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• 1. [Article] Use, Microbiological Effectiveness and Health Impact of a Household Water Filter Intervention in Rural Rwanda-A Matched Cohort Study

  Unsafe drinking water is a substantial health risk contributing to child diarrhoea. We investigated impacts of a program that provided a water filter to households in rural Rwandan villages. We assessed ...

  Citation × Citation Citation Abstract Copy Title: Use, Microbiological Effectiveness and Health Impact of a Household Water Filter Intervention in Rural Rwanda-A Matched Cohort Study Author: Kirby, Miles A., Nagel, Corey L., Rosa, Ghislaine, Umupfasoni, Marie Mediatrice, Lyakaremye, Laurien, Thomas, Evan A., Clasen, Thomas F. Year: 2017 Unsafe drinking water is a substantial health risk contributing to child diarrhoea. We investigated impacts of a program that provided a water filter to households in rural Rwandan villages. We assessed drinking water quality and reported diarrhoea 12–24 months after intervention delivery among 269 households in the poorest tertile with a child under 5 from 9 intervention villages and 9 matched control villages. We also documented filter coverage and use. In Round 1 (12–18 months after delivery), 97.4% of intervention households reported receiving the filter, 84.5% were working, and 86.0% of working filters contained water. Sensors confirmed half of households with working filters filled them at least once every other day on average. Coverage and usage was similar in Round 2 (19–24 months after delivery). The odds of detecting faecal indicator bacteria in drinking water were 78% lower in the intervention arm than the control arm (odds ratio (OR) 0.22, 95% credible interval (CrI) 0.10–0.39, p < 0.001). The intervention arm also had 50% lower odds of reported diarrhoea among children <5 than the control arm (OR = 0.50, 95% CrI 0.23–0.90, p = 0.03). The protective effect of the filter is also suggested by reduced odds of reported diarrhoea-related visits to community health workers or clinics, although these did not reach statistical significance. Title: Use, Microbiological Effectiveness and Health Impact of a Household Water Filter Intervention in Rural Rwanda-A Matched Cohort Study Author: Kirby, Miles A., Nagel, Corey L., Rosa, Ghislaine, Umupfasoni, Marie Mediatrice, Lyakaremye, Laurien, Thomas, Evan A., Clasen, Thomas F. Year: 2017 Unsafe drinking water is a substantial health risk contributing to child diarrhoea. We investigated impacts of a program that provided a water filter to households in rural Rwandan villages. We assessed drinking water quality and reported diarrhoea 12–24 months after intervention delivery among 269 households in the poorest tertile with a child under 5 from 9 intervention villages and 9 matched control villages. We also documented filter coverage and use. In Round 1 (12–18 months after delivery), 97.4% of intervention households reported receiving the filter, 84.5% were working, and 86.0% of working filters contained water. Sensors confirmed half of households with working filters filled them at least once every other day on average. Coverage and usage was similar in Round 2 (19–24 months after delivery). The odds of detecting faecal indicator bacteria in drinking water were 78% lower in the intervention arm than the control arm (odds ratio (OR) 0.22, 95% credible interval (CrI) 0.10–0.39, p < 0.001). The intervention arm also had 50% lower odds of reported diarrhoea among children <5 than the control arm (OR = 0.50, 95% CrI 0.23–0.90, p = 0.03). The protective effect of the filter is also suggested by reduced odds of reported diarrhoea-related visits to community health workers or clinics, although these did not reach statistical significance. Close

• 2. [Article] Comparison of Respondent-reported and Sensor-recorded Latrine Utilization Measures in Rural Bangladesh: A Cross-sectional Study

  Background: Health improvements realized through sanitation are likely achieved through high levels of facilities utilization by all household members. However, measurements of sanitation often rely on ...

  Citation × Citation Citation Abstract Copy Title: Comparison of Respondent-reported and Sensor-recorded Latrine Utilization Measures in Rural Bangladesh: A Cross-sectional Study Author: Delea, Maryann G., Nagel, Corey L., Thomas, Evan A., Halder, Amal K., Amin, Nuhu, Shoab, Abul K., Freeman, Matthew C., Unicomb, Leanne, Clasen, Thomas F. Year: 2017 Background: Health improvements realized through sanitation are likely achieved through high levels of facilities utilization by all household members. However, measurements of sanitation often rely on either the presence of latrines, which does not guarantee use, or respondent-reported utilization of sanitation facilities, which is prone to response bias. Overstatement of sanitation metrics limits the accuracy of program outcome measures, and has implications for the interpretation of related health impact data. Methods: We conducted a cross-sectional study of 213 households in 14 village water, sanitation and hygiene committee clusters throughout rural Bangladesh and used a combined data- and relationship-scale approach to assess agreement between respondent-reported latrine utilization and sensor-recorded measurement. Results: Four-day household-level respondent-reported defecation averaged 28 events (inter-quartile range [IQR] 20–40), while sensor-recorded defecation averaged 17 events (IQR 11–29). Comparative analyses suggest moderately high accuracy (bias correction factor=0.84), but imprecision in the data (broad scatter of data, Pearson’s r=0.35) and thus only weak concordance between measures (ρc=0.29 [95% BCa CI 0.15 to 0.43]). Conclusions: Respondent-reported latrine utilization data should be interpreted with caution, as evidence suggests use is exaggerated. Coupling reported utilization data with objective measures of use may aid in the estimation of latrine use. Title: Comparison of Respondent-reported and Sensor-recorded Latrine Utilization Measures in Rural Bangladesh: A Cross-sectional Study Author: Delea, Maryann G., Nagel, Corey L., Thomas, Evan A., Halder, Amal K., Amin, Nuhu, Shoab, Abul K., Freeman, Matthew C., Unicomb, Leanne, Clasen, Thomas F. Year: 2017 Background: Health improvements realized through sanitation are likely achieved through high levels of facilities utilization by all household members. However, measurements of sanitation often rely on either the presence of latrines, which does not guarantee use, or respondent-reported utilization of sanitation facilities, which is prone to response bias. Overstatement of sanitation metrics limits the accuracy of program outcome measures, and has implications for the interpretation of related health impact data. Methods: We conducted a cross-sectional study of 213 households in 14 village water, sanitation and hygiene committee clusters throughout rural Bangladesh and used a combined data- and relationship-scale approach to assess agreement between respondent-reported latrine utilization and sensor-recorded measurement. Results: Four-day household-level respondent-reported defecation averaged 28 events (inter-quartile range [IQR] 20–40), while sensor-recorded defecation averaged 17 events (IQR 11–29). Comparative analyses suggest moderately high accuracy (bias correction factor=0.84), but imprecision in the data (broad scatter of data, Pearson’s r=0.35) and thus only weak concordance between measures (ρc=0.29 [95% BCa CI 0.15 to 0.43]). Conclusions: Respondent-reported latrine utilization data should be interpreted with caution, as evidence suggests use is exaggerated. Coupling reported utilization data with objective measures of use may aid in the estimation of latrine use. Close