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Assessing the Impact of WaterGuard and Micronutrient Sprinkles Use on Diarrheal Prevalence Among Kenyan Children Aged 6 to 35 Months

Shah, Ami B. (2011)
Master's Thesis (54 pages)
Committee Chair / Thesis Adviser: Barr, Dana Boyd
Committee Members: Tolbert, Paige ; Suchdev, Parminder S
Research Fields: Health Sciences, Nutrition; Health Sciences, Hygiene; Health Sciences, Public Health
Partnering Agencies: CDC ; International Non-governmental organization (e.g., CARE, Inc.) ; Emory University schools, faculty or affiliated programs
Keywords: WaterGuard; Micronutrient Sprinkles; Diarrhea
Program: Rollins School of Public Health, Environmental Health (Global Environmental Health)
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Assessing the Impact of WaterGuard and Micronutrient Sprinkles Use on Diarrheal Prevalence Among Kenyan Children Aged 6 to 35 Months
By Ami Shah

Background: In 2007, CDC partnered with the Safe Water and AIDS Project in Kenya to launch the Nyando Integrated Child Health and Education project (NICHE) to evaluate the effectiveness of community-based distribution of micronutrient Sprinkles among children between 6 and 59 months. Following the baseline survey in 2007, 12-month and 24-month follow-up surveys were conducted in 2008 and 2009. Data from the first year of the study demonstrated high Sprinkles coverage, acceptability and efficacy on iron deficiency anemia. In August 2010, a 42-month follow-up survey was conducted in 60 study villages, and data regarding the use of Sprinkles and a point-of-use chlorination system, WaterGuard, were obtained. While results from previous NICHE surveys demonstrated good uptake of Sprinkles and WaterGuard in Nyando District, the effects of using both products on diarrhea have not been evaluated.

Objective: To evaluate how different combinations of WaterGuard and Sprinkles utilization impact diarrhea prevalence in children between 6 and 35 months.

Methods: Data from the 42-month follow-up cross-sectional survey of 867 children, aged 6-35 months were analyzed using logistic regression, which adjusted for clustering at the village-level. Questionnaires administered to mothers or caretakers of eligible children provided data on demographics, WaterGuard use, Sprinkles use and diarrhea in the past 24 hours.

Results: 11.1% of children currently used Sprinkles, whereas 53.8% of children reported current use of WaterGuard. The odds of diarrhea among individuals who currently used WaterGuard only were 0.63 times the odds of diarrhea among individuals who used neither WaterGuard nor Sprinkles. Infrequent users of Sprinkles (those consuming between 1 and 4 sachets in the previous 7 days) had the highest prevalence of diarrhea compared to non-users and frequent users. Factors crudely associated with diarrheal prevalence included age, socioeconomic status, wasting, and Sprinkles dose (p-value < 0.10). The presence of chlorine residual confounded the relationship between exposure and outcome; however, chlorine residual in drinking water was not protective against diarrhea (OR = 1.613, p-value = 0.0515).

Conclusions: The use of WaterGuard and Sprinkles individually and together was protective against diarrhea. However, only the use of WaterGuard showed a statistically significant impact on reducing diarrheal prevalence.

Table of Contents




Diarrheal Treatment: WaterGuard...6


Micronutrient Malnutrition...8
Micronutrient Malnutrition Treatment: Iron, Zinc and Sprinkles...9

The Nyando Integrated Child Health and Education Project...12


Composition of 2010 NICHE Follow-up Survey...14
Data Cleaning and Analysis...15

Primary Outcome: Diarrhea...17
Exposures of Interest: Health Product Utilization...18

Statistical Analysis...19

Assessment of Confounding and Interaction...20


Modeling Results...23


Strengths and Limitations...26

Conclusions and Recommendations...28
Tables and Figures...30
Appendix A...39
Works Cited...42


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