在低收入和中等收入国家(LMICs),腹泻病对5岁以下儿童的影响不成比例。引起腹泻的病原体通常通过粪便污染的饮用水传播。在过去的十年中,救生杆家庭使用的水过滤器一直是干预研究的主题,并且是世界卫生组织在其水处理评估计划中评估的第一个过滤器,以提供针对许多引起腹泻的病原体的全面保护。这项系统评价旨在:1)报告与物理环境和实施有关的方面,以及2)根据随访≥12个月的研究,对救生筏家庭过滤器对儿童腹泻的有效性进行更新的荟萃分析。
■我们在2022年11月使用MEDLINE进行了文献检索,Embase,科克伦,和CINAHL数据库。纳入标准为:1)随机对照试验,群集RCT,准实验,或针对2)LifetrawFamily1.0或2.0过滤器的匹配队列研究3)在LMICs中进行的4)评估了对<5和5)儿童腹泻的过滤器有效性的评估,分析了≥12个月的腹泻临床有效性的随访数据,分别为6)从2010年开始发表,并提供7)英文全文。使用改良的纽卡斯尔-渥太华量表评估偏倚风险。提取相对风险(RR)和95%置信区间(CIs)并使用随机效应荟萃分析进行分析。
■我们纳入了6项LMIC研究,涉及4740名儿童<5。在四种临床有效的干预措施中,共同特征是获得改善的水源(75%),2.0版本的过滤器或1.0版本的额外储水(100%),使用行为改变理论,社区参与,和健康信息(75%),局部过滤器维修和更换机制(75%),和受过专门训练的当地干预人员(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)。
■生活稻草家庭滤水器可以有效干预措施,以减少至少一年的弱势儿科人群的腹泻,尽管与物理环境和实施有关的某些方面可能会增加其对公共卫生的影响。这项研究的结果表明,在实现普遍获得安全饮用水之前,可以在需要长期临时解决方案的环境中应用扩大规模的考虑因素。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.