Design and rationale of a matched cohort study to assess the effectiveness of a combined household-level piped water and sanitation intervention in rural Odisha, India

doi:10.1136/bmjopen-2016-012719

. 2017 Mar 31;7(3):e012719.

doi: 10.1136/bmjopen-2016-012719.

Design and rationale of a matched cohort study to assess the effectiveness of a combined household-level piped water and sanitation intervention in rural Odisha, India

Heather Reese ¹, Parimita Routray ², Belen Torondel ², Gloria Sclar ¹, Maryann G Delea ^{1

2}, Sheela S Sinharoy ³, Laura Zambrano ¹, Bethany Caruso ¹, Samir R Mishra ⁴, Howard H Chang ⁵, Thomas Clasen ^{1

2}

Affiliations

¹ Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
² London School of Hygiene and Tropical Medicine, London, UK.
³ Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, USA.
⁴ School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India.
⁵ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

PMID: 28363920
PMCID: PMC5387990
DOI: 10.1136/bmjopen-2016-012719

Design and rationale of a matched cohort study to assess the effectiveness of a combined household-level piped water and sanitation intervention in rural Odisha, India

Heather Reese et al. BMJ Open. 2017.

. 2017 Mar 31;7(3):e012719.

doi: 10.1136/bmjopen-2016-012719.

Authors

Heather Reese ¹, Parimita Routray ², Belen Torondel ², Gloria Sclar ¹, Maryann G Delea ^{1

2}, Sheela S Sinharoy ³, Laura Zambrano ¹, Bethany Caruso ¹, Samir R Mishra ⁴, Howard H Chang ⁵, Thomas Clasen ^{1

2}

Affiliations

¹ Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
² London School of Hygiene and Tropical Medicine, London, UK.
³ Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, USA.
⁴ School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India.
⁵ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

PMID: 28363920
PMCID: PMC5387990
DOI: 10.1136/bmjopen-2016-012719

Abstract

Introduction: Government efforts to address massive shortfalls in rural water and sanitation in India have centred on construction of community water sources and toilets for selected households. However, deficiencies with water quality and quantity at the household level and community coverage and actual use of toilets have led Gram Vikas, a local non-governmental organization in Odisha, India, to develop an approach that provides household-level piped water connections contingent on full community-level toilet coverage.

Methods: This matched cohort study was designed to assess the effectiveness of a combined piped water and sanitation intervention. Households with children <5 years in 45 randomly selected intervention villages and 45 matched control villages will be followed over 17 months. The primary outcome is prevalence of diarrhoeal diseases; secondary health outcomes include soil-transmitted helminth infection, nutritional status, seroconversion to enteric pathogens, urogenital infections and environmental enteric dysfunction. In addition, intervention effects on sanitation and water coverage, access and use, environmental fecal contamination, women's empowerment, as well as collective efficacy, and intervention cost and cost-effectiveness will be assessed.

Ethics and dissemination: The study protocol has been reviewed and approved by the ethics boards of the London School of Hygiene and Tropical Medicine, UK and KIIT University, Bhubaneswar, India. Findings will be disseminated via peer-reviewed literature and presentation to stakeholders, government officials, implementers and researchers.

Trial registration number: NCT02441699.

Keywords: diarrheal diseases; piped water supply; sanitation.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Figure 1

Study sites in Ganjam and Gajapati districts, Odisha, India, with intervention villages in black and control villages in white. Inset shows location of districts in India.

Figure 2

Figure 2

Restriction, matching and exclusion process for selection of intervention and control villages (1), and timeline for study rounds and outcome data collection (2).

See this image and copyright information in PMC

References

1. UNICEF, WHO. Progress and sanitation and drinking water: 2015 update and MDG assessment. Geneva: World Health Organization, 2015.
1. Water and Sanitation Program. A decade of the total sanitation campaign: rapid assessment of processes and outcomes. World Bank, 2010.
1. Coffey D, Gupta A, Hathi P et al. . Culture and the health transition: understanding sanitation behavior in rural north India. International Growth Centre Working Paper, 2015.
1. Clasen T, Pruss-Ustun A, Mathers CD et al. . Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods. Trop Med Int Heal 2014;19:884–93. 10.1111/tmi.12330 - DOI - PubMed
1. Arnold BF, Khush RS, Ramaswamy P et al. . Causal inference methods to study nonrandomized, preexisting development interventions. Proc Natl Acad Sci USA 2010;107:22605–10. 10.1073/pnas.1008944107 - DOI - PMC - PubMed

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[1] UNICEF, WHO. Progress and sanitation and drinking water: 2015 update and MDG assessment. Geneva: World Health Organization, 2015.

[2] UNICEF, WHO. Progress and sanitation and drinking water: 2015 update and MDG assessment. Geneva: World Health Organization, 2015.

[3] Water and Sanitation Program. A decade of the total sanitation campaign: rapid assessment of processes and outcomes. World Bank, 2010.

[4] Water and Sanitation Program. A decade of the total sanitation campaign: rapid assessment of processes and outcomes. World Bank, 2010.

[5] Coffey D, Gupta A, Hathi P et al. . Culture and the health transition: understanding sanitation behavior in rural north India. International Growth Centre Working Paper, 2015.

[6] Coffey D, Gupta A, Hathi P et al. . Culture and the health transition: understanding sanitation behavior in rural north India. International Growth Centre Working Paper, 2015.

[7] Clasen T, Pruss-Ustun A, Mathers CD et al. . Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods. Trop Med Int Heal 2014;19:884–93. 10.1111/tmi.12330 - DOI - PubMed

[8] Clasen T, Pruss-Ustun A, Mathers CD et al. . Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods. Trop Med Int Heal 2014;19:884–93. 10.1111/tmi.12330 - DOI - PubMed

[9] Arnold BF, Khush RS, Ramaswamy P et al. . Causal inference methods to study nonrandomized, preexisting development interventions. Proc Natl Acad Sci USA 2010;107:22605–10. 10.1073/pnas.1008944107 - DOI - PMC - PubMed

[10] Arnold BF, Khush RS, Ramaswamy P et al. . Causal inference methods to study nonrandomized, preexisting development interventions. Proc Natl Acad Sci USA 2010;107:22605–10. 10.1073/pnas.1008944107 - DOI - PMC - PubMed

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Design and rationale of a matched cohort study to assess the effectiveness of a combined household-level piped water and sanitation intervention in rural Odisha, India

Affiliations

Design and rationale of a matched cohort study to assess the effectiveness of a combined household-level piped water and sanitation intervention in rural Odisha, India

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical