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

Seema Jain 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

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Osman K. Sahanoon 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

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Elizabeth Blanton 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

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Ann Schmitz 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

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Kathleen A. Wannemuehler 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

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Robert M. Hoekstra 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

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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

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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.

Author Notes

*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@cdc.gov

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@cdc.gov. Osman K. Sahanoon, NewEnergy, Tamale, Ghana.

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