Abstract
In rural regions with limited resources, the provision of clean water remains challenging. The resulting high incidence of diarrhea can lead to acute kidney injury and death, particularly in the young and the old. Membrane filtration using recycled hemodialyzers allows water purification. This study quantifies the public health effects. Between 02/2018 and 12/2018, 4 villages in rural Ghana were provided with a high-volume membrane filtration device (NuFiltration). Household surveys were collected monthly with approval from Ghana Health Services. Incidence rates of diarrhea for 5-month periods before and after implementation of the device were collected and compared to corresponding rates in 4 neighboring villages not yet equipped. Data of 1,130 villagers over 10 months from the studied communities were studied. Incidence rates showed a decline following the implementation of the device from 0.18 to 0.05 cases per person-month (ppm) compared to the control villages (0.11 to 0.08 ppm). The rate ratio of 0.27 for the study villages is revised to 0.38 when considering the non-significant rate reduction in the control villages. Provision of a repurposed hemodialyzer membrane filtration device markedly improves health outcomes as measured by diarrhea incidence within rural communities.
Highlights
In rural regions with limited resources, the provision of clean water remains challenging
Using the incidence rate ratio for the second 5 months over the first 5 months gives a seasonally adjusted rate ratio of 0.38 (0.28/0.73), which translates to a diarrhea incidence rate that is reduced by 62% following initiation of the hemodialyzer filtration device in the study villages
Our data, collected in 4 rural communities in the Ada-East distric of Greater Accra Region in Ghana, before and after the implementation of a hemodialyzer membrane filtration device to produce clean drinking water, shows a substantially reduced risk of self-reported diarrhea by 72%. This is a major public health outcome since diarrhea is well known to be associated with deleterious consequences such as acute kidney injury and death, in younger children and the elderly
Summary
In rural regions with limited resources, the provision of clean water remains challenging. Provision of a repurposed hemodialyzer membrane filtration device markedly improves health outcomes as measured by diarrhea incidence within rural communities. A recent publication of the initiative has identified that a majority of cases of acute kidney injury in the developing world are (in contrast to the most frequently reported pathogenesis in first world countries) are associated with community-acquired disease and to a major part with d iarrhea[4]. This is evident in children 2 to 5 years of age in whom mortality is very h igh[5]. These data provide a powerful stimulus for widespread joint action by the world community to achieve this goal
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