Effect of household-based water chlorination on childhood diarrhea accounting for non-adherence: A reanalysis of a double-blind randomized placebo-controlled trial in Orissa, India Público

White, Kyndall (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/f7623d38r?locale=es
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Abstract

Diarrhea causes 13% of deaths among children under 5 in India. A common household water treatment method to prevent diarrhea is water chlorination. A double-blind randomized controlled trial in Orissa, India saw no effect of a household water chlorination intervention on diarrhea among children under 5 during a 12 month period. However, adherence to the intervention was only observed by measurable residual free chlorine in the child's drinking water in less than one-third of the follow-up visits to intervention households. We conducted a reanalysis of the Orissa trial to identify demographic characteristics of households within the intervention arm associated with adherence and to demonstrate the effect of chlorination on under-5 diarrhea among adherent households. Adherence was classified as non-adherent, reported-only adherent for households who self-reported using the tablets but did not have measurable residual free chlorine, and confirmed adherent for households that did have measurable residual free chlorine. Education of the caregiver and living in the rural villages of Dhenkanal were associated with having confirmed adherence. Children in houses with confirmed adherence were 31% less likely to have diarrhea than children in non-adherent households (OR=0.69, 95% CI: 0.55-0.87). Our results agree with those of other open-label trials and contrast those of blinded published trials, which demonstrate no effect of treatment.

Table of Contents

Introduction...................1

Methods........................4 Study Population..........4 Outcome Assessment....5 Statistical Analysis........6 Results..........................7 Discussion.....................10 Appendix.......................16 References....................21

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