Impact of low-cost point-of-use water treatment technologies on enteric infections and growth among children in Limpopo, South Africa.
Author(s)
Type
Journal Article
Abstract
Enteric infections early in life have been associated with poor linear growth among children in low-resource settings. Point-of-use water treatment technologies provide effective and low-cost solutions to reduce exposure to enteropathogens from drinking water, but it is unknown whether the use of these technologies translates to improvements in child growth. We conducted a community-based randomized controlled trial of two water treatment technologies to estimate their effects on child growth in Limpopo, South Africa. We randomized 404 households with a child younger than 3 years to receive a silver-impregnated ceramic water filter, a silver-impregnated ceramic tablet, a safe-storage water container alone, or no intervention, and these households were followed up quarterly for 2 years. We estimated the effects of the interventions on linear and ponderal growth, enteric infections assessed by quantitative molecular diagnostics, and diarrhea prevalence. The silver-impregnated ceramic water filters and tablets consistently achieved approximately 1.2 and 3 log reductions, respectively, in total coliform bacteria in drinking water samples. However, the filters and tablets were not associated with differences in height (height-for-age z-score differences compared with no intervention: 0.06, 95% CI: -0.29, 0.40, and 0.00, 95% CI: -0.35, 0.35, respectively). There were also no effects of the interventions on weight, diarrhea prevalence, or enteric infections. Despite their effectiveness in treating drinking water, the use of the silver-impregnated ceramic water filters and tablets did not reduce enteric infections or improve child growth. More transformative water, sanitation, and hygiene interventions that better prevent enteric infections are likely needed to improve long-term child growth outcomes.
Date Issued
2020-10
Date Acceptance
2020-06-19
Citation
American Journal of Tropical Medicine and Hygiene, 2020, 103 (4), pp.1405-1415
ISSN
0002-9637
Publisher
American Society of Tropical Medicine and Hygiene
Start Page
1405
End Page
1415
Journal / Book Title
American Journal of Tropical Medicine and Hygiene
Volume
103
Issue
4
Copyright Statement
2020 by The American Society of Tropical Medicine and Hygiene. This is an open-access article distributed under the terms of the
Creative Commons Attribution (CC-BY) License, which permits un-
restricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.
Creative Commons Attribution (CC-BY) License, which permits un-
restricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32840201
Subjects
Child Development
Child Health
Child, Preschool
Diarrhea
Diarrhea, Infantile
Drinking Water
Family Characteristics
Filtration
Humans
Hygiene
Infant
Infant, Newborn
Infection Control
Intestinal Diseases
South Africa
Water Purification
Waterborne Diseases
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2020-08-24