Enteric infections early in life have been associated with poor linear growth among children in low-resource settings. Point-of-use water treatment technologies provide effective and low-cost solutions to reduce exposure to enteropathogens from drinking water, but it is unknown whether the use of these technologies translates to improvements in child growth. We conducted a community-based randomized controlled trial of two water treatment technologies to estimate their effects on child growth in Limpopo, South Africa. We randomized 404 households with a child younger than 3 years to receive a silver-impregnated ceramic water filter, a silver-impregnated ceramic tablet, a safe-storage water container alone, or no intervention, and these households were followed up quarterly for 2 years. We estimated the effects of the interventions on linear and ponderal growth, enteric infections assessed by quantitative molecular diagnostics, and diarrhea prevalence. The silver-impregnated ceramic water filters and tablets consistently achieved approximately 1.2 and 3 log reductions, respectively, in total coliform bacteria in drinking water samples. However, the filters and tablets were not associated with differences in height (height-for-age z-score differences compared with no intervention: 0.06, 95% CI: −0.29, 0.40, and 0.00, 95% CI: −0.35, 0.35, respectively). There were also no effects of the interventions on weight, diarrhea prevalence, or enteric infections. Despite their effectiveness in treating drinking water, the use of the silver-impregnated ceramic water filters and tablets did not reduce enteric infections or improve child growth. More transformative water, sanitation, and hygiene interventions that better prevent enteric infections are likely needed to improve long-term child growth outcomes.
Bibliographical noteFunding Information:
Financial support: This work was supported by the Thrasher Research Fund grant (13923) to E. T. R. M.; the U.S. National Academies of Sciences and USAID grant (AID-OAA-A-11-00012) to P. O. B.; the National Research Foundation of South Africa grant (114725) to P. O. B.; the National Science Foundation grant (CBET-1438619) to J. A. S.; the National Institutes of Health, Fogarty International Center grant (D43TW009359) to R. L. G., E. T. R. M., J. N. E., and D. M. K.; and the National Institutes of Health, National Institute of Allergy and Infectious Diseases grant (K01AI130326) to E. T. R. M. Student effort was supported by the University of Virginia (UVA) Jefferson Public Citizens Program, the UVA Center for Global Health, and the National Institutes of Health, National Institute on Minority Health and Health Disparities grant (T37MD008659) to R. A. D.
Disclaimer: The opinions, findings, conclusions, or recommendations are those of the authors alone and do not necessarily reflect the views of NAS, USAID, the National Research Foundation of South Africa, the Thrasher Research Fund, NSF, or the NIH.
Copyright © 2020 by The American Society of Tropical Medicine and Hygiene
PubMed: MeSH publication types
- Journal Article
- Randomized Controlled Trial
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Research Support, U.S. Gov't, Non-P.H.S.