Solar Drinking Water Disinfection (SODIS) to Reduce Childhood Diarrhoea in Rural Bolivia: A Cluster-Randomized, Controlled Trial

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Background:
Solar drinking water disinfection (SODIS) is a low-cost, point-of-use water purification method that has been disseminated globally. Laboratory studies suggest that SODIS is highly efficacious in inactivating waterborne pathogens. Previous field studies provided limited evidence for its effectiveness in reducing diarrhoea.

Methods and Findings:
We conducted a cluster-randomized controlled trial in 22 rural communities in Bolivia to evaluate the effect of SODIS in reducing diarrhoea among children under the age of 5 y. A local nongovernmental organisation conducted a standardised interactive SODIS-promotion campaign in 11 communities targeting households, communities, and primary schools. Mothers completed a daily child health diary for 1 y. Within the intervention arm 225 households (376 children) were trained to expose water-filled polyethyleneteraphtalate bottles to sunlight. Eleven communities (200 households, 349 children) served as a control. We recorded 166,971 person-days of observation during the trial representing 79.9% and 78.9% of the total possible person-days of child observation in intervention and control arms, respectively. Mean compliance with SODIS was 32.1%. The reported incidence rate of gastrointestinal illness in children in the intervention arm was 3.6 compared to 4.3 episodes/year at risk in the control arm. The relative rate of diarrhoea adjusted for intracluster correlation was 0.81 (95% confidence interval 0.59–1.12). The median length of diarrhoea was 3 d in both groups.

Conclusions:
Despite an extensive SODIS promotion campaign we found only moderate compliance with the intervention and no strong evidence for a substantive reduction in diarrhoea among children. These results suggest that there is a need for better evidence of how the well-established laboratory efficacy of this home-based water treatment method translates into field effectiveness under various cultural settings and intervention intensities. Further global promotion of SODIS for general use should be undertaken with care until such evidence is available.

Trial Registration: www.ClinicalTrials.gov NCT00731497

: Please see later in the article for Editors' Summary

Vyšlo v časopise: Solar Drinking Water Disinfection (SODIS) to Reduce Childhood Diarrhoea in Rural Bolivia: A Cluster-Randomized, Controlled Trial. PLoS Med 6(8): e32767. doi:10.1371/journal.pmed.1000125
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000125

Souhrn

Zdroje

1. WHO 2005 The World Health Report 2005 - make every mother and child count Geneva World Health Organization

2. PrussA

KayD

FewtrellL

BartramJ

2002 Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environ Health Perspect 110 537 542

3. FewtrellL

KaufmannRB

KayD

EnanoriaW

HallerL

ColfordJMJr

2005 Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5 42 52

4. ZwaneAP

KremerM

2007 What works in fighting diarrheal diseases in developing countries? A critical review. National Bureau of Economic Research Working Paper Series No. 12987. March 2007. Available: http://www.nber.org/papers/w12987

5. ClasenT

SchmidtWP

RabieT

RobertsI

CairncrossS

2007 Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis. BMJ 334 782

6. SobseyM

2002 Managing water in the home: Accelerated health gains from improved water. WHO/SDE/WSH/02.07 Geneva World Health Organization

7. ConroyRM

Elmore-MeeganM

JoyceT

McGuiganKG

BarnesJ

1996 Solar disinfection of drinking water and diarrhoea in Maasai children: a controlled field trial. Lancet 348 1695 1697

8. ConroyRM

MeeganME

JoyceT

McGuiganK

BarnesJ

1999 Solar disinfection of water reduces diarrhoeal disease: an update. Arch Dis Child 81 337 338

9. RoseA

RoyS

AbrahamV

HolmgrenG

GeorgeK

2006 Solar disinfection of water for diarrhoeal prevention in southern India. Arch Dis Child 91 139 141

10. EisenbergJN

ScottJC

PorcoT

2007 Integrating disease control strategies: balancing water sanitation and hygiene interventions to reduce diarrheal disease burden. Am J Public Health 97 846 852

