201275 Impact of Home-based Solar Water Disinfection (SODIS) on child diarrhoea in a community-randomized evaluation in Bolivia: Does Drinking up Result in Health up?

Monday, November 9, 2009: 2:30 PM

Daniel Mäusezahl, PhD MPH , Department of Public Health & Epidemiology, Swiss Tropical Institute, University of Basel, Basel, Switzerland
Andri Christen, MSc , Department of Public Health & Epidemiology, Swiss Tropical Institute, University of Basel, Basel, Switzerland
Gonzalo Duran Pacheco, MSc , Department of Public Health & Epidemiology, Swiss Tropical Institute, University of Basel, Basel, Switzerland
Fidel Alvarez Tellez , Oficina Central, Project Concern International, Cochabamba, Bolivia
Mercedes Iriarte, Ing , Facultad de Tecnología, Universidad Mayor de San Simón, Centro de Aguas y Saneamiento Ambiental, Cochabamba, Bolivia
Maria Estrella Zapata Schultze, lic , Facultad de Medicina, Instituto de Investigacion Biomedica (IIBISMED), Universidad Mayor de San Simón, Cochabamba, Bolivia
Jan Hattendorf, PhD , Department of Public Health & Epidemiology, Swiss Tropical Institute, University of Basel, Basel, Switzerland
Myriam Cevallos, MSc , Department of Public Health & Epidemiology, Swiss Tropical Institute, University of Basel, Basel, Switzerland
Monica Daigl Cattaneo, MSc MPH , Department of Public Health & Epidemiology, Swiss Tropical Institute, University of Basel, Basel, Switzerland
Benjamin Arnold, MPH , Division of Epidemiology, University of California, Berkeley, Berkeley, CA
Thomas A. Smith, PhD , Department of Public Health & Epidemiology, Swiss Tropical Institute, University of Basel, Basel, Switzerland
John Colford, MD PhD , Division of Epidemiology, University of California, Berkeley, Berkeley, CA
Background: Solar drinking water disinfection is a low-cost, point-of-use water purification method disseminated globally. SODIS is highly efficacious in inactivating waterborne pathogens. Previous field studies provided limited evidence for its effectiveness in reducing diarrhoea.

Methods: We conducted a community-randomized trial in 22 rural Bolivian communities to evaluate the effect of SODIS to reduce diarrhoea among children <5. A local NGO conducted a standardised interactive SODIS-promotion campaign in 11 communities targeted at households, communities and primary schools. Mothers completed a daily child health diary for one year.

Results: 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 80% of the total possible person-days of child observation in intervention and control arms. 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%-CI 0.59-1.12).

Conclusions: Despite an extensive SODIS campaign we found only a moderate compliance with the intervention and detected no significant reduction in child diarrhoea. These results suggest that better evidence is needed 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.

Learning Objectives:
Describe the appropriateness of conducting a group randomized trial to evaluate POU-HWT methods. Summarize the main outcomes of this evaluation and the challenges to acquire accurate data in settings under resource constraints. Discuss the relevance of this cRCT for global advocacy for the SODIS home-based water treatment method.

Keywords: Evaluation, Water

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: principal investigator for the research presented and public health specialist engaged in environmental, child health and health system research over the past 20 years. Working experience in research, programme implementation and health development in Africa, Asia, Western and Eastern Europe and Latin America
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.