Impact of integrated water, sanitation, hygiene, health and nutritional interventions on diarrhoea disease epidemiology and microbial quality of water in a resource-constrained setting in Kenya: A controlled intervention study.

OBJECTIVES: We assessed the impact of water, hygiene and sanitation (WASH), maternal, new-born and child health (MNCH), nutrition and early childhood development (ECD) on diarrhoea and microbial quality of water in a resource-constrained rural setting in Kenya. METHODS: Through a controlled intervention study, we tested faecal and water samples collected from both the intervention and control sites before and after the interventions using microbiological, immunological and molecular assays to determine the prevalence of diarrhoeagenic agents and microbial quality of water. Data from the hospital registers were used to estimate all-cause diarrhoea prevalence. RESULTS: After the interventions, we observed a 58.2% (95% CI: 39.4-75.3) decline in all-cause diarrhoea in the intervention site versus a 22.2% (95% CI: 5.9-49.4) reduction of the same in the control site. Besides rotavirus and pathogenic Escherichia coli, the rate of isolation of other diarrhoea-causing bacteria declined substantially in the intervention site. The microbial quality of community and household water improved considerably in both the intervention (81.9%; 95% CI: 74.5%-87.8%) and control (72.5%; 95% CI: 64.2%-80.5%) sites with the relative improvements in the intervention site being slightly larger. CONCLUSIONS: The integrated WASH, MNCH, nutrition and ECD interventions resulted in notable decline in all-cause diarrhoea and improvements in water quality in the rural resource-limited population in Kenya. This indicates a direct public health impact of the interventions and provides early evidence for public health policy makers to support the sustained implementation of these interventions.

Impact of integrated WASH and maternal and child health interventions on diarrhea disease prevalence in a resource-constrained setting in Kenya.

BACKGROUND: Water, sanitation and hygiene (WASH) and child health interventions are proven simple and cost-effective strategies for preventing diarrhea and minimizing excess mortality. Individually, they are able to prevent diarrhea though sub-optimally, and their effectiveness when combined may be higher. This study examined the effect of integrated WASH and maternal and child health (MCH) interventions on prevalence of diarrhea, in a resource-limited setting in Kenya. METHODS: A controlled intervention was implemented in Narok County. The interventions included WASH interventions integrated with promotion of MCH. A structured questionnaire was used to collect data on targeted indicators before and after the interventions. Data were analyzed using descriptive statistics and Chi-square to establish the impact of the interventions. RESULTS: A total of 431and 424 households and 491 and 487 households in intervention and control sites, respectively, participated in the baseline and endline surveys. Following implementation of the interventions, prevalence of diarrhea decreased by 69.1% (95% CI: 49.6-87.1%) and 58.6% (95% CI: 26.6-82.4%) in the intervention and control site, respectively. Treatment of drinking water and animal husbandry practices were significantly associated with diarrhea post-interventions. CONCLUSIONS: Integrating WASH interventions with other diarrhea control strategies and contextualizing them to meet site-specific needs may effectively prevent diarrhea.