Effect of household water treatment with chlorine on diarrhea among children under the age of five years in rural areas of Dire Dawa, eastern Ethiopia: a cluster randomized controlled trial

Autor: Bezatu Mengistie, Helmut Kloos, Ephrem Tefera Solomon, Sirak Robele
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Rural Population
Diarrhea
030231 tropical medicine
Population
Under-five children
Rate ratio
Disease cluster
Cluster randomized controlled trial
law.invention
Water Purification
lcsh:Infectious and parasitic diseases
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
WaterGuard
law
Environmental health
medicine
Prevalence
Humans
Effect
lcsh:RC109-216
030212 general & internal medicine
education
education.field_of_study
business.industry
Incidence (epidemiology)
Drinking Water
Incidence
lcsh:Public aspects of medicine
Public Health
Environmental and Occupational Health

Infant
Newborn

Waterborne diseases
Infant
lcsh:RA1-1270
General Medicine
medicine.disease
Child mortality
Infectious Diseases
Child
Preschool

Female
Ethiopia
medicine.symptom
Chlorine
business
Research Article
Water treatment with chlorine
Zdroj: Infectious Diseases of Poverty, Vol 9, Iss 1, Pp 1-13 (2020)
Infectious Diseases of Poverty
ISSN: 2049-9957
DOI: 10.1186/s40249-020-00680-9
Popis: Background Diarrheal disease is a leading cause of child mortality and morbidity worldwide. Household water treatment with chlorine significantly reduces morbidity due to waterborne diseases. However, the effect of point-of-use (POU) water treatment in improving the quality of water in areas where POU is not provided free of charge and the effectiveness of home visits in inspiring household members to use POU regularly have not been studied. The objective of this study was to evaluate the effectiveness of drinking water disinfection by chlorination on diarrheal disease reduction among children under the age of 5 years in rural eastern Ethiopia. Methods A cluster randomized controlled trial was carried out in rural Dire Dawa from October 2018 through January 2019. The 405 households were randomized to intervention and control arms and intervention materials were distributed after conducting a baseline survey. This trial evaluated the effectiveness of household drinking water disinfection by chlorination in reducing incidence of diarrhea among children under the age of 5 years. Intervention households received 1.2% sodium hypochlorite with demonstration of its proper use. Participants in the control households continued with their usual habits of water collection and water storage. Generalized estimation equations (GEE) with log link Poisson distribution family and exchangeable correlation matrix was used to compute crude incidence rate ratio (IRR), adjusted IRR and the corresponding 95% confidence intervals. Results In the intervention households, in total, 281 cases of diarrhea were documented (8.7 cases per 100 person-weeks observation); in the control households, in total 446 cases of diarrhea were documented (13.8 cases per 100 person-weeks observation). A 36.0% (adjusted IRR = 0.64, 95% CI: 0.57–0.73) reduction in incidence of diarrhea was observed in the intervention arm when compared with the control arm. The highest and the lowest reductions were obtained in children of age ranges 1 to 2 years and 3 to 4 years, 42.7 and 30.4%, respectively. Adherence to the intervention was 81.3% as measured by free residual chlorine test. Conclusions In rural areas where diarrhea is the second leading cause of morbidity, water chlorination at the household level using liquid bleach considerably reduced episodes of diarrhea among children under the age of 5 years. Therefore, chlorinating drinking water at the household level may be a valuable interim solution for reducing the incidence of diarrheal diseases until potable water is made accessible to the majority of the population in Dire Dawa Administration and other Ethiopian communities. Trial registration PACTR, PACTR201807815961394. Registered 16 July 2018, www.pactr.org
Databáze: OpenAIRE
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