ObjectivesInnovations to improve public sanitation facilities, especially in healthcare facilitie... more ObjectivesInnovations to improve public sanitation facilities, especially in healthcare facilities (HCFs) in low‐income countries, are limited. SaTo pans represent novel, largely untested, modifications to reduce odour and flies and improve acceptability of HCF sanitation facilities. We conducted a pilot project to evaluate acceptability, cleanliness, flies and odour within latrines in 37 HCFs in Kisumu, Kenya, randomised into intervention (SaTo pan modifications) and control arms by sub‐county and HCF level.MethodsAt baseline (pre‐intervention) and endline (>3 months after completion of SaTo pan installations in latrines in intervention HCFs), we surveyed users, cleaners and in‐charges, observed odour and cleanliness, and assessed flies using fly tape. Unadjusted difference‐in‐difference analysis compared changes from baseline to endline in patient‐reported acceptability and observed latrine conditions between intervention and control HCFs. A secondary assessment compared patien...
Background: Decentralized drinking water treatment methods generally apply membrane-based treatme... more Background: Decentralized drinking water treatment methods generally apply membrane-based treatment approaches. Ozonation of drinking water, which previously has only been possible at large centralized facilities, can now be accomplished on a small-scale using microplasma technology. The efficacy of decentralized solar-powered ozonation for drinking water treatment is not known. Methods: We established a 1,000L decentralized solar-powered water treatment system located in Kisumu County, Kenya. Highly contaminated surface water is pumped to the treatment system, which includes flocculation and filtration steps prior to ozonation. Turbidity, total coliform bacteria, and E. coli were measured at various stages of water treatment, and bacterial log reduction values (LRVs) were calculated. Results: Nine trials were conducted treating 1000L of water in three hours. Baseline turbidity and E. coli concentrations were reduced from a median of 238 nephelometric turbidity units (NTU) and 2,752...
Background: Decentralized drinking water treatment methods generally apply membrane-based treatme... more Background: Decentralized drinking water treatment methods generally apply membrane-based treatment approaches. Ozonation of drinking water, which previously has only been possible at large centralized facilities, can now be accomplished on a small-scale using microplasma technology. The efficacy of decentralized solar-powered ozonation for drinking water treatment is not known. Methods: We established a 1,000L decentralized solar-powered water treatment system located in Kisumu County, Kenya. Highly contaminated surface water is pumped to the treatment system, which includes flocculation and filtration steps prior to ozonation. Turbidity, total coliform bacteria, and E. coli were measured at various stages of water treatment, and bacterial log reduction values (LRVs) were calculated. Results: Nine trials were conducted treating 1000L of water in three hours. Baseline turbidity and E. coli concentrations were reduced from a median of 238 nephelometric turbidity units (NTU) and 2,752...
Abstract. Although anemia in preschool children is most often attributed to iron deficiency, othe... more Abstract. Although anemia in preschool children is most often attributed to iron deficiency, other nutritional, infectious, and genetic contributors are rarely concurrently measured. In a population-based, cross-sectional survey of 858 children 6–35 months of age in western Kenya, we measured hemoglobin, malaria, inflammation, sickle cell, a-thalassemia, iron deficiency, vitamin A deficiency, anthropometry, and socio-demographic characteristics. Anemia (Hb < 11 g/dL) and severe anemia (Hb < 7 g/dL) prevalence ratios (PRs) for each exposure were determined using multivariable modeling. Anemia (71.8%) and severe anemia (8.4%) were common. Characteristics most strongly associ-ated with anemia were malaria (PR: 1.7; 95 % confidence interval [CI] = 1.5–1.9), iron deficiency (1.3; 1.2–1.4), and homozygous a-thalassemia (1.3; 1.1–1.4). Characteristics associated with severe anemia were malaria (10.2; 3.5–29.3), inflammation (6.7; 2.3–19.4), and stunting (1.6; 1.0–2.4). Overall 16.8 %...
