Assessing the Health Impact of a Combined Water and Sanitation Intervention in Rural Odisha, India

This is a matched-cohort study designed to assess the health impact of a rural demand-driven water and sanitation intervention that provides piped treated water and household level pour-flush latrines and bathing rooms, as implemented by Gram Vikas.

Study Overview

• Status: Unknown
• Conditions: Diarrhea; Stunting; Soil-transmitted Helminth Infection; Enteric Infection
• Intervention / Treatment: Behavioral: Improved water supply and sanitation

Detailed Description

We will undertake a matched-cohort study among 84 villages in Ganjam district, Orissa, India to assess the health impact of a program that provides improved water supplies and sanitation to rural villages.

• Study Type: Observational
• Enrollment (Anticipated): 2940

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, WC1E 7HT
    • London School of Hygiene & Tropical Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Rural householders living in Ganjam district, Orissa, India.

Description

Inclusion Criteria:

• Households in participating villages will be eligible to participate in the study if they have at least one child under 5 years.

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Intervention group; Rural villages in which Gram Vikas has fully implemented its water supply and sanitation (Mantra) intervention. Intervention villages must: 1) be within 3 hours travel to the study office in Brahmapur, 2) have started the intervention by January 2003, and 3) have completed the intervention by January 2013.	Behavioral: Improved water supply and sanitation; Village-level reticulated water supply with distribution to household taps; pour-flush pit latrines.
Control group; Rural villages that have been matched with intervention villages on demographics and other criteria. The sampling frame for control villages is limited to those: 1) within 3 hours travel to the study office in Brahmapur, and 2) within Gram Panchayats which do not include an intervention village and are not adjacent to an intervention village, to minimize spillover effects. In addition, both intervention and control villages must appear in the Government of India Census in 2001.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Reported diarrhoea in children <5 years	7-day recall, assessed 4 times during 3-month follow-up rounds

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reported lower respiratory infection in children <5		7-day recall, assessed 4 times during 3-month follow-up rounds
Diarrhoea among all ages		7-day recall, assessed 4 times during 3-month follow-up roundsits
Lower respiratory infection among all ages		7-day recall, assessed 4 times during 3-month follow-up roundsts
Soil-transmitted helminth infection	Stool samples taken and assayed for ascaris, trichuris, hookworm	Point prevalence assessed in rounds 2 (approximately 90-120 days after study commencement) and 4 (approximately 240 to 360 days after study commencement)
Height-for-age among children < 2 years	Children height measured and HAZ scores computed	Assessed approximately every 90 days for a total of four measurement over study period
Weight-for-age among children <5	Children weighed and WAZ scores computed	Assessed approximately every 90 days for a total of four measurement over study periodAssessed during all four follow up rounds
Biomarkers of environmental enteropathy and enteric infection		Assessed once during round 3 (approximately 180 to 240 days following commencement of study

Collaborators and Investigators

• Sponsor: London School of Hygiene and Tropical Medicine
• Collaborators: Emory University; Bill and Melinda Gates Foundation; KIIT University, Bhubaneswar, Orissa; Gram Vikas, Bhubanesar, Orissa; Loyola Hospital, Bhubaneswar, Orissa

Publications and helpful links

General Publications

• Sinharoy SS, Reese HE, Praharaj I, Chang HH, Clasen T. Effects of a combined water and sanitation intervention on biomarkers of child environmental enteric dysfunction and associations with height-for-age z-score: A matched cohort study in rural Odisha, India. PLoS Negl Trop Dis. 2021 Mar 8;15(3):e0009198. doi: 10.1371/journal.pntd.0009198. eCollection 2021 Mar.
• Reese H, Routray P, Torondel B, Sinharoy SS, Mishra S, Freeman MC, Chang HH, Clasen T. Assessing longer-term effectiveness of a combined household-level piped water and sanitation intervention on child diarrhoea, acute respiratory infection, soil-transmitted helminth infection and nutritional status: a matched cohort study in rural Odisha, India. Int J Epidemiol. 2019 Dec 1;48(6):1757-1767. doi: 10.1093/ije/dyz157.
• Reese H, Routray P, Torondel B, Sclar G, Delea MG, Sinharoy SS, Zambrano L, Caruso B, Mishra SR, Chang HH, Clasen T. Design and rationale of a matched cohort study to assess the effectiveness of a combined household-level piped water and sanitation intervention in rural Odisha, India. BMJ Open. 2017 Mar 31;7(3):e012719. doi: 10.1136/bmjopen-2016-012719.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2015
• Primary Completion (Anticipated): December 1, 2019
• Study Completion (Anticipated): December 1, 2019

Study Registration Dates

• First Submitted: April 27, 2015
• First Submitted That Met QC Criteria: May 7, 2015
• First Posted (Estimate): May 12, 2015

Study Record Updates

• Last Update Posted (Actual): August 21, 2019
• Last Update Submitted That Met QC Criteria: August 20, 2019
• Last Verified: August 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Signs and Symptoms, Digestive; Parasitic Diseases; Infections; Communicable Diseases; Diarrhea; Helminthiasis
• Other Study ID Numbers: 9071