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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

Temporal trend in diarrhea prevalence in children 8–32 months of age.
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pone.0121907.g006: Temporal trend in diarrhea prevalence in children 8–32 months of age.

Mentions: A total of 1814 index children were enrolled into the study. Mean index child age over the follow-up period was 20 months (range: 8–32 months). Diarrhea prevalence in index children in the control arm was 10.6% over the study period; prevalence decreased with increasing study duration in all three arms but showed a peak at the onset of the monsoon (Fig. 6). The youngest age group had the highest diarrhea prevalence (Table 3). The ICC for repeated diarrhea measures within children was 0.06.


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)

Temporal trend in diarrhea prevalence in children 8–32 months of age.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0121907.g006: Temporal trend in diarrhea prevalence in children 8–32 months of age.
Mentions: A total of 1814 index children were enrolled into the study. Mean index child age over the follow-up period was 20 months (range: 8–32 months). Diarrhea prevalence in index children in the control arm was 10.6% over the study period; prevalence decreased with increasing study duration in all three arms but showed a peak at the onset of the monsoon (Fig. 6). The youngest age group had the highest diarrhea prevalence (Table 3). The ICC for repeated diarrhea measures within children was 0.06.

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