Environmental Engineering Reference
In-Depth Information
Recent systematic reviews concluded that interventions to improve the microbial
quality of drinking water in households are effective at reducing diarrhea, which is
a principal source of morbidity and mortality among young children in developing
countries [3-5]. One widely promoted water disinfection method with encouraging
evidence of effi cacy in laboratory settings is SODIS [6]. Global efforts are underway
to promote SODIS as a simple, environmentally sustainable, low-cost solution for
household drinking water treatment, and safe storage (www.who.int/household_water,
www.sodisafricanet.org). The SODIS is currently promoted in more than 30 countries
worldwide (www.sodis.ch) and in at least seven Latin American countries through the
SODIS Foundation including in Bolivia.
Despite this widespread promotion, evidence of the effectiveness of SODIS from
fi eld studies is limited. The three reported SODIS trials to date implemented the
intervention at the household level, two of them in highly controlled settings that
ensured very high compliance [7-9]. The highest reduction in incidence (36%) was
recorded in a trial carried out among 200 children in an urban slum in Vellore, India
[9].
Because SODIS is a behavioral intervention designed to reduce infectious diar-
rhea, disease transmission and its interruption likely have community-level dynamics
[10]. In addition, because SODIS is typically rolled out in practice through commu-
nity rather than household level promotion, there is an urgent need for effectiveness
data from such settings. We conducted a community-randomized intervention trial to
evaluate the effectiveness of SODIS in decreasing diarrhea in children <5 year in rural
communities in Bolivia.
MATERIALS AND METHODS
Ethics Statement
The study was approved by the three human subjects review boards of the Univer-
sity of Basel, Switzerland, the University of California, Berkeley, and the Univer-
sity of San Simon, Cochabamba, Bolivia. The Cochabamba and Totora municipal
authorities also approved the study and informed consent was obtained from com-
munity leaders and male and female household heads prior to implementation of
the study. Informed consent was obtained before randomization to the treatment
arms (Figure 1). Mildly ill children from households participating in the study were
provided with and instructed to use oral rehydration ORS, or they were referred
by field staff to the local health system where clinical services were provided free
of charge. The project provided transport and treatment costs for those patients.
All project staff completed training on research ethics (www.fhi.org/training/sp/
Retc/). Project staff comprised all project personnel of all project partners. Field
staff comprised all personnel working in our laboratories and at our Totora field sta-
tion including data enumerators and data- and project-management staff, supervi-
sors, and community-based field workers living in the study communities. The trial
protocol and the CONSORT statement checklist are available online as supporting
information.
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