A Randomized Controlled Trial of Household-Based Flocculant-Disinfectant Drinking Water Treatment for Diarrhea Prevention in Rural Guatemala

Reller, Megan E.; Mendoza, Carlos Enrique Guzmán; Lopez, M. Beatriz; Alvarez, Maricruz; Hoekstra, Robert M.; Olson, Curtis A.; Baier, Kathleen; Keswick, Bruce H.; Luby, Stephen P.

doi:10.4269/ajtmh.2003.69.411

Cited by 131 publications

(129 citation statements)

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“…Other studies, however, have not found such a large advantage for chlorine. A study in Guatemala that evaluated sodium hypochlorite (bleach) and PUR demonstrated no significant difference between the two technologies, both of which reduced diarrhea by ~25% (28). Precise rankings of POU-based disease reduction are difficult to ascertain, as we describe in the following paragraph, but more qualitative conclusions are possible.…”

Section: A Shift To Household Technologiesmentioning

confidence: 88%

Water And Sanitation in Developing Countries: Including Health in the Equation

Montgomery¹,

Elimelech²

2007

Environ. Sci. Technol.

795

420

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hanced and services expanded through greater collaboration between the fields of water and sanitation engineering and public health. Second, researchers should focus on the sustainability of water and sanitation services by developing strategies that holistically address the influence of the environment, culture, and economics on the implementation and long-term maintenance of treatment systems. Lowcost household technologies, as opposed to centralized systems, offer one means of addressing water and sanitation needs in a more integrated and sustainable manner. Third, the obstacles to improving water and sanitation services, such as lack of investment, lack of political will, and difficulty in maintaining services, must be overcome so that these services can be improved and global coverage ultimately achieved. This will require greater collaboration among the water, health, and education sectors in conducting community-based research and work, formulating evidence-based policies that allow for effective investments, and focusing on developing solutions that can be locally managed and maintained. Billions suffer without improved water and sanitation servicesGlobal figures that describe the lack of water and sanitation services are alarming. More than 1.1 billion people do not have access to improved drink-I mproving global access to clean drinking water and safe sanitation is one of the least expensive and most effective means to improve public health and save lives. The concept of clean water and safe sanitation as essential to health is not a novel idea. In 350 B.C., Hippocrates recommended boiling water to inactivate "impurities". The U.S. and Central Europe, where water and sanitation services are nearly universal, significantly reduced water-, sanitation-, and hygiene-related diseases by the start of the 20th century by protecting water sources and installing sewage systems. However, in developing countries, water and sanitation services are still severely lacking. As a result, millions suffer from preventable illnesses and die every year (1). Many obstacles must be overcome to improve these statistics. The integration of public health into engineering problem solving is critical, but current efforts are insufficient. Through partnerships with local communities to implement water and sanitation solutions that consider environmental, cultural, and economic conditions, progress toward achieving and sustaining global coverage of water and sanitation services will be greatly enhanced.In this article, we discuss three main themes about water, sanitation, and health in developing regions. First, water and sanitation services have markedly improved health and engendered many secondary benefits. These benefits could be en-

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Section: A Shift To Household Technologiesmentioning

confidence: 88%

Water And Sanitation in Developing Countries: Including Health in the Equation

Montgomery¹,

Elimelech²

2007

Environ. Sci. Technol.

