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Effects of source- versus household contamination of tubewell water on child diarrhea in rural Bangladesh: a randomized controlled trial.

Ercumen A, Naser AM, Unicomb L, Arnold BF, Colford JM, Luby SP - PLoS ONE (2015)

Bottom Line: Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water.There was no added benefit from combining safe storage with chlorination.Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology, School of Public Health, University of California, Berkeley, California, United States of America.

ABSTRACT

Background: Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh.

Methods: We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants' source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions.

Findings: Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias.

Conclusions: Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.

Trial registration: ClinicalTrials.gov NCT01350063.

No MeSH data available.


Related in: MedlinePlus

Flowchart of study participation.
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pone.0121907.g001: Flowchart of study participation.

Mentions: Of the 1800 households enrolled and randomly assigned into study arms, 1786 received promotion visits by the field team (including control households that received visits unrelated to safe water); 14 households were lost due to relocation (n = 10), refusal to participate (n = 3) and death of enrolled child (n = 1) before the onset of promotion activities and the delivery of hardware to intervention households. A total of 10 follow-up visits per household were conducted between October 2011 and November 2012; 1649 households completed the study while a cumulative 151 households were lost to follow-up due to relocation (n = 120), refusal to participate (n = 26), and death of enrolled child (n = 5) (Fig. 1). The refusal rate was similar between study arms (10 households in chlorine plus safe storage arm, 9 households in safe storage arm and 7 households in control arm), suggesting no difference in willingness to participate. Households that left the study were similar in their characteristics to households that completed the study, and the balance of baseline variables between the three study arms was maintained among the households that remained in the study (S4 and S5 Tables), suggesting that loss to follow-up did not depend on covariates; we assumed that data were missing completely at random [43].


Effects of source- versus household contamination of tubewell water on child diarrhea in rural Bangladesh: a randomized controlled trial.

Ercumen A, Naser AM, Unicomb L, Arnold BF, Colford JM, Luby SP - PLoS ONE (2015)

Flowchart of study participation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4376788&req=5

pone.0121907.g001: Flowchart of study participation.
Mentions: Of the 1800 households enrolled and randomly assigned into study arms, 1786 received promotion visits by the field team (including control households that received visits unrelated to safe water); 14 households were lost due to relocation (n = 10), refusal to participate (n = 3) and death of enrolled child (n = 1) before the onset of promotion activities and the delivery of hardware to intervention households. A total of 10 follow-up visits per household were conducted between October 2011 and November 2012; 1649 households completed the study while a cumulative 151 households were lost to follow-up due to relocation (n = 120), refusal to participate (n = 26), and death of enrolled child (n = 5) (Fig. 1). The refusal rate was similar between study arms (10 households in chlorine plus safe storage arm, 9 households in safe storage arm and 7 households in control arm), suggesting no difference in willingness to participate. Households that left the study were similar in their characteristics to households that completed the study, and the balance of baseline variables between the three study arms was maintained among the households that remained in the study (S4 and S5 Tables), suggesting that loss to follow-up did not depend on covariates; we assumed that data were missing completely at random [43].

Bottom Line: Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water.There was no added benefit from combining safe storage with chlorination.Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology, School of Public Health, University of California, Berkeley, California, United States of America.

ABSTRACT

Background: Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh.

Methods: We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants' source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions.

Findings: Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias.

Conclusions: Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.

Trial registration: ClinicalTrials.gov NCT01350063.

No MeSH data available.


Related in: MedlinePlus