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Author Notes:

Thomas Clasen, Email: thomas.f.clasen@emory.edu

T.C. and M.K. conceptualized the study. S.H., M.K., T.C., A.G., G.T., and E.T. authored the study protocol. H.C. informed the statistical approach. A.G., G.T., and E.T. led the design and implementation of the intervention. S.H., M.K., and L.I. managed data collection. S.H. analyzed the data and wrote the first draft of the manuscript. All authors reviewed and provided edits to the writing of the manuscript. S.H. and M.K. are co-first authors and contributed equally to this work.

We thank the study participants, Community Health Club Facilitators, Environmental Health Officers, and enumerators: Jean de Dieu Numugisha, Anicet Nyandwi, Godelieve Mukagatare, Mushamuka Innocent, Jean Batista Uwiringiyemungu, Mwiza Florence, Emile Uwayezue, and Jean Claude Niyonsenga. We are grateful to Alphonsine Mukamunana from the Rwanda Ministry of Health, Radu Ban from the Gates Foundation, Alison Hill from Vestegaard International, Netanya Huska from DevWorks International, Abigail Bradshaw and Laura MacDonald from the University of Colorado at Boulder, Lambert Mugabo, Pie Nkubito, and Marie Claire Nikuze from Amazi Yego, Cindy Kushner from UNICEF, Matthew Freeman from Emory University, and our partners at RNEC, SNV-Rwanda, CRS, AEE, Amazi Yego, and Eagle Research Center.

The authors declare no competing interests.

Subject:

Research Funding:

This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation [INV-008372]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Vestegaard International donated the filters for the purposes of the study.

The Bill & Melinda Gates Foundation funded this research, and had input on the study design and progress of the study, but did not have any role in data collection, data analysis, data interpretation, or writing of these results. Vestergaard International donated the filters for the study, but had no role at any stage in the study design, data collection, data analysis, data interpretation, or writing of these results. The authors had full access to all of the data and had the final responsibility for the decision to submit for publication.

SH was additionally supported by the National Institute of Environmental Health Sciences (NIEHS) 5T32ES012870–17 and MK received additional salary support from a Feed the Future Innovation Lab for Nutrition grant awarded to Tufts University and Boston Children’s Hospital, supported by the US Agency for International Development (USAID; award number AID-OAA-L-10–00006).

Keywords:

  • Science & Technology
  • Technology
  • Life Sciences & Biomedicine
  • Physical Sciences
  • Engineering, Chemical
  • Environmental Sciences
  • Water Resources
  • Engineering
  • Environmental Sciences & Ecology
  • DRINKING-WATER
  • FECAL CONTAMINATION
  • COUNTRIES
  • DIARRHEA
  • IMPACT
  • INTERVENTIONS
  • SANITATION
  • BENEFITS
  • SCALE
  • BIAS

Effects of adding household water filters to Rwanda's Community-Based Environmental Health Promotion Programme: a cluster-randomized controlled trial in Rwamagana district

Tools:

Journal Title:

NPJ CLEAN WATER

Volume:

Volume 5, Number 1

Publisher:

, Pages 42-42

Type of Work:

Article | Final Publisher PDF

Abstract:

Unsafe drinking water remains a major cause of mortality and morbidity. While Rwanda’s Community-Based Environmental Health Promotion Programme (CBEHPP) promotes boiling and safe storage, previous research found these efforts to be ineffective in reducing fecal contamination of drinking water. We conducted a cluster randomized control led trial to determine if adding a household water filter with safe storage to the CBEHPP would improve drinking water quality and reduce child diarrhea. We enrolled 1,199 households with a pregnant person or child under 5 across 60 randomly selected villages in Rwamagana district. CBEHPP implementers distributed and promoted water purifiers to a random half of villages. We conducted two unannounced follow-up visits over 13–16 months after the intervention delivery. The intervention reduced the proportions of households with detectable E. coli in drinking water samples (primary outcome) by 20% (PR 0.80, 95% CI 0.74–0.87, p < 0.001) and with moderate and higher fecal contamination (≥10 CFU/100 mL) by 35% (PR 0.65, 95% CI 0.57–0.74, p < 0.001). The proportion of children under 5 experiencing diarrhea in the last week was reduced by 49% (aPR 0.51, 95%CI 0.35–0.73, p < 0.001). Our findings identify an effective intervention for improving water quality and child health that can be added to the CBEHPP.

Copyright information:

© The Author(s) 2022

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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