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Published in: Trials 1/2018

Open Access 01-12-2018 | Research

The effect of SODIS water treatment intervention at the household level in reducing diarrheal incidence among children under 5 years of age: a cluster randomized controlled trial in Dabat district, northwest Ethiopia

Authors: Bikes Destaw Bitew, Yigzaw Kebede Gete, Gashaw Andargie Biks, Takele Tadesse Adafrie

Published in: Trials | Issue 1/2018

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Abstract

Background

Solar Disinfection (SODIS) of water is an economical, user-friendly, and environmentally safe household water treatment method that has been advocated as a means of decreasing the burden of diarrhea among children under 5 years of age. Laboratory studies have consistently shown the efficacy of the SODIS method to destroy waterborne pathogens. However, the evidence-based health effect of a SODIS intervention at the household level is limited. The main aim of the study was to examine the effectiveness of a SODIS intervention in reducing the incidence of diarrhea among under-five children.

Methods

A community-based, cluster randomized controlled trial was conducted, over 6 months from 10 January to 7 July 2016, in 28 rural villages of northwest Ethiopia. In the intervention group, 384 children in 279 households received polyethylene terephthalate (PET) bottles, and in the control group 394 children in 289 households who continued to use their usual drinking-water sources were included in the trial. The study compared diarrheal incidence among the intervention group children who were exposed to SODIS household water treatment and the control group children who were not exposed to such water treatment. A generalized estimating equation (GEE) model was used to compute the adjusted incidence rate ratio and the corresponding 95% confidence interval.

Results

In this trial, the overall SODIS compliance was 90.6%. The incidence of diarrhea was 8.3 episodes/100 person-week observations in the intervention group compared to 15.3 episodes/100 person-week observations in the control group. A statistically significant reduction was observed in the incidence of diarrhea in the intervention group compared to the control (adjusted IRR 0.60 (95% CI 0.52, 0.70) with a corresponding prevention of 40% (95% CI: 34, 48).

Conclusion

The SODIS intervention substantially reduced the incidence of diarrhea among under-five children in a rural community of northwest Ethiopia. This indicates that a SODIS intervention is an invaluable strategy that needs to be integrated with the National Health Extension Program to be addressed to rural communities.