Journal of Water Sanitation and Hygiene for Development, 2020
Author(s): Kim, Sunkyung; Laughlin, Mark; Morris, Jamae; Otieno, Ronald; Odhiambo, Aloyce; Oremo,... more Author(s): Kim, Sunkyung; Laughlin, Mark; Morris, Jamae; Otieno, Ronald; Odhiambo, Aloyce; Oremo, Jared; Graham, Jay; Hirai, Mitsuaki; Wells, Emma; Basler, Colin; Okello, Anna; Matanock, Almea; Eleveld, Alie; Quick, Robert | Abstract: Abstract The Safe Water and AIDS Project (SWAP), a non-governmental organization in western Kenya, opened kiosks run as businesses by community health promoters (CHPs) to increase access to health products among poor rural families. We conducted a baseline survey in 2014 before kiosks opened, and a post-intervention follow-up in 2016, enrolling 1,517 households with children l18 months old. From baseline to follow-up, we observed increases in reported exposure to the SWAP program (3–11%, p = 0.01) and reported purchases of any SWAP product (3–10%, p l 0.01). The percent of households with confirmed water treatment (detectable free chlorine residual (FCR) g0.2 mg/ml) was similar from baseline to follow-up (7% vs. 8%, p = 0.57). The odds of reported diar...
Despite multiple studies demonstrating the effectiveness of household water treatment with chlori... more Despite multiple studies demonstrating the effectiveness of household water treatment with chlorine in disinfecting water and preventing diarrhea, social marketing of this intervention in low- and middle-income countries has resulted in only modest uptake. In a cluster randomized trial in Vihiga district, western Kenya, we compared uptake of household water treatment with chlorine among six villages served by community vendors trained in standard social marketing plus education through listening (ETL), an innovative behavior change method, and six villages served by community vendors trained in standard social marketing only. Water treatment uptake, water quality, and childhood diarrhea were measured over 6 months and compared between the two groups of villages. During the 6-month period, we found no association between ETL exposure and reported and confirmed household water treatment with chlorine. In both groups (ETL and comparison), reported use of water treatment was low and did...
Journal of Health Care for the Poor and Underserved
We evaluated whether antenatal supply-side and demand-side interventions in 10 public health care... more We evaluated whether antenatal supply-side and demand-side interventions in 10 public health care facilities (HCFs) increased the percentage of women who had four or more antenatal care (ANC4+) visits and HCF deliveries from baseline to follow-up compared with women in 10 public control HCFs in Kenya. We compared maternal registry data during baseline and follow-up periods between public intervention and public control HCFs; we added seven private intervention HCFs and five private control HCFs to evaluate an unanticipated pilot insurance program that enabled women to use private intervention HCFs. From baseline to follow-up, ANC4+ visits and HCF deliveries in public intervention HCFs were 1.64 and 1.19 times greater, respectively, than in public control HCFs. Health care facility deliveries were 1.5 times higher in private intervention HCFs than public intervention HCFs. Results suggested that the combined antenatal and insurance interventions motivated increased ANC4+ visits and HCF deliveries. Women appeared to prefer private HCFs for delivery.
Financially sustainable strategies are needed to increase access to safe drinking water in low-in... more Financially sustainable strategies are needed to increase access to safe drinking water in low-income settings. We designed a novel in-line chlorine doser that employs the Venturi principle to automatically add liquid chlorine at the point of water collection (tap outflows). The Venturi does not require electricity or moving parts, and users do not have to change the way they typically collect water. We field-tested the Venturi and assessed its technical performance and sales viability at water kiosks in Kisumu County, Kenya. We offered kiosk owners 6-month service packages to lease or lease-to-own the device; 27% of kiosks given a sales pitch committed to a service package. All but one kiosk paid in full during the 6-month service period and more than two-thirds purchased the device with payments totaling >$250 USD per kiosk. Kiosk customers could choose to purchase chlorinated or unchlorinated water from separate taps; 66% reported buying chlorinated water. Kiosk taps fitted wi...
Background: Decentralized drinking water treatment methods generally apply membrane-based treatme... more Background: Decentralized drinking water treatment methods generally apply membrane-based treatment approaches. Ozonation of drinking water, which previously has only been possible at large centralized facilities, can now be accomplished on a small-scale using microplasma technology. The efficacy of decentralized solar-powered ozonation for drinking water treatment is not known. Methods: We established a 1,000L decentralized solar-powered water treatment system located in Kisumu County, Kenya. Highly contaminated surface water is pumped to the treatment system, which includes flocculation and filtration steps prior to ozonation. Turbidity, total coliform bacteria, and E. coli were measured at various stages of water treatment, and bacterial log reduction values (LRVs) were calculated. Results: Nine trials were conducted treating 1000L of water in three hours. Baseline turbidity and E. coli concentrations were reduced from a median of 238 nephelometric turbidity units (NTU) and 2,752...
International Journal of Environmental Research and Public Health
Ozonation is widely used in high-income countries for water disinfection in centralized treatment... more Ozonation is widely used in high-income countries for water disinfection in centralized treatment facilities. New microplasma technology has reduced the energy requirements for ozone generation dramatically, such that a 15-watt solar panel is sufficient to produce small quantities of ozone. This technology has not been used previously for point-of-use drinking water treatment. We conducted a series of assessments of this technology, both in the laboratory and in homes of residents of a village in western Kenya, to estimate system efficacy and to determine if the solar-powered point-of-use water ozonation system appears safe and acceptable to end-users. In the laboratory, two hours of point-of-use ozonation reduced E. coli in 120 L of wastewater by a mean (standard deviation) of 2.3 (0.84) log-orders of magnitude and F+ coliphage by 1.54 (0.72). Based on laboratory efficacy, 10 families in Western Kenya used the system to treat 20 L of household stored water for two hours on a daily ...
An antimicrobial towel designed for repeated use was developed to prevent recontamination of wash... more An antimicrobial towel designed for repeated use was developed to prevent recontamination of washed hands after drying. This field trial in Kenya found that nearly all antimicrobial hand towels and untreated control towels were contaminated with E. coli after household use. The antimicrobial towel did not inactivate E. coli.
Efforts to provide safe water are challenged by recontamination and regrowth of pathogens in trea... more Efforts to provide safe water are challenged by recontamination and regrowth of pathogens in treated water during storage. This study evaluated the potential of metallic silver with a chemically etched surface to reduce recontamination risks during water storage in ceramic water filters. Batch experiments were conducted in the laboratory with water storage buckets containing three configurations of varying amounts of silver. Field trials in a rural area in Kenya assessed the effect of the same configurations in the storage buckets of locally produced ceramic pot filters without colloidal silver coating. The tests revealed that the etched silver slightly reduced microbiological recontamination risks during water storage despite the low diffusion of silver ions (<5 µg Ag/L). The effect was strongly influenced by water chemistry parameters. A statistically significant difference in the removal of E. coli (Δ Log Removal Value (LRV) = 0.6) and total coliforms (Δ LRV = 1.7) was found b...
Household water treatment with chlorine can improve microbiological quality and reduce diarrhea. ... more Household water treatment with chlorine can improve microbiological quality and reduce diarrhea. Chlorination is typically assessed using free chlorine residual (FCR), with a lower acceptable limit of 0.2 mg/L, however, accurate measurement of FCR is challenging with turbid water. To compare potential measures of adherence to treatment and water quality, we chlorinated recently-collected water in rural Kenyan households and measured total chlorine residual (TCR), FCR, oxidation reduction potential (ORP), and E. coli concentration over 72 h in clay and plastic containers. Results showed that 1) ORP served as a useful proxy for chlorination in plastic containers up to 24 h; 2) most stored water samples disinfected by chlorination remained significantly less contaminated than source water for up to 72 h, even in the absence of FCR; 3) TCR may be a useful proxy indicator of microbiologic water quality because it confirms previous chlorination and is associated with a lower risk of E. coli contamination compared to untreated source water; and 4) chlorination is more effective in plastic than clay containers presumably because of lower chlorine demand in plastic.
