This study evaluates the implementation and effectiveness of in-line chlorination (ILC) for improving drinking water quality in rural Nigeria. Unsafe drinking water remains a major contributor to diarrheal disease, particularly among children under five. Inline chlorination is a passive water treatment approach that automatically doses chlorine at community water systems without requiring electricity or daily user action. Two cluster randomized controlled trials will be conducted in Kano State (North-West Nigeria) and Cross River State (South-South Nigeria). Communities will be randomized to either receive in-line chlorination installed at eligible communal water systems or serve as controls with no chlorination. The unit of randomization is a community or a cluster of communities that share water system for drinking water. The primary objective is to estimate the causal impact of in-line chlorination on household drinking water quality. Outcomes include the prevalence of Escherichia coli contamination in tap water and stored household water as well as the presence of free chlorine residual. Secondary objectives assess water source usage and adoption of chlorinated sources, as well as reduction in diarrheal disease. Implementation fidelity and operational performance of chlorination devices will also be monitored.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
2,655
In-line chlorination devices will be installed on all compatible communal water systems within treatment communities. Devices automatically dose chlorine proportional to water flow without requiring electricity or daily user input. Technologies will include TuriTap liquid dosers installed at handpumps and CTI-8 tablet dosers installed at tanks or piped systems. Devices will be calibrated and routinely monitored to maintain chlorine residual within recommended ranges. In addition to device installation, communities will participate in behavior change communication (BCC) activities designed to support understanding and acceptance of chlorinated water. BCC activities will include community sensitization meetings conducted by the implementing partner. Meetings will provide information on the purpose of chlorination through the in-line chlorination devices, expected benefits and limitations, safe water handling practices, and guidance for addressing taste or odor concerns.
Yala LGA
Yala, Cross River State, Nigeria
Makoda LGA
Makuda, Kano State, Nigeria
Proportion of water source samples with detectable free chlorine residual.
Measured as \>0.1 ppm.
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Proportion of household stored drinking water samples with detectable free chlorine residual.
Measured as \>0.1 ppm.
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Proportion of household stored drinking water samples positive for Escherichia coli.
Measured as \>1 MPN/100 mL of water by culture-based assay
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Proportion of water source samples with detectable total chlorine residual.
Measured as \>0.1 ppm.
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Concentration of E. coli in water source samples
Concentration of E. coli (in log10 MPN/100ml) in water source samples by culture-based assay
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Concentration of E. coli in household stored water samples
Concentration of E. coli (in log10 MPN/100ml) in household stored water samples by culture-based assay
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Concentration of total coliform bacteria in water source samples
Concentration of total coliform bacteria (MPN/100mL) in water source samples
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Concentration of total coliform bacteria in household stored water samples
Concentration of total coliform bacteria (MPN/100mL) in household stored water samples
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Prevalence of caregiver-reported diarrhea among children under five years of age
Measured as the proportion of children under five reported by caregivers to have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey.
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Prevalence of caregiver-reported diarrhea among household members, any age
Measured as the proportion of individuals surveyed in the household that have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey. Measured for subset of available respondents.
Time frame: About 4-, 8-, and 12-month follow ups after device installations
Prevalence of diarrhea among female caregivers
Measured as the proportion of respondents that have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey.
Time frame: Time frame - About 4-, 8-, and 12-month follow ups after device installations
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