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Am. J. Trop. Med. Hyg., 82(1), 2010, pp. 16-22
doi:10.4269/ajtmh.2010.08-0584;
Copyright © 2010 by The American Society of Tropical Medicine and Hygiene

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Sodium Dichloroisocyanurate Tablets for Routine Treatment of Household Drinking Water in Periurban Ghana: A Randomized Controlled Trial

Seema Jain*, Osman K. Sahanoon, Elizabeth Blanton, Ann Schmitz, Kathleen A. Wannemuehler, Robert M. Hoekstra, AND Robert E. Quick
Enteric Diseases Epidemiology Branch, Division of Foodborne, Bacterial, and Mycotic Diseases, National Center for Zoonotic, Vector-borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Infectious Diseases (School of Medicine) and Center for Global Safe Water (Rollins School of Public Health), Emory University, Atlanta, Georgia; NewEnergy, Tamale, Ghana

We conducted a randomized, placebo-controlled, triple-blinded trial to determine the health impact of daily use of sodium dichloroisocyanurate (NaDCC) tablets for household drinking water treatment in periurban Ghana. We randomized 240 households (3,240 individuals) to receive either NaDCC or placebo tablets. All households received a 20-liter safe water storage vvessel. Over 12 weeks, 446 diarrhea episodes (2.2%) occurred in intervention and 404 (2.0%) in control households (P = 0.38). Residual free chlorine levels indicated appropriate tablet use. Escherichia coli was found in stored water at baseline in 96% of intervention and 88% of control households and at final evaluation in 8% of intervention and 54% of control households (P = 0.002). NaDCC use did not prevent diarrhea but improved water quality. Diarrhea rates were low and water quality improved in both groups. Safe water storage vessels may have been protective. A follow-up health impact study of NaDCC tablets is warranted.

Received November 7, 2008. Accepted for publication September 1, 2009.

The authors, first and foremost, express their appreciation to the study participants, who warmly and graciously tolerated their frequent interruptions of their daily activities. They are indebted to Ayuba Abukari, Jennifer Apiung, Issah Baba, Chief M.S. Caesar, Luqman Mahama, Issahaku Mohammed, Alhassan Tahiru Seini, and Imoro Z. Tuu-naa for their work as field officers; Musin Salifu, Musah Abdul-Wahab, Sayibu Imoro Wunpini, and Bukari Mohammed Yakubu as water quality testers; Ibrahim Mohammed Ali and Abdallah Mashud for data entry. The authors thank Emmanuel Agyemang Ansaaku and Benjamin K. Moses for their laboratory work at the Ghana Water Company. The authors thank all the staff at New Energy for their logistical support with special thanks to Thomas Sayibu Imoro. They are grateful to Rochelle Rainey and Sharon Murray from the United States Agency for International Development and the West Africa Water Initiative for their assistance in finding local partners. They appreciate the technical expertise and support provided by Daniele Lantagne, PE. The authors thank James M. Hughes, M.D. for his insight and guidance.

Financial support: The United States Agency for International Development, the Bureau of Oceans and Environmental Science of the United States Department of State, Medentech Ltd, and the Chlorine Chemistry Council funded the study. Medentech, Ltd provided NaDCC and placebo tablets.

Authors' addresses: Seema Jain, Elizabeth Blanton, Ann Schmitz, Kathleen A. Wannemuehler, Robert M. Hoekstra, and Robert E. Quick, Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: bwc8{at}cdc.gov. Osman K. Sahanoon, NewEnergy, Tamale, Ghana.

*Address correspondence to Seema Jain, Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-38, Atlanta, GA 30333. E-mail: bwc8{at}cdc.gov






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