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.
Luby
Stephen P
SP
Division of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia, USA. sluby@icddrb.org
Agboatwalla
Mubina
M
Painter
John
J
Altaf
Arshad
A
Billhimer
Ward
W
Keswick
Bruce
B
Hoekstra
Robert M
RM
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