Evaluating the sustained health impact of household chlorination of drinking water in rural Haiti
Open accessAbstract
The Jolivert Safe Water for Families program has sold sodium hypochlorite solution (chlorine) and conducted household visits in rural Haiti since 2002. To assess the impact of the program on diarrheal disease, in 2010 we conducted a survey and water quality testing in 201 program participants and 425 control households selected at random. Fifty-six percent of participants (versus 10% of controls) had free chlorine residuals between 0.2 and 2.0 mg/L, indicating correct water treatment. Using intention-to-treat analysis, we found that significantly fewer children < 5 in participant households had an episode of diarrhea in the previous 48 hours (32% versus 52%; P < 0.001) with 59% reduced odds (odds ratio = 0.41, 95% confidence interval = 0.21-0.79). Treatment-on-treated estimates of the odds of diarrhea indicated larger program effects for participants who met more stringent verifications of participation. Diarrheal disease reduction in this long-term program was comparable with that seen in short-term randomized, controlled interventions, suggesting that household chlorination can be an effective long-term water treatment strategy.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Only four studies of drinking water reported results by sex; thus, the estimates are not disaggregated by sex.
“Only four studies of drinking water (three POU filter studies36, 37, 38 and one POU chlorine study39) reported results by sex; thus, our estimates are not disaggregated by sex (appendix 1 pp 5–7).”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Filmer, D. P., & Pritchett, L. H. (2001) · Demography · doi:10.2307/3088292 · Cited by 5,843 · see citing works
Progress on sanitation and drinking-water 2010 update
worl (2010) · Cited by 831 · see citing works
Sobsey, M. D., Stauber, C. E., Casanova, L. M., Brown, J. M., & Ellıott, M. (2008) · Environmental Science & Technology · doi:10.1021/es702746n · Cited by 710 · see citing works
Arnold, B. F., & Colford, J. M. (2007) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2007.76.354 · Cited by 389 · see citing works
Household water treatment in poor populations: is there enough evidence for scaling up now?
Schmidt, W.-P., & Cairncross, S. (2009) · Environmental Science & Technology · doi:10.1021/es802232w · Cited by 296 · see citing works
Hunter, P. R. (2009) · Environmental Science & Technology · doi:10.1021/es9028217 · Cited by 246 · see citing works
Water distribution system and diarrheal disease transmission: a case study in Uzbekistan.
Semenza, J. C., Roberts, L., Henderson, A. D., Bogan, J., & Rubin, C. (1998) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.1998.59.941 · Cited by 228 · see citing works
Diarrhea prevention through household-level water disinfection and safe storage in Zambia.
Quick, R. E., Kimura, A. C., Thevos, A. K., Tembo, M., Shamputa, I. C., Hutwagner, L., & Mintz, E. M. (2002) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2002.66.584 · Cited by 226 · see citing works
Estimating the Scope of Household Water Treatment in Low- and Medium-Income Countries
Rosa, G. A., & Clasen, T. (2010) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2010.09-0382 · Cited by 223 · see citing works
Quick, R. E., Venczel, L., Mintz, E. D., Soleto, L., Aparicio, J. C. M., Gironaz, M., Hutwagner, L., Greene, K. D., Bopp, C. A., Maloney, K. H., et al. (1999) · Epidemiology and Infection · doi:10.1017/s0950268898001782 · Cited by 212 · see citing works
Crump, J. A., Otieno, P. O., Slutsker, L., Keswick, B. H., Rosen, D. H., Hoekstra, R. M., VULULE, J. M., & Luby, S. P. (2005) · BMJ · doi:10.1136/bmj.38512.618681.e0 · Cited by 164 · see citing works
Reller, M. E., MENDOZA, C. E., López, B., Alvarez, M., Hoekstra, R. M., Olson, C. A., Baier, K., Keswick, B. H., & Luby, S. P. (2003) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2003.69.411 · Cited by 156 · see citing works
Eisenberg, J. N. S., Scott, J. C., & Porco, T. (2007) · American Journal of Public Health · doi:10.2105/ajph.2006.086207 · Cited by 136 · see citing works
Delayed effectiveness of home-based interventions in reducing childhood diarrhea, Karachi, Pakistan
LUBY, S. P., AGBOATWALLA, M., HOEKSTRA, R. M., RAHBAR, M. H., BILLHIMER, W., & KESWICK, B. H. (2004) · The American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2004.71.420 · Cited by 79 · see citing works
Haiti Enquête Mortalité, Morbidité et Utilisation des Services 2005-2006
Cayemittes, M., Busangu, M.-A. F., Bizimana, J. D. D., Barrère, B., & Sévère, B. (2001) · Cited by 71 · see citing works
Flagged first, then by citations
1 of the 16 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Interventions to improve water quality for preventing diarrhoea
Clasen, T., Alexander, K., Sinclair, D., Boisson, S., Peletz, R., Chang, H. H., Majorin, F., & Cairncross, S. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004794.pub3 · Cited by 498 · see citing works
Wolf, J., Hubbard, S., Brauer, M., Ambelu, A., Arnold, B. F., Bain, R., Bauza, V., Brown, J., Caruso, B. A., Clasen, T., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00937-0 · Cited by 377 · see citing works
for the Social Determinants of Health Study Team, Darvesh, N., Das, J. K., Vaivada, T., Gaffey, M. F., Rasanathan, K., & Bhutta, Z. A. (2017) · BMC Public Health · doi:10.1186/s12889-017-4746-1 · Cited by 177 · see citing works
Iannotti, L. L., Dulience, S. J. L., Green, J., Joseph, S., François, J., Anténor, M.-L., LESOROGOL, C. K., Mounce, J., & Nickerson, N. M. (2013) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.063883 · Cited by 131 · see citing works
Mengistie, B., Berhane, Y., & Worku, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0077887 · Cited by 94 · see citing works
Chirgwin, H., Cairncross, S., Zehra, D., & Waddington, H. S. (2021) · Campbell Systematic Reviews · doi:10.1002/cl2.1194 · Cited by 97 · see citing works
Safe Drinking Water for Low-Income Regions
Amrose, S. E., Burt, Z., & Ray, I. (2015) · Annual Review of Environment and Resources · doi:10.1146/annurev-environ-031411-091819 · Cited by 81 · see citing works
Nielsen, A. M., Garcia, L. A. T., Silva, K. J. S., Sabogal-Paz, L. P., Hincapié, M., Montoya, L. J., Galeano, L., Galdos-Balzategui, A., Reygadas, F., Herrera, C., et al. (2022) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2022.114004 · Cited by 82 · see citing works
Health Outcomes for Children in Haiti Since the 2010 Earthquake: A Systematic Review
Dube, A., Moffatt, M., Davison, C., & Bartels, S. A. (2017) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x17007105 · Cited by 68 · see citing works
Kamara, J. K., Galukande, M., Maeda, F., Luboga, S., & Renzaho, A. M. N. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14060602 · Cited by 55 · see citing works
Chan, E. Y. Y., Tong, K. H. Y., Dubois, C., Mcdonnell, K., Kim, J. H., Hung, K. K. C., & Kwok, K. O. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312268 · Cited by 51 · see citing works
Solomon, E. T., Gari, S. R., Kloos, H., & Mengistie, B. (2020) · Infectious Diseases of Poverty · doi:10.1186/s40249-020-00680-9 · Cited by 37 · see citing works
Feleke, H., Medhin, G., Kloos, H., Gangathulasi, J., & Asrat, D. (2018) · Environmental Monitoring and Assessment · doi:10.1007/s10661-018-7033-4 · Cited by 35 · see citing works
Adoption of Point-of-Use Chlorination for Household Drinking Water Treatment: A Systematic Review
Crider, Y. S., Tsuchiya, M., Mukundwa, M., Ray, I., & Pickering, A. J. (2023) · Environmental Health Perspectives · doi:10.1289/ehp10839 · Cited by 39 · see citing works
Understanding the socioeconomic and environmental indicators of household water treatment in Nigeria
Abubakar, I. R. (2021) · Utilities Policy · doi:10.1016/j.jup.2021.101209 · Cited by 32 · see citing works
Caruso, B. A., Ballard, A. M., Sobolik, J. S., Patrick, M., Dsouza, J., Sinharoy, S. S., Cumming, O., Wolf, J., & Ray, I. (2024) · Nature Water · doi:10.1038/s44221-024-00299-2 · Cited by 28 · see citing works
The Critical Role of Compliance in Delivering Health Gains from Environmental Health Interventions
Brown, J. M., Hayashi, M. A. L., & Eisenberg, J. N. S. (2019) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.18-0624 · Cited by 21 · see citing works
Patil, R. A., Ahmad, D., Balkundae, P., Kausley, S. B., & Malhotra, C. P. (2020) · Journal of Water Process Engineering · doi:10.1016/j.jwpe.2020.101435 · Cited by 20 · see citing works
Low-cost ceramic filtration for point-of-use water treatment in low-income countries
Chaukura, N., Moyo, W., Kajau, T. A., Muleja, A. A., Mamba, B. B., & Nkambule, T. T. I. (2023) · Water Security · doi:10.1016/j.wasec.2023.100145 · Cited by 20 · see citing works
Kleyi, P. E., Ray, S. S., Abia, A. L. K., Ubomba‐Jaswa, E., Wesley‐Smith, J., & Maity, A. (2016) · Applied Clay Science · doi:10.1016/j.clay.2016.04.012 · Cited by 20 · see citing works
Fagerli, K., Trivedi, K. K., Sodha, S. V., Blanton, E. M., Ati, A., Nguyen, T. H., Delea, K. C., Ainslie, R., Figueroa, M. E., Kim, S., et al. (2017) · Epidemiology and Infection · doi:10.1017/s0950268817002217 · Cited by 20 · see citing works
Blanton, E. M., Wilhelm, N., O’Reilly, C. E., Muhonja, E., Karoki, S., Ope, M. O., Langat, D., Omolo, J. O., Wamola, N., Oundo, J. O., et al. (2014) · Journal of Water and Health · doi:10.2166/wh.2014.173 · Cited by 19 · see citing works
Yates, T., Armitage, E., Lehmann, L., Branz, A., & Lantagne, D. (2015) · Environmental Science & Technology · doi:10.1021/acs.est.5b00309 · Cited by 18 · see citing works
Evaluation of household drinking water filter distribution programs in Haiti
Rayner, J., Murray, A. L., Joseph, M. L., Branz, A., & Lantagne, D. (2016) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2016.121 · Cited by 17 · see citing works
Chaúque, B. J. M., Issufo, M., Benitez, G. B., Cossa, V. C., Chaúque, L. G. H., Stauber, C. E., Benetti, A. D., & Rott, M. B. (2023) · Journal of environmental chemical engineering · doi:10.1016/j.jece.2023.110575 · Cited by 17 · see citing works
Rayner, J., Yates, T., Joseph, M. L., & Lantagne, D. (2016) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2016.068 · Cited by 16 · see citing works
Evaluating four measures of water quality in clay pots and plastic safe storage containers in Kenya
Murphy, J. L., Ayers, T., Knee, J., Oremo, J., Odhiambo, A., Faith, S. H., Nyagol, R., Stauber, C., Lantagne, D., & Quick, R. E. (2016) · Water Research · doi:10.1016/j.watres.2016.08.022 · Cited by 14 · see citing works
Forests moderate the effectiveness of water treatment at reducing childhood diarrhea
Rasolofoson, R., Ricketts, T. H., Johnson, K., Jacob, A., & Fisher, B. (2021) · Environmental Research Letters · doi:10.1088/1748-9326/abff88 · Cited by 12 · see citing works
Ritter, M. R., Camille, E., Velcine, C., Guillaume, R.-K., & Lantagne, D. (2017) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.16-0820 · Cited by 10 · see citing works
Haque, S. S., Kirby, M. A., Iyakaremye, L., Gebremariam, A., Tessema, G., Thomas, E., Chang, H. H., & Clasen, T. (2022) · npj Clean Water · doi:10.1038/s41545-022-00185-y · Cited by 11 · see citing works
MacDonald, M. C., Juran, L., Jose, J., Sekar, S., Ali, S. I., Aronson, K. J., & Hall, K. R. (2015) · International Journal of Environmental Health Research · doi:10.1080/09603123.2015.1089532 · Cited by 11 · see citing works
Wilner, L. B., Wells, E., Ritter, M. R., Casimir, J. M., Chui, K. K. H., & Lantagne, D. (2017) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2017.035 · Cited by 7 · see citing works
Need for certification of household water treatment products: examples from Haiti
Murray, A. L., Pierre-Louis, J. B., Joseph, F., Sylvain, G., Patrick, M., & Lantagne, D. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12445 · Cited by 5 · see citing works
Tsai, F., Wu, M., & Lin, C.-P. (2020) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.19-0606 · Cited by 5 · see citing works
Impact Evaluation of an SMS Campaign to Promote Household Chlorination in Rural Haiti
Ritter, M. R., Camille, E., Velcine, C., Guillaume, R.-K., Casimir, J. M., & Lantagne, D. (2020) · Water · doi:10.3390/w12113095 · Cited by 3 · see citing works
Gerges, D. I., LaPlant, W. G., HYDE, J. N., Previl, H., & Forrester, J. E. (2016) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2016.043 · Cited by 3 · see citing works
Commodités familiales et santé des enfants de moins de cinq ans en Haïti
Roy, I., & Defo, B. K. (2017) · Canadian Journal of Public Health · doi:10.17269/cjph.108.5921 · Cited by 2 · see citing works
Lantagne, D., Saltori, R., Shaylor, E., String, G. M., Wise, T., Quick, R. E., & Ramos, M. (2023) · Environmental Health Perspectives · doi:10.1289/ehp13164 · Cited by 1 · see citing works
Comment on “household effectiveness vs. laboratory efficacy of point-of-use chlorination”
Lantagne, D. (2014) · Water Research · doi:10.1016/j.watres.2014.10.053
Working Papers in Environmental Social Sciences
Mosler, H., Günther, I., Johnston, R., & Werner, J. (2014)
Kim, S.-K., O’Reilly, C. E., Abayneh, S., Bhattarai, A., Ahmed, J., Mekonnen, A. B., Salah, Z., & Quick, R. (2020) · Water · doi:10.3390/w12113261
- Authors
- Harshfield, E., Lantagne, D., Turbes, A., & Null, C.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Null, Clair
- Venue
- The American Society of Tropical Medicine and Hygiene
- Published
- 2012-11-07
- Volume
- 87
- Issue
- 5
- Pages
- 786-795
- ISSN
- 0002-9637 (ISSN-L)
- 1476-1645
- PMC
- PMC3516252
- OpenAlex
- W1967595572
- Cited by
- 43
- References
- 16
- Citations by year
- 2024: 1 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 1 · 2018: 1 · 2017: 7 · 2016: 5 · 2015: 6 · 2014: 4 · 2013: 2
- FWCI
- 3.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Tropical Medicine and Hygiene (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Apollo
- Funders
- Emory University
- Centers for Disease Control and Prevention Foundation
- Centers for Disease Control and Prevention
- School of Medicine, Emory University
- Emory Global Health Institute
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Water Treatment and Disinfection
- Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
- Keywords
- drinking water treatment, sodium hypochlorite, diarrheal disease, childhood diarrhea, free residual chlorine, water quality, rural Haiti, waterborne disease prevention
- MeSH terms
- Child, Chlorine, Diarrhea, Disinfectants, Haiti, Humans, Drinking Water
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