The American journal of tropical medicine and hygiene, Jan 7, 2015
To assess the health impact of reusable, antimicrobial hand towels, we conducted a cluster random... more To assess the health impact of reusable, antimicrobial hand towels, we conducted a cluster randomized, yearlong field trial. At baseline, we surveyed mothers, and gave four towels plus hygiene education to intervention households and education alone to controls. At biweekly home visits, we asked about infections in children < 2 years old and tested post-handwashing hand rinse samples of 20% of mothers for Escherichia coli. At study's conclusion, we tested 50% of towels for E. coli. Baseline characteristics between 188 intervention and 181 control households were similar. Intervention and control children had similar rates of diarrhea (1.47 versus 1.48, P = 0.99), respiratory infections (1.38 versus 1.48, P = 0.92), skin infections (1.76 versus 1.79, P = 0.81), and subjective fever (2.62 versus 3.40, P = 0.04) per 100 person-visits. Post-handwashing hand contamination was similar; 67% of towels exhibited E. coli contamination. Antimicrobial hand towels became contaminated over...
Background: Maternal syphilis infection causes perinatal death or disability in about 60% of untr... more Background: Maternal syphilis infection causes perinatal death or disability in about 60% of untreated pregnancies. Nyanza Province has the highest syphilis burden (2.3% among reproductive-aged women) and second highest neonatal mortality rate (39 per 1000 live births) among Kenya’s administrative provinces. Many pregnant women receive their antenatal care (ANC) at facilities not offering syphilis testing. We evaluated how integrating rapid syphilis tests (RSTs) into routine ANC services affected syphilis test uptake in 2 rural districts in Nyanza. Methods: In February 2011, nurses from 25 rural clinics were trained on using RSTs and recording results, and from March 2011–February 2012 RSTs and penicillin treatment kits were provided at no charge to ANC attendees (“intervention”). We used antenatal registry data from 8 priority clinics to compare syphilis and HIV testing and syphilis treatment during the 12 month intervals before and after training and provision of RSTs. Results: Sy...
We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into ro... more We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into routine antenatal clinic (ANC) services in two rural districts in Nyanza Province, Kenya. In February 2011, nurses from 25 clinics were trained in using RSTs and documenting test results and treatment. During March 2011–February 2012, free RSTs and treatment kits were provided to clinics for use during ANC visits. We analyzed ANC registry data from eight clinics during the 12-month periods before and during RST program implementation and compared syphilis testing, diagnosis, and treatment during the two periods. Syphilis testing at first ANC visit increased from 18% (279 of 1,586 attendees) before the intervention to 70% (1,123 of 1,614 attendees) during the intervention (P<0.001); 35 women (3%) tested positive during the intervention period compared with 1 (<1%) before (P<0.001). Syphilis treatment was not recorded according to training recommendations; seven clinics identified 2...
Journal of Water Sanitation and Hygiene for Development, 2020
In developing countries, most households transport water from distant sources, placing physical b... more In developing countries, most households transport water from distant sources, placing physical burdens on women and children, who commonly carry water on their heads. A lightweight backpack was developed to alleviate physical stress from water carriage and provide a safe storage container. In 2015, we conducted a baseline survey among 251 Kenyan households with children <5 years old, distributed one backpack per household, and made 6 monthly home visits to ask about backpack use. At baseline, the median reported water collection time was 40 minutes/round trip; 80% of households reported collecting water daily (median 3 times/day). At follow-up visits, respondents reported backpack use to carry water ranged from 4% to 20% in the previous day; reported backpack use for water storage in the previous day ranged from 31% to 67%. Pain from water carriage was reported at 9% of all followup visits. The odds of backpack use in the past day to collect water were lower during rainy season ...
