Effect of Household-Based Drinking Water Chlorination on Diarrhoea among Children under Five in Orissa, India: A Double-Blind Randomised Placebo-Controlled Trial

Boisson, Sophie; Stevenson, Matthew M.; Shapiro, Lily; Kumar, Vinod; Singh, Lakhwinder; Ward, Dana; Clasen, Thomas

doi:10.1371/journal.pmed.1001497

Cited by 79 publications

(85 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, the level of contamination of drinking water was significantly lower than that observed in previous studies in Orissa. 30,31 Thus, our study may not have had the power to detect a difference between the groups.…”

Section: Discussionmentioning

confidence: 93%

Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India

Heijnen

Routray

Torondel

et al. 2015

The American Society of Tropical Medicine and Hygiene

Self Cite

View full text Add to dashboard Cite

Abstract. A large and growing proportion of the global population rely on shared sanitation facilities despite evidence of a potential increased risk of adverse health outcomes compared with individual household latrines (IHLs). We sought to explore differences between households relying on shared sanitation versus IHLs in terms of demographics, sanitation facilities, and fecal exposure. We surveyed 570 households from 30 slums in Orissa, India, to obtain data on demographics, water, sanitation, and hygiene. Latrine spot-checks were conducted to collect data on indicators of use, privacy, and cleanliness. We collected samples of drinking water and hand rinses to assess fecal contamination. Households relying on shared sanitation were poorer and less educated than those accessing IHLs. Individuals in sharing households were more likely to practice open defecation. Shared facilities were less likely to be functional, less clean, and more likely to have feces and flies. No differences in fecal contamination of drinking water or hand-rinse samples were found. Important differences exist among households accessing shared facilities versus IHLs that may partly explain the apparent adverse health outcomes associated with shared sanitation. As these factors may capture differences in risk and promote sanitary improvements, they should be considered in future policy.

show abstract

Section: Discussionmentioning

confidence: 93%

Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India

Heijnen

Routray

Torondel

et al. 2015

The American Society of Tropical Medicine and Hygiene

Self Cite

View full text Add to dashboard Cite

show abstract

“…Since these behaviours were self-reported, noncompliance is likely underestimated, particularly for children who were not always supervised by the survey respondent (Rosa et al, , 2014a. Previous work has identified non-exclusive and inconsistent use of household water treatment products as challenges in this and other lowincome settings (Barstow et al, 2014;Boisson et al, 2013;Peletz et al, 2012;Rosa et al, 2014b). This behaviour can diminish the health gains that are possible (Brown and Clasen, 2012;Enger et al, 2013;Hunter et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Use, microbiological effectiveness and health impact of a household water filter intervention in rural Rwanda—A matched cohort study

Kirby

Nagel

Rosa

et al. 2017

International Journal of Hygiene and Environmental Health

View full text Add to dashboard Cite

Kirby, M.A.; Nagel, C.L.; Rosa, G.; Umupfasoni, M.M.; Iyakaremye, L.; Clasen, T.F. (2017) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Graphical abstract ABSTRACTUnsafe drinking water is a substantial health risk contributing to child diarrhoea. We investigated impacts of a program that provided a water filter to households in rural Rwandan villages. We assessed drinking water quality and reported diarrhoea 12-24 months after intervention delivery among 269 households in the poorest tertile with a child under 5 from 9 intervention villages and 9 matched control villages. We also documented filter coverage and use. In Round 1 (12-18 months after delivery), 97.4% of intervention households reported receiving the filter, 84.5%were working, and 86.0% of working filters contained water. Sensors confirmed half of households with working filters filled them at least once every other day on average. Coverage and usage was similar in Round 2 (19-24 months after delivery). The odds of detecting faecal indicator bacteria in drinking water were 78% lower in the intervention arm than the control arm (odds ratio (OR) 0.22, 95% credible interval (CrI) 0.10-0.39, p<0.001). The intervention arm also had 50% lower odds of reported diarrhoea among children <5 than the control arm (OR=0.50, 95% CrI 0.23-0.90, p=0.03). The protective effect of the filter is also suggested by reduced odds of reported diarrhoea-related visits to community health workers or clinics, although these did not reach statistical significance.

show abstract

“…Most field trials evaluating the effect of water quality on diarrhea in India have tended to focus on point-of-use disinfection; and while methods such as household chlorination, gravity filters (such as ceramic filters) and boiling have shown potential for microbiological disinfection, low compliance and acceptability reduce the benefits consumers might gain from their use 11,26–29. Improving access to clean drinking water is millennium development goal 7c, and is the responsibility of the Ministry of Drinking Water and Sanitation in India.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Membrane Filtration to Improve Drinking Water: A Quasi-Experimental Study from Rural Southern India

Francis

Sarkar

Roy

et al. 2016

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Since point-of-use methods of water filtration have shown limited acceptance in Vellore, southern India, this study evaluated the effectiveness of decentralized membrane filtration 1) with safe storage, 2) without safe storage, versus 3) no intervention, consisting of central chlorination as per government guidelines, in improving the microbiological quality of drinking water and preventing childhood diarrhea. Periodic testing of water sources, pre-/postfiltration samples, and household water, and a biweekly follow up of children less than 2 years of age was done for 1 year. The membrane filters achieved a log reduction of 0.86 (0.69–1.06), 1.14 (0.99–1.30), and 0.79 (0.67–0.94) for total coliforms, fecal coliforms, and Escherichia coli, respectively, in field conditions. A 24% (incidence rate ratio, IRR [95% confidence interval, CI] = 0.76 [0.51–1.13]; P = 0.178) reduction in diarrheal incidence in the intervention village with safe storage and a 14% (IRR [95% CI] = 1.14 [0.75–1.77]; P = 0.530) increase in incidence for the intervention village without safe storage versus no intervention village was observed, although not statistically significant. Microbiologically, the membrane filters decreased fecal contamination; however, provision of decentralized membrane-filtered water with or without safe storage was not protective against childhood diarrhea.

show abstract

Effect of Household-Based Drinking Water Chlorination on Diarrhoea among Children under Five in Orissa, India: A Double-Blind Randomised Placebo-Controlled Trial

Cited by 79 publications

References 37 publications

Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India

Shared Sanitation Versus Individual Household Latrines in Urban Slums: A Cross-Sectional Study in Orissa, India

Use, microbiological effectiveness and health impact of a household water filter intervention in rural Rwanda—A matched cohort study

Effectiveness of Membrane Filtration to Improve Drinking Water: A Quasi-Experimental Study from Rural Southern India

Contact Info

Product

Resources

About