BACKGROUND Open defecation is widespread in rural India, and few households have piped water connections. While government and other efforts have increased toilet coverage in India, and evaluations found limited immediate impacts on health, longer-term effects have not been rigorously assessed. METHODS We conducted a matched cohort study to assess the longer-term effectiveness of a combined household-level piped water and sanitation intervention implemented by Gram Vikas (an Indian NGO) in rural Odisha, India. Forty-five intervention villages were randomly selected from a list of those where implementation was previously completed at least 5 years before, and matched to 45 control villages. We conducted surveys and collected stool samples between June 2015 and October 2016 in households with a child <5 years of age (n = 2398). Health surveillance included diarrhoea (primary outcome), acute respiratory infection (ARI), soil-transmitted helminth infection, and anthropometry. RESULTS Intervention villages had higher improved toilet coverage (85% vs 18%), and increased toilet use by adults (74% vs 13%) and child faeces disposal (35% vs 6%) compared with control villages. There was no intervention association with diarrhoea [adjusted OR (aOR): 0.94, 95% confidence interval (CI): 0.74-1.20] or ARI. Compared with controls, children in intervention villages had lower helminth infection (aOR: 0.44, 95% CI: 0.18, 1.00) and improved height-for-age z scores (HAZ) (+0.17, 95% CI: 0.03-0.31). CONCLUSIONS This combined intervention, where household water connections were contingent on community-wide household toilet construction, was associated with improved HAZ, and reduced soil-transmitted helminth (STH) infection, though not reduced diarrhoea or ARI. Further research should explore the mechanism through which these heterogenous effects on health may occur.

中文翻译：

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评估家庭自来水和卫生措施相结合对儿童腹泻，急性呼吸道感染，土壤传播的蠕虫感染和营养状况的长期有效性：一项在印度奥里萨邦农村进行的队列研究。

背景技术露天排便在印度农村地区很普遍，很少有家庭使用自来水管道连接。尽管政府和其他方面的努力增加了印度的厕所覆盖率，并且评估发现对健康的直接影响有限，但尚未对长期影响进行严格评估。方法我们进行了一项队列研究，以评估由Gram Vikas（印度非政府组织）在印度奥里萨邦农村实施的家庭级自来水和卫生设施联合干预措施的长期效果。从至少在5年之前完成实施的村庄清单中随机选择了45个，并与45个对照村庄相匹配。我们在2015年6月至2016年10月之间对年龄小于5岁（n = 2398）的家庭进行了调查并收集了粪便样本。健康监测包括腹泻（主要结局），急性呼吸道感染（ARI），土壤传播的蠕虫感染和人体测量学。结果与对照村相比，干预村的厕所覆盖率提高了（85％比18％），成年人使用厕所的比例更高（74％比13％）和儿童粪便处理（35％比6％）。没有与腹泻的干预相关性[校正OR（aOR）：0.94，95％置信区间（CI）：0.74-1.20]或ARI。与对照组相比，干预村的儿童的蠕虫感染率更低（aOR：0.44，95％CI：0.18，1.00），年龄高度z得分（HAZ）提高了（+ 0.17，95％CI：0.03-0.31）。结论这种联合干预措施使家庭用水连接取决于整个社区的家庭厕所建设，从而改善了热影响区，并减少了土壤传播的蠕虫（STH）感染，尽管没有减少腹泻或ARI。进一步的研究应探索这些异质性影响健康的机制。