Skip to main content

Diarrhoea prevention in a high-risk rural Kenyan population through point-of-use chlorination, safe water storage, sanitation, and rainwater harvesting

  • V. GARRETT (a1), P. OGUTU (a2), P. MABONGA (a2), S. OMBEKI (a2), A. MWAKI (a2), G. ALUOCH (a2), M. PHELAN (a1) and R. E. QUICK (a1)...

Lack of access to safe water and sanitation contributes to diarrhoea moribidity and mortality in developing countries. We evaluated the impact of household water treatment, latrines, shallow wells, and rainwater harvesting on diarrhoea incidence in rural Kenyan children. We compared diarrhoea rates in 960 children aged <5 years in 556 households in 12 randomly selected intervention villages and six randomly selected comparison villages during weekly home visits over an 8-week period. On multivariate analysis, chlorinating stored water [relative risk (RR) 0·44, 95% confidence interval (CI) 0·28–0·69], latrine presence (RR 0·71, 95% CI 0·54–0·92), rainwater use (RR 0·70, 95% CI 0·52–0·95), and living in an intervention village (RR 0·31, 95% CI 0·23–0·41), were independently associated with lower diarrhoea risk. Diarrhoea risk was higher among shallow well users (RR 1·78, 95% CI 1·12–2·83). Chlorinating stored water, latrines, and rainwater use all decreased diarrhoea risk; combined interventions may have increased health impact.