11. McCuinRM

BukhariZ

SobrinhoJ

ClancyJL

2001 Recovery of Cryptosporidium oocysts and Giardia cysts from source water concentrates using immunomagnetic separation. J Microbiol Methods 45 69 76

12. MurrayDM

1998 Design and analysis of group-randomized trials New York, Oxford Oxford University Press

13. EdwardsSJ

BraunholtzDA

LilfordRJ

StevensAJ

1999 Ethical issues in the design and conduct of cluster randomised controlled trials. BMJ 318 1407 1409

14. ChingonoA

LaneT

ChitumbaA

KulichM

MorinS

2008 Balancing science and community concerns in resource-limited settings: Project Accept in rural Zimbabwe. Clin Trials 5 273 276

15. RansonMK

SinhaT

MorrisSS

MillsAJ

2006 CRTs–cluster randomized trials or “courting real troubles”: challenges of running a CRT in rural Gujarat, India. Can J Public Health 97 72 75

16. HayesRJ

BennettS

1999 Simple sample size calculation for cluster-randomized trials. Int J Epidemiol 28 319 326

17. Ministry of Health, Bolivia. Situación de salud Bolivia 2004 La Paz, Bolivia Ministry of Health Available: http://www.sns.gov.bo/snis/

18. ClasenT

RobertsI

RabieT

SchmidtW

CairncrossS

2006 Intervention to improve water quality for preventing diarrhoea. Cochrane Database Syst Rev 3 CD004794

19. WHO 1988 Persistent diarrhoea in children in developing countries: memorandum from a WHO meeting. Bull World Health Organ 66 709 717

20. BaquiAH

BlackRE

YunusM

HoqueAR

ChowdhuryHR

1991 Methodological issues in diarrhoeal diseases epidemiology: definition of diarrhoeal episodes. Int J Epidemiol 20 1057 1063

21. MorrisSS

CousensSN

LanataCF

KirkwoodBR

1994 Diarrhoea–defining the episode. Int J Epidemiol 23 617 623

22. WrightJA

GundrySW

ConroyR

WoodD

DuPM

2006 Defining episodes of diarrhoea: results from a three-country study in Sub-Saharan Africa. J Health Popul Nutr 24 8 16

23. MorrisSS

CousensSN

KirkwoodBR

ArthurP

RossDA

1996 Is prevalence of diarrhea a better predictor of subsequent mortality and weight gain than diarrhea incidence? Am J Epidemiol 144 582 588

24. LubySP

AgboatwallaM

PainterJ

AltafA

BillhimerW

2006 Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial. Trop Med Int Health 11 479 489

25. HobbinsMA

2004 Home-based drinking water purification through sunlight: from promotion to health effectiveness [PhD dissertation] Basel, Switzerland Swiss Tropical Institute, University Basel 214

26. YoungML

PreisserJS

QaqishBF

WolfsonM

2007 Comparison of subject-specific and population averaged models for count data from cluster-unit intervention trials. Stat Methods Med Res 16 167 184

27. TwiskJWR

2006 Applied multilevel analysis: a practical guide for medical researchers Cambridge Cambridge University Press

28. TurnerRM

OmarRZ

ThompsonSG

2006 Constructing intervals for the intracluster correlation coefficient using Bayesian modelling, and application in cluster randomized trials. Stat Med 25 1443 1456

29. SommerB

MariñoA

SolarteY

SalasML

DierolfC

1997 SODIS - an emerging water treatment process. J Water SRT 46 127 137

30. CampbellMK

ElbourneDR

AltmanDG

2004 CONSORT statement: extension to cluster randomised trials. BMJ 328 702 708

31. KumarV

MohantyS

KumarA

MisraRP

SantoshamM

2008 Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial. Lancet 372 1151 1162

32. CampbellR

StarkeyF

HollidayJ

AudreyS

BloorM

2008 An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. Lancet 371 1595 1602

33. SchmidtWP

CairncrossS

2009 Household water treatment in poor populations: is there enough evidence for scaling up now? Environ Sci Technol 43 986 992

34. SODIS Web site. Available: http://www.sodis.ch

35. ColfordJMJr

WadeTJ