scholarly journals Diarrhea prevalence in a randomized, controlled prospective trial of point-of-use water filters in homes and schools in the Dominican Republic

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Nathan Tintle ◽  
Kristin Van De Griend ◽  
Rachel Ulrich ◽  
Randall D. Wade ◽  
Tena M. Baar ◽  
...  
Keyword(s):  
Drinking Water ◽  
Water Samples ◽  
Controlled Trial ◽  
World Health ◽  
Dissolved Metals ◽  
Randomized Controlled ◽  
Point Of Use ◽  
Diarrhea Prevalence ◽  
Clean Drinking Water ◽  
Post Filter

Abstract Background Lack of sustainable access to clean drinking water continues to be an issue of paramount global importance, leading to millions of preventable deaths annually. Best practices for providing sustainable access to clean drinking water, however, remain unclear. Widespread installation of low-cost, in-home, point of use water filtration systems is a promising strategy. Methods We conducted a prospective, randomized, controlled trial whereby 16 villages were selected and randomly assigned to one of four treatment arms based on the installation location of Sawyer® PointONE™ filters (filter in both home and school; filter in home only; filter in school only; control group). Water samples and self-reported information on diarrhea were collected at multiple times throughout the study. Results Self-reported household prevalence of diarrhea decreased from 25.6 to 9.76% from installation to follow-up (at least 7 days, and up to 200 days post-filter installation). These declines were also observed in diarrhea with economic or educational consequences (diarrhea which led to medical treatment and/or missing school or work) with baseline prevalence of 9.64% declining to 1.57%. Decreases in diarrhea prevalence were observed across age groups. There was no evidence of a loss of efficacy of filters up to 200 days post-filter installation. Installation of filters in schools was not associated with decreases in diarrhea prevalence in school-aged children or family members. Unfiltered water samples both at schools and homes contained potential waterborne bacterial pathogens, dissolved heavy metals and metals associated with particulates. All dissolved metals were detected at levels below World Health Organization action guidelines. Conclusions This controlled trial provides strong evidence of the effectiveness of point-of-use, hollow fiber membrane filters at reducing diarrhea from bacterial sources up to 200 days post-installation when installed in homes. No statistically significant reduction in diarrhea was found when filters were installed in schools. Further research is needed in order to explore filter efficacy and utilization after 200 days post-installation. Trial registration ClinicalTrials.gov, NCT03972618. Registered 3 June 2019—retrospectively registered.

scholarly journals Diarrhea prevalence in a randomized, controlled prospective trial of point-of-use water filters in homes and schools in the Dominican Republic

2020 ◽  
Author(s):  
Nathan Tintle ◽  
Kristin Van De Griend ◽  
Rachel Ulrich ◽  
Randall D. Wade ◽  
Tena M. Baar ◽  
...  
Keyword(s):  
Drinking Water ◽  
Water Samples ◽  
Controlled Trial ◽  
World Health ◽  
Randomized Controlled ◽  
Link Type ◽  
Point Of Use ◽  
Diarrhea Prevalence ◽  
Clean Drinking Water ◽  
Post Filter

AbstractBackgroundLack of sustainable access to clean drinking water continues to be an issue of paramount global importance, leading to millions of preventable deaths annually. Best practices for providing sustainable access to clean drinking water, however, remain unclear. Widespread installation of low-cost, in-home, point of use water filtration systems is a promising strategy.MethodsWe conducted a prospective, randomized, controlled trial whereby 16 villages were selected and randomly assigned to one of four treatment arms based on the installation location of Sawyer® PointONE™ filters (filter in both home and school; filter in home only; filter in school only; control group). Water samples and self-reported information on diarrhea were collected at multiple times throughout the study.ResultsSelf-reported household prevalence of diarrhea decreased from 25.6% to 9.76% from installation to follow-up (at least 7 days, and up to 200 days post-filter installation). These declines were also observed in diarrhea with economic or educational consequences (diarrhea which led to medical treatment and/or missing school or work) with baseline prevalence of 9.64% declining to 1.57%. Decreases in diarrhea prevalence were observed across age groups. There was no evidence of a loss of efficacy of filters up to 200 days post filter installation. Installation of filters in schools was not associated with decreases in diarrhea prevalence in school-aged children or family members. Unfiltered water samples both at schools and homes contained potential waterborne bacterial pathogens, dissolved heavy metals and metals associated with particulates. All dissolved metals were detected at levels below World Health Organization action guidelines.ConclusionsThis controlled trial provides strong evidence of the effectiveness of point-of-use, hollow fiber membrane filters at reducing diarrhea from bacterial sources up to 200 days post installation when installed in homes. No statistically significant reduction in diarrhea was found when filters were installed in schools. Further research is needed in order to explore filter efficacy and utilization after 200 days post-installation. Trial registration: ClinicalTrials.gov, NCT03972618. Registered 3 June 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03972618.

