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Clinical Trial
. 2005 Sep 3;331(7515):478.
doi: 10.1136/bmj.38512.618681.E0. Epub 2005 Jul 26.

Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: cluster randomised controlled trial

John A Crump  1 , Peter O Otieno, Laurence Slutsker, Bruce H Keswick, Daniel H Rosen, R Michael Hoekstra, John M Vulule, Stephen P Luby
Affiliations
Clinical Trial

Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: cluster randomised controlled trial

John A Crump et al. BMJ. .

Abstract

Objective: To compare the effect on prevalence of diarrhoea and mortality of household based treatment of drinking water with flocculant-disinfectant, sodium hypochlorite, and standard practices in areas with turbid water source in Africa.

Design: Cluster randomised controlled trial over 20 weeks.

Setting: Family compounds, each containing several houses, in rural western Kenya.

Participants: 6650 people in 605 family compounds.

Intervention: Water treatment: flocculant-disinfectant, sodium hypochlorite, and usual practice (control).

Main outcome measures: Prevalence of diarrhoea and all cause mortality. Escherichia coli concentration, free residual chlorine concentration, and turbidity in household drinking water as surrogates for effectiveness of water treatment.

Results: In children < 2 years old, compared with those in the control compounds, the absolute difference in prevalence of diarrhoea was -25% in the flocculant-disinfectant arm (95% confidence interval -40 to -5) and -17% in the sodium hypochlorite arm (-34 to 4). In all age groups compared with control, the absolute difference in prevalence was -19% in the flocculant-disinfectant arm (-34 to -2) and -26% in the sodium hypochlorite arm (-39 to -9). There were significantly fewer deaths in the intervention compounds than in the control compounds (relative risk of death 0.58, P = 0.036). Fourteen per cent of water samples from control compounds had E coli concentrations < 1 CFU/100 ml compared with 82% in flocculant-disinfectant and 78% in sodium hypochlorite compounds. The mean turbidity of drinking water was 8 nephelometric turbidity units (NTU) in flocculant-disinfectant households, compared with 55 NTU in the two other compounds (P < 0.001).

Conclusions: In areas of turbid water, flocculant-disinfectant was associated with a significant reduction in diarrhoea among children < 2 years. This health benefit, combined with a significant reduction in turbidity, suggests that the flocculant-disinfectant is well suited to areas with highly contaminated and turbid water.

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Figures

Fig 1
Fig 1
Recruitment and flow of participants
Fig 2
Fig 2
Crude prevalence of diarrhoea in children aged <2 and in all age groups by intervention
See this image and copyright information in PMC

Comment in

References

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