Adoption, Diarrhea, Water Quality
Conditions
Keywords
Inline Chlorination, Safe Water, Water Practices, Behavior, Diarrhea, Children
Brief summary
This study evaluates the implementation and effectiveness of in-line chlorination (ILC) for improving drinking water quality in rural Nigeria. Unsafe drinking water remains a major contributor to diarrheal disease, particularly among children under five. Inline chlorination is a passive water treatment approach that automatically doses chlorine at community water systems without requiring electricity or daily user action. Two cluster randomized controlled trials will be conducted in Kano State (North-West Nigeria) and Cross River State (South-South Nigeria). Communities will be randomized to either receive in-line chlorination installed at eligible communal water systems or serve as controls with no chlorination. The unit of randomization is a community or a cluster of communities that share water system for drinking water. The primary objective is to estimate the causal impact of in-line chlorination on household drinking water quality. Outcomes include the prevalence of Escherichia coli contamination in tap water and stored household water as well as the presence of free chlorine residual. Secondary objectives assess water source usage and adoption of chlorinated sources, as well as reduction in diarrheal disease. Implementation fidelity and operational performance of chlorination devices will also be monitored.
Interventions
DEVICEIn-line Chlorination (ILC) with Behavioral Change Communication (BCC)
In-line chlorination devices will be installed on all compatible communal water systems within treatment communities. Devices automatically dose chlorine proportional to water flow without requiring electricity or daily user input. Technologies will include TuriTap liquid dosers installed at handpumps and CTI-8 tablet dosers installed at tanks or piped systems. Devices will be calibrated and routinely monitored to maintain chlorine residual within recommended ranges. In addition to device installation, communities will participate in behavior change communication (BCC) activities designed to support understanding and acceptance of chlorinated water. BCC activities will include community sensitization meetings conducted by the implementing partner. Meetings will provide information on the purpose of chlorination through the in-line chlorination devices, expected benefits and limitations, safe water handling practices, and guidance for addressing taste or odor concerns.
Sponsors
University of California, Berkeley
University of Michigan
Bayero University Kano, Nigeria
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
15 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adult (18+) or emancipated minor (15+) pregnant women and women with children under 5 years old who do not plan to permanently move in the next 12 months. * Must be knowledgeable about the household's water collection and management practices
Exclusion criteria
* Non-age-eligible women. Men and non-emancipated minors. Women who do not consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of water source samples with detectable free chlorine residual. | About 4-, 8-, and 12-month follow ups after device installations | Measured as \>0.1 ppm. |
| Proportion of household stored drinking water samples with detectable free chlorine residual. | About 4-, 8-, and 12-month follow ups after device installations | Measured as \>0.1 ppm. |
| Proportion of household stored drinking water samples positive for Escherichia coli. | About 4-, 8-, and 12-month follow ups after device installations | Measured as \>1 MPN/100 mL of water by culture-based assay |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of water source samples with detectable total chlorine residual. | About 4-, 8-, and 12-month follow ups after device installations | Measured as \>0.1 ppm. |
| Concentration of E. coli in water source samples | About 4-, 8-, and 12-month follow ups after device installations | Concentration of E. coli (in log10 MPN/100ml) in water source samples by culture-based assay |
| Concentration of E. coli in household stored water samples | About 4-, 8-, and 12-month follow ups after device installations | Concentration of E. coli (in log10 MPN/100ml) in household stored water samples by culture-based assay |
| Concentration of total coliform bacteria in water source samples | About 4-, 8-, and 12-month follow ups after device installations | Concentration of total coliform bacteria (MPN/100mL) in water source samples |
| Concentration of total coliform bacteria in household stored water samples | About 4-, 8-, and 12-month follow ups after device installations | Concentration of total coliform bacteria (MPN/100mL) in household stored water samples |
| Prevalence of caregiver-reported diarrhea among children under five years of age | About 4-, 8-, and 12-month follow ups after device installations | Measured as the proportion of children under five reported by caregivers to have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey. |
| Prevalence of caregiver-reported diarrhea among household members, any age | About 4-, 8-, and 12-month follow ups after device installations | Measured as the proportion of individuals surveyed in the household that have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey. Measured for subset of available respondents. |
| Prevalence of diarrhea among female caregivers | Time frame - About 4-, 8-, and 12-month follow ups after device installations | Measured as the proportion of respondents that have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey. |
Countries
Nigeria
Contacts
CONTACTAmy J Pickering
CONTACTElisa M Maffioli
PRINCIPAL_INVESTIGATORAmy J Pickering
University of California, Berkeley
PRINCIPAL_INVESTIGATORElisa M Maffioli
University of Michigan
PRINCIPAL_INVESTIGATORAdamu I Tanko, PhD
Bayero University Kano, Nigeria
Outcome results
None listed