Chlorination
Conditions
Keywords
Diarrhea, Health Systems
Brief summary
Access to safe water remains a pressing public health challenge in Nigeria, where 67% of the population lacks safely managed drinking water and waterborne diseases cause an estimated 70,000 child deaths annually. Building on evidence that point-of-use chlorination is highly cost-effective in reducing diarrheal disease, this study evaluates a scalable, community-based chlorine distribution model through a cluster-randomized controlled trial (RCT) in Kano State. Thirty communities across four Local Government Areas will be randomly assigned to one of three groups: (i) 20 treatment communities receiving community demonstrations and local chlorine redemption points, (ii) 10 control communities where no intervention will be conducted. After 3 months, 5 control communities will receive an individual-level sensitization and a voucher program and 5 will remain pure control communities. The RCT aims to estimate the causal impact of the community-based intervention on household chlorination rates, water quality (E. coli contamination), and knowledge of safe water practices over six months. By rigorously testing a community-led water treatment model, this study contributes new evidence on sustainable and cost-effective approaches to expand safe water access in low-resource settings. The results will inform national and regional strategies for scaling point-of-use chlorination across sub-Saharan Africa.
Interventions
BEHAVIORALCommunity Demonstrations
Facilitators will collaborate with local leaders, WASH officials and health facility staff in conducting community demonstrations introducing the chlorine product (WaterGuard+) to communities in the treatment group. Local leaders in the community will organize the meeting, while facilitators in the country will demonstrate how to use the product, what the correct dosage is, and explain the importance of water treatment. They will also show how village water is contaminated with Ecoli. These meetings will be targeted at eligible women (pregnant women and women with children under the age of 5), however all members of the community will be invited to attend. At the meeting, each attendee will be given one bottle of WaterGuard+, which is enough to treat drinking water for a household of 5 members for about a month, and 1,000 naira. Water Guard + is a 180g bottle of sodium dichloroisocyanurate (NaDCC) in granulated / powder form, produced and distributed by the Society for Family Health.
BEHAVIORALRedemption points
Study staff will set up at least one chlorine redemption point for each community. The location of the redemption point will be determined in consultation with the local community during Community Demonstrations. The redemption points could be health facilities, local shops/dispensaries/kiosks, local pharmacies, house of the village leader, CHW, or health staff or other suitable sites. Households will be able to visit the location and redeem a month's supply of a chlorine product. Distributors will use a redemption log to keep track of when participants redeem the chlorine product.
Sponsors
Princeton University
University of Michigan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
Yes
Inclusion criteria
* Pregnant mothers and women with children under 5 children
Exclusion criteria
* Men, women with no children under 5 years old
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Treat drinking water with chlorine (tested in water sample) | Measured up to 6 months of follow-up | Proportion of water samples with detectable chlorine in stored drinking water |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Presence of E.coli | Measured up to 6 months of follow-up | Proportion of water samples with detectable E.coli |
| Level of E.coli | Measured up to 6 months of follow-up | Level of E-coli (in log10 MPN/100ml) in water samples |
| Unsafe risk of Coliform | Measured up to 6 months of follow-up | Proportion of water samples with unsafe coliform ( \>100 colony forming units per 100mL) |
| Treat drinking water with chlorine (self-reported) | Measured up to 6 months of follow-up | Proportion of women who reported using chlorine in the previous two days |
| Ever used chlorine | Measured up to 6 months of follow-up | Proportion of women who ever used chlorine |
| Last used chlorine | Measured up to 6 months of follow-up | Proportion of women who used chlorine yesterday or the day before |
| Heard about chlorine | Measured up to 6 months of follow-up | Proportion of women who ever heard about chlorine |
Countries
Nigeria
Contacts
Primary ContactElisa Maria Maffioli, PhD
Outcome results
None listed