Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial.
OBJECTIVE
To evaluate the effectiveness of point of use water treatment with flocculent-disinfectant on reducing diarrhoea and the additional benefit of promoting hand washing with soap.


METHODS
The study was conducted in squatter settlements of Karachi, Pakistan, where diarrhoea is a leading cause of childhood death. Interventions were randomly assigned to 47 neighbourhoods. Households in 10 neighbourhoods received diluted bleach and a water vessel; nine neighbourhoods received soap and were encouraged to wash hands; nine neighbourhoods received flocculent-disinfectant water treatment and a water vessel; 10 neighbourhoods received disinfectant-disinfectant water treatment and soap and were encouraged to wash hands; and nine neighbourhoods were followed as controls. Field workers visited households at least once a week from April to December 2003 to promote use of the interventions and to collect data on diarrhoea.


RESULTS
Study participants in control neighbourhoods had diarrhoea on 5.2% of days. Compared to controls, participants living in intervention neighbourhoods had a lower prevalence of diarrhoea: 55% (95% CI 17%, 80%) lower in bleach and water vessel neighbourhoods, 51% (95% CI 12%, 76%) lower in hand washing promotion with soap neighbourhoods, 64% lower (95% CI 29%, 90%) in disinfectant-disinfectant neighbourhoods, and 55% (95% CI 18%, 80%) lower in disinfectant-disinfectant plus hand washing with soap neighbourhoods.


CONCLUSIONS
With an intense community-based intervention and supplies provided free of cost, each of the home-based interventions significantly reduced diarrhoea. There was no benefit by combining hand washing promotion with water treatment.
Division of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia, USA. sluby@icddrb.org
Stephen P
SP
Luby
Mubina
M
Agboatwalla
John
J
Painter
Arshad
A
Altaf
Ward
W
Billhimer
Bruce
B
Keswick
Robert M
RM
Hoekstra
D000293:Adolescent; D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D004202:Disinfectants; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D007223:Infant; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D012915:Soaps; D012959:Socioeconomic Factors; D012973:Sodium Hypochlorite; D016896:Treatment Outcome; D018508:Water Purification / Q000379:methods*; D014881:Water Supply / Q000592:standards*
D004202:Disinfectants; D012915:Soaps; D012973:Sodium Hypochlorite