世卫组织营养行动证据电子图书馆(eLENA)

饮用水、环境卫生和个人卫生干预措施与腹泻病预防

生物学、行为学和背景依据

2011年10月

近90%的因腹泻引起的死亡(主要见于儿童)是由于缺乏安全、洁净的饮用水和基本环境卫生设施以及不良个人卫生所致1。 虽然目前全球有87%的人口能享用经改良的水源,但仍有39%的人口缺乏良好的环境卫生设施2。此外,在发展中国家,有11亿人仍在使用露天厕所,平均仅17%的人如厕后使用肥皂洗手2,3

导致腹泻的最主要原因包括:粪便处理不当导致人体摄入病原体或个人卫生情况差。每日排水样便三次以上即可诊断为腹泻 4。急性腹泻期宏量营养素的吸收量通常较大,但如果腹泻持续时间在14天以上,患儿可出现严重的吸收不良。频繁腹泻可导致营养素和体液大量丢失,使患儿全身软弱无力和脱水。电解质失衡可增加死亡风险;此外,就发病而言,越来越多的证据表明,电解质失衡可造成远期疾病负担,如发育和认知功能受损5

腹泻的基本预防措施包括:采取饮用水、环境卫生和个人卫生干预措施,减少病原体的粪-口传播,以及改善供水、实行水安全规划、家庭水处理和安全贮水、改善环境卫生设施和开展个人卫生教育。改善供水是指诸如采用家庭自来水管道连接、公用水龙头、管体式水塔以及保护井水、泉水和雨水收集系统的技术。改善环境卫生设施包括:与化粪池相连的抽水马桶/冲水马桶、改良的坑厕(如通风、有隔板)或堆肥厕所2。水安全规划需要做好从水源到水龙头的整体管理6。水处理可在水源地或家庭进行,而安全储水则是使用容器,避免家庭用水的二次污染 7。个人卫生教育可以解决多方面的问题,其中包括便后和制备食物前洗手等8

通过改善水源管理、水质干预(12个月后)、环境卫生设施干预和用肥皂洗手,腹泻的发病率分别降低了5%、19%、36%和47%(据合并分析估算)9,10。由于家庭或社区间病原体传播减少,个人卫生行为持续改变,更大规模、更长期的干预可能会产生进一步的效果。不卫生的环境可导致多次和频繁感染,因而其中某些干预措施可能效果有限。但无论如何,它们是实现下一阶段持续减少发病目标的先决条件 11,12

除用于预防腹泻外,饮用水、环境卫生设施和个人卫生干预也有助于预防肠道寄生虫感染,因为此类感染与营养不良具有协同效应 13-15。多方面研究文献证明,获得安全饮用水、环境卫生设施和个人卫生的状况可用于预测儿童的发育和营养不良16-20

行为因素对理解和坚持采用饮用水、环境卫生和个人卫生的技术和规范十分重要。虽然饮用水、环境卫生和个人卫生干预措施具有很好的潜在效果,但其有效性在一定程度上取决于行为的改变和具体背景情况。在安装和运行饮用水和环境卫生设施时,需要同时传播使用知识,并努力促进可持续的行为改变 9。为达到改进目的,对现有服务/设施进行维护和定期更新、宣传个人卫生也是必需的 21

低收入国家尤其饱受供水系统和服务不足、环境卫生设施和个人卫生状况差劣之苦 1,2。 在贫困家庭实施饮用水、环境卫生和个人卫生干预措施时,当覆盖率达50%时效果最为明显;不过,较富裕的家庭也同样需要此类干预措施 22


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