Project Details

Effectiveness of water treatment technologies to prevent child stunting in Limpopo, South Africa

Elizabeth Rogawski, PhD, MSPH

Summary

BACKGROUND: Exposure to enteropathogens in contaminated drinking water contributes to environmental enteropathy, an inflammatory condition of the gut, which can lead to poor linear growth, cognitive impairment, and increased risk of chronic disease later in life. Point-of-use water treatment technologies have the potential to provide effective and low-cost solutions to improve drinking water quality and may contribute to efforts to reduce child stunting. GAP: One such technology, a silver-impregnated ceramic tablet called the MadiDrop, continually disinfects water in household water storage containers by diffusing silver into the water for daily treatment of 10 to 15 liters for at least six months. While use of the MadiDrop has proven to be highly effective in treating water, it is unknown whether the use of this technology will translate to improvements in child growth and development outcomes. HYPOTHESIS: We hypothesized that the MadiDrop would be associated with greater improvements in linear growth among children over two years of use compared to a safe storage water container or no intervention. We hypothesized that the mechanism for this effect would be through reduced enteropathogen burden in these children. METHODS: This study was a community-based randomized controlled trial among households with a healthy child under 3 years of age in the Dzimauli communities in Limpopo, South Africa. Households were randomized to receive a MadiDrop, a ceramic water filter, a safe-storage water container, or no intervention and were followed for two years to detect enteric infections and measure child growth outcomes. RESULTS: The ceramic water filters and MadiDrops consistently achieved approximately 1.2 and 3 log reductions, respectively, in total coliform bacteria in drinking water samples. However, the filters and MadiDrops were not associated with differences in child 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 any of the 8 enteric infections interrogated. IMPACT: Despite their effectiveness in treating drinking water, the use of the ceramic water filters and MadiDrops 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. Website Link: https://globalhealth.virginia.edu/This project is a collaboration between the University of Virginia and the University of Venda in Limpopo, South Africa.

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