A cluster randomized controlled trial to reduce childhood diarrhea using hollow fiber water filter and/or hygiene-sanitation educational interventions

Abstract

Safe domestic potable water supplies are urgently needed to reduce childhood diarrheal disease. In periurban neighborhoods in Cochabamba, Bolivia, we conducted a cluster randomized controlled trial to evaluate the efficacy of a household-level hollow fiber filter and/or behavior change communication (BCC) on water, sanitation, and hygiene (WASH) to reduce the diarrheal disease in children less than 5 years of age. In total, 952 households were followed for a period of 12 weeks post-distribution of the study interventions. Households using Sawyer PointONE filters had significantly less diarrheal disease compared with the control arm during the intervention period, which was shown by diarrheal prevalence ratios of 0.21 (95% confidence interval [95% CI] = 0.15-0.30) for the filter arm and 0.27 (95% CI = 0.22-0.34) for the filter and WASH BCC arm. A non-significant reduction in diarrhea prevalence was reported in the WASH BCC study arm households (0.71, 95% CI = 0.59-0.86).

Figure 1.

(A) The PointONE Filter produced by the Sawyer Corporation attached to a bucket with a lid was used in this study. (B) A transparent version of hollow fiber filter cartridge located within the filter casing. (C) A PointONE Filter bucket system in use and modeled for depiction in the filter training manuals used in the study.

Figure 2.

Intervention assignment and completed follow-up using CONSORT 2010 (CONsolidated Standards Of Reporting Trials).

Figure 3.

Diarrhea prevalence by study month. Percent prevalence for each study arm is shown above each point. Dashed black line = filter and WASH BCC arm; solid black = filter arm; dashed gray = WASH BCC arm; solid gray = control arm.