Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial

Ercümen, Ayşe; Naser, Abu Mohd; Unicomb, Leanne; Arnold, Benjamin F.; Colford, John M.; Luby, Stephen P.

doi:10.1371/journal.pone.0121907

Cited by 82 publications

(84 citation statements)

References 49 publications

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“…Safe water storage alone in this previously published trial did however lead to a significant 31% reduction in pediatric diarrhea prevalence compared with the control arm. 49 This finding demonstrates that safe water storage alone, although not sufficient to remove all fecal contamination in drinking water this setting, was sufficient to significantly reduce pediatric diarrheal disease. Future studies should evaluate the efficacy of the CHoBI7 intervention in reducing diarrheal disease prevalence in susceptible pediatric populations.…”

Section: Discussionmentioning

confidence: 90%

Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

George¹,

Jung²,

Saif‐Ur‐Rahman³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention.

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Section: Discussionmentioning

confidence: 90%

Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

George¹,

Jung²,

Saif‐Ur‐Rahman³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…However, recent studies found that one of these chlorine tablets (NaDCC [33 mg]) can produce a 2 mg/L dose of free chlorine residual in 10 L water. 20 Therefore, we decided to use this chlorination ratio in our experiment; each container was filled with 10 L DWASA water and treated with one chlorine tablet. Then, free and total chlorine concentrations were measured before treatment and at seven time points (30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours) after chlorine treatment using the HACH Pocket Colorimeter ™ II.…”

Section: Methodsmentioning

confidence: 99%

Chlorination of Household Drinking Water Among Cholera Patients' Households to Prevent Transmission of Toxigenic Vibrio cholerae in Dhaka, Bangladesh: CHoBI7 Trial

Rashid

George

Monira

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Household members of cholera patients are at a 100 times higher risk of cholera infections than the general population because of shared contaminated drinking water sources and secondary transmission through poor household hygiene practices. In this study, we investigated the bactericidal concentration of free chlorine required to inactivate Vibrio cholerae in household drinking water in Dhaka, Bangladesh. In laboratory experiments, we found that the concentrations of free chlorine required to inactivate 10 5 colony-forming units (CFU)/mL of V. cholerae serogroups O1 and O139 were 0.1 mg/L and 0.2 mg/L, respectively. The concentration of free chlorine generated by a single chlorine tablet (sodium dichloroisocyanurate [33 mg]) after a 30-minute reaction time in a 10-L sealed vessel containing Dhaka city municipal supply water was 1.8 mg/L; and the concentration declined to 0.26 mg/L after 24 hours. In field measurements, water collected from 165 households enrolled in a randomized controlled trial (RCT) of a chlorine and handwashing with soap intervention (Cholera-Hospital-Based-Intervention-for-7-Days[CHoBI7]), we observed significantly higher free chlorine concentrations in the 82 intervention arm households (mean = 1.12 mg/L, standard deviation [SD] = 0.52, range = 0.07-2.6 mg/L) compared with the 83 control households (0.017 mg/L, SD = 0.01, range = 0-0.06 mg/L) (P < 0.001) during spot check visits. These findings suggest that point-of-use chlorine tablets present an effective approach to inactivate V. cholerae from drinking water in households of cholera patients in Dhaka city. This result is consistent with the findings from the RCT of CHoBI7 which found that this intervention led to a significant reduction in symptomatic cholera infections among household members of cholera patients and no stored drinking water samples with detectable V. cholerae. BACKGROUND

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“…In order to control for the potential impact of precipitation on water quality and diarrhoea Levy et al, 2016;Mukabutera et al, 2016), total precipitation within the previous 10 days to each household's survey date was included in analyses as a potential confounder (Ercumen et al, 2015b). Data were downloaded in Network Common Data Format (NetCDF) for each village centroid from Climate Hazards Group InfraRed Precipitation with Station data 2.0 (CHIRPS) (Funk et al, 2015), which comprises daily gridded precipitation data derived from satellite and in-situ station data at 0.05 degree spatial resolution (approximately 5.3km).…”

Section: Precipitation Datamentioning

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

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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.

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Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial

Cited by 82 publications

References 49 publications

Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

Chlorination of Household Drinking Water Among Cholera Patients' Households to Prevent Transmission of Toxigenic Vibrio cholerae in Dhaka, Bangladesh: CHoBI7 Trial

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

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