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

Bezatu Mengistie,Yemane Berhane,Alemayehu Worku,Zulfiqar A Bhutta

doi:10.1371/journal.pone.0077887

Bezatu Mengistie, Yemane Berhane + Show 2 more

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https://doi.org/10.1371/journal.pone.0077887

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Abstract

BackgroundHousehold water treatment has been advocated as a means of decreasing the burden of diarrheal diseases among young children in areas where piped and treated water is not available. However, its effect size, the target population that benefit from the intervention, and its acceptability especially in rural population is yet to be determined. The objective of the study was to assess the effectiveness of household water chlorination in reducing incidence of diarrhea among children under-five years of age.MethodA cluster randomized community trial was conducted in 36 rural neighborhoods of Eastern Ethiopia. Households with at least one child under-five years of age were included in the study. The study compared diarrhea incidence among children who received sodium hypochlorite (liquid bleach) for household water treatment and children who did not receive the water treatment. Generalized Estimation Equation model was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval.ResultIn this study, the incidence of diarrhea was 4.5 episodes/100 person week observations in the intervention arm compared to 10.4 episodes/100 person week observations in the control arm. A statistically significant reduction in incidence of diarrhea was observed in the intervention group compared to the control (Adjusted IRR = 0.42, 95% CI 0.36–0.48).ConclusionExpanding access to household water chlorination can help to substantially reduce child morbidity and achieve millennium development goal until reliable access to safe water is achieved.Trial RegistrationClinicalTrials.gov NCT01376440

Highlights

Diarrheal disease kills 1.5 million people mostly children under the age of five years in developing countries each year [1]
Water collected from initially acceptable microbial quality, it often becomes contaminated with pathogens during transport and storage [5]
Uptake and use is low among rural population who are more at risk of water borne disease [18]

Summary

Introduction

Diarrheal disease kills 1.5 million people mostly children under the age of five years in developing countries each year [1]. To overcome the difficulties in providing safe water, point-ofuse water treatment has been advocated as a means to improve access to potable water and decrease the global burden of diarrheal diseases [2,6,7]. The studies on effectiveness of water quality interventions in reducing diarrhea have been flawed due to responder observer biases [2,17]. Household water treatment has been advocated as a means of decreasing the burden of diarrheal diseases among young children in areas where piped and treated water is not available. The objective of the study was to assess the effectiveness of household water chlorination in reducing incidence of diarrhea among children under-five years of age

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