Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking water

Abstract

Objective To examine the effect of a new point-of-use treatment for drinking-water, a commercially developed flocculant-disinfectant, on the prevalence of diarrhoea in children. Methods We conducted a randomized controlled trial among 514 rural Guatemalan households, divided into 42 neighbourhood clusters, for 13 weeks, from 4 November 2002 through 31 January 2003. Clusters assigned to water treatment with the flocculantdisinfectant were compared with those using their usual water-handling practices. The longitudinal prevalence of diarrhoea was calculated as the proportion of total days with diarrhoea divided by the total number of days of observation. The prevalence of diarrhoea was compared using the Wilcoxon rank-sum test. Findings The 1702 people in households receiving the disinfectant had a prevalence of diarrhoea that was 40% lower than that among the 1699 people using standard water-handling practices (0.9% versus 1.5%; P = 0.001). In households using the flocculant-disinfectant, children < 1 year of age had a 39% lower prevalence of diarrhoea than those in households using their standard practices (3.7% versus 6.0%; P = 0.005). Conclusion In settings where families rarely treat drinking-water, we introduced a novel flocculant-disinfectant that reduced the longitudinal prevalence of diarrhoea, especially among children aged < 1 year, among whom diarrhoea has been strongly associated with mortality. Successful introduction and use of this product could contribute to preventing diarrhoeal disease globally.Keywords Diarrhea/epidemiology/prevention and control; Potable water/microbiology; Disinfectants; Water purification/methods; Child; Randomized controlled trials; Longitudinal studies; Guatemala (source: MeSH, NLM). Mots clés Diarrhée/épidémiologie/prévention et contrôle; Eau potable/microbiologie; Désinfectants; Purification eau/méthodes; Enfant; Essai clinique randomisé; Etude longitudinale; Guatemala (source: MeSH, INSERM). Palabras clave Diarrea/epidemiología/prevención y control; Agua potable/microbiología; Desinfectantes; Purificación del agua/ métodos; Niño; Ensayos controlados aleatorios; Estudios longitudinales; Guatemala (fuente: DeCS, BIREME). Voir page 34 le résumé en français. En la página 34 figura un resumen en español.

Drinking Water Quality, Feeding Practices, and Diarrhea among Children under 2 Years of HIV-Positive Mothers in Peri-Urban Zambia

“…9 Second, even for mothers that choose to breastfeed, infants may be exposed to waterborne pathogens; water treatment has been found to reduce diarrhea among breastfed children. 13 Third, children 6-24 months of age generally experience increased exposure to waterborne pathogens because of the introduction of complementary feeds, including drinking water, and heightened contact with their environment. Finally, young children that do contract the HIV virus will be more susceptible to water-related pathogens because of a weakened immune system and may particularly benefit from improved environmental conditions.…”

Evaluation of the Role of School Children in the Promotion of Point-of-Use Water Treatment and Handwashing in Schools and Households—Nyanza Province, Western Kenya, 2007

“…In several field trials, PuR ® removed organic solids from water, left a chlorine residual, and reduced the risk of diarrhea by 16-90%. [9][10][11][12][13] In May 2006, a pilot program was initiated in 3 schools and it was determined that PuR ® could be a practical water-quality intervention for schools with turbid surface water sources. In February 2007, this program was expanded to 17 additional schools, and an evaluation was initiated.…”

Turbidity and chlorine demand reduction using locally available physical water clarification mechanisms before household chlorination in developing countries

“…Source waters treated with one or two full bottle cap(s) receive a dosage of 1.875 or 3.75 mg l 21 sodium hypochlorite, respectively. In five randomized, controlled trials, the SWS has resulted in reductions in diarrhoeal disease incidence ranging from 26 to 84% (Semenza et al 1998;Quick et al 1999Quick et al , 2002Luby et al 2004;Crump et al 2005;Chiller et al 2006). …”