ObjectivesInnovations to improve public sanitation facilities, especially in healthcare facilitie... more ObjectivesInnovations to improve public sanitation facilities, especially in healthcare facilities (HCFs) in low‐income countries, are limited. SaTo pans represent novel, largely untested, modifications to reduce odour and flies and improve acceptability of HCF sanitation facilities. We conducted a pilot project to evaluate acceptability, cleanliness, flies and odour within latrines in 37 HCFs in Kisumu, Kenya, randomised into intervention (SaTo pan modifications) and control arms by sub‐county and HCF level.MethodsAt baseline (pre‐intervention) and endline (>3 months after completion of SaTo pan installations in latrines in intervention HCFs), we surveyed users, cleaners and in‐charges, observed odour and cleanliness, and assessed flies using fly tape. Unadjusted difference‐in‐difference analysis compared changes from baseline to endline in patient‐reported acceptability and observed latrine conditions between intervention and control HCFs. A secondary assessment compared patien...
Background: Decentralized drinking water treatment methods generally apply membrane-based treatme... more Background: Decentralized drinking water treatment methods generally apply membrane-based treatment approaches. Ozonation of drinking water, which previously has only been possible at large centralized facilities, can now be accomplished on a small-scale using microplasma technology. The efficacy of decentralized solar-powered ozonation for drinking water treatment is not known. Methods: We established a 1,000L decentralized solar-powered water treatment system located in Kisumu County, Kenya. Highly contaminated surface water is pumped to the treatment system, which includes flocculation and filtration steps prior to ozonation. Turbidity, total coliform bacteria, and E. coli were measured at various stages of water treatment, and bacterial log reduction values (LRVs) were calculated. Results: Nine trials were conducted treating 1000L of water in three hours. Baseline turbidity and E. coli concentrations were reduced from a median of 238 nephelometric turbidity units (NTU) and 2,752...
Background: Decentralized drinking water treatment methods generally apply membrane-based treatme... more Background: Decentralized drinking water treatment methods generally apply membrane-based treatment approaches. Ozonation of drinking water, which previously has only been possible at large centralized facilities, can now be accomplished on a small-scale using microplasma technology. The efficacy of decentralized solar-powered ozonation for drinking water treatment is not known. Methods: We established a 1,000L decentralized solar-powered water treatment system located in Kisumu County, Kenya. Highly contaminated surface water is pumped to the treatment system, which includes flocculation and filtration steps prior to ozonation. Turbidity, total coliform bacteria, and E. coli were measured at various stages of water treatment, and bacterial log reduction values (LRVs) were calculated. Results: Nine trials were conducted treating 1000L of water in three hours. Baseline turbidity and E. coli concentrations were reduced from a median of 238 nephelometric turbidity units (NTU) and 2,752...
Abstract. Although anemia in preschool children is most often attributed to iron deficiency, othe... more Abstract. Although anemia in preschool children is most often attributed to iron deficiency, other nutritional, infectious, and genetic contributors are rarely concurrently measured. In a population-based, cross-sectional survey of 858 children 6–35 months of age in western Kenya, we measured hemoglobin, malaria, inflammation, sickle cell, a-thalassemia, iron deficiency, vitamin A deficiency, anthropometry, and socio-demographic characteristics. Anemia (Hb < 11 g/dL) and severe anemia (Hb < 7 g/dL) prevalence ratios (PRs) for each exposure were determined using multivariable modeling. Anemia (71.8%) and severe anemia (8.4%) were common. Characteristics most strongly associ-ated with anemia were malaria (PR: 1.7; 95 % confidence interval [CI] = 1.5–1.9), iron deficiency (1.3; 1.2–1.4), and homozygous a-thalassemia (1.3; 1.1–1.4). Characteristics associated with severe anemia were malaria (10.2; 3.5–29.3), inflammation (6.7; 2.3–19.4), and stunting (1.6; 1.0–2.4). Overall 16.8 %...
