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A Cluster Randomized Trial of the Impact of Education through Listening (a Novel Behavior Change Technique) on Household Water Treatment with Chlorine in Vihiga District, Kenya, 2010–2011

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  • 1 Department of Population Health Sciences, School of Public Health, Atlanta, Georgia State University, Atlanta, Georgia;
  • | 2 Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
  • | 3 Safe Water and AIDS Project, Kisumu, Kenya

ABSTRACT

Despite multiple studies demonstrating the effectiveness of household water treatment with chlorine in disinfecting water and preventing diarrhea, social marketing of this intervention in low- and middle-income countries has resulted in only modest uptake. In a cluster randomized trial in Vihiga district, western Kenya, we compared uptake of household water treatment with chlorine among six villages served by community vendors trained in standard social marketing plus education through listening (ETL), an innovative behavior change method, and six villages served by community vendors trained in standard social marketing only. Water treatment uptake, water quality, and childhood diarrhea were measured over 6 months and compared between the two groups of villages. During the 6-month period, we found no association between ETL exposure and reported and confirmed household water treatment with chlorine. In both groups (ETL and comparison), reported use of water treatment was low and did not change during our 6-month follow-up. However, persons confirmed to have chlorinated water had improved bacteriologic water quality. Study findings suggest that ETL implementation was suboptimal, which, along with unexpected changes in the supply and price of chlorine, may have prevented an accurate assessment of the potential impact of ETL on water treatment behavior. Taken together, these observations exemplify the complexities of habits, practices, attitudes, and external factors that can create challenging conditions for implementing behavioral interventions. As a consequence, in this trial, ETL had no measurable impact on water treatment behavior.

Author Notes

Address correspondence to Christine E. Stauber, Department of Population Health Sciences, School of Public Health, 140 Decatur St., Atlanta, GA 30303. E-mail: cstauber@gsu.edu

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Financial support: This project was supported by a Georgia State University/CDC Seed grant and the U.S. Agency for International Development.

Authors’ addresses: Christine E. Stauber and Matthew J. Hayat, Georgia State University, School of Public Health, Atlanta, GA, E-mails: cstauber@gsu.edu and mhayat@gsu.edu. Bobbie Person, Schistosomiasis Consortium for Operational Research and Evaluation, University of Georgia, Athens, GA, E-mail: bobbieperson@gmail.com. Ronald Otieno, Nyando Integrated Child Health Project, Safe Water and AIDS Project, Kisumu, Kenya, E-mail: ronotien0@yahoo.com. Jared Oremo, Safe Water and AIDS Project, Kisumu, Kenya, E-mail: jerryoresh@yahoo.com. Katharine Schilling, School of Public Health, Georgia State University, Atlanta, GA, and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: schil1ka@gmail.com. Tracy Ayers, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: eyk6@cdc.gov. Robert Quick, Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: rxq1@cdc.gov.

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