Expanding Access to Safe Water in Nigeria

Access to safe water remains a pressing public health challenge in Nigeria, where 67% of the population lacks safely managed drinking water and waterborne diseases cause an estimated 70,000 child deaths annually. Building on evidence that point-of-use chlorination is highly cost-effective in reducing diarrheal disease, this study evaluates a scalable, community-based chlorine distribution model through a cluster-randomized controlled trial (RCT) in Kano State. Thirty communities across four Local Government Areas will be randomly assigned to one of three groups: (i) 20 treatment communities receiving community demonstrations and local chlorine redemption points, (ii) 10 control communities where no intervention will be conducted. After 3 months, 5 control communities will receive an individual-level sensitization and a voucher program and 5 will remain pure control communities. The RCT aims to estimate the causal impact of the community-based intervention on household chlorination rates, water quality (E. coli contamination), and knowledge of safe water practices over six months. By rigorously testing a community-led water treatment model, this study contributes new evidence on sustainable and cost-effective approaches to expand safe water access in low-resource settings. The results will inform national and regional strategies for scaling point-of-use chlorination across sub-Saharan Africa.

Study Overview

• Status: Recruiting
• Conditions: Chlorination
• Intervention / Treatment: Behavioral: Community Demonstrations; Behavioral: Redemption points

• Study Type: Interventional
• Enrollment (Estimated): 700
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Elisa Maria Maffioli, PhD; Phone Number: 4438754930; Email: elisamaf@umich.edu

Study Locations

• Nigeria
  • Kano, Nigeria
    • Recruiting
    • Kura, Dawakin Kudu, Kiru, and Rano LGAs
    • Contact: Gbenga Adedayo; Phone Number: +234 805 602 6845; Email: gadedayo@hanovialimited.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Pregnant mothers and women with children under 5 children

Exclusion Criteria:

• Men, women with no children under 5 years old

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treatment; Community Demonstrations and Redemption Points	Behavioral: Community Demonstrations; Facilitators will collaborate with local leaders, WASH officials and health facility staff in conducting community demonstrations introducing the chlorine product (WaterGuard+) to communities in the treatment group. Local leaders in the community will organize the meeting, while facilitators in the country will demonstrate how to use the product, what the correct dosage is, and explain the importance of water treatment. They will also show how village water is contaminated with Ecoli. These meetings will be targeted at eligible women (pregnant women and women with children under the age of 5), however all members of the community will be invited to attend. At the meeting, each attendee will be given one bottle of WaterGuard+, which is enough to treat drinking water for a household of 5 members for about a month, and 1,000 naira. Water Guard + is a 180g bottle of sodium dichloroisocyanurate (NaDCC) in granulated / powder form, produced and distributed by the Society for Family Health.; Behavioral: Redemption points; Study staff will set up at least one chlorine redemption point for each community. The location of the redemption point will be determined in consultation with the local community during Community Demonstrations. The redemption points could be health facilities, local shops/dispensaries/kiosks, local pharmacies, house of the village leader, CHW, or health staff or other suitable sites. Households will be able to visit the location and redeem a month's supply of a chlorine product. Distributors will use a redemption log to keep track of when participants redeem the chlorine product.
No Intervention: Control; Neither community distributions will be conducted nor redemption points will be set-up during the study period

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treat drinking water with chlorine (tested in water sample)	Proportion of water samples with detectable chlorine in stored drinking water	Measured up to 6 months of follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treat drinking water with chlorine (self-reported)	Proportion of women who reported using chlorine in the previous two days	Measured up to 6 months of follow-up
Presence of E.coli	Proportion of water samples with detectable E.coli	Measured up to 6 months of follow-up
Level of E.coli	Level of E-coli (in log10 MPN/100ml) in water samples	Measured up to 6 months of follow-up
Unsafe risk of Coliform	Proportion of water samples with unsafe coliform ( >100 colony forming units per 100mL)	Measured up to 6 months of follow-up
Heard about chlorine	Proportion of women who ever heard about chlorine	Measured up to 6 months of follow-up
Ever used chlorine	Proportion of women who ever used chlorine	Measured up to 6 months of follow-up
Last used chlorine	Proportion of women who used chlorine yesterday or the day before	Measured up to 6 months of follow-up

Collaborators and Investigators

• Sponsor: University of Michigan
• Collaborators: Princeton University
• Investigators: Principal Investigator: Elisa Maria Maffioli, PhD, University of Michigan; Principal Investigator: Pascaline Dupas, Princeton University; Principal Investigator: Ana Radu, Princeton University

Study record dates

Study Major Dates

• Study Start (Actual): September 30, 2025
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: November 17, 2025
• First Submitted That Met QC Criteria: November 17, 2025
• First Posted (Actual): November 24, 2025

Study Record Updates

• Last Update Posted (Actual): November 24, 2025
• Last Update Submitted That Met QC Criteria: November 17, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: Diarrhea; Health Systems
• Additional Relevant MeSH Terms: Signs and Symptoms, Digestive; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Diarrhea
• Other Study ID Numbers: HUM00277959

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No