795

420

View full text Add to dashboard Cite

show abstract

“…The lack of health impact in the context of successful treatment of stored drinking water was not consistent with results of previous studies of other chlorine-based, point-of-use water treatment interventions. 7,9,[12][13][14][15][16] There are several possible explanations for the observed lack of health impact. First, it is possible that disinfected stored water does not prevent diarrhea.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5]7,9,[12][13][14][15][16] A recent meta-epidemiological study assessed the evidence for bias in controlled trials due to lack of blinding 34 and, although the review did not specifically assess point-ofuse water treatment intervention trials, it did estimate that trials with subjective outcomes exaggerated the actual effect of those outcomes by approximately 25%. Thus, even if the pooled estimate of the effect of household water treatment were adjusted by this factor of 25%, the protective effect would still be greater than 30%.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, a number of household water treatment technologies have been developed, tested, and disseminated to protect the health of populations lacking access to safe water. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] One of these household water treatment technologies is sodium dichloroisocyanurate (NaDCC) tablets, an alternative to sodium hypochlorite (NaOCl) solution, which is produced and distributed in many countries for water treatment. 17 Both NaDCC tablets and NaOCl solution disinfect water by releasing free available chlorine in the form of hypochlorous acid, which is an effective microbicide against a wide range of bacteria, viruses, and parasites.…”

Section: Introductionmentioning

confidence: 99%

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Sodium Dichloroisocyanurate Tablets for Routine Treatment of Household Drinking Water in Periurban Ghana: A Randomized Controlled Trial

Jain

Sahanoon²,

Blanton³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Abstract. We conducted a randomized, placebo-controlled, triple-blinded trial to determine the health impact of daily use of sodium dichloroisocyanurate (NaDCC) tablets for household drinking water treatment in periurban Ghana. We randomized 240 households (3,240 individuals) to receive either NaDCC or placebo tablets. All households received a 20-liter safe water storage vessel. Over 12 weeks, 446 diarrhea episodes (2.2%) occurred in intervention and 404 (2.0%) in control households ( P = 0.38). Residual free chlorine levels indicated appropriate tablet use. Escherichia coli was found in stored water at baseline in 96% of intervention and 88% of control households and at final evaluation in 8% of intervention and 54% of control households ( P = 0.002). NaDCC use did not prevent diarrhea but improved water quality. Diarrhea rates were low and water quality improved in both groups. Safe water storage vessels may have been protective. A follow-up health impact study of NaDCC tablets is warranted.

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“…3 Evidence on the positive effect of point-of-use treatment on water quality, and significant reductions in diarrheal diseases among its users, exists. [4][5][6][7][8][9][10][11] The usage of chlorine products has been described as one effective and easy-to-use means of water disinfection. Likewise, the protective effect of solar-disinfected water against cholera infections in small children has been shown and could serve as an alternative point-of-use treatment method.…”

Section: Introductionmentioning

confidence: 99%

Factors Determining Water Treatment Behavior for the Prevention of Cholera in Chad

Lilje

Kessely

Mosler

2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Cholera is a well-known and feared disease in developing countries, and is linked to high rates of morbidity and mortality. Contaminated drinking water and the lack of sufficient treatment are two of the key causes of high transmission rates. This article presents a representative health survey performed in Chad to inform future intervention strategies in the prevention and control of cholera. To identify critical psychological factors for behavior change, structured household interviews were administered to N = 1,017 primary caregivers, assessing their thoughts and attitudes toward household water treatment according to the Risk, Attitude, Norm, Ability, and Self-regulation model. The intervention potential for each factor was estimated by analyzing differences in means between groups of current performers and nonperformers of water treatment. Personal risk evaluation for diarrheal diseases and particularly for cholera was very low among the study population. Likewise, the perception of social norms was found to be rather unfavorable for water treatment behaviors. In addition, self-reported ability estimates (self-efficacy) revealed some potential for intervention. A mass radio campaign is proposed, using information and normative behavior change techniques, in combination with community meetings focused on targeting abilities and personal commitment to water treatment.

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A Randomized Controlled Trial of Household-Based Flocculant-Disinfectant Drinking Water Treatment for Diarrhea Prevention in Rural Guatemala

Cited by 131 publications

References 10 publications

Water And Sanitation in Developing Countries: Including Health in the Equation

Water And Sanitation in Developing Countries: Including Health in the Equation

Sodium Dichloroisocyanurate Tablets for Routine Treatment of Household Drinking Water in Periurban Ghana: A Randomized Controlled Trial

Factors Determining Water Treatment Behavior for the Prevention of Cholera in Chad

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