An inter-disciplinary approach to understanding the contribution of household flooring to disease burden in rural Kenya

采用跨学科方法来了解家庭地板对肯尼亚农村疾病负担的影响

基本信息

批准号：
MR/T029811/1
负责人：
Rachel Pullan
金额：
$ 287.66万
依托单位：
London School of Hygiene & Tropical Medicine
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2020
资助国家：
英国
起止时间：
2020 至无数据
项目状态：
未结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FT029811%2F1
关键词：
inter disciplinary approach understanding contribution

项目摘要

Access to adequate, safe and affordable housing plays a fundamental role in human health. This includes thorough limits our exposure to infectious diseases such as those that cause diarrhoea, which remains a leading cause of death in children under five. Conventional approaches to reducing environmental exposure to faecal pathogens include ensuring universal access to safe water and basic sanitation. Recent evidence has suggested that this alone may be insufficient to reduce the high levels of environmental contamination seen in poor rural communities, and that transformative cross-sectoral approaches will be required to see real impacts in child health. For example, these approaches fail to address the fact that most poor rural homes have rudimentary (earth, sand or dirt) floors that are difficult to sanitise, providing an ideal environment for the survival of faecal pathogens and other parasites. These floors can also host parasitic infections including intestinal nematodes and sand fleas, both of which are responsible for considerable morbidity and poor quality of life. We propose to examine flooring and its impact on enteric and parasitic diseases in three culturally and environmentally diverse settings in Kenya, and aim to address two related questions: 1. What is the importance of household flooring as a driver of enteric and parasitic infection risk in rural communities, and does this vary across wider social and environmental contexts?2. Can infection risk be mitigated by replacing existing rudimentary (earth, sand or dirt) floors with improved (sealed, washable and durable) materials, and what additional behaviour changes are required to ensure impact?We expect that successful installation and ongoing maintenance of improved flooring will reduce the transmission of enteric and parasitic infections, by preventing direct exposure and through an intermediate effect of improved domestic hygiene. This will however be influenced by local context. A priority in each setting will therefore be to explore the interplay between domestic flooring, water and sanitation infrastructure, domestic hygiene behaviours, and the wider socio-cultural and environmental context. Our planned approach involves comprehensive formative research, intervention development conducted in collaborative partnership with recipient communities and key stakeholders, and then implementation trials to test the effects, feasibility and acceptability of the resulting intervention. We will assess the impact of the intervention on a range of child health outcomes, including prevalence of enteric and intestinal worm infections, prevalence of tungiasis, and incidence of gastrointestinal illness. We will also monitor levels of environmental contamination, and explore the impact of the intervention on domestic routines and self-reported wellness. During implementation, we will work with recipients and stakeholders at community, regional and national level to assess the extent to which interventions are acceptable to target communities, feasible given existing resource constraints, and can be scaled-up across Kenya and elsewhere. This includes work undertaken to understand options for scale-up should the intervention prove successful. This study is the first of its kind to comprehensively assess feasibility and effects of combining improved flooring technologies with tailored behaviour change programming on a wide range of parasitic and enteric outcomes. In doing so, we aim to provide important policy and technical guidance on the impact and effectiveness of new transformative approaches to community health. This is an important first step towards the establishment of transformative, community-driven and cross-sectoral approaches to building out water, sanitation and hygiene-related diseases.

获得足够，安全和负担得起的住房在人类健康中起着基本作用。这包括彻底限制我们暴露于传染病（例如引起腹泻的疾病），这仍然是五岁以下儿童的主要死亡原因。减少环境暴露于粪便病原体的常规方法包括确保普遍获得安全水和基本卫生。最近的证据表明，仅此一项可能就不足以减少贫穷农村社区中高水平的环境污染，并且需要进行变革性的跨部门方法来了解对儿童健康的真正影响。例如，这些方法无法解决这样一个事实，即大多数贫穷的农村房屋具有难以消毒的基本（地球，沙子或污垢）地板，为粪便病原体和其他寄生虫的生存提供了理想的环境。这些地板还可以托管寄生虫感染，包括肠线虫和沙跳蚤，这两者都导致了相当大的发病率和生活质量差。我们建议在肯尼亚的三种文化和环境不同的环境中检查地板及其对肠和寄生虫疾病的影响，并旨在解决两个相关问题：1。作为农村社区中肠道和寄生虫感染风险的家庭地板的重要性是什么，在更广泛的社会和环境环境中，这种群体和寄生虫感染风险的重要性是什么？是否可以通过改进（密封，可洗和耐用）材料来代替现有的基本（土，沙子或污垢）地板来减轻感染风险，并且需要采取哪些其他行为改变以确保影响？我们期望通过直接暴露于直接暴露于肠道和寄生虫感染，可以成功地降低肠道和寄生虫感染的成功，并通过直接暴露于国际互联网和国际互联网效应。但是，这将受到当地环境的影响。因此，在每种环境中的优先事项将是探索国内地板，水和卫生基础设施，家庭卫生行为以及更广泛的社会文化和环境环境之间的相互作用。我们计划中的方法涉及全面的形成性研究，与接受者社区和主要利益相关者合作进行的干预开发，然后进行实施试验以测试效果，可行性和可接受性的干预措施。我们将评估干预措施对一系列儿童健康结果的影响，包括肠道和肠道蠕虫感染的流行，通牙的患病率以及胃肠道疾病的发病率。我们还将监测环境污染的水平，并探讨干预对国内常规和自我报告的健康的影响。在实施过程中，我们将与社区，地区和国家一级的接收者和利益相关者合作，以评估目标社区可以接受干预措施的程度，鉴于现有的资源限制，可以在肯尼亚和其他地方进行扩大。这包括为了了解干预措施成功而进行规模缩小的工作。这项研究是第一个全面评估将改进的地板技术与量身定制的行为变化编程结合在各种寄生和肠结合结果上的可行性和影响的第一项。在此过程中，我们旨在为新的变革性方法对社区健康的影响和有效性提供重要的政策和技术指导。这是朝着建立变革性，以社区为导向和跨部门的方法来建立水，卫生和卫生相关疾病的重要第一步。