Corresponding author
*Author for correspondence: R. E. Quick, M.D., M.P.H., Foodborne and Diarrhoeal Diseases Branch, Mailstop A38, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. (Email:
Hide All
1. Blakely T, et al. The global distribution of risk factors by poverty level. Bulletin of the World Health Organization 2005; 83: 118132.
2. WHO, United Nations Children's Fund (UNICEF), Water Supply and Sanitation Council. Global Water Supply and Sanitation Assessment 2000 Report. New York, NY: UNICEF, 2000, pp. 16, 7779.
3. Hammad ZH, Dirar HA. Microbiologicalal examination of sebeel water. Applied Environmental Microbiology 1982; 43: 12381243.
4. Han AM, et al. Contamination of drinking water during collection and storage. Tropical & Geographical Medicine 1989; 41: 138140.
5. Black R, Lanata C. Epidemiology of diarrhoeal diseases in developing countries. In: Blaser MJ, Smith PD, Ravdin JI eds. Infections of the Gastrointestinal Tract. New York: Raven Press Ltd, 1995, pp. 1336.
6. Parashar UD, Bresee JS, Glass RI. The global burden of diarrhoeal disease in children. Bulletin of the World Health Organization 2003; 81: 236.
7. UNESCO. World Water Assessment Programme 2007 ( Accessed 16 March 2007.
8. World Health Organization/UNICEF. Meeting the MDG Drinking Water and Sanitation Target: The Urban and Rural Challenge of the Decade. Geneva: WHO Press, 2006, pp. 614.
9. CDC. Safe Water Systems for the Developing World: A Handbook for Implementing Household-Based Water Treatment and Safe Storage Projects (SWS). Atlanta: Centers for Disease Control and Prevention, 2000.
10. Quick RE, et al. Diarrhoea prevention in Bolivia through point-of-use water treatment and safe storage: a promising new strategy. Epidemiology and Infection 1999; 122: 8390.
11. Semenza JC, et al. Water distribution system and diarrhoeal disease transmission: a case study in Uzbekistan. American Journal of Tropical Medicine and Hygiene 1998; 59: 941946.
12. Quick R, et al. Diarrhoea prevention through household-level water disinfection and safe storage in Zambia. American Journal of Tropical Medicine and Hygiene 2002; 66: 584589.
13. Luby SP, et al. Delayed effectiveness of home-based interventions in reducing childhood diarrhoea, Karachi, Pakistan. American Journal of Tropical Medicine and Hygiene 2004; 71: 420427.
14. Lule JR, et al. Effect of home-based water chlorination and safe storage on diarrhoea among persons with human immunodeficiency virus in Uganda. American Journal of Tropical Medicine and Hygiene 2005; 73: 926933.
15. Makutsa P, et al. Challenges in implementing a point-of-use water quality intervention in rural Kenya. American Journal of Public Health 2001; 91: 15711573.
16. Ogutu P, et al. Seeking safe storage: a comparison of drinking water quality in clay and plastic vessels. American Journal of Public Health 2001; 91: 16101611.
17. Sawyer R, Simpson-Hebert M, Wood S. PHAST Step-by-Step Guide: A Participatory Approach for the Control of Diarrhoeal Disease. WHO/EOS/98.3ed. Geneva: World Health Organization, 1998.
18. Dunston C, et al. Collaboration, cholera, and cyclones: how a pilot project to improve point-of-use water quality grew to national scale in less than a year. American Journal of Public Health 2001; 91: 15741576.
19. Safe water systems: an evaluation of the Zambia Clorin program ( Accessed 23 October 2007.
20. CDC. Removing barriers to point of use water treatment products through social marketing and entrepreneurship: a case study in western Kenya ( Accessed 23 October 2007.
21. Esrey SA, Feachem RG, Hughes JM. Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities. Bulletin of the World Health Organization 1985; 63: 757772.
22. Esrey SA, et al. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bulletin of the World Health Organization 1991; 69: 609621.
23. Quick RE, et al. Narrow-mouthed water storage vessels and in situ chlorination in a Bolivian community: a simple method to improve drinking water quality. American Journal of Tropical Medicine and Hygiene 1996; 54: 511516.
24. Luby S, et al. A low-cost intervention for cleaner drinking water in Karachi, Pakistan. International Journal of Infectious Diseases 2001; 5: 144150.
25. Roberts L, et al. Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial. Bulletin of the World Health Organization 2001; 79: 280287.
26. Mong Y, et al. Impact of the safe water system on water quality in cyclone-affected communities in Madagascar. American Journal of Public Health 2001; 91: 15771579.
27. McGuigan K, et al. Solar disinfection of drinking water contained in transparent plastic bottles: characterizing the bacterial inactivation process. Journal of Applied Microbiology 1998; 84: 11381148.
28. McGuigan K, Joyce TM, Conroy RM. Solar disinfection: use of sunlight to decontaminate drinking water in developing countries. Journal of Medical Microbiology 1999; 48: 785787.
29. Crump JA, et al. Effect of point-of-use disinfection, flocculation and combined flocculation-disinfection on drinking water quality in western Kenya. Journal of Applied Microbiology 2004; 97: 225231.
30. Clasen T, et al. Interventions to improve water quality for preventing diarrhoea [Review]. The Cochrane Library 2006 (3) ( Accessed 16 March 2007.
31. Fewtrell L, et al. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infectious Diseases 2005; 5: 4252.
32. Clasen TF, Cairncross S. Household water management: refining the dominant paradigm. Tropical Medicine and International Health 2005; 9: 187191.
33. Eisenberg JNS, Scott JC, Porco T. Balancing water sanitation and hygiene interventions to reduce diarrheal disease burden. American Journal of Public Health 2001; 97: 17.
34. Tiballs J. Teaching hospital medical staff to handwash. Medical Journal of Australia 1996; 164: 395398.
35. Luby S, et al. Combining water treatment and hand washing for diarrhoea prevention: a cluster randomized controlled trial. Tropical Medicine and International Health 2006; 11: 479489.
36. Parker A, et al. Sustained high levels of stored drinking water treatment and retention of hand washing knowledge in rural Kenyan households following a clinic-based intervention. Epidemiology and Infection 2006; 134: 10291036.
37. Arnold BF, Colford JM. Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: a systematic review and meta-analysis. American Journal of Tropical Medicine and Hygiene 2007; 76: 354364.
38. Stockman LJ, et al. Awareness and use of WaterGuard among mothers in Malawi: lessons learned from a national survey, 2005. Emerging Infectious Diseases 2007; 13: 10771080.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 5
Total number of PDF views: 71 *
Loading metrics...

Abstract views

Total abstract views: 530 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 17th November 2017. This data will be updated every 24 hours.