Effects of adding household water filters to Rwanda’s Community-Based Environmental Health Promotion Programme: a cluster-randomized controlled trial in Rwamagana district

• Published in: npj clean water Vol. 5; no. 1; pp. 42 - 11
• Main Authors: Haque, Sabrina, Kirby, Miles A., Iyakaremye, Laurien, Gebremariam, Alemayehu, Tessema, Getachew, Thomas, Evan, Chang, Howard H., Clasen, Thomas
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2022; Nature Publishing Group; Nature Portfolio
• Subjects: 4014/4004; 704/172; 704/844; 706/134; Aquatic Pollution; Clusters; Contamination; Diarrhea; Drinking water; E coli; Earth and Environmental Science; Environment; Environmental health; Fecal coliforms; Filters; Health promotion; Households; Morbidity; Nanotechnology; Villages; Waste Water Technology; Water analysis; Water filters; Water Industry/Water Technologies; Water Management; Water Pollution Control; Water purification; Water quality; Water Quality/Water Pollution; Water sampling; Rwanda; Development studies; Environmental social sciences; Environmental sciences; Developing world
• ISSN: 2059-7037; 2059-7037
• DOI: 10.1038/s41545-022-00185-y

Unsafe drinking water remains a major cause of mortality and morbidity. While Rwanda’s Community-Based Environmental Health Promotion Programme (CBEHPP) promotes boiling and safe storage, previous research found these efforts to be ineffective in reducing fecal contamination of drinking water. We conducted a cluster randomized control led trial to determine if adding a household water filter with safe storage to the CBEHPP would improve drinking water quality and reduce child diarrhea. We enrolled 1,199 households with a pregnant person or child under 5 across 60 randomly selected villages in Rwamagana district. CBEHPP implementers distributed and promoted water purifiers to a random half of villages. We conducted two unannounced follow-up visits over 13–16 months after the intervention delivery. The intervention reduced the proportions of households with detectable E. coli in drinking water samples (primary outcome) by 20% (PR 0.80, 95% CI 0.74–0.87, p  < 0.001) and with moderate and higher fecal contamination (≥10 CFU/100 mL) by 35% (PR 0.65, 95% CI 0.57–0.74 , p  < 0.001). The proportion of children under 5 experiencing diarrhea in the last week was reduced by 49% (aPR 0.51, 95%CI 0.35–0.73, p  < 0.001). Our findings identify an effective intervention for improving water quality and child health that can be added to the CBEHPP.