Title

Impact of Low-Cost Point-of-Use Water Treatment Technologies on Enteric Infections and Growth among Children in Limpopo, South Africa

DOI

10.4269/ajtmh.20-0228

Authors

Courtney L. Hill, Department of Engineering Systems and Environment, University of Virginia, Charlottesville, Virginia.
Kelly McCain, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Mzwakhe E. Nyathi, Department of Animal Science, University of Venda, Thohoyandou, South Africa.
Joshua N. Edokpayi, Department of Hydrology and Water Resources Mining and Environmental Geology, University of Venda, Thohoyandou, South Africa.
David M. Kahler, Center for Environmental Research and Education, Duquesne University, Pittsburgh, Pennsylvania.
Darwin J. Operario, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia.
David D. Taylor, Department of Civil and Mineral Engineering, University of Toronto, Toronto, Canada.
Natasha C. Wright, Department of Mechanical Engineering, University of Minnesota Twin Cities, Minneapolis, Minnesota.
James A. Smith, Department of Engineering Systems and Environment, University of Virginia, Charlottesville, Virginia.
Richard L. Guerrant, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia.
Amidou Samie, Department of Microbiology, University of Venda, Thohoyandou, South Africa.
Rebecca A. Dillingham, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia.
Pascal O. Bessong, Department of Microbiology, University of Venda, Thohoyandou, South Africa.
Elizabeth T. Rogawski McQuade, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.

Document Type

Journal Article

Publication Date

10-1-2020

Publication Title

The American journal of tropical medicine and hygiene

Volume

103

Issue

4

First Page

1405

Last Page

1415

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 -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.

Open Access

Gold

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