title: Assessing the impact of water filters and improved cook stoves on drinking water quality and household air pollution: a randomised controlled trial in Rwanda.
abstract: Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions.
  
  
  BACKGROUND
  Clinicaltrials.gov; NCT01882777; http://clinicaltrials.gov/ct2/results?term=NCT01882777&Search=Search.
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Rosa
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Majorin
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Sophie
authors.initials: S
authors.lastname: Boisson
authors.affiliation: Department of Civil, Environmental and Architectural Engineering, University of Colorado at Boulder, Boulder, Colorado, United States of America.
authors.forename: Christina
authors.initials: C
authors.lastname: Barstow
authors.affiliation: Berkeley Air Monitoring Group, Berkeley, California, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Miles
authors.initials: M
authors.lastname: Kirby
authors.affiliation: Ministry of Health, Government of Rwanda, Kigali, Rwanda.
authors.forename: Fidele
authors.initials: F
authors.lastname: Ngabo
authors.affiliation: Department of Mechanical and Materials Engineering, Portland State University, Portland, Oregon, United States of America.
authors.forename: Evan
authors.initials: E
authors.lastname: Thomas
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clasen
mesh_terms: D016902:Air Pollution, Indoor / Q000032:analysis*; D003296:Cooking; D060766:Drinking Water / Q000592:standards*; D005191:Family Characteristics; D005374:Filtration / Q000295:instrumentation*; D019983:Guideline Adherence; D006801:Humans; D010316:Particle Size; D052638:Particulate Matter / Q000032:analysis; D011795:Surveys and Questionnaires; D014874:Water Pollutants, Chemical / Q000032:analysis; D060753:Water Quality
chemical_list: D060766:Drinking Water; D052638:Particulate Matter; D014874:Water Pollutants, Chemical