title: The Effect of Improved Water Supply on Diarrhea Prevalence of Children under Five in the Volta Region of Ghana: A Cluster-Randomized Controlled Trial.
abstract: Although a number of studies have been conducted to explore the effect of water quality improvement, the majority of them have focused mainly on point-of-use water treatment, and the studies investigating the effect of improved water supply have been based on observational or inadequately randomized trials. We report the results of a matched cluster randomized trial investigating the effect of improved water supply on diarrheal prevalence of children under five living in rural areas of the Volta Region in Ghana. We compared the diarrheal prevalence of 305 children in 10 communities of intervention with 302 children in 10 matched communities with no intervention (October 2012 to February 2014). A modified Poisson regression was used to estimate the prevalence ratio. An intention-to-treat analysis was undertaken. The crude prevalence ratio of diarrhea in the intervention compared with the control communities was 0.85 (95% CI 0.74-0.97) for Krachi West, 0.96 (0.87-1.05) for Krachi East, and 0.91 (0.83-0.98) for both districts. Sanitation was adjusted for in the model to remove the bias due to residual imbalance since it was not balanced even after randomization. The adjusted prevalence ratio was 0.82 (95% CI 0.71-0.96) for Krachi West, 0.95 (0.86-1.04) for Krachi East, and 0.89 (0.82-0.97) for both districts. This study provides a basis for a better approach to water quality interventions.
authors.affiliation: Korea International Cooperation Agency, 825 Daewangpangyo-ro, Sujeong-gu, Seongnam-si, Gyeongo-do 13449, Republic of Korea. jesuscha@koica.go.kr.|Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, Keppel Street London WC1E 7HT, London, UK. jesuscha@koica.go.kr.
authors.forename: Seungman
authors.initials: S
authors.lastname: Cha
authors.affiliation: World Vision Korea, 77-1, Yeouinaru-ro, Yeongdeungpo-gu, Seoul, 07327, Republic of Korea. douk_kang@wvi.org.
authors.forename: Douk
authors.initials: D
authors.lastname: Kang
authors.affiliation: Training Research and Networking for Development, Post Office. Box Cantonments 6135, Cantonments, Accra, Ghana. btuffuor@gmail.com.
authors.forename: Benedict
authors.initials: B
authors.lastname: Tuffuor
authors.affiliation: Korea International Cooperation Agency, 825 Daewangpangyo-ro, Sujeong-gu, Seongnam-si, Gyeongo-do 13449, Republic of Korea. ghlee@koica.go.kr.
authors.forename: Gyuhong
authors.initials: G
authors.lastname: Lee
authors.affiliation: Korea International Cooperation Agency, 825 Daewangpangyo-ro, Sujeong-gu, Seongnam-si, Gyeongo-do 13449, Republic of Korea. jmcho@koica.go.kr.
authors.forename: Jungmyung
authors.initials: J
authors.lastname: Cho
authors.affiliation: World Vision Korea, 77-1, Yeouinaru-ro, Yeongdeungpo-gu, Seoul, 07327, Republic of Korea. jeehae_chung@wvi.org.
authors.forename: Jihye
authors.initials: J
authors.lastname: Chung
authors.affiliation: Korea International Cooperation Agency, 825 Daewangpangyo-ro, Sujeong-gu, Seongnam-si, Gyeongo-do 13449, Republic of Korea. serenti@koica.go.kr.
authors.forename: Myongjin
authors.initials: M
authors.lastname: Kim
authors.affiliation: Korea International Cooperation Agency, 825 Daewangpangyo-ro, Sujeong-gu, Seongnam-si, Gyeongo-do 13449, Republic of Korea. hsl810@koica.go.kr.
authors.forename: Hoonsang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Korea International Cooperation Agency, 825 Daewangpangyo-ro, Sujeong-gu, Seongnam-si, Gyeongo-do 13449, Republic of Korea. jelee21@koica.go.kr.
authors.forename: Jaeeun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Korea International Cooperation Agency, 825 Daewangpangyo-ro, Sujeong-gu, Seongnam-si, Gyeongo-do 13449, Republic of Korea. och7512@koica.go.kr.
authors.forename: Chunghyeon
authors.initials: C
authors.lastname: Oh
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012111:Residence Characteristics; D012499:Sanitation / Q000379:methods; D018508:Water Purification / Q000379:methods; D060753:Water Quality; D014881:Water Supply / Q000592:standards
keywords: Ghana; children under five; cluster-randomized controlled trial; diarrhea; improved water supply