• 1.

    Parashar UD, Bresee JS, Glass RI, 2003. The global burden of diarrhoeal disease in children. Bull World Health Organ 81: 236.

  • 2.

    National Statistical Office and UNICEF, 2008. Malawi Multiple Indicator Cluster Survey 2006, Final Report. Lilongwe, Malawi: National Statistical Office and UNICEF. Available at: http://www.childinfo.org/files/MICS3_Malawi_FinalReport_2006_eng.pdf. Accessed March 14, 2010.

    • Search Google Scholar
    • Export Citation
  • 3.

    Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colfor JM Jr, 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4253.

    • Search Google Scholar
    • Export Citation
  • 4.

    Clasen T, Schmidt WP, Rabie T, Roberts I, Cairncross S, 2007. Interventions to improve water quality for preventing diarrhoea: systemic review and meta-analysis. BMJ 334: 755756.

    • Search Google Scholar
    • Export Citation
  • 5.

    Curtis V, Cairncross S, 2003. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 3: 275281.

    • Search Google Scholar
    • Export Citation
  • 6.

    Hammad ZH, Dirar HA, 1982. Microbiological examination of sebeel water. Appl Environ Microbiol 43: 12381243.

  • 7.

    Han AM, Oo KN, Midorikawa Y, Shwe S, 1989. Contamination of drinking water during collection and storage. Trop Geogr Med 41: 138140.

  • 8.

    Kramer MS, Kakuma R, 2002. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev CD003517.

  • 9.

    Stockman LJ, Fischer TK, Deming M, Ngwira B, Quick RE, 2007. Point-of-use water treatment and use among mothers in Malawi. Emerg Infect Dis 13: 10771080.

    • Search Google Scholar
    • Export Citation
  • 10.

    Bryce J, Daelmans B, Dwivedi A, Fauveau V, Lawn JE, Mason E, Newby H, Shankar A, Starrs A, Wardlaw T, 2008. Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. Lancet 371: 12471258.

    • Search Google Scholar
    • Export Citation
  • 11.

    Parker AA, Stephenson R, Riley PL, Ombeki S, Komolleh C, Sibley L, Quick R, 2006. Sustained high levels of stored drinking water treatment and retention of hand-washing knowledge in rural Kenyan households following a clinic-based intervention. Epidemiol Infect 134: 10291036.

    • Search Google Scholar
    • Export Citation
  • 12.

    Blanton E, Ombeki S, Oluoch GO, Mwaki A, Wannemuehler K, Quick R, 2010. Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households—Nyanza Province, Western Kenya, 2007. Am J Trop Med Hyg 82: 664671.

    • Search Google Scholar
    • Export Citation
  • 13.

    Filmer D, Pritchett LH, 2001. Estimating wealth effects without expenditure data–or tears: an application to educational enrollments in states of India. Demography 38: 115132.

    • Search Google Scholar
    • Export Citation
  • 14.

    Eliasziw M, Donner A, 1991. Application of the McNemar test to non-independent matched pair data. Stat Med 10: 19811991.

  • 15.

    Mintz ED, Reiff FM, Tauxe TV, 1995. Safe water treatment and storage in the home: a practical new strategy to prevent waterborne disease. JAMA 273: 948953.

    • Search Google Scholar
    • Export Citation
  • 16.

    Tuttle J, Ries AA, Chimba RM, Perera CU, Bean NH, Griffin PM, 1995. Antimicrobial-resistant epidemic Shigella dysenteriae type 1 in Zambia: modes of transmission. J Infect Dis 171: 371375.

    • Search Google Scholar
    • Export Citation
  • 17.

    Roberts L, Chartier Y, Chartier O, Malenga G, Toole M, Rodka H, 2001. Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial. Bull World Health Organ 79: 280287.

    • Search Google Scholar
    • Export Citation
  • 18.

    Arnold BF, Colford JM, 2007. Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: a systemic review and meta-analysis. Am J Trop Med Hyg 76: 354364.

    • Search Google Scholar
    • Export Citation
  • 19.

    Rhee V, Mullaly LC, Khatry S, Katz J, LeClerq SC, Darmstadt GL, Tielsch JM, 2008. Maternal and birth attendant hand washing and neonatal mortality in southern Nepal. Arch Mediatr Adolesc Med 162: 603608.

    • Search Google Scholar
    • Export Citation
  • 20.

    Thevos A, Olsen S, Rangel J, Kaona F, Tembo M, Quick R, 2002–2003. Social marketing and motivational interviewing as community interventions for safe water behaviors: follow-up surveys in Zambia. Int Q Community Health Educ 21: 5165.

    • Search Google Scholar
    • Export Citation
  • 21.

    Dunston C, McAfee D, Kasier R, Rakotoarison D, Rambeloson L, Hoang AT, Quick RE, 2001. Collaboration, cholera, and cyclones: a project to improve point-of-use water quality in Madagascar. Am J Public Health 91: 15741576.

