Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial

被引:70
|
作者
Ercumen, Ayse [1 ]
Naser, Abu Mohd. [2 ]
Unicomb, Leanne [2 ]
Arnold, Benjamin F. [1 ]
Colford, John M., Jr. [1 ]
Luby, Stephen P. [2 ,3 ,4 ]
机构
[1] Univ Calif Berkeley, Sch Publ Hlth, Div Epidemiol, Berkeley, CA 94720 USA
[2] Int Ctr Diarrhoeal Dis Res, Ctr Communicable Dis, Dhaka 1000, Bangladesh
[3] Stanford Univ, Sch Med, Stanford, CA 94305 USA
[4] Ctr Dis Control & Prevent, Atlanta, GA USA
来源
PLOS ONE | 2015年 / 10卷 / 03期
关键词
DICHLOROISOCYANURATE NADCC TABLETS; SAFE DRINKING-WATER; DEVELOPING-COUNTRIES; FECAL CONTAMINATION; ROUTINE TREATMENT; ESCHERICHIA-COLI; WELL-WATER; QUALITY; DISEASE; RISK;
D O I
10.1371/journal.pone.0121907
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh. Methods We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants' source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions. Findings Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias. Conclusions Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.
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页数:22
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