School of Public Health - International Health
A cluster-randomized controlled trial of safe drinking water
Diarrhea is the second leading cause of death in children under 5 years of age globally, causing an estimated 800,000 deaths annually. Previous studies have identified lack of caregiver hand washing with soap and treatment of household drinking water, poor water storage practices, and lack of caregiver knowledge of diarrhea prevention as important risk factors for diarrheal disease in pediatric populations.. WASH interventions promoting household chlorination of drinking water and hand washing with soap have the potential to reduce diarrheal disease incidence in children less than five years of age an estimated 30 to 40%. However, there has been limited success in encouraging households to sustain these behaviors over time. Furthermore, Community Based WASH interventions are expensive and often difficult to implement in an urban context in low resource settings.
Our team has recently developed a Hospital Based WASH intervention which is entitled CHoBI7 (Cholera Hospital-Based Intervention for 7 days). Chobi means â€œpictureâ€ in Bangla. The CHoBI7 intervention was initially designed to reduce cholera infection among family members of hospitalized cholera cases during the one week high risk period after the case presents at the hospital. This Hospital Based WASH intervention is disseminated by health facility based promoters to hospitalized diarrhea patients and their family members and includes: (1) A pictorial module on diarrhea transmission and prevention, and (2) A diarrhea prevention package which contains chlorine tablets for water treatment, a soapy water bottle, and a sealed water vessel to ensure safe water storage.
The findings from our recent randomized controlled trial of CHoBI7 demonstrated that this intervention was effective in significantly reducing cholera, and had significant sustained impacts on hand washing with soap and water treatment behaviors 12 months post intervention. Our current USAID funded randomized controlled trial is to test strategies to bring this intervention to scale in health facilities across Bangladesh. This field trial is a collaboration between the International Center for Diarrheal Disease Research, Bangladesh (icddr,b), and Johns Hopkins School of Public Health.
Global Health Mentor/PI: Christine Marie George, PhD