Trial registration

Clinical Trial Registry India, ID: CTRI/​2017/​09/​009640. Registered retrospectively on 5 September 2017.
Appendix
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Literature
1.
Berney M, Weilenmann H-U, Egli T. Flow-cytometric study of vital cellular functions in Escherichia coli during solar disinfection (SODIS). Microbiology. 2006;152(6):1719–29.CrossRefPubMed
2.
3.
4.
Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn J, Rudan I, Campbell H, Cibulskis R, Li M. Child Health Epidemiology Reference Group of WHO and UNICEF global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151–61.CrossRefPubMed
5.
Khatun A, Rahman SS, Rahman H, Hossain S. A cross sectional study on prevalence of diarrhoeal disease and nutritional status among children under 5-years of age in Kushtia, Bangladesh. Sci J Public Health. 2013;1(2):56–61.CrossRef
6.
Godana W, Mengiste B. Environmental factors associated with acute diarrhea among children under five years of age in Derashe district, southern Ethiopia. Sci J Public Health. 2013;1(3):119–24.CrossRef
7.
8.
9.
10.
Amenu D, Menkir S, Gobena T. Assessing the bacteriological quality of drinking water from sources to household water samples of the rural communities of Dire Dawa Administrative Council, eastern Ethiopia. Sci Technol Arts Res J. 2013;2(3):126–33.CrossRef
11.
Rahman AE, Moinuddin M, Molla M, Worku A, Hurt L, Kirkwood B, Mohan SB, Mazumder S, Bhutta Z, Raza F, et al. Childhood diarrhoeal deaths in seven low- and middle-income countries. Bull World Health Organ. 2014;92(9):664–71.CrossRefPubMedPubMedCentral
12.
Mohammed S, Tilahun M, Tamiru D. Morbidity and associated factors of diarrheal diseases among under five children in Arba-Minch district, southern Ethiopia, 2012. Sci J Public Health. 2013;1(2):102–6.CrossRef
13.
Eshete WB, Gebremariam A, Deboch B. Environmental determinants of diarrhea among under-five children in Nekemte town, western Ethiopia. Epidemiology. 2009;20(6):S23.CrossRef
14.
Mengistie B, Berhane Y, Worku A. Prevalence of diarrhea and associated risk factors among children under-five years of age in eastern Ethiopia: a cross-sectional study. Open J Prev Med. 2013;3(07):446–53.CrossRef
15.
Genser B, Strina A, Teles CA, Prado MS, Barreto ML. Risk factors for childhood diarrhea incidence: dynamic analysis of a longitudinal study. Epidemiology. 2006;17(6):658–67.CrossRefPubMed
16.
Checkley W, Gilman RH, Black RE, Epstein LD, Cabrera L, Sterling CR, Moulton LH. Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community. Lancet. 2004;363(9403):112–8.CrossRefPubMed
17.
Maponga BA, Chirundu D, Gombe NT, Tshimanga M, Shambira G, Takundwa L. Risk factors for contracting watery diarrhoea in Kadoma City, Zimbabwe, 2011: a case control study. BMC Infect Dis. 2013;13(1):567.CrossRefPubMedPubMedCentral
18.
Jensen P, Jayasinghe G, Wvd H, Cairncross S, Dalsgaard A. Is there an association between bacteriological drinking water quality and childhood diarrhoea in developing countries? Tropical Med Int Health. 2004;9(11):1210–5.CrossRef
19.
Teklemariam S, Getaneh T, Bekele F. Environmental determinants of diarrheal morbidity in under-five children, Keffa-Sheka zone, south West Ethiopia. Ethiop Med J. 2000;38(1):27–34.PubMed
20.
Tornheim JA, Morland KB, Landrigan PJ, Cifuentes E. Water privatization, water source, and pediatric diarrhea in Bolivia: epidemiologic analysis of a social experiment. Int J Occup Environ Health. 2009;15(3):241–8.CrossRefPubMed
21.
Sobel J, Gomes TAT, Ramos R, Hoekstra M, Rodrigue D, Rassi V, Griffin P. Pathogen-specific risk factors and protective factors for acute diarrheal illness in children aged 12–59 months in Sao Paulo, Brazil. Clin Infect Dis. 2004;38(11):1545–51.CrossRefPubMed
22.
