Abstract
.Enteric infections early in life have been associated with poor linear growth among children in low-resource settings. Point-of-use water treatment technologies provide effective and low-cost solutions to reduce exposure to enteropathogens from drinking water, but it is unknown whether the use of these technologies translates to improvements in child growth. We conducted a community-based randomized controlled trial of two water treatment technologies to estimate their effects on child growth in Limpopo, South Africa. We randomized 404 households with a child younger than 3 years to receive a silver-impregnated ceramic water filter, a silver-impregnated ceramic tablet, a safe-storage water container alone, or no intervention, and these households were followed up quarterly for 2 years. We estimated the effects of the interventions on linear and ponderal growth, enteric infections assessed by quantitative molecular diagnostics, and diarrhea prevalence. The silver-impregnated ceramic water filters and tablets consistently achieved approximately 1.2 and 3 log reductions, respectively, in total coliform bacteria in drinking water samples. However, the filters and tablets were not associated with differences in height (height-for-age z-score differences compared with no intervention: 0.06, 95% CI: −0.29, 0.40, and 0.00, 95% CI: −0.35, 0.35, respectively). There were also no effects of the interventions on weight, diarrhea prevalence, or enteric infections. Despite their effectiveness in treating drinking water, the use of the silver-impregnated ceramic water filters and tablets did not reduce enteric infections or improve child growth. More transformative water, sanitation, and hygiene interventions that better prevent enteric infections are likely needed to improve long-term child growth outcomes.
Highlights
In low-resource settings, lack of safe water has long-term detrimental consequences for child health and development
Households were excluded if they had chlorinated water piped into the home or routinely delivered to a permanent, engineered system that stored the water within the property, they used a ceramic filter or other commercial water treatment system, they had plans to move outside the community in the 6 months, the child’s caregiver was younger than 16 years or unable to give consent, or the youngest child aged less than 3 years was seriously ill
Adjusting for age, there were no differences in ΔHAZ, ΔWAZ, or ΔWHZ among children in the intervention groups compared with children in the no intervention group (Table 2)
Summary
In low-resource settings, lack of safe water has long-term detrimental consequences for child health and development. Exposure to enteropathogens in contaminated drinking water causes enteric infections and diarrhea and may contribute to environmental enteropathy, an inflammatory condition of the gut associated with increased intestinal permeability, impaired gut immune function, and malabsorption.[1] The cumulative impact of this exposure has been associated with poor linear growth and stunting,[2,3] which affects approximately 162 million[4] or 27% of children[5] younger than 5 years globally. Earlier studies have focused mainly on caregiver-reported diarrhea, which is subject to recall bias.[11] Interventions that improve access to safe water have the potential to make an impact on child growth and enteric infections, but have not been well studied toward this aim
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