Protocol for a cluster randomised stepped wedge trial assessing the impact of a community-level hygiene intervention and a water intervention using riverbank filtration technology on diarrhoeal prevalence in India.
Diarrhoea is a leading cause of death globally, mostly occurring as a result of insufficient or unsafe water supplies, inadequate sanitation and poor hygiene. Our study aims to investigate the impact of a community-level hygiene education program and a water quality intervention using riverbank filtration (RBF) technology on diarrhoeal prevalence.



We have designed a stepped wedge cluster randomised trial to estimate the health impacts of our intervention in 4 rural villages in Karnataka, India. At baseline, surveys will be conducted in all villages, and householders will receive hygiene education. New pipelines, water storage tanks and taps will then be installed at accessible locations in each village and untreated piped river water will be supplied. A subsequent survey will evaluate the impact of hygiene education combined with improved access to greater water volumes for hygiene and drinking purposes (improved water quantity). Villages will then be randomly ordered and RBF-treated water (improved water quality) will be sequentially introduced into the 4 villages in a stepwise manner, with administration of surveys at each time point. The primary outcome is a 7-day period prevalence of self-reported diarrhoea. Secondary outcomes include self-reported respiratory and skin infections, and reported changes in hygiene practices, household water usage and water supply preference. River, tank and tap water from each village, and stored water from a subset of households, will be sampled to assess microbial and chemical quality.



Ethics approval was obtained from the Monash University Human Research Ethics Committee in Australia and The Energy and Resources Institute Institutional Ethics Committee in India. The results of the trial will be presented at conferences, published in peer-reviewed journals and disseminated to relevant stakeholders. This study is funded by an Australian National Health and Medical Research Council (NHMRC) project grant.



ACTRN12616001286437; pre-results.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Sarah L
SL
McGuinness
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Joanne E
JE
O'Toole
Department of Civil and Environmental Engineering and Geosciences, University of Rhode Island, Kingston, Rhode Island, USA.
Thomas B
TB
Boving
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Andrew B
AB
Forbes
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Martha
M
Sinclair
The Energy and Resources Institute (TERI), Bangalore, Karnataka, India.
Sumit K
SK
Gautam
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Karin
K
Leder
D003967:Diarrhea / Q000517:prevention & control*; D060766:Drinking Water; D005191:Family Characteristics; D005374:Filtration; D006266:Health Education; D006801:Humans; D006920:Hygiene; D007194:India; D015995:Prevalence; D012111:Residence Characteristics; D045483:Rivers; D012424:Rural Population; D012498:Sanitary Engineering; D011795:Surveys and Questionnaires; D013672:Technology; D014867:Water; D060753:Water Quality; D014881:Water Supply
D060766:Drinking Water; D014867:Water
EPIDEMIOLOGY; INFECTIOUS DISEASES; PUBLIC HEALTH