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DELAYED EFFECTIVENESS OF HOME-BASED INTERVENTIONS IN REDUCING CHILDHOOD DIARRHEA, KARACHI, PAKISTAN

STEPHEN P. LUBYDivision of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Oriented Preventive Education, Karachi, Pakistan; Procter & Gamble Company, Cincinnati, Ohio, USA Community Health Sciences, Aga Khan University, Karachi, Pakistan; College of Human Medicine, Michigan State University, East Lansing, Michigan

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MUBINA AGBOATWALLADivision of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Oriented Preventive Education, Karachi, Pakistan; Procter & Gamble Company, Cincinnati, Ohio, USA Community Health Sciences, Aga Khan University, Karachi, Pakistan; College of Human Medicine, Michigan State University, East Lansing, Michigan

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ROBERT M. HOEKSTRADivision of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Oriented Preventive Education, Karachi, Pakistan; Procter & Gamble Company, Cincinnati, Ohio, USA Community Health Sciences, Aga Khan University, Karachi, Pakistan; College of Human Medicine, Michigan State University, East Lansing, Michigan

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MOHAMMAD H. RAHBARDivision of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Oriented Preventive Education, Karachi, Pakistan; Procter & Gamble Company, Cincinnati, Ohio, USA Community Health Sciences, Aga Khan University, Karachi, Pakistan; College of Human Medicine, Michigan State University, East Lansing, Michigan

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WARD BILLHIMERDivision of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Oriented Preventive Education, Karachi, Pakistan; Procter & Gamble Company, Cincinnati, Ohio, USA Community Health Sciences, Aga Khan University, Karachi, Pakistan; College of Human Medicine, Michigan State University, East Lansing, Michigan

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BRUCE H. KESWICKDivision of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Oriented Preventive Education, Karachi, Pakistan; Procter & Gamble Company, Cincinnati, Ohio, USA Community Health Sciences, Aga Khan University, Karachi, Pakistan; College of Human Medicine, Michigan State University, East Lansing, Michigan

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We introduced home drinking water disinfection and handwashing with soap in Karachi squatter settlements to evaluate their effect on diarrhea. In April 2000, 150 households received soap, 76 received dilute bleach and a water storage vessel, and 76 were enrolled as controls. In 2000, among households wealthy enough to own a refrigerator, children in households that received bleach and a vessel had a 73% lower incidence of diarrhea than controls; those that received soap had a 56% lower incidence. There was no reduction in diarrhea in intervention households without a refrigerator. In 2001, households that received bleach and a vessel had a 71% lower incidence of diarrhea and children in households that received soap had a 35% lower incidence than controls. In 2001, the interventions were equally effective in households that had a refrigerator and those that did not. Both of these home-based interventions were ultimately effective in preventing diarrhea, but only households of slightly higher socioeconomic status changed their behavior quickly enough to benefit during the first summer.

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