Volume 91, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Safe domestic potable water supplies are urgently needed to reduce childhood diarrheal disease. In periurban neighborhoods in Cochabamba, Bolivia, we conducted a cluster randomized controlled trial to evaluate the efficacy of a household-level hollow fiber filter and/or behavior change communication (BCC) on water, sanitation, and hygiene (WASH) to reduce the diarrheal disease in children less than 5 years of age. In total, 952 households were followed for a period of 12 weeks post-distribution of the study interventions. Households using Sawyer PointONE filters had significantly less diarrheal disease compared with the control arm during the intervention period, which was shown by diarrheal prevalence ratios of 0.21 (95% confidence interval [95% CI] = 0.15–0.30) for the filter arm and 0.27 (95% CI = 0.22–0.34) for the filter and WASH BCC arm. A non-significant reduction in diarrhea prevalence was reported in the WASH BCC study arm households (0.71, 95% CI = 0.59–0.86).

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

Loading full text...

Full text loading...



  1. Bartram J, Cairncross S, , 2010. Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med 7: 19.[Crossref]
  2. United Nations Children's Fund and World Health Organization, 2012. Progress on Drinking Water and Sanitation: 2012 Update. New York, NY: United Nations Children's Fund.
  3. United Nations, 2012. The Millennium Development Goals Report 2012. Available at: http://www.un.org/millenniumgoals/pdf/MDG%20Report%202012.pdf. Accessed September 28, 2013.
  4. Institute for Health Metrics and Evaluation (IHME), 2012. Global Burden of Disease Study 2010. Global Burden of Disease Study 2010 (GBD 2010) Results by Risk Factor 1990–2010. Seattle, WA: Institute for Health Metrics and Evaluation (IHME).
  5. World Health Organization, 2010. GLAAS 2010: UN-Water Global Annual Assessment of Sanitation and Drinking-Water: Targeting Resources for Better Results. Geneva: World Health Organization.
  6. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, , 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375: 19691987.[Crossref]
  7. Centro de Documentación e Información Bolivia, 2007. Datos del Distrito 8. Cochabamba, Bolivia: Centro de Documentación e Información Bolivia.
  8. Centro de Documentación e Información Bolivia, 2007. Datos del Distrito 14. Cochabamba, Bolivia: Centro de Documentación e Información Bolivia.
  9. Coa R, Ochoa LH, , 2009. Encuesta Nacional de Demografía y Salud: ENDSA 2008. La Paz, Bolivia: Ministerio de Salud y Deportes.
  10. United Nations Children's Fund and World Health Organization, 2009. Diarrhoea: Why Children Are Still Dying and What Can Be Done. New York, NY: United Nations Children's Fund, 68.
  11. World Health Organization, 2011. Evaluating Household Water Treatment Options: Health-Based Targets and Microbiological Performance Specifications. Geneva: World Health Organization.
  12. Stauber CE, Elliott MA, Koksal F, Ortiz GM, DiGiano FA, Sobsey MD, , 2006. Characterisation of the biosand filter for E. coli reductions from household drinking water under controlled laboratory and field use conditions. Water Sci Technol 54: 17.[Crossref]
  13. Stauber CE, Ortiz GM, Loomis DP, Sobsey MD, , 2009. A randomized controlled trial of the concrete biosand filter and its impact on diarrheal disease in Bonao, Dominican Republic. Am J Trop Med Hyg 80: 286293.
  14. Clasen TF, Suntura O, Cairncross S, , 2004. Reducing diarrhea through the use of household-based ceramic water filters: a randomized, controlled trial in rural Bolivia. Am J Trop Med Hyg 70: 651657.
  15. Clasen TF, Brown J, Collin SM, , 2006. Preventing diarrhoea with household ceramic water filters: assessment of a pilot project in Bolivia. Int J Environ Health Res 16: 231239.[Crossref]
  16. Duke WF, Nordin RN, Baker D, Mazumder A, , 2006. The use and performance of BioSand filters in the Artibonite Valley of Haiti: a field study of 107 households. Rural Remote Health 6: 570.
