A randomized trial to evaluate the risk of gastrointestinal disease due to consumption of drinking water meeting current microbiological standards.

Payment, Pierre; Richardson, Lesley; Siemiatycki, Jack; Dewar, Ron; Edwardes, Michael; Franco, Eduardo L.

doi:10.2105/ajph.81.6.703

Cited by 301 publications

(219 citation statements)

References 11 publications

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“…The estimate of population incidence rate was lower than that found in studies in the US and Canada [10,11] but was similar to that found in the Dutch study (their case definition required symptoms to last over 24 h) [9]. The presentation rate to GPs was similar to that found in GP studies in the UK in the early 1980s [5,6] and in the recent Dutch study [9], but were lower than the most recent general practice morbidity statistics [12].…”

Section: Discussioncontrasting

confidence: 64%

A pilot study of infectious intestinal disease in England

et al. 1995

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SUMMARYPilot studies to test methods to determine the incidence, agents, risk factors and socioeconomic costs of infectious intestinal disease (IID) in England were carried out as recommended by the Committee on the Microbiological Safety of Food (the Richmond Committee) by eight general practices. There were case control and enumeration studies of patients presenting to general practice with IID, a population-based prospective cohort study, and a survey of socioeconomic costs of cases of IID. Information on risk factors was obtained by questionnaire (selfadministered compared with interview) and a stool sample was requested on all cases and controls. Response rates in the GP case control study were 75 % for case questionnaires and 74 % for stools; for controls the figures were 70 % and 68 % respectively. The acceptance rate into the cohort study was 49 %; this was significantly higher where phone contact was made. The rate was similar if recruitment was by individual or household. Follow-up of the cohort by negative reporting was complete for up to 6 months. Direct postage by subject was required to obtain fresh stool specimens. Estimates were obtained of presentation rates of IID and the distribution of risk factors which were used to plan the main study. The pilot study demonstrated that it is possible to undertake a national study based in general practice to determine the incidence of IID in the population and presenting to GPs and its agents, risk factors and costs.

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Section: Discussioncontrasting

confidence: 64%

A pilot study of infectious intestinal disease in England

et al. 1995

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“…[3][4][5][6][7][8][9] Contaminated municipal water supplies have been implicated in disease transmission in diarrheal outbreaks around the world. 6,[8][9][10][11][12][13] However, few studies to date have evaluated the burden and routes of transmission of enteric diseases in relatively developed countries with suboptimal sanitary infrastructure, such as the newly independent Central Asian States. Our analysis of disease transmission in Nukus reveals that in this case the endemic disease burden is caused primarily by contaminated public water supply rather than by poor sanitation, poor hygiene practices, or other causes.…”

Section: Discussionmentioning

confidence: 99%

“…12 Individuals with access to piped water at their residence experience fewer episodes of diarrheal disease than those without access to piped water. Nonetheless, drinking home-chlorinated water results in lower diarrheal incidence than drinking the piped water provided in Nukus.…”

Section: Discussionmentioning

confidence: 99%

Water distribution system and diarrheal disease transmission: a case study in Uzbekistan.

Semenza¹,

Roberts²,

Henderson³

et al. 1998

Am J Trop Med Hyg

188

159

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Abstract. Deteriorating water treatment facilities and distribution systems pose a significant public health threat, particularly in republics of the former Soviet Union. Interventions to decrease the disease burden associated with these water systems range from upgrading distribution networks to installing reverse osmosis technology. To provide insight into this decision process, we conducted a randomized intervention study to provide epidemiologic data for water policy decisions in Nukus, Uzbekistan, where drinking water quality is suboptimal. We interviewed residents of 240 households, 120 with and 120 without access to municipal piped water. Residents of 62 households without piped water were trained to chlorinate their drinking water at home in a narrow-necked water container with a spout. All study subjects (1583 individuals) were monitored biweekly for self-reported diarrheal illness over a period of 9.5 weeks. The home chlorination intervention group had the lowest diarrheal rate (28.8/1,000 subjects/month) despite lack of access to piped water in their homes. Compared with the two groups that did not receive the intervention this rate was one-sixth that of the group with no piped water (179.2/1,000 subjects/month) and one-third that of the households with piped water (75.5/1,000 subjects/month). More than 30% of the households with piped water lacked detectable levels of chlorine residues in their drinking water, despite two-stage chlorination of the source water, and were at increased risk of diarrhea. Forty-two percent of these municipal users reported that water pressure had been intermittent within the previous two days. The dramatic reduction in diarrheal rates in the home-chlorination intervention group indicates that a large proportion of diarrheal diseases in Nukus are water-borne. The home-chlorination group had less diarrhea than the group with piped water, implicating the distribution system as a source of disease transmission. Taken together, these epidemiologic data would support the hypothesis that diarrhea in the piped water group could be attributed to cross-contamination between the municipal water supply and sewer, due to leaky pipes and lack of water pressure. Relatively inexpensive steps, including chlorination, maintaining water pressure, and properly maintaining the distribution system, rather than reverse osmosis technology, should reduce diarrheal rates.

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“…HCGI was defined as having three or more loose, watery stools within a 24-hour period, blood in the stool, and/or vomiting using a 2-day recall period. 19,20 The remaining eligible households comprised of 51 spatially coherent household clusters with a mean cluster size of 10 households. A random number was then assigned to each household and sorted in ascending order, first by the random number and then by cluster number.…”

Section: Methodsmentioning

confidence: 99%

Quantification of Human Norovirus GII on Hands of Mothers with Children Under the Age of Five Years in Bagamoyo, Tanzania

Mattioli¹,

Davis²,

Mrisho³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Human noroviruses are the most common cause of viral gastroenteritis worldwide and one of the leading causes of viral diarrhea in children under the age of 5 years. Hands have been shown to play an important role in norovirus transmission. Norovirus outbreaks tend to exhibit strong seasonality, most often occurring during cold, dry months, but recently have also been documented during hot, dry winter months in the southern hemisphere. Other research suggests that rainfall is an important factor in norovirus outbreaks. This study examines the prevalence and concentration of human norovirus GII on the hands of mothers in Bagamoyo, Tanzania, during the rainy and dry seasons. Norovirus GII was detected in approximately 5% of hand rinse samples during both the rainy and dry seasons. Fecal indicator bacteria levels, Escherichia coli and enterococci, in hand rinse samples were not associated with norovirus hand contamination. Turbidity of the hand rinses was found to be associated with norovirus presence on mothers' hands; however, this relationship was only observed during the rainy season. The results suggest mothers' hands serve as a source of norovirus exposure for young children in Tanzanian households, and further work is needed to determine better indicators of norovirus contamination in these environments.

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A randomized trial to evaluate the risk of gastrointestinal disease due to consumption of drinking water meeting current microbiological standards.

Cited by 301 publications

References 11 publications

A pilot study of infectious intestinal disease in England

A pilot study of infectious intestinal disease in England

Water distribution system and diarrheal disease transmission: a case study in Uzbekistan.

Quantification of Human Norovirus GII on Hands of Mothers with Children Under the Age of Five Years in Bagamoyo, Tanzania

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