Effect of a Point-of-Use Water Treatment and Safe Water Storage Intervention on Diarrhea in Infants of HIV-Infected Mothers

Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
The Journal of Infectious Diseases (Impact Factor: 6). 10/2009; 200(8):1186-93. DOI: 10.1086/605841
Source: PubMed


To reduce mother-to-child transmission of human immunodeficiency virus (HIV) in resource-poor settings, the World Health Organization
recommends exclusive breast-feeding for 6 months, followed by rapid weaning if replacement feeding is affordable, feasible,
available, safe, and sustainable. In the Kisumu Breastfeeding Study (trial registration: identifier NCT00146380), infants of HIV-infected mothers who received antiretroviral therapy experienced high rates of diarrhea at weaning. To address
this problem, mothers in the Kisumu Breastfeeding Study were given safe water storage vessels, hygiene education, and bleach
for household water treatment. We compared the incidence of diarrhea in infants enrolled before (cohort A) and after (cohort
B) implementation of the intervention. Cohort B infants experienced less diarrhea than cohort A infants, before and after
weaning (P<.001 and P=.047, respectively); however, during the weaning period, there were no differences in the frequency
of diarrhea between cohorts (P=0.89). Testing of stored water in cohort B homes indicated high adherence (monthly range, 80%–95%)
to recommended chlorination practices. Among infants who were weaned early, provision of safe water may be insufficient to
prevent weaning-associated diarrhea

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Available from: Timothy K Thomas, Dec 01, 2015
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    • "A randomized controlled trial in South Africa found a 20.7 per cent reduction of cryptosporidiosis through use of a ceramic water filter (Abebe et al., 2013). In a study on the effects of household chlorination on diarrhoeal disease, Harris et al. (2009) found that participants in the study experience fewer diarrhoeal episodes than the control group. "
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    ABSTRACT: People living with HIV (PLHIV) have compromised immune systems and are highly susceptible to diarrhoeal diseases. Water, sanitation, and hygiene (WASH) interventions have been proven to be effective in reducing diarrhoeal diseases among PLHIV, yet little information exists on how integration of WASH into HIV/AIDS programmes occurs. The goals of this study were to: 1) identify specific WASH activities that have been integrated into HIV/AIDS programmes; 2) characterize the behavioural change techniques used to improve WASH-related behaviours; 3) identify WASH indicators used to evaluate WASH activities; and 4) discuss implementation challenges and potential ways to move the sector forward. A semi-structured questionnaire was used to obtain information from six organizations integrating WASH into HIV/AIDS programmes. Additionally, in-depth interviews were conducted with four of those six organizations. Each of the organizations integrated at least one of the three key WASH interventions into their HIV/AIDS programme, including: 1) household water treatment and safe storage; 2) hand washing with soap; and 3) safe handling and disposal of faeces. No organization integrated all three interventions. Sanitation interventions were least common among the programmes, highlighting the neglect of sanitation.
    Full-text · Article · Apr 2014 · Waterlines
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    • "An observational study of an intervention to promote clean water among HIV-positive women through provision of materials for point-of-use treatment and safe water storage supplies reported a lower risk of diarrheal disease in infants after weaning; however, no reduction in risk was observed during weaning. The authors observed that women demonstrated a high level of adherence to the intervention based on empirical evidence of water testing [30]. "
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    ABSTRACT: ABSTRACT: Partners In Health (PIH) works with the Ministry of Health to provide comprehensive health services in Haiti. Between 1994 and 2009, PIH recommended exclusive formula feeding in the prevention of mother-to-child transmission (PMTCT) of HIV program and provided support to implement this strategy. We conducted this study to assess HIV-free survival and prevalence of diarrhea and malnutrition among infants in our PMTCT program in rural Haiti where exclusive formula feeding was supported. We reviewed medical charts of PMTCT mother-infant pairs at PIH between November 2004 and August 2006 through a retrospective longitudinal study and cross-sectional survey. We performed household surveys for each pair and at control households matched by infant's age and gender. 254 mother-infant pairs were included. 15.3% of infants were low birth weight; most births occurred at home (68.8%). 55.9% of households had no latrine; food insecurity was high (mean score of 18; scale 0-27, SD = 5.3). HIV-free survival at 18 months was 90.6%. Within the cohort, 9 children (3.5%) were HIV-infected and 17 (6.7%) died. Community controls were more likely to be breastfed (P = 0.003) and more likely to introduce food early (P = 0.003) than PMTCT-program households. There was no difference in moderate malnutrition (Z score ≤ 2 SD) between PMTCT and community groups after controlling for guardian's education, marital status, and food insecurity (OR = 1.05; 95% CI: 0.67, 1.64; P = 0.84). Diarrhea was 2.9 times more prevalent among community children than PMTCT infants (30.3% vs. 12.2%; P < 0.0001). In a PIH-supported program in rural Haiti that addressed socioeconomic barriers to ill-health, breast milk substitution was safe, acceptable and feasible for PMTCT for HIV-infected women choosing this option.
    Full-text · Article · Oct 2011 · AIDS Research and Therapy
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    • "Our subset of sample was too small for proper analysis. Water sanitation and hygiene practice influence rates of diarrhoea as well (Lima & Guerrant 1992; Arnold & Colford 2007; Harris et al. 2009), but we were not able to apply water disinfectant usage as an independent variable in our analyses because of high compliance rate. To our surprise, access to tap water is associated with diarrhoea. "
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    ABSTRACT: To evaluate a pilot prevention of mother-to-child transmission post-natal programme in Lilongwe, Malawi, through observed retention and infant diarrhoeal rates. Free fortified porridge and water hygiene packages were offered to mothers to encourage frequent post-natal visits and to reduce diarrhoeal rates in infants on replacement feeding. Participant retention and infant health outcome were assessed. Of 474 patients enrolled, 357 (75.3%) completed 3-month follow-up visits. Ninety-nine percent of women reported hygiene package use, and only 17.7% (95% CI 13.8-22.0%) of the infants had diarrhoea at least once over the 3-month period. Being 12 months or younger, confirmed HIV positive, access to tap water, and having a mother with diarrhoea were all associated with increased risk of infant diarrhoea. The majority of participants adhered to their scheduled visits and retention was favourable, possibly because of the introduction of hygiene and nutrition incentives. The infant diarrhoeal rate was low, suggesting benefits of regular medical care with hygiene package usage and reliable replacement feeding options. Continuation and expansion of the programme would allow further studies and improve the post-natal care of HIV-exposed infants in Malawi and in other resource-constrained countries.
    Full-text · Article · Oct 2010 · Tropical Medicine & International Health
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