Evaluating the Sustained Health Impact of Household Chlorination of Drinking Water in Rural Haiti

• Type of Material: Article
• Authors: Eric Harshfield, Emory University; Daniele Lantagne, Emory University; Anna Turbes, Emory University; Clair Null, Emory University
• Language: English
• Date: 2012-11-07
• Publisher: American Society of Tropical Medicine and Hygiene
• Publication Version: Final Published Version
• Copyright Statement: ©The American Society of Tropical Medicine and Hygiene
• Final Published Version (URL): http://dx.doi.org/10.4269%2Fajtmh.2012.12-0010
• Title of Journal or Parent Work: American Journal of Tropical Medicine and Hygiene
• ISSN: 0002-9637
• Volume: 87
• Issue: 5
• Start Page: 786
• End Page: 795
• Grant/Funding Information: This study was supported by the Emory Global Health Institute, Emory Sustainability Initiatives, and the Gangarosa Endowment for Safe Water at the CDC Foundation.
• Research Categories: Health Sciences, Public Health

Abstract

The Jolivert Safe Water for Families program has sold sodium hypochlorite solution (chlorine) and conducted household visits in rural Haiti since 2002. To assess the impact of the program on diarrheal disease, in 2010 we conducted a survey and water quality testing in 201 program participants and 425 control households selected at random. Fifty-six percent of participants (versus 10% of controls) had free chlorine residuals between 0.2 and 2.0 mg/L, indicating correct water treatment. Using intention-to-treat analysis, we found that significantly fewer children < 5 in participant households had an episode of diarrhea in the previous 48 hours (32% versus 52%; P < 0.001) with 59% reduced odds (odds ratio = 0.41, 95% confidence interval = 0.21–0.79). Treatment-on-treated estimates of the odds of diarrhea indicated larger program effects for participants who met more stringent verifications of participation. Diarrheal disease reduction in this long-term program was comparable with that seen in short-term randomized, controlled interventions, suggesting that household chlorination can be an effective long-term water treatment strategy.