Evaluating the Sustained Health Impact of Household Chlorination of Drinking Water in Rural Haiti

Abstract

The Jolivert Safe Water for Families program has sold sodium hypochlorite solution (chlorine) and conducted household visits in rural Haiti since 2002. To assess the impact of the program on diarrheal disease, in 2010 we conducted a survey and water quality testing in 201 program participants and 425 control households selected at random. Fifty-six percent of participants (versus 10% of controls) had free chlorine residuals between 0.2 and 2.0 mg/L, indicating correct water treatment. Using intention-to-treat analysis, we found that significantly fewer children < 5 in participant households had an episode of diarrhea in the previous 48 hours (32% versus 52%; P < 0.001) with 59% reduced odds (odds ratio = 0.41, 95% confidence interval = 0.21–0.79). Treatment-on-treated estimates of the odds of diarrhea indicated larger program effects for participants who met more stringent verifications of participation. Diarrheal disease reduction in this long-term program was comparable with that seen in short-term randomized, controlled interventions, suggesting that household chlorination can be an effective long-term water treatment strategy.

Household Water Chlorination Reduces Incidence of Diarrhea among Under-Five Children in Rural Ethiopia: A Cluster Randomized Controlled Trial

“…Our result on reduction of diarrhea episode was consistent with similar studies conducted in Kenya [26] and Haiti [14]. But, the finding was higher than other studies from Bolivia [9] and Brazil [16].…”

The Critical Role of Compliance in Delivering Health Gains from Environmental Health Interventions

“…Per protocol analysis, on the other hand, defines exposure based on whether or not someone actually uses the intervention. 2,13,14 The latter, which incorporates compliance to the intervention, is uncommon, partly because compliance for environmental interventions can be difficult to measure and partly because per protocol analysis results in the loss of randomization. Similarly, treatment-on-the-treated analysis uses an instrumental variable approach to estimate the effect of interventions among those who actually received/complied with the intervention.…”

Need for certification of household water treatment products: examples from Haiti

“…), reduce diarrhoeal disease incidence in developing countries (Arnold & Colford ) and may be an effective long‐term HWT intervention in Haiti (Harshfield et al . ). Concerns about taste acceptability (Figueroa & Kincaid ) and trihalomethane formation (Lantagne et al .…”

“…In 2012, 59.9% of urban and 78.0% of rural Haitian households, which typically collect and store water in 1-gallon or 5-gallon containers, reported treating drinking water, and approximately 90% of those reported using chlorine products (Cayemittes et al 2013). Chlorine-based HWT products improve microbiological water quality (Crump et al 2005), reduce diarrhoeal disease incidence in developing countries (Arnold & Colford 2007) and may be an effective long-term HWT intervention in Haiti (Harshfield et al 2012). Concerns about taste acceptability (Figueroa & Kincaid 2010) and trihalomethane formation (Lantagne et al 2008) with chlorination have generated interest in alternative, non-chlorine-based products; and the HWT market has responded by introducing new, nonchlorine products, some of which are promoted in Haiti.…”