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BMJ. 2005 Sep 3;331(7515):478. 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.

Author information

  • 1Foodborne and Diarrhoeal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-38, Atlanta, Georgia 30333, USA. jcrump@cdc.gov

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.

PMID:
16046440
[PubMed - indexed for MEDLINE]
PMCID:
PMC1199021
Free PMC Article
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