Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda.

Authors:
Miles A Kirby
Miles A Kirby
London School of Hygiene and Tropical Medicine
Corey L Nagel
Corey L Nagel
Oregon Health and Science University
United States
Ghislaine Rosa
Ghislaine Rosa
London School of Hygiene and Tropical Medicine
United Kingdom
Sanctus Musafiri, PhD
Sanctus Musafiri, PhD
National University of Rwanda
Professor (Associate)
Respiratory Medicine
Kigali, Rwanda | Rwanda
Evan A Thomas
Evan A Thomas
Portland State University
Portland | United States
Thomas Clasen
Thomas Clasen
London School of Hygiene and Tropical Medicine
United Kingdom

PLoS Med 2019 Jun 3;16(6):e1002812. Epub 2019 Jun 3.

London School of Hygiene and Tropical Medicine, London, United Kingdom.

Background: Unsafe drinking water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household water filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale.

Methods And Findings: In a large-scale program in Western Province, Rwanda, water filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking water (piped, borehole, protected spring/well, or rainwater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have water in their filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes.

Conclusions: Our findings indicate that the intervention improved household drinking water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI.

Trial Registration: Clinical Trials.gov NCT02239250.

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Source
http://dx.doi.org/10.1371/journal.pmed.1002812DOI Listing
June 2019
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References

(Supplied by CrossRef)
Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015
C Troeger et al.
Lancet Infect Dis 2017
Rwanda Demographic and Health Survey 2014–15
2015
Risk factors for severe acute lower respiratory tract infection in under-five children
S Broor et al.
Indian Pediatr 2001
Interventions to improve water quality for preventing diarrhoea
TF Clasen et al.
Cochrane database Syst Rev 2015

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