Effects of adding household water filters to Rwanda's Community-Based Environmental Health Promotion Programme: a cluster-randomized controlled trial in Rwamagana district.
Sabrina S HaqueMiles A KirbyLaurien IyakaremyeAlemayehu Gebremariam AgenaGetachew TessemaEvan ThomasHoward H ChangThomas ClasenPublished in: NPJ clean water (2022)
Unsafe drinking water remains a major cause of mortality and morbidity. While Rwanda's Community-Based Environmental Health Promotion Programme (CBEHPP) promotes boiling and safe storage, previous research found these efforts to be ineffective in reducing fecal contamination of drinking water. We conducted a cluster randomized control led trial to determine if adding a household water filter with safe storage to the CBEHPP would improve drinking water quality and reduce child diarrhea. We enrolled 1,199 households with a pregnant person or child under 5 across 60 randomly selected villages in Rwamagana district. CBEHPP implementers distributed and promoted water purifiers to a random half of villages. We conducted two unannounced follow-up visits over 13-16 months after the intervention delivery. The intervention reduced the proportions of households with detectable E. coli in drinking water samples (primary outcome) by 20% (PR 0.80, 95% CI 0.74-0.87, p < 0.001) and with moderate and higher fecal contamination (≥10 CFU/100 mL) by 35% (PR 0.65, 95% CI 0.57-0.74 , p < 0.001). The proportion of children under 5 experiencing diarrhea in the last week was reduced by 49% (aPR 0.51, 95%CI 0.35-0.73, p < 0.001). Our findings identify an effective intervention for improving water quality and child health that can be added to the CBEHPP.
Keyphrases
- drinking water
- health promotion
- water quality
- study protocol
- randomized controlled trial
- health risk
- health risk assessment
- phase iii
- mental health
- placebo controlled
- south africa
- open label
- phase ii
- young adults
- clinical trial
- pregnant women
- alcohol consumption
- clostridium difficile
- escherichia coli
- irritable bowel syndrome
- coronary artery disease
- type diabetes
- cardiovascular disease
- heavy metals