  17. Hydreion LLC (Missoula, MT), 2005. Microbiological Testing of the Sawyer 7/6B Filter. Report No. S05-03. Available at: http://sawyer.com/wp-content/uploads/2013/12/field-micro.pdf. Accessed January 29, 2013.
  18. Sawyer Corporation, 2013. What Can I Expect as a Flow Rate from My PointONE Filter. Available at: http://sawyer.com/wp-content/uploads/2013/12/flow-full1.pdf. Accessed January 29, 2013.
  19. Faul F, Erdfelder E, Lang AG, Buchner A, , 2007. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39: 175191.[Crossref]
  20. Clasen T, Schmidt WP, Rabie T, Roberts I, Cairncross S, , 2007. Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis. BMJ 334: 782.[Crossref]
  21. Christakis NA, Fowler JH, , 2007. The spread of obesity in a large social network over 32 years. N Engl J Med 357: 370379.[Crossref]
  22. Christakis NA, Fowler JH, , 2008. The collective dynamics of smoking in a large social network. N Engl J Med 358: 22492258.[Crossref]
  23. Fowler JH, Christakis NA, , 2008. Estimating peer effects on health in social networks: a response to Cohen-Cole and Fletcher; Trogdon, Nonnemaker, Pais. J Health Econ 27: 14001405.[Crossref]
  24. Fowler JH, Christakis NA, , 2008. Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. BMJ 337: a2338.[Crossref]
  25. Davis TP, , 2004. Barrier Analysis Facilitator's Guide: A Tool for Improving Behavior Change Communication in Child Survival and Community Development Programs. Washington, DC: Food for the Hungry.
  26. Laughlin M, , 2004. The Care Group Difference: A Guide to Mobilizing Community Based Volunteer Health Educators. Baltimore, MD: World Relief.
  27. Liang KY, Zeger SL, , 1986. Longitudinal data analysis using generalized linear models. Biometrika 73: 1322.[Crossref]
  28. Emrich LJ, Piedmonte MR, , 1992. On some small sample properties of generalized estimating equation estimates for multivariate dichotomous outcomes. J Stat Comput Simul 41: 1929.[Crossref]
  29. Dinerstein E, Olson DM, Graham DJ, , 1995. A Conservation Assessment of the Terrestrial Ecoregions of Latin America and the Caribbean. Washington, DC: The World Bank.[Crossref]
  30. Brown J, Sobsey MD, Loomis D, , 2008. Local drinking water filters reduce diarrheal disease in Cambodia: a randomized, controlled trial of the ceramic water purifier. Am J Trop Med Hyg 79: 394400.
  31. Stauber C, Printy E, McCarty F, Liang K, Sobsey M, , 2011. Cluster randomized controlled trial of the plastic biosand water filter in Cambodia. Environ Sci Technol 46: 722728.[Crossref]
  32. Hunter PR, , 2009. Household water treatment in developing countries: comparing different intervention types using meta-regression. Environ Sci Technol 43: 89918997.[Crossref]
  33. Alam N, Henry FJ, Rahaman MM, , 1989. Reporting errors in one-week diarrhoea recall surveys: experience from a prospective study in rural Bangladesh. Int J Epidemiol 18: 697700.[Crossref]
  34. Boerma JT, Black RE, Sommerfelt AE, Rutstein SO, Bicego GT, , 1991. Accuracy and completeness of mothers' recall of diarrhoea occurrence in pre-school children in demographic and health surveys. Int J Epidemiol 20: 10731080.[Crossref]
  35. Schmidt WP, Luby SP, Genser B, Barreto ML, Clasen T, , 2007. Estimating the longitudinal prevalence of diarrhea and other episodic diseases: continuous versus intermittent surveillance. Epidemiology 18: 537543.[Crossref]
  36. Melo MC, Taddei JA, Diniz-Santos DR, May DS, Carneiro NB, Silva LR, , 2007. Incidence of diarrhea: poor parental recall ability. Braz J Infect Dis 11: 571579.[Crossref]
  37. Emanuel EJ, Wendler D, Killen J, Grady C, , 2004. What makes clinical research in developing countries ethical? The benchmarks of ethical research. J Infect Dis 189: 930937.[Crossref]

Data & Media loading...

  • Received : 30 Sep 2013
  • Accepted : 07 Mar 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error