Psychosocial Factors Mediating the Effect of the CHoBI7 Mobile Health Program on Handwashing With Soap and Household Stored Water Quality: A Randomized Controlled Trial

2021 ◽  
pp. 109019812098713
Author(s):  
Christine Marie George ◽  
Md. Sazzadul Islam Bhuyian ◽  
Elizabeth D. Thomas ◽  
Tahmina Parvin ◽  
Shirajum Monira ◽  
...  
Keyword(s):  
Water Quality ◽  
Randomized Controlled Trial ◽  
Drinking Water ◽  
Controlled Trial ◽  
Drinking Water Quality ◽  
Response Efficacy ◽  
Randomized Controlled ◽  
Diarrhea Patient ◽  
Handwashing With Soap

Household members of diarrhea patients are at higher risk of developing diarrheal diseases (>100 times for cholera) than the general population during the 7 days after the diarrhea patient is admitted at a health facility. There is growing evidence demonstrating that theory-driven water, sanitation, and hygiene (WASH) interventions are likely to yield greater behavior change than those based on health education alone. The Cholera Hospital-Based Intervention for 7-Days (CHoBI7) mobile health (mHealth) program is a theory-driven WASH intervention initially delivered to a diarrhea patient by a health promoter during a health facility visit and reinforced through weekly voice and text messages. In the recent randomized controlled trial (RCT) of the CHoBI7-mHealth program in Bangladesh, this intervention significantly reduced diarrheal disease and stunting, and increased handwashing with soap and stored drinking water quality over the 12-month program period. The aim of this study was to assess the underlying mechanism of change of this intervention. Handwashing with soap was measured by 5-hour structured observation. Stored drinking water quality was assessed by the presence of Escherichia coli during unannounced spot checks. Psychosocial factors were measured among 1,468 participants in the CHoBI7-mHealth RCT. Perceived susceptibility, response efficacy, self-efficacy, dirt reactivity, and diarrhea knowledge were mediators of the CHoBI7-mHealth program’s effect on stored drinking water quality at the 1-week follow-up. Self-efficacy, response efficacy, and diarrhea knowledge were mediators of the intervention’s effect on handwashing with soap habit maintenance and stored drinking water quality at the 12-month follow-up. This study demonstrates how theory-driven approaches for intervention design can facilitate WASH behavior change.

scholarly journals Azithromycin Reduction to Reach Elimination of Trachoma (ARRET): study protocol for a cluster randomized trial of stopping mass azithromycin distribution for trachoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abdou Amza ◽  
Boubacar Kadri ◽  
Beido Nassirou ◽  
Ahmed M. Arzika ◽  
Ariana Austin ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Controlled Trial ◽  
Clinical Signs ◽  
Cluster Randomized Trial ◽  
World Health ◽  
Baseline Assessment ◽  
Randomized Controlled ◽  
Registration Number ◽  
Cluster Randomized ◽  
Health Organization

Abstract Background The World Health Organization (WHO) recommends annual mass azithromycin distribution until districts drop below 5% prevalence of trachomatous inflammation—follicular (TF). Districts with very low TF prevalence may have little or no transmission of the ocular strains of Chlamydia trachomatis that cause trachoma, and additional rounds of mass azithromycin distribution may not be useful. Here, we describe the protocol for a randomized controlled trial designed to evaluate whether mass azithromycin distribution can be stopped prior to the current WHO guidelines. Methods The Azithromycin Reduction to Reach Elimination of Trachoma (ARRET) study is a 1:1 community randomized non-inferiority trial designed to evaluate whether mass azithromycin distribution can be stopped in districts with baseline prevalence of TF under 20%. Communities in Maradi, Niger are randomized after baseline assessment either to continued annual mass azithromycin distribution or stopping annual azithromycin distribution over a 3-year period. We will compare the prevalence of ocular C. trachomatis (primary outcome), TF and other clinical signs of trachoma, and serologic markers of trachoma after 3 years. We hypothesize that stopping annual azithromycin distribution will be non-inferior to continued annual azithromycin distributions for all markers of trachoma prevalence and transmission. Discussion The results of this trial are anticipated to provide potentially guideline-changing evidence for when mass azithromycin distributions can be stopped in low TF prevalence areas. Trial registration number This study is registered at clinicaltrials.gov (NCT04185402). Registered December 4, 2019; prospectively registered pre-results.

scholarly journals Physico-chemical quality of drinking water in the Njoro sub-county in Kenya

2018 ◽  
Vol 8 (3) ◽  
pp. 497-507
Author(s):  
Philip Ruciaka Kirianki ◽  
Edward Muchiri ◽  
Natasha Potgieter
Keyword(s):  
Drinking Water ◽  
Water Samples ◽  
Water Source ◽  
World Health ◽  
Water Shortages ◽  
Storage Container ◽  
Standard Assessment ◽  
Physico Chemical ◽  
Study Support ◽  
Health Organization

