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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