    • Search Google Scholar
    • Export Citation
  • 22.

    Makutsa P, Nzaku K, Ogutu P, Barasa P, Ombeki S, Mwaki A, Garrett V, Quick R, 2001. Challenges in the implementation of a socially-marketed point-of-use water treatment and safe storage intervention in rural western Kenya. Am J Public Health 91: 15711573.

    • Search Google Scholar
    • Export Citation
  • 23.

    Institute of Medicine, Health and Behavior, 2001: The Interplay of Biological, Behavioral and Societal Influences. Washington, DC: Academy Press.

    • Search Google Scholar
    • Export Citation
  • 24.

    McLeroy KR, Bibeau D, Steckler A, Glanz K, 1988. An ecological perspective on health promotion programs. Health Educ Q 15: 351377.

  • 25.

    Gilman RH, Skillicorn P, 1985. Boiling of drinking-water: can a fuel-scarce community afford it? Bull World Health Organ 63: 157163.

  • 26.

    Biran A, Abbot J, Mace R, 2004. Families and firewood: the costs and benefits of children in firewood collection and use in two rural communities in sub-Saharan Africa. Hum Ecol 32: 125.

    • Search Google Scholar
    • Export Citation
  • 27.

    Rogers EM, 1995: Diffusion of Innovations, Fourth edition. New York: The Free Press.

  • 28.

    Victora CG, Wagstaff A, Schellenberg JA, Gwatkin D, Claeson M, Habicht J, 2003. Applying an equity lens to child health and mortality: more of the same is not enough. Lancet 362:233241.

    • Search Google Scholar
    • Export Citation
  • 29.

    Wiseman V, Hawley WA, ter Kuile FO, Phillips-Howard PA, Vulule JM, Nahlen BL, Mills AJ, 2003. The cost-effectiveness of permethrin-treated bed nets in an area of intense malaria transmission in western Kenya. Am J Trop Med Hyg 68 (Suppl 4): 161167.

    • Search Google Scholar
    • Export Citation
  • 30.

    Mathanga DP, Luman ET, Campbell CH, Silwimba C, Malenga G, 2009. Integration of insecticide-treated net distribution into routine immunization services in Malawi: a pilot study. Trop Med Int Health 14: 792801.

    • Search Google Scholar
    • Export Citation
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Impact of the Integration of Water Treatment and Handwashing Incentives with Antenatal Services on Hygiene Practices of Pregnant Women in Malawi

Anandi N. ShethEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Elizabeth T. RussoEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Manoj MenonEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Kathleen WannemuehlerEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Merri WeingerEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Amose C. KudzalaEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Blessius TauzieEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Humphreys D. MasukuEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Tapona E. MsowoyaEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Robert QuickEpidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Agency for International Development, Washington, District of Columbia; United Nations Children's Fund – Malawi, Lilongwe, Malawi; Government of Malawi Ministry of Health, Lilongwe, Malawi

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Access to safe drinking water and improved hygiene are important for reducing morbidity and mortality from diarrhea. We surveyed 330 pregnant women who participated in an antenatal clinic-based intervention in Malawi that promoted water treatment and hygiene through distribution of water storage containers, sodium hypochlorite water treatment solution, soap, and educational messages. Program participants were more likely to know correct water treatment procedures (62% versus 27%, P < 0.0001), chlorinate drinking water (61% versus 1%, P < 0.0001), demonstrate correct handwashing practices (68% versus 22%, P < 0.0001), and purchase water treatment solution after free distribution (32% versus 1%, P < 0.0001). Among participants, 72% had at least three antenatal visits, 76% delivered in a health facility, and 54% had a postnatal check. This antenatal-clinic-based program is an effective new strategy for promoting water treatment and hygiene behaviors among pregnant women. Participants had high use of antenatal, delivery, and postnatal services, which could improve maternal and child health.

Author Notes

*Address correspondence to Anandi N. Sheth, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-38, Atlanta, GA 30333. E-mail: asheth@cdc.gov

Authors' addresses: Anandi N. Sheth, Elizabeth T. Russo, Manoj Menon, Kathleen Wannemuehler, and Robert Quick, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: asheth@cdc.gov, erusso@cdc.gov, mmenon@cdc.gov, kpw9@cdc.gov, and rquick@cdc.gov. Merri Weinger, United States Agency for International Development, Washington, DC, E-mail: mweinger@usaid.gov. Amose C. Kudzala, Blessius Tauzie, and Tapona E. Msowoya, United Nationals Children's Fund, Lilongwe, Malawi, E-mails: akudzala@unicef.org, btauzie@unicef.org, and tmsowoya@unicef.org. Humphreys D. Masuku, Government of Malawi Ministry of Health, Lilongwe, Malawi, E-mail: dzanjom@yahoo.co.uk.

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