Journal of Water Sanitation and Hygiene for Development, 2020
Author(s): Kim, Sunkyung; Laughlin, Mark; Morris, Jamae; Otieno, Ronald; Odhiambo, Aloyce; Oremo,... more Author(s): Kim, Sunkyung; Laughlin, Mark; Morris, Jamae; Otieno, Ronald; Odhiambo, Aloyce; Oremo, Jared; Graham, Jay; Hirai, Mitsuaki; Wells, Emma; Basler, Colin; Okello, Anna; Matanock, Almea; Eleveld, Alie; Quick, Robert | Abstract: Abstract The Safe Water and AIDS Project (SWAP), a non-governmental organization in western Kenya, opened kiosks run as businesses by community health promoters (CHPs) to increase access to health products among poor rural families. We conducted a baseline survey in 2014 before kiosks opened, and a post-intervention follow-up in 2016, enrolling 1,517 households with children l18 months old. From baseline to follow-up, we observed increases in reported exposure to the SWAP program (3–11%, p = 0.01) and reported purchases of any SWAP product (3–10%, p l 0.01). The percent of households with confirmed water treatment (detectable free chlorine residual (FCR) g0.2 mg/ml) was similar from baseline to follow-up (7% vs. 8%, p = 0.57). The odds of reported diar...
Despite multiple studies demonstrating the effectiveness of household water treatment with chlori... more Despite multiple studies demonstrating the effectiveness of household water treatment with chlorine in disinfecting water and preventing diarrhea, social marketing of this intervention in low- and middle-income countries has resulted in only modest uptake. In a cluster randomized trial in Vihiga district, western Kenya, we compared uptake of household water treatment with chlorine among six villages served by community vendors trained in standard social marketing plus education through listening (ETL), an innovative behavior change method, and six villages served by community vendors trained in standard social marketing only. Water treatment uptake, water quality, and childhood diarrhea were measured over 6 months and compared between the two groups of villages. During the 6-month period, we found no association between ETL exposure and reported and confirmed household water treatment with chlorine. In both groups (ETL and comparison), reported use of water treatment was low and did...
Journal of Health Care for the Poor and Underserved
We evaluated whether antenatal supply-side and demand-side interventions in 10 public health care... more We evaluated whether antenatal supply-side and demand-side interventions in 10 public health care facilities (HCFs) increased the percentage of women who had four or more antenatal care (ANC4+) visits and HCF deliveries from baseline to follow-up compared with women in 10 public control HCFs in Kenya. We compared maternal registry data during baseline and follow-up periods between public intervention and public control HCFs; we added seven private intervention HCFs and five private control HCFs to evaluate an unanticipated pilot insurance program that enabled women to use private intervention HCFs. From baseline to follow-up, ANC4+ visits and HCF deliveries in public intervention HCFs were 1.64 and 1.19 times greater, respectively, than in public control HCFs. Health care facility deliveries were 1.5 times higher in private intervention HCFs than public intervention HCFs. Results suggested that the combined antenatal and insurance interventions motivated increased ANC4+ visits and HCF deliveries. Women appeared to prefer private HCFs for delivery.
Financially sustainable strategies are needed to increase access to safe drinking water in low-in... more Financially sustainable strategies are needed to increase access to safe drinking water in low-income settings. We designed a novel in-line chlorine doser that employs the Venturi principle to automatically add liquid chlorine at the point of water collection (tap outflows). The Venturi does not require electricity or moving parts, and users do not have to change the way they typically collect water. We field-tested the Venturi and assessed its technical performance and sales viability at water kiosks in Kisumu County, Kenya. We offered kiosk owners 6-month service packages to lease or lease-to-own the device; 27% of kiosks given a sales pitch committed to a service package. All but one kiosk paid in full during the 6-month service period and more than two-thirds purchased the device with payments totaling >$250 USD per kiosk. Kiosk customers could choose to purchase chlorinated or unchlorinated water from separate taps; 66% reported buying chlorinated water. Kiosk taps fitted wi...
Background: Decentralized drinking water treatment methods generally apply membrane-based treatme... more Background: Decentralized drinking water treatment methods generally apply membrane-based treatment approaches. Ozonation of drinking water, which previously has only been possible at large centralized facilities, can now be accomplished on a small-scale using microplasma technology. The efficacy of decentralized solar-powered ozonation for drinking water treatment is not known. Methods: We established a 1,000L decentralized solar-powered water treatment system located in Kisumu County, Kenya. Highly contaminated surface water is pumped to the treatment system, which includes flocculation and filtration steps prior to ozonation. Turbidity, total coliform bacteria, and E. coli were measured at various stages of water treatment, and bacterial log reduction values (LRVs) were calculated. Results: Nine trials were conducted treating 1000L of water in three hours. Baseline turbidity and E. coli concentrations were reduced from a median of 238 nephelometric turbidity units (NTU) and 2,752...
