Household water chlorination reduces incidence of diarrhea among under-five children in rural Ethiopia: a cluster randomized controlled trial

Bezatu Mengistie, Yemane Berhane, Alemayehu Worku, Bezatu Mengistie, Yemane Berhane, Alemayehu Worku

Abstract

Background: Household water treatment has been advocated as a means of decreasing the burden of diarrheal diseases among young children in areas where piped and treated water is not available. However, its effect size, the target population that benefit from the intervention, and its acceptability especially in rural population is yet to be determined. The objective of the study was to assess the effectiveness of household water chlorination in reducing incidence of diarrhea among children under-five years of age.

Method: A cluster randomized community trial was conducted in 36 rural neighborhoods of Eastern Ethiopia. Households with at least one child under-five years of age were included in the study. The study compared diarrhea incidence among children who received sodium hypochlorite (liquid bleach) for household water treatment and children who did not receive the water treatment. Generalized Estimation Equation model was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval.

Result: In this study, the incidence of diarrhea was 4.5 episodes/100 person week observations in the intervention arm compared to 10.4 episodes/100 person week observations in the control arm. A statistically significant reduction in incidence of diarrhea was observed in the intervention group compared to the control (Adjusted IRR = 0.42, 95% CI 0.36-0.48).

Conclusion: Expanding access to household water chlorination can help to substantially reduce child morbidity and achieve millennium development goal until reliable access to safe water is achieved.

Trial registration: ClinicalTrials.gov NCT01376440.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exist.

Figures

Figure 1. Community randomized trial flow of…
Figure 1. Community randomized trial flow of participants on household water chlorination, eastern Ethiopia, 2011.
Figure 2. Weekly prevalence of diarrhea versus…
Figure 2. Weekly prevalence of diarrhea versus weeks of observation, Kersa district, Eastern Ethiopia, 2011.
Figure 3. Percentage of residual chlorine during…
Figure 3. Percentage of residual chlorine during observation period, Kersa district, Eastern Ethiopia, 2011.

