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| Name | Class |
|---|---|
| University of Michigan | OTHER |
| Bayero University Kano, Nigeria | OTHER |
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This study evaluates the implementation and effectiveness of in-line chlorination (ILC) for improving drinking water quality in rural Nigeria. Unsafe drinking water remains a major contributor to diarrheal disease, particularly among children under five. Inline chlorination is a passive water treatment approach that automatically doses chlorine at community water systems without requiring electricity or daily user action. Two cluster randomized controlled trials will be conducted in Kano State (North-West Nigeria) and Cross River State (South-South Nigeria). Communities will be randomized to either receive in-line chlorination installed at eligible communal water systems or serve as controls with no chlorination. The unit of randomization is a community or a cluster of communities that share water system for drinking water. The primary objective is to estimate the causal impact of in-line chlorination on household drinking water quality. Outcomes include the prevalence of Escherichia coli contamination in tap water and stored household water as well as the presence of free chlorine residual. Secondary objectives assess water source usage and adoption of chlorinated sources, as well as reduction in diarrheal disease. Implementation fidelity and operational performance of chlorination devices will also be monitored.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Arm 1: Inline Chlorination (ILC) with Behavioral Change Communication (BCC) | Experimental | Communities randomized to this arm will receive inline chlorination installed at eligible communal drinking water systems, such as boreholes or handpumps, and behavioral change communication. |
|
| Arm 2: Control (No Chlorination) | No Intervention | Communities randomized to this arm will not receive inline chlorination during the study period and will continue their usual water collection and treatment practices. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| In-line Chlorination (ILC) with Behavioral Change Communication (BCC) | Device | In-line chlorination devices will be installed on all compatible communal water systems within treatment communities. Devices automatically dose chlorine proportional to water flow without requiring electricity or daily user input. Technologies will include TuriTap liquid dosers installed at handpumps and CTI-8 tablet dosers installed at tanks or piped systems. Devices will be calibrated and routinely monitored to maintain chlorine residual within recommended ranges. In addition to device installation, communities will participate in behavior change communication (BCC) activities designed to support understanding and acceptance of chlorinated water. BCC activities will include community sensitization meetings conducted by the implementing partner. Meetings will provide information on the purpose of chlorination through the in-line chlorination devices, expected benefits and limitations, safe water handling practices, and guidance for addressing taste or odor concerns. |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of water source samples with detectable free chlorine residual. | Measured as >0.1 ppm. | About 4-, 8-, and 12-month follow ups after device installations |
| Proportion of household stored drinking water samples with detectable free chlorine residual. | Measured as >0.1 ppm. | About 4-, 8-, and 12-month follow ups after device installations |
| Proportion of household stored drinking water samples positive for Escherichia coli. | Measured as >1 MPN/100 mL of water by culture-based assay | About 4-, 8-, and 12-month follow ups after device installations |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of water source samples with detectable total chlorine residual. | Measured as >0.1 ppm. | About 4-, 8-, and 12-month follow ups after device installations |
| Concentration of E. coli in water source samples |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of households reporting an ILC-compatible water source as their primary drinking water source | Measured as the percentage of surveyed households identifying an ILC-compatible water system as their source of drinking water. ILC-compatible water systems (boreholes, piped systems, or handpumps have chlorinated water in treatment) | About 4-, 8-, and 12-month follow ups after device installations |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Amy J Pickering | Contact | +1.510.410.2666 | pickering@berkeley.edu | |
| Elisa M Maffioli | Contact | +1.443.875.4930 | elisamaf@umich.edu |
| Name | Affiliation | Role |
|---|---|---|
| Amy J Pickering | University of California, Berkeley | Principal Investigator |
| Elisa M Maffioli | University of Michigan | Principal Investigator |
| Adamu I Tanko, PhD |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Yala LGA | Yala | Cross River State | Nigeria |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31402005 | Background | Pickering AJ, Crider Y, Sultana S, Swarthout J, Goddard FG, Anjerul Islam S, Sen S, Ayyagari R, Luby SP. Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial. Lancet Glob Health. 2019 Sep;7(9):e1247-e1256. doi: 10.1016/S2214-109X(19)30315-8. | |
| 35700262 |
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| ID | Term |
|---|---|
| D003967 | Diarrhea |
| D001519 | Behavior |
| ID | Term |
|---|---|
| D012817 | Signs and Symptoms, Digestive |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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Concentration of E. coli (in log10 MPN/100ml) in water source samples by culture-based assay
| About 4-, 8-, and 12-month follow ups after device installations |
| Concentration of E. coli in household stored water samples | Concentration of E. coli (in log10 MPN/100ml) in household stored water samples by culture-based assay | About 4-, 8-, and 12-month follow ups after device installations |
| Concentration of total coliform bacteria in water source samples | Concentration of total coliform bacteria (MPN/100mL) in water source samples | About 4-, 8-, and 12-month follow ups after device installations |
| Concentration of total coliform bacteria in household stored water samples | Concentration of total coliform bacteria (MPN/100mL) in household stored water samples | About 4-, 8-, and 12-month follow ups after device installations |
| Prevalence of caregiver-reported diarrhea among children under five years of age | Measured as the proportion of children under five reported by caregivers to have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey. | About 4-, 8-, and 12-month follow ups after device installations |
| Prevalence of caregiver-reported diarrhea among household members, any age | Measured as the proportion of individuals surveyed in the household that have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey. Measured for subset of available respondents. | About 4-, 8-, and 12-month follow ups after device installations |
| Prevalence of diarrhea among female caregivers | Measured as the proportion of respondents that have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey. | Time frame - About 4-, 8-, and 12-month follow ups after device installations |
| Proportion of households switching away from ILC-treated water sources | Measured as the percentage of households that discontinue use of a chlorinated water system for drinking water compared to baseline. | About 4-, 8-, and 12-month follow ups after device installations |
| Proportion of households reporting any household-level water treatment | Measured as the percentage of households reporting treatment of drinking water prior to consumption (e.g., boiling, filtration, manual chlorination). | About 4-, 8-, and 12-month follow ups after device installations |
| Time spent on household-level water treatment | Time (minutes) reported by households per day on making water safer to drink (gender stratified) | About 4-, 8-, and 12-month follow ups after device installations |
| Bayero University Kano, Nigeria |
| Principal Investigator |
| Makoda LGA | Makuda | Kano State | Nigeria |
|
| Lindmark M, Cherukumilli K, Crider YS, Marcenac P, Lozier M, Voth-Gaeddert L, Lantagne DS, Mihelcic JR, Zhang QM, Just C, Pickering AJ. Passive In-Line Chlorination for Drinking Water Disinfection: A Critical Review. Environ Sci Technol. 2022 Jul 5;56(13):9164-9181. doi: 10.1021/acs.est.1c08580. Epub 2022 Jun 14. |