背景:改善的卫生条件是指那些以卫生的方式有效避免人类与排泄物接触的卫生条件。改善厕所是采用安全方法处理儿童粪便的关键因素。然而,先前在非洲进行的研究表明,拥有与家庭儿童粪便处理实践相关的改善的厕所设施的结果不一致,并且没有对这些发现进行系统的审查。因此,本研究旨在综合以下证据,说明在非洲有5岁以下儿童的家庭中,改善厕所设施对儿童粪便安全处理措施的重要性.
方法:搜索的数据库包括:PubMed/Medline,Ovid/Embase,ScienceDirect,AJOL和Cochrane图书馆。在搜索过程中,谷歌学者和其他研究的参考被考虑。这篇综述包括没有任何时间限制的英文发表的研究。这项研究的结果是对改良厕所的所有权与儿童粪便处置方法之间的关联的估计。两名审稿人使用Excel数据提取工具从纳入审查的研究中提取相关数据。使用Stata版本16,使用随机效应统计模型进行荟萃分析。方差逆指数(I2)用于评估异质性。森林地块用于显示具有95%置信区间的汇总估计值。使用Egger检验和漏斗图评估发表偏倚。
结果:在检索到的616项研究中,15例纳入系统评价分析,10例纳入荟萃分析。纳入的所有研究都是在埃塞俄比亚进行的横断面研究,尼日利亚,冈比亚,马拉维,埃斯瓦蒂尼,加纳,赞比亚,一项研究使用了撒哈拉以南非洲的数据。厕所设施的改善大大加强了安全处理儿童粪便的做法,如总效应大小所示(OR=2.74;95%CI=1.24-1.35,I2=99.95%)。在按样本量进行的亚组分析中,在样本量小于1000的研究中,改善厕所的存在显着提高了儿童粪便处理的安全性(OR=3.24;95%CI=2.86-3.62,I2=61.38%),而样本量大于1000的研究没有显着差异(OR=2.67;95%CI=0.69-4.64,I2=99.97%)。然而,涉及5岁以下儿童的研究表明,厕所设施的改善显著提高了儿童粪便处理的安全性(OR=4.02;95%CI=2.03-6.09;I2=99.96%).
结论:在这项研究中,我们研究了在非洲有5岁儿童的家庭中改善厕所设施的所有权,以便以更安全的方式加强儿童粪便的处理.研究之间的高度异质性和所包括研究的横断面设计限制了结果的因果推断和普遍性。因此,需要对纵向和实验研究进行荟萃分析,以确认非洲厕所设施改善与儿童粪便安全处理措施之间的因果关系。
BACKGROUND: Improved sanitation refers to those that effectively avoid human contact with excreta in a hygienic manner. Having improved latrines is a key factor in adopting safe ways of disposing of child feces. However, previous studies in Africa that examined how owning improved latrine facilities associated with household child feces disposal practices has shown inconsistent results, and no systematic review of these findings has been done. Therefore, this study aims to synthesize the evidence on the significance of households having improved latrine facilities for safe child feces disposal practices among households with under five-year-old children in Africa.
METHODS: The searched databases include: PubMed/Medline, Ovid/Embase, ScienceDirect, AJOL and the Cochrane Library. In the search process, Google Scholar and references of other studies were considered. This review included studies that were published in English without any time restrictions. The outcome of this study was an estimate of the association between the ownership of an improved latrine and the disposal practices of children\'s feces. Two reviewers used the Excel data extraction tool to extract the relevant data from the studies that were included in the review. Using Stata version 16, a meta-analysis was performed with a random effects statistical model. The inverse index of variance (I2) was used to assess heterogeneity. Forest plots were used to show the pooled estimate with a 95% confidence interval. Publication bias was assessed using Egger\'s test and a funnel plot.
RESULTS: Out of the 616 studies that were retrieved, 15 were included in the systematic review analysis and 10 were included in the meta-analysis. All studies that were included are cross-sectional studies done in Ethiopia, Nigeria, Gambia, Malawi, Eswatini, Ghana, Zambia, and a study used data from sub-Saharan Africa. Improved latrine facilities significantly enhanced the practice of safe child feces disposal, as shown by the overall effect size (OR = 2.74; 95% CI = 1.24-1.35, I2 = 99.95%). In the subgroup analysis by sample size, the presence of improved latrines significantly enhanced safe child feces disposal in studies with sample sizes less than 1000 (OR = 3.24; 95% CI = 2.86-3.62, I2 = 61.38%), while there was no significant difference in studies with sample sizes greater than 1000 (OR = 2.67; 95% CI = 0.69-4.64, I2 = 99.97%). However, studies that involved children under 5 years old indicated that improved latrine facilities significantly enhanced the practice of safe child feces disposal (OR = 4.02; 95% CI = 2.03-6.09; I2 = 99.96%).
CONCLUSIONS: In this research study, we examined the ownership of improved latrine facilities among households with five-year-old children to enhance the disposal of child feces in a safer manner in Africa. The high heterogeneity among the studies and the cross-sectional design of the included studies limit the causal inference and generalizability of the findings. Therefore, meta-analyses of longitudinal and experimental studies are needed to confirm the causal relationship between improved latrine facilities and safe child feces disposal practices in Africa.