Sanitation: an unfinished global agenda

2007年，读者BMJ(British Medical Journal) chose “sanitation” as the most importantmedicalmilestone since 1840. It reminded us of the importance of safe water and sanitation for people’s lives. Still, improving access to sanitation remained an unfinished agenda in the global community.

在全球范围内，2015年仍无法获得改善的卫生设施，其中约有10亿人必须进行公开排便。许多发展中国家的妇女患有与卫生有关的社会心理压力以及健康和暴力的风险。

五岁以下的儿童也是改善厕所覆盖范围低以及缺乏安全水和卫生的巨大受害者。腹泻完全负责9.2％的儿童死亡，这些死亡集中在低收入国家。

There is an increasing demand for evidence on how to increase uptake and utilization of improved sanitation facilities and to decrease health risks, especially of the children under five.

An effort to tackle the sanitation issue

Given the scarcity of sound evidence on the protective effect of improved sanitation, we decided to test the possibility of small-sized and low-cost WASH (Water, Sanitation and Hygiene) intervention in remote rural villages of Idiofa, Bandundu, Democratic Republic of the Congo.

洗committees, elected by the people living in each village, take important roles in mobilizing community members to improve latrines and to employ hygienic practices.

We also wanted to clarify the extent to which well-equipped latrines, which are made with locally available material, can have health benefits. Especially in the conditions where the latrine coverage reached the level required to generate herd protection effect against diarrheal diseases.

In implementing this WASH intervention, we will promote a community-based approach. WASH committees, elected by the people living in each village, take important roles in mobilizing community members to improve latrines and to employ hygienic practices. They are also vital in monitoring progress and regularly updating sanitation maps.

A total of 720 children under four were registered for this longitudinal study. The incidence of the diarrhea of the children will be recorded by the mother or caregiver on the Sanitation Calendar distributed to each registered household.

By employing the diary methodology, we expect to prevent the recall bias and reporting fatigue leading to underestimation issues. This will also allow us to capture more precisely the effects of well-equipped latrines on the duration of diarrhea and diarrheal incidence density. Household surveys will be conducted regularly as well in order to collect data on community members’ sanitation and hygienic behavior change.

本研究将提供valuable information on the herd protection effect of WASH intervention. We can also expect to see the effect of non-discriminative distribution of material subsidies contingent upon voluntary preparation of some materials for latrine improvement and a commitment of labor in increasing the uptake of well-equipped latrines. We can also test the possibility of employing a sanitation calendar as a cost-effective method to measure progress.

已经有一些结果了。厕所的覆盖范围高达97％ - 高于我们设定的目标。虽然我们希望在今年年底看到此WASH干预的最终结果，但我们认为促进牛群保护效应所需的水平足够。