References

    1. WHO/UNICEF (2009) Diarrhoea: Why children are still dying and what can be done. Geneva/Newyork: The United Nations Children’s Fund/World Health Organization.
    1. Clasen T, Roberts I, Rabie T, Schmidt W, Cairncross S (2006) Interventions to improve water quality for preventing diarrhoea. Cochrane Database Syst Rev 3: CD004794.
    1. UNICEF/WHO (2012) Progress on Drinking Water and Sanitation: 2012 Update. Geneva,Swizerland: The United Nations Children’s Fund/World Health Organization. Available: .
    1. WHO (2012) Rapid assessment of drinking-water quality: a handbook for implementation. Geneva, Swizerland: World Health Organization.
    1. WHO (2007) Combating waterborne disease at the household level. Geneva, Swizerland: World Health Organization.
    1. Wright J, Gundry S, Conroy R (2004) Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use. Tropical Medicine and International Health 9 (1): 106–117.
    1. Brown J, Clasen T (2012) High Adherence Is Necessary to Realize Health Gains from Water Quality Interventions. PLoS ONE 7(5): e36735 doi:
    1. Semenza JC, Roberts L, Henderson A, Bogan J, Rubin CH (1998) Water distribution system and diarrheal disease transmission: a case study in Uzbekistan. The American Journal of Tropical Medicine and Hygiene 59(6): 941–946.
    1. Quick RE, Venczel LV, Mintz ED, Soleto L, Aparicio J, et al. (1999) Diarrhoea prevention in Bolivia through point-of-use water treatment and safe storage: a promising new strategy. Epidemiol and Infection 122(1): 83–90.
    1. Quick RE, Kimura A, Thevos A, Tembo M, Shamputa I, et al. (2002) Diarrhea prevention through household-level water disinfection and safe storage in Zambia. Am J Trop Med Hyg 66(5): 584–589.
    1. Reller ME, Mendoza CE, Lopez M (2003) A randomized controlled trial of household based flocculant-disinfectant drinking water for diarrhoea prevention in rural Guatemala. The American Journal of Tropical Medicine and Hygiene 69(4): 411–419.
    1. Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer W (2006) Combining drinking water treatment and hand washing for diarrhea prevention, a cluster randomised controlled trial. Tropical Medicine and International Health 11(4): 479–489.
    1. Jain S, Sahanoon OK, Blanton E, Schmitz A, Wannemuehler KA, et al. (2010) Sodium Dichloroisocyanurate Tablets for Routine Treatment of Household Drinking Water in Periurban Ghana: A Randomized Controlled Trial. Amrican Journal of Tropical Medicine and Hygiene 82(1): 16–22.
    1. Harshfield E, Lantagne D, Turbes A, Null C (2012) Evaluating the Sustained Health Impact of Household Chlorination of Drinking Water in Rural Haiti. Am J Trop Med Hyg 87(5): 786–795.
    1. Doocy S, Burnham G (2006) Point-of-use water treatment and diarrhoea reduction in the emergency context: an effectiveness trial in Liberia. Tropical Medicine and International Health 11(10): 1542–1552.
    1. Kirchhoff LV, McClelland KE, Do Carmo Pinho M, Araujo JG, De Sousa MA, et al. (1985) Feasibility and efficacy of in-home water chlorination in rural North-eastern Brazil. Journal of hygiene 94(2): 173–180.
    1. Schmidt WP, Cairncross S (2009) Household water treatment in poor populations: is there enough evidence for scaling up now? Environ Science and Technology 43(4): 986–992.
    1. Rosa G, Clasen T (2010) The scope of household water treatment in low- and medium-income countries. Am J Trop Med Hyg 82(2): 289–300.
    1. Hayes RJ, Bennett S (1999) Simple sample size calculation for clusterrandomized trials. International Journal of Epidemiology 28: 319–332.
    1. Mengistie B, Berhane Y, Worku A (2012) Prevalence of diarrhea and associated risk factors among under-five childern in Kersa distrct, Eastern Ethiopia. Article in presss.
    1. CDC (2008) Safe water for the community. A guide for establishing community based safe water system programme. Atlanta, USA: Center for Disease Control.
    1. Morris SS, Cousens SN, Lanata CF, Kirkwood BR (1994) Diarrhoea-defining the episode. Int J Epidemiology 23: 617–623.
    1. Wright JA, Gundry SW, Conroy R, Wood D, Du PM (2006) Defining episodes of diarrhoea: results from a three-country study in Sub-Saharan Africa. J Health Popul Nutr 24: 8–16.
    1. Schmidt WF, Arnold BF, Boisson S, Genser B, Luby SP, et al. (2011) Epidemiological methods in diarrhoea studies – an update. International Journal of Epidemiology 40: 1678–1692.
    1. UNEP/WHO (1996) water quality monitoring: A practical guide to the design and implemntation of fresh water quality studies and monitoring programmes. London, UK: United Nation Environmental Programme/World Health Organization.
    1. Garrett P, Ogutu P, Mabonga P, Ombeki S, Mwaki A, et al. (2008) Diarrhoea prevention in a high-risk rural Kenyan population through point-of-use chlorination, safe water storage, sanitation, and rainwater harvesting. Epidemiol and Infection 136: 1463–1471.
    1. Lule JR, Mermin J, Ekwaru JP, Malamba S, Downing R, et al. (2005) Effect of home-based water chlorination and safe storage on diarrhea among persons with human immunodeficiency virus in Uganda. Am J Trop Med Hyg 73(5): 926–933.
    1. Chiller TM, Mendoza EC, Lopez MB, Alvarez M, Hoekstra RM, et al. (2006) Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water. Bulletin of the World Health Organization 84(1): 28–35.
    1. Clasen T, Haller L, Walker D, Bartram J, Cairncross S (2007) Cost-effectiveness of water quality interventions for preventing diarrhoeal disease in developing countries Journal of Water and Health. 5(4): 599–608.
    1. Clasen T (2008) Water Quality Interventions to Prevent Diarrhoea: Cost and Cost-Effectiveness. Geneva, Swizerland: World health organization.
    1. Mäusezahl D, Christen A, Duran Pacheco G, Tellez FA, Iriarte M, et al. (2009) Solar Drinking Water Disinfection (SODIS) to Reduce Childhood Diarrhoea in Rural Bolivia: A Cluster-Randomized, Controlled Trial. PLoS Med 6(8): e1000125 doi:

Source: PubMed

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