Abstract Njoro sub-county in Kenya suffers from constant water shortages causing the residents to rely on both improved and unimproved water sources in the area. The households in the sub-county also use different household storage containers to store drinking water in times when water is not readily available. This study was therefore undertaken to assess selective physico-chemical parameters of water used by the population for drinking purposes using standard assessment methods. A total of 372 water source samples and 162 storage container water samples were tested over a period of three months. Turbidity (0.70–273.85 NTU), iron (0.7–2.10 mg/L), fluoride (0.15–4.01 mg/L), manganese (0.01–0.37 mg/L), and nitrate (0.09–27.90 mg/L) levels in water samples were generally higher than the Kenya Bureau of Standards (KEBS) and/or the World Health Organization (WHO) water quality recommendations for safe drinkable water. The results from this study support the need for continuous monitoring and treating drinking water at the points of collection and of consumption to minimize the long-term health effects on communities consuming this water.

scholarly journals Research and Implementation Lessons Learned From a Youth-Targeted Digital Health Randomized Controlled Trial (the ARMADILLO Study)

10.2196/13005 ◽  
2019 ◽  
Vol 7 (8) ◽  
pp. e13005
Author(s):  
Lianne Gonsalves ◽  
Winnie Wangari Njeri ◽  
Megan Schroeder ◽  
Jefferson Mwaisaka ◽  
Peter Gichangi
Keyword(s):  
Randomized Controlled Trial ◽  
Digital Health ◽  
Controlled Trial ◽  
Text Message ◽  
Health Interventions ◽  
World Health ◽  
Intervention Period ◽  
Implementation Challenges ◽  
Randomized Controlled ◽  
Client Side

Background Evidence is lacking on the efficacy of sexual and reproductive health (SRH) communication interventions for youth (aged 15-24 years), especially from low- and middle-income countries. Therefore, the World Health Organization initiated the Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) program, a free, menu-based, on-demand text message (SMS, short message service) platform providing validated SRH content developed in collaboration with young people. A randomized controlled trial (RCT) assessing the effect of the ARMADILLO intervention on SRH-related outcomes was implemented in Kwale County, Kenya. Objective This paper describes the implementation challenges related to the RCT, observed during enrollment and the intervention period, and their implications for digital health researchers and program implementers. Methods This was an open, three-armed RCT. Following completion of a baseline survey, participants were randomized into the ARMADILLO intervention (arm 1), a once-a-week contact SMS text message (arm 2), or usual care (arm 3, no intervention). The intervention period lasted seven weeks, after which participants completed an endline survey. Results Two study team decisions had significant implications for the success of the trial’s enrollment and intervention implementation: a hands-off participant recruitment process and a design flaw in an initial language selection menu. As a result, three weeks after recruitment began, 660 participants had been randomized; however, 107 (53%) participants in arm 1 and 136 (62%) in arm 2 were “stuck” at the language menu. The research team called 231 of these nonengaging participants and successfully reached 136 to learn reasons for nonengagement. Thirty-two phone numbers were found to be either not linked to our participants (a wrong number) or not in their primary possession (a shared phone). Among eligible participants, 30 participants indicated that they had assumed the introductory message was a scam or spam. Twenty-seven participants were confused by some aspect of the system. Eleven were apathetic about engaging. Twenty-four nonengagers experienced some sort of technical issue. All participants eventually started their seven-week study period. Conclusions The ARMADILLO study’s implementation challenges provide several lessons related to both researching and implementing client-side digital health interventions, including (1) have meticulous phone data collection protocols to reduce wrong numbers, (2) train participants on the digital intervention in efficacy assessments, and (3) recognize that client-side digital health interventions have analog discontinuation challenges. Implementation lessons were (1) determine whether an intervention requires phone ownership or phone access, (2) digital health campaigns need to establish a credible presence in a busy digital space, and (3) interest in a service can be sporadic or fleeting. Clinical Trial International Standard Randomized Controlled Trial Number (ISRCTN): 85156148; http://www.isrctn. com/ISRCTN85156148

scholarly journals Metalliferous content of drinking water and sediments in storage tanks of some schools in Erbil city, Iraq

2020 ◽  
Vol 9 (3) ◽  
Author(s):  
Hawraz Sami Khalid ◽  
Hoshyar Saadi Ali ◽  
Dhary Almashhadany
Keyword(s):  
Heavy Metals ◽  
Water Quality ◽  
Heavy Metal ◽  
Drinking Water ◽  
Water Samples ◽  
World Health ◽  
Storage Tanks ◽  
Quality Indices ◽  
Toxic Heavy Metals ◽  
Water Quality Indices

