Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala

Arnold, Benjamin F.; Arana, Byron; Mäusezahl, Daniel; Hubbard, Alan; Colford, John M.

doi:10.1093/ije/dyp241

Cited by 113 publications

(133 citation statements)

References 34 publications

Supporting

Mentioning

124

Contrasting

Order By: Relevance

“…In order to compare the balance of household characteristics between arms, the standardized difference was calculated (Arnold et al, 2009;Rubin, 2007). The standardized difference is the difference of the means in terms of standard deviations, with a value of 0 indicating equal means and a value of 1 indicating a one standard deviation difference (Austin, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Village-level matching was performed using a combination of restriction, propensity score matching, and rapid assessment (Arnold et al, 2009(Arnold et al, , 2010. Intervention villages were first exact matched to non-bordering potential control villages within the same health centre catchment area (sub-district).…”

Section: Village Selection and Matchingmentioning

confidence: 99%

“…The matched cohort design seeks to minimise the risk of unmeasured confounders by matching on characteristics likely to impact outcomes of interest (Austin, 2011;Stuart, 2010). This design has been used in other studies of pre-existing interventions where randomization is not possible (Arnold et al, 2009(Arnold et al, , 2010Ercumen et al, 2015a).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Section: Discussionmentioning

confidence: 99%

Section: Village Selection and Matchingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

show abstract

“…The attractive features of the design are that it naturally estimates the average effect of an intervention deployed by actually implementing organizations in populations most likely to receive it and yields information about intervention sustainability without years of prospective follow-up. Our motivating example adds to three previous applications of similar methods (to our knowledge) to evaluate preexisting interventions in development settings (19)(20)(21), but prior work has not clearly articulated the design's underlying framework, assumptions, and threats to validity. In SI Materials and Methods and Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Epidemiology and the social sciences have a long history of using matched cohort designs to study interventions and exposures that are not randomly assigned (14,15). Recent efforts have used the design in prospective group-level intervention studies (16)(17)(18) and in preexisting intervention studies (19)(20)(21). In a typical scenario, investigators define a study population, and a subset of the population is selected to receive the intervention by a known or unknown process that is not random.…”

Section: Methodsmentioning

confidence: 99%

Causal inference methods to study nonrandomized, preexisting development interventions

Arnold

Khush

Padmavathi

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

Empirical measurement of interventions to address significant global health and development problems is necessary to ensure that resources are applied appropriately. Such intervention programs are often deployed at the group or community level. The gold standard design to measure the effectiveness of communitylevel interventions is the community-randomized trial, but the conditions of these trials often make it difficult to assess their external validity and sustainability. The sheer number of community interventions, relative to randomized studies, speaks to a need for rigorous observational methods to measure their impact. In this article, we use the potential outcomes model for causal inference to motivate a matched cohort design to study the impact and sustainability of nonrandomized, preexisting interventions. We illustrate the method using a sanitation mobilization, water supply, and hygiene intervention in rural India. In a matched sample of 25 villages, we enrolled 1,284 children <5 y old and measured outcomes over 12 mo. Although we found a 33 percentage point difference in new toilet construction [95% confidence interval (CI) = 28%, 39%], we found no impacts on height-for-age Z scores (adjusted difference = 0.01, 95% CI = −0.15, 0.19) or diarrhea (adjusted longitudinal prevalence difference = 0.003, 95% CI = −0.001, 0.008) among children <5 y old. This study demonstrates that matched cohort designs can estimate impacts from nonrandomized, preexisting interventions that are used widely in development efforts. Interpreting the impacts as causal, however, requires stronger assumptions than prospective, randomized studies.impact evaluation | study design | propensity score matching | communityled total sanitation | open defecation

show abstract

Hand washing promotion for preventing diarrhoea

Ejemot-Nwadiaro

Ehiri

Arikpo

et al. 2015

Cochrane Database of Systematic Reviews

229

214

View full text Add to dashboard Cite

BackgroundDiarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing.ObjectivesTo assess the effects of hand washing promotion interventions on diarrhoeal episodes in children and adults.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register (27 May 2015); CENTRAL (published in the Cochrane Library 2015, Issue 5); MEDLINE (1966 to 27 May 2015); EMBASE (1974 to 27 May 2015); LILACS (1982 to 27 May 2015); PsycINFO (1967 to 27 May 2015); Science Citation Index and Social Science Citation Index (1981 to 27 May 2015); ERIC (1966 to 27 May 2015); SPECTR (2000 to 27 May 2015); Bibliomap (1990 to 27 May 2015); RoRe, The Grey Literature (2002 to 27 May 2015); World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), metaRegister of Controlled Trials (mRCT), and reference lists of articles up to 27 May 2015. We also contacted researchers and organizations in the field.Selection criteriaIndividually randomized controlled trials (RCTs) and cluster-RCTs that compared the effects of hand washing interventions on diarrhoea episodes in children and adults with no intervention.Data collection and analysisThree review authors independently assessed trial eligibility, extracted data, and assessed risk of bias. We stratified the analyses for child day-care centres or schools, community, and hospital-based settings. Where appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random-effects model with 95% confidence intervals (CIs). We used the GRADE approach to assess the quality of evidence.Main resultsWe included 22 RCTs: 12 trials from child day-care centres or schools in mainly high-income countries (54,006 participants), nine community-based trials in LMICs (15,303 participants), and one hospital-based trial among people with acquired immune deficiency syndrome (AIDS) (148 participants).Hand washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevents around one-third of diarrhoea episodes in high income countries (rate ratio 0.70; 95% CI 0.58 to 0.85; nine trials, 4664 participants, high quality evidence), and may prevent a similar proportion in LMICs but only two trials from urban Egypt and Kenya have evaluated this (rate ratio 0.66, 95% CI 0.43 to 0.99; two trials, 45,380 participants, low quality evidence). Only three trials reported measures of behaviour change and the methods of data collection were susceptible to bias. In one trial from the USA hand washing behaviour was reported to improve; and in the trial from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; three trials, 1845 participants, low quality evidence).Hand washing promotion among communities in LMICs probably prevents around one-quarter of diarrhoea episodes (rate ratio 0.72, 95% CI 0.62 to 0.83; eight trials, 14,726 participants, modera...

show abstract

Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala

Cited by 113 publications

References 34 publications

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

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

Causal inference methods to study nonrandomized, preexisting development interventions

Hand washing promotion for preventing diarrhoea

Contact Info

Product

Resources

About