foreign, Commonwealth & Development Office, and National Institute of Environmental Health Sciences.
摘要：
对水的有效性的估计，卫生，提供高水平儿童腹泻服务的卫生干预措施(WASH)很少。我们旨在提供关于WASH造成的疾病负担以及不同类型的WASH干预措施对低收入和中等收入国家（LMICs）儿童腹泻的影响的最新估计。
在这篇系统综述和荟萃分析中，我们通过搜索MEDLINE按照他们的搜索策略更新了以前的评论，Embase,Scopus,科克伦图书馆,和BIOSIS引文索引，用于研究基本的WASH干预措施和提供高水平服务的WASH干预措施，在2016年1月1日至2021年5月25日之间发布。我们纳入了在家庭或社区层面进行的随机和非随机对照试验，这些试验与WASH可持续发展目标（SDG）的所谓服务阶梯方法的暴露类别相匹配。两名评审员独立提取研究水平的数据，并使用修改的纽卡斯尔-渥太华量表评估偏倚风险，并使用修改的建议分级评估证据的确定性。评估,发展,和评价方法。我们使用随机效应荟萃分析和荟萃回归模型分析了提取的相对风险(RR)和95%CI。这项研究在PROSPERO注册，CRD42016043164。
从搜索中确定了19837条记录，其中包括124项研究，提供83水（62616名儿童），20个卫生设施（40799名儿童），和41个卫生(98416名儿童)比较。与未经改善的水源未经处理的水相比，在使用点处理水（POU）时，腹泻的风险降低了多达50％：过滤（n=23项研究；RR0·50[95％CI0·41-0·60]），太阳能处理(n=13；0·63[0·50-0·80])，和氯化(n=25；0·66[0·56-0·77])。与未改进的源相比，在水质较高的场所提供改善的饮用水供应将腹泻风险降低了52%(n=2;0·48[0·26-0·87])。总的来说,卫生干预措施将腹泻风险降低了24%(0·76[0·61-0·94])。与未改善的卫生条件相比，提供下水道连接将腹泻风险降低了47%(n=5;0·53[0·30-0·93])。推广用肥皂洗手可将腹泻风险降低30%(0·70[0·64-0·76])。
WASH干预降低了低收入国家儿童腹泻的风险。提供在POU过滤的水的干预措施，从改善的水源中获得更高的水质，或与下水道连接的基本卫生服务与减少的增加有关。我们的结果支持SDG6要求的更高服务水平。值得注意的是,没有研究评估提供安全管理的WASH服务的干预措施，在可持续发展目标下，到2030年实现全民覆盖的服务水平。
谁,外国,联邦和发展办公室，和国家环境健康科学研究所。
在这篇系统综述和荟萃分析中，我们通过搜索MEDLINE按照他们的搜索策略更新了以前的评论，Embase,Scopus,科克伦图书馆,和BIOSIS引文索引，用于研究基本的WASH干预措施和提供高水平服务的WASH干预措施，在2016年1月1日至2021年5月25日之间发布。我们纳入了在家庭或社区层面进行的随机和非随机对照试验，这些试验与WASH可持续发展目标（SDG）的所谓服务阶梯方法的暴露类别相匹配。两名评审员独立提取研究水平的数据，并使用修改的纽卡斯尔-渥太华量表评估偏倚风险，并使用修改的建议分级评估证据的确定性。评估,发展,和评价方法。我们使用随机效应荟萃分析和荟萃回归模型分析了提取的相对风险(RR)和95%CI。这项研究在PROSPERO注册，CRD42016043164。
从搜索中确定了19837条记录，其中包括124项研究，提供83水（62616名儿童），20个卫生设施（40799名儿童），和41个卫生(98416名儿童)比较。与未经改善的水源未经处理的水相比，在使用点处理水（POU）时，腹泻的风险降低了多达50％：过滤（n=23项研究；RR0·50[95％CI0·41-0·60]），太阳能处理(n=13；0·63[0·50-0·80])，和氯化(n=25；0·66[0·56-0·77])。与未改进的源相比，在水质较高的场所提供改善的饮用水供应将腹泻风险降低了52%(n=2;0·48[0·26-0·87])。总的来说,卫生干预措施将腹泻风险降低了24%(0·76[0·61-0·94])。与未改善的卫生条件相比，提供下水道连接将腹泻风险降低了47%(n=5;0·53[0·30-0·93])。推广用肥皂洗手可将腹泻风险降低30%(0·70[0·64-0·76])。
WASH干预降低了低收入国家儿童腹泻的风险。提供在POU过滤的水的干预措施，从改善的水源中获得更高的水质，或与下水道连接的基本卫生服务与减少的增加有关。我们的结果支持SDG6要求的更高服务水平。值得注意的是,没有研究评估提供安全管理的WASH服务的干预措施，在可持续发展目标下，到2030年实现全民覆盖的服务水平。
谁,外国,联邦和发展办公室，和国家环境健康科学研究所。