The present study was conducted to evaluate the quality of drinking water in randomly selected schools in Erbil city, Kurdistan Region, Iraq. The water quality indices such as the Heavy metal Pollution Index (HPI) and Heavy metal Evaluation Index (HEI) were applied to characterize water quality. Eighteen schools were incorporated and sampled for their water storage tanks available to students. Water samples and sediment samples from tanks floor were analyzed by Inductively Coupled Plasma Optical Emission Spectrometer for the determination of twenty-two metal elements. In drinking water samples, all detected metals did not exceed the permissible limits of the World Health Organization. The results of this study showed that the average values of HPI and HEI for As, Cd, Cr, Cu, Fe, Pb, Mn, Ni, and Zn were 54.442 and 0.221, respectively. According to data of the water quality indices, the schools drinking water quality are good and suitable for drinking in terms of heavy metals. However, sediments samples contained high concentrations of all elements including the toxic heavy metals (As, Cd, Cr, and Pb). Re-suspension of sediments into water column after refilling storage tanks can pose a serious threat to students drinking water from such vessels. It is therefore recommended that proper storage tanks are provided to the schools accompanied by continuous sanitation and hygiene practice to mitigate the corrosion of tanks to avoid health risks of toxic metal

scholarly journals Effect of a Low-fodmap Diet for the Management of Functional Abdominal Pain Disorders in Children: A Study Protocol for a Randomized Controlled Trial

2020 ◽  
Author(s):  
Agata Stróżyk ◽  
Andrea Horvath ◽  
Jane Muir ◽  
Hania Szajewska
Keyword(s):  
Randomized Controlled Trial ◽  
Abdominal Pain ◽  
Controlled Trial ◽  
Well Being ◽  
World Health ◽  
Reliable Change Index ◽  
Functional Abdominal Pain ◽  
Regular Diet ◽  
Randomized Controlled ◽  
Fodmap Diet

Abstract Background Evidence from studies in adults documents that fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may be triggers of symptoms in individuals with functional abdominal pain disorders (FAPDs). However, in children, the evidence is very limited. We aim to assess the effects of a low-FODMAP diet compared with a regular diet for the management of children with FAPDs. Methods We will perform a randomized, quadruple-blinded, controlled trial. Seventy-four children aged 8 to 18 years with a FAPD (Irritable Bowel Syndrome or Functional Abdominal Pain-Not Otherwise Specified), diagnosed according to the Rome IV criteria, will be randomly allocated to receive either a low-FODMAP diet or a regular diet for 4 weeks. The primary outcome will be the percentage of the responders, defined as the participants who have at least 30% improvement in abdominal pain intensity on a Visual Analogue Scale (VAS) during the last week of the trial compared with baseline, that is at least equal to the Reliable Change Index (≥ 25 mm change on VAS). Other outcomes will include changes in stool consistency, abdominal pain frequency, total scores on the Gastrointestinal Symptom Rating Scale, KIDSCREEN-10 Index and World Health Organization Five Well-Being Index, child’s school attendance and parents’ work absenteeism, and BMI-for-age z-score. Compliance, tolerability of the low-FODMAP diet, and adverse events also will be evaluated. Each FAPD subtype will be assessed separately.DiscussionThere is a need for high-quality evidence regarding the dietary management of children with FAPDs. This randomized controlled trial (RCT) of rigorous methodological design will help to establish the effectiveness, if any, of a low-FODMAP diet for the management of FAPDs in the pediatric population. The findings of this RCT will assist with the development of guidelines and influence the direction of further research. Trial registration: NCT04528914

scholarly journals Assessment of Some Heavy Metals in Drinking Water Samples of Tunceli, Turkey

2011 ◽  
Vol 8 (1) ◽  
pp. 276-280 ◽  
Author(s):  
Olcay Kaplan ◽  
Nuran Cikcikoglu Yildirim ◽  
Numan Yildirim ◽  
Nilgun Tayhan
Keyword(s):  
Heavy Metals ◽  
Drinking Water ◽  
Water Samples ◽  
World Health ◽  
Environment Protection ◽  
Protection Agency ◽  
Supply Networks ◽  
Health Organization ◽  
The City ◽  
Drinking Water Samples

The drinking water quality is associated with the conditions of the water supply networks, the pollution and the contamination of groundwater with pollutants of both anthropogenic and natural origin. In this study, water samples were taken from four different waterworks in Tunceli, Turkey and heavy metals concentrations (As, Cu, Cd, Cr, Pb, Ni and Hg) were measured. Four sampling sites were pre-defined in different locations of the city. The obtained results showed that, the heavy metals concentrations in water samples did not exceed the values of WHO (World Health Organization), EC (Europe Community), EPA (Environment Protection Agency) and TSE-266 (Turkish Standard) guidelines.

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