Gebru T, Taha M, Kassahun W. Risk factors of diarrhoeal disease in under-five children among health extension model and non-model families in Sheko district rural community, Southwest Ethiopia: comparative cross-sectional study. BMC Public Health. 2014;14(1):395.CrossRefPubMedPubMedCentral
23.
Tadesse T, Getachew A, Admassu M, Yigzaw Kebede Y, Awoke T, Tesfahun Melese T, et al. Demographic and health survey at dabat district in northwest Ethiopia: report of the 2008 baseline survey. Ethiop J Health Biomed Sci. 2011;4(Special Issue):1–23.
24.
Anteneh ZA, Andargie K, Tarekegn M. Prevalence and determinants of acute diarrhea among children younger than five years old in Jabithennan District, Northwest Ethiopia, 2014. BMC Public Health. 2017;17(1):99.CrossRefPubMedPubMedCentral
25.
Abatneh Y, Sahu O, Yimer S. Purification of drinking water by low cost method in Ethiopia. Appl Water Sci. 2014;4(4):357–62.CrossRef
26.
27.
28.
Clasen T, Boisson S. Household-based ceramic water filters for the treatment of drinking water in disaster response: an assessment of a pilot programme in the Dominican Republic. Water Pract Technol. 2006;1(2):1-9
29.
30.
31.
Bitew BD, Gete YK, Biks GA, Adafrie TT. Knowledge, attitude, and practice of mothers/caregivers on household water treatment methods in Northwest Ethiopia: a community-based cross-sectional study. Am J Trop Med Hyg. 2017;97(3):918–26.CrossRef
32.
McGuigan KG, Conroy RM, Mosler H-J, Md P, Ubomba-Jaswa E, Fernandez-Ibañez P. Solar water disinfection (SODIS): a review from bench-top to roof-top. J Hazard Mater. 2012;235:29–46.CrossRefPubMed
33.
Berney M, Weilenmann HU, Simonetti A, Egli T. Efficacy of solar disinfection of Escherichia coli, Shigella flexneri, Salmonella typhimurium and Vibrio cholerae. J Appl Microbiol. 2006;101(4):828–36.CrossRefPubMed
34.
Fontán-Sainz M, Gómez-Couso H, Fernández-Ibáñez P, Ares-Mazás E. Evaluation of the solar water disinfection process (SODIS) against Cryptosporidium parvum using a 25-L static solar reactor fitted with a compound parabolic collector (CPC). Am J Trop Med Hyg. 2012;86(2):223–8.CrossRefPubMedPubMedCentral
35.
36.
Mustafa A, Scholz M, Khan S, Ghaffar A. Application of solar disinfection for treatment of contaminated public water supply in a developing country: field observations. J Water Health. 2013;11(1):135–45.CrossRefPubMed
37.
Okpara C, Oparaku N, Ibeto C. An overview of water disinfection in developing countries and potentials of renewable energy. J Environ Sci Technol. 2011;4(1):18–30.CrossRef
38.
Ubomba-Jaswa E, Fernández-Ibáñez P, McGuigan KG. A preliminary Ames fluctuation assay assessment of the genotoxicity of drinking water that has been solar disinfected in polyethylene terephthalate (PET) bottles. J Water Health. 2010;8(4):712–9.CrossRefPubMed
39.
Bach C, Dauchy X, Severin I, Munoz J-F, Etienne S, Chagnon M-C. Effect of sunlight exposure on the release of intentionally and/or non-intentionally added substances from polyethylene terephthalate (PET) bottles into water: chemical analysis and in vitro toxicity. Food Chem. 2014;162:63–71.CrossRefPubMed
40.
Amin MT, Alazba AA, Amin MN, Han M. Effects of UV blocking and heat-resistant plastic bags on solar disinfection of rainwater at different weathers. Environ Eng Manage J. 2014;13(2):457-69
41.
Hayes R, Bennett S. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol. 1999;28(2):319–26.CrossRefPubMed
42.
Mengistie B, Berhane Y, Worku A. Household water chlorination reduces incidence of diarrhea among under-five children in rural Ethiopia: a cluster randomized controlled trial. PLoS One. 2013;8(10):e77887.CrossRefPubMedPubMedCentral
43.
Schmidt W-P, Arnold BF, Boisson S, Genser B, Luby SP, Barreto ML, Clasen T, Cairncross S. Epidemiological methods in diarrhoea studies—an update. Int J Epidemiol. 2011;40(6):1678–92.CrossRefPubMedPubMedCentral
44.
Wright JA, Gundry SW, Conroy R, Wood D, Preez MD, Ferro-Luzzi A, Genthe B, Kirimi M, Moyo S, Mutisi C. Defining episodes of diarrhoea: results from a three-country study in sub-Saharan Africa. J Health Popul Nutr. 2006;24(1):8–16.
