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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)
Permanent url: http://pid.emory.edu/ark:/25593/93t28

Abstract



Abstract
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


TABLE OF CONTENTS

Introduction…………..………………………………………………………1

Diarrhea……………………………………………………………….3


Diarrheal Treatment: WaterGuard..…………….…………………………..6

Malnutrition………………………………………………………….. .6


Micronutrient Malnutrition……………………………….……………….. 8


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

The Nyando Integrated Child Health and Education Project. . . . . . . . . 12
Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Composition of 2010 NICHE Follow-up Survey……………………..14

Data Cleaning and Analysis………………….. …………………….. .15


Primary Outcome: Diarrhea………………………………………………17

Covariates…………………………………………………………………18

Exposures of Interest: Health Product Utilization……………………….. .18

Statistical Analysis…………………………………………………….19


Assessment of Confounding and Interaction…………………….………..20
Results………………………………………………………………………21

Modeling Results……………………………………………………..23
Discussion………………………………………………………………….. 24

Strengths and Limitations…………………………………………….26
Conclusions and Recommendations………………………………………. .28
Tables and Figures…………………………………………………………..30

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