Improved water supply infrastructure to reduce acute diarrhoeal diseases and cholera in Uvira, Democratic Republic of the Congo: Results and lessons learned from a pragmatic trial.

Autor: Gallandat K; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom., Macdougall A; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom., Jeandron A; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom., Mufitini Saidi J; Ministère de la Santé Publique, Division Provinciale de la Santé du Sud-Kivu, Zone de Santé d'Uvira, Uvira, Democratic Republic of Congo., Bashige Rumedeka B; Ministère de la Santé Publique, Division Provinciale de la Santé du Sud-Kivu, Zone de Santé d'Uvira, Uvira, Democratic Republic of Congo., Malembaka EB; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States of America.; Centre for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo., Azman AS; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States of America.; Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.; Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland., Bompangue D; Service d'Ecologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo., Cousens S; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom., Allen E; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom., Cumming O; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2024 Jul 03; Vol. 18 (7), pp. e0012265. Date of Electronic Publication: 2024 Jul 03 (Print Publication: 2024).
DOI: 10.1371/journal.pntd.0012265
Abstrakt: Background: Safely managed drinking water is critical to prevent diarrhoeal diseases, including cholera, but evidence on the effectiveness of piped water supply in reducing these diseases in low-income and complex emergency settings remains scarce.
Methods: We conducted a trial of water supply infrastructure improvements in Uvira (DRC). Our primary objective was to estimate the relationship between a composite index of water service quality and the monthly number of suspected cholera cases admitted to treatment facilities and, as a secondary analysis, the number of cases confirmed by rapid diagnostic tests. Other exposures included the quantity of supplied water and service continuity. We used Poisson generalised linear models with generalised estimating equations to estimate incidence rate ratios.
Findings: Associations between suspected cholera incidence and water service quality (RR 0·86, 95% CI 0·73-1·01), quantity (RR 0·80, 95% CI 0·62-1·02) and continuity (RR 0·81, 95% CI 0·77-0·86) were estimated. The magnitudes of the associations were similar between confirmed cholera incidence and water service quality (RR 0·84, 95% CI 0·73-0·97), quantity (RR 0·76, 95% CI 0·61-0·94) and continuity (RR 0·75, 95% CI 0·69-0·81). These results suggest that an additional 5 L/user/day or 1.2 hour per day of water production could reduce confirmed cholera by 24% (95% CI 6-39%) and 25% (95% CI 19-31%), respectively.
Interpretation: Ensuring a sufficient and continuous piped water supply may substantially reduce the burden of endemic cholera and diarrhoeal diseases but evaluating this rigorously is challenging. Pragmatic strategies are needed for public health research on complex interventions in protracted emergency settings.
Trial Registration: The trial is registered in ClinicalTrials.gov ID NCT02928341. https://classic.clinicaltrials.gov/ct2/show/NCT02928341.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Gallandat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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