45.
46.
47.
48.
49.
Odonkor ST, Ampofo JK. Escherichia coli as an indicator of bacteriological quality of water: an overview. Microbiol Res. 2013;4(1):1-11.
50.
51.
52.
53.
du Preez M, Conroy RM, Ligondo S, Hennessy J, Elmore-Meegan M, Soita A, McGuigan KG. Randomized intervention study of solar disinfection of drinking water in the prevention of dysentery in Kenyan children aged under 5 years. Environ Sci Technol. 2011;45(21):9315–23.CrossRefPubMed
54.
McGuigan KG, Samaiyar P, du Preez M, Conroy RM. High compliance randomized controlled field trial of solar disinfection of drinking water and its impact on childhood diarrhea in rural Cambodia. Environ Sci Technol. 2011;45(18):7862–7.CrossRefPubMed
55.
Graf J, Togouet SZ, Kemka N, Niyitegeka D, Meierhofer R, Pieboji JG. Health gains from solar water disinfection (SODIS): evaluation of a water quality intervention in Yaounde, Cameroon. J Water Health. 2010;8(4):779–96.CrossRefPubMed
56.
Rose A, Roy S, Abraham V, Holmgren G, George K, Balraj V, Abraham S, Muliyil J, Joseph A, Kang G. Solar disinfection of water for diarrhoeal prevention in southern India. Arch Dis Child. 2006;91(2):139–41.CrossRefPubMedPubMedCentral
57.
Du Preez M, McGuigan KG, Conroy RM. Solar disinfection of drinking water in the prevention of dysentery in South African children aged under 5 years: the role of participant motivation. Environ Sci Technol. 2010;44(22):8744–9.CrossRefPubMed
58.
Mäusezahl D, Christen A, Pacheco GD, Tellez FA, Iriarte M, Zapata ME, Cevallos M, Hattendorf J, Cattaneo MD, Arnold B. Solar drinking water disinfection (SODIS) to reduce childhood diarrhoea in rural Bolivia: a cluster-randomized, controlled trial. PLoS Med. 2009;6(8):e1000125.CrossRefPubMedPubMedCentral
59.
60.
Dessie A, Alemayehu E, Mekonen S, Legesse W, Kloos H, Ambelu A. Solar disinfection: an approach for low-cost household water treatment technology in southwestern Ethiopia. J Environ Health Sci Eng. 2014;12(1):25.CrossRefPubMedPubMedCentral
61.
Islam MA, Azad AK, Akber MA, Rahman M, Sadhu I. Effectiveness of solar disinfection (SODIS) in rural coastal Bangladesh. J Water Health. 2015;13(4):1113–22.CrossRefPubMed
62.
Chiller TM, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Keswick BH, Luby SP. Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water. Bull World Health Organ. 2006;84(1):28–35.CrossRefPubMedPubMedCentral
63.
Asiimwe J, Quilty B, Muyanja C, McGuigan K. Field comparison of solar water disinfection (SODIS) efficacy between glass and polyethylene terephalate (PET) plastic bottles under sub-Saharan weather conditions. J Water Health. 2013;11(4):729–37.CrossRefPubMed
64.
Tsega N, Sahile S, Kibret M, Abera B. Bacteriological and physico-chemical quality of drinking water sources in a rural community of Ethiopia. Afr Health Sci. 2013;13(4):1156–61.CrossRefPubMedPubMedCentral
65.
Schulz KF, Grimes DA. Blinding in randomised trials: hiding who got what. Lancet. 2002;359(9307):696–700.CrossRefPubMed
66.
Clasen T, Schmidt W-P, Rabie T, Roberts I, Cairncross S. Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis. BMJ. 2007;334(7597):782.CrossRefPubMedPubMedCentral
67.
Schmidt W-P, Cairncross S. Household water treatment in poor populations: is there enough evidence for scaling up now? Environ Sci Technol. 2009;43(4):986–92.CrossRefPubMed
Metadata
Title
The effect of SODIS water treatment intervention at the household level in reducing diarrheal incidence among children under 5 years of age: a cluster randomized controlled trial in Dabat district, northwest Ethiopia
Authors
Bikes Destaw Bitew
Yigzaw Kebede Gete
Gashaw Andargie Biks
Takele Tadesse Adafrie
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Trials / Issue 1/2018
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-018-2797-y

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