International Journal of Environmental Research and Public Health
Ozonation is widely used in high-income countries for water disinfection in centralized treatment... more Ozonation is widely used in high-income countries for water disinfection in centralized treatment facilities. New microplasma technology has reduced the energy requirements for ozone generation dramatically, such that a 15-watt solar panel is sufficient to produce small quantities of ozone. This technology has not been used previously for point-of-use drinking water treatment. We conducted a series of assessments of this technology, both in the laboratory and in homes of residents of a village in western Kenya, to estimate system efficacy and to determine if the solar-powered point-of-use water ozonation system appears safe and acceptable to end-users. In the laboratory, two hours of point-of-use ozonation reduced E. coli in 120 L of wastewater by a mean (standard deviation) of 2.3 (0.84) log-orders of magnitude and F+ coliphage by 1.54 (0.72). Based on laboratory efficacy, 10 families in Western Kenya used the system to treat 20 L of household stored water for two hours on a daily ...
An antimicrobial towel designed for repeated use was developed to prevent recontamination of wash... more An antimicrobial towel designed for repeated use was developed to prevent recontamination of washed hands after drying. This field trial in Kenya found that nearly all antimicrobial hand towels and untreated control towels were contaminated with E. coli after household use. The antimicrobial towel did not inactivate E. coli.
Efforts to provide safe water are challenged by recontamination and regrowth of pathogens in trea... more Efforts to provide safe water are challenged by recontamination and regrowth of pathogens in treated water during storage. This study evaluated the potential of metallic silver with a chemically etched surface to reduce recontamination risks during water storage in ceramic water filters. Batch experiments were conducted in the laboratory with water storage buckets containing three configurations of varying amounts of silver. Field trials in a rural area in Kenya assessed the effect of the same configurations in the storage buckets of locally produced ceramic pot filters without colloidal silver coating. The tests revealed that the etched silver slightly reduced microbiological recontamination risks during water storage despite the low diffusion of silver ions (<5 µg Ag/L). The effect was strongly influenced by water chemistry parameters. A statistically significant difference in the removal of E. coli (Δ Log Removal Value (LRV) = 0.6) and total coliforms (Δ LRV = 1.7) was found b...
Household water treatment with chlorine can improve microbiological quality and reduce diarrhea. ... more Household water treatment with chlorine can improve microbiological quality and reduce diarrhea. Chlorination is typically assessed using free chlorine residual (FCR), with a lower acceptable limit of 0.2 mg/L, however, accurate measurement of FCR is challenging with turbid water. To compare potential measures of adherence to treatment and water quality, we chlorinated recently-collected water in rural Kenyan households and measured total chlorine residual (TCR), FCR, oxidation reduction potential (ORP), and E. coli concentration over 72 h in clay and plastic containers. Results showed that 1) ORP served as a useful proxy for chlorination in plastic containers up to 24 h; 2) most stored water samples disinfected by chlorination remained significantly less contaminated than source water for up to 72 h, even in the absence of FCR; 3) TCR may be a useful proxy indicator of microbiologic water quality because it confirms previous chlorination and is associated with a lower risk of E. coli contamination compared to untreated source water; and 4) chlorination is more effective in plastic than clay containers presumably because of lower chlorine demand in plastic.
The American journal of tropical medicine and hygiene, Jan 7, 2015
To assess the health impact of reusable, antimicrobial hand towels, we conducted a cluster random... more To assess the health impact of reusable, antimicrobial hand towels, we conducted a cluster randomized, yearlong field trial. At baseline, we surveyed mothers, and gave four towels plus hygiene education to intervention households and education alone to controls. At biweekly home visits, we asked about infections in children < 2 years old and tested post-handwashing hand rinse samples of 20% of mothers for Escherichia coli. At study's conclusion, we tested 50% of towels for E. coli. Baseline characteristics between 188 intervention