Comparison of boiling and chlorination on the quality of stored drinking water and childhood diarrhoea in Indonesian households

Abstract

SUMMARY We compared the impact of a commercial chlorination product (brand name Air RahMat) in stored drinking water to traditional boiling practices in Indonesia. We conducted a baseline survey of all households with children <5 years in four communities, made 11 subsequent weekly home visits to assess acceptability and use of water treatment methods, measured Escherichia coli concentration in stored water, and determined diarrhoea prevalence among children <5 years. Of 281 households surveyed, boiling (83%) and Air RahMat (7%) were the principal water treatment methods. Multivariable log-binomial regression analyses showed lower risk of E. coli in stored water treated with Air RahMat than boiling (risk ratio (RR) 0·75, 95% confidence interval (CI) 0·56–1·00). The risk of diarrhoea in children <5 years was lower among households using Air RahMat (RR 0·43, 95% CI 0·19–0·97) than boiling, and higher in households with E. coli concentrations of 1–1000 MPN/100 ml (RR 1·54, 95% CI 1·04–2·28) or >1000 MPN/100 ml (RR 1·86, 95% CI 1·09–3·19) in stored water than in households without detectable E. coli. Although results suggested that Air RahMat water treatment was associated with lower E. coli contamination and diarrhoeal rates among children <5 years than water treatment by boiling, Air RahMat use remained low.

Intestinal parasitosis, anaemia and risk factors among pre-school children in Tigray region, northern Ethiopia

“…Though not statistically significant, children whose family did not treat their water were 1.2 times (p = 0.057) more likely to be infected by IPIs. Chlorination is less expensive, less time consuming and provides residual disinfection against recontamination and significantly reduces diarrhea [54]. However, due to the smell and taste [55], only a few families use chlorination in our study.…”

“…Possible reasons for the variation in anaemia prevalence could be due to differences in maternal education [57] concomitant childhood malaria superinfection [55], family income [58], drinking water source [51], personal-hygiene [68] and STH infections [54,57]. For example, the high anaemia rate in the studies such as Tanzania, Kenya, Senegal, Uganda, south Ethiopia, was due to concomitant malaria infection.…”

“…In this study, anaemia was negatively associated with household water treatment of mothers. This is because intestinal helminths and diarrhoea, which cause anaemia [16], can be killed with household water treatments methods [5,6,54].…”

Drinking water improvements and rates of urinary and gastrointestinal infections in Galápagos, Ecuador: Assessing household and community factors

“…The household practice of regularly adding chlorine to the cistern provided an additional protective effect in decreasing high fecal contamination levels after the DWTP. In limited resource settings, home chlorination interventions have been associated with dramatically reduced rates of self‐reported diarrhea (Fagerli et al, ; Mengistie, Berhane, & Worku, ). In contrast, households that reported that they washed their cistern within the last month, or even less than a year ago had high levels of fecal contamination, which were not present in households that washed their cistern over a year ago or had never washed it.…”

Narrative Review of Primary Preventive Interventions against Water-Borne Diseases: Scientific Evidence of Health-EDRM in Contexts with Inadequate Safe Drinking Water

“…Low strength of evidence due to low intervention uptake which confers difficulty in evaluating the impacts of intervention [54] • Significant association between education intervention and reduction in diarrheal incidence as seen in RCTs [39,56,79,102] The majority of the reviewed studies demonstrated positive relationship between primary preventive interventions on diarrhea incidence and disease transmission by ad-dressing WBD associated health risks, however, there is a lack of assessed literature that quantifies the extent of the efficacy of such interventions on disease reduction. In the case of water treatment, many studies conferred a well-established link between less contaminated household drinking water and reduction in diarrhea risk, but not the effectiveness of WBD reduction and associated health outcomes, such as mortality, within the community [29,41,51,55,59,64,70,71,83,85,100,101].…”