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Local Drinking Water Filters Reduce Diarrheal Disease in Cambodia: A Randomized, Controlled Trial of the Ceramic Water Purifier

A randomized, controlled intervention trial of two household-scale drinking water filters was conducted in a rural village in Cambodia. After collecting four weeks of baseline data on household water quality, diarrheal disease, and other data related to water use and handling practices, households were randomly assigned to one of three groups of 60 households: those receiving a ceramic water purifier (CWP), those receiving a second filter employing an iron-rich ceramic (CWP-Fe), and a control group receiving no intervention. Households were followed for 18 weeks post-baseline with biweekly follow-up. Households using either filter reported significantly less diarrheal disease during the study compared with a control group of households without filters as indicated by longitudinal prevalence ratios CWP: 0.51 (95% confidence interval [CI]: 0.41–0.63); CWP-Fe: 0.58 (95% CI: 0.47–0.71), an effect that was observed in all age groups and both sexes after controlling for clustering within households and within individuals over time.

Received November 26, 2007. Accepted for publication June 11, 2008.

Acknowledgments: The authors thank Uon Virak, Choun Bunnara, Lim Kimly, Michelle Molina, Oum Sopharo, Song Kimsrong, and Van Sokheng for conducting interviews and analyzing water samples. Special thanks to project manager Sorya Proum and adviser Mickey Sampson. Thanks also to Jan-Willem Rosenboom of the Water and Sanitation Programme, the Cambodian Ministry of Rural Development, and Douglas Wait and the UNC Environmental Microbiology and Health group. Laboratory space and logistical support was generously provided by Resource Development International-Cambodia. This paper was greatly improved by the critical insight of our anonymous reviewers, who have our sincere thanks.

Financial support: This study was supported by grants from the United States Environmental Protection Agency and the National Science Foundation.

^* Address correspondence to Joe Brown, University of Alabama, Department of Biological Sciences, New College, Box 870229, Tuscaloosa, AL 35487-0229. E-mails: joebrown{at}bama.ua.edu or brown{at}bama.ua.edu

Authors’ addresses: Joe Brown, University of Alabama, Department of Biological Sciences, New College, Box 870229, Tuscaloosa, AL 35487-0229, Tel: 205-348-0418, Fax: 205-348-8417. Mark D. Sobsey, University of North Carolina—Chapel Hill, School of Public Health, Department of Environmental Sciences and Engineering, CB 7431 Rosenau Hall, Chapel Hill, NC 27599-7431, Tel: 919-966-7303, Fax: 919-966-7911. Dana Loomis, School of Public Health/271, University of Nevada-Reno, Reno, NV 89557-0036, Tel: 775-682-7103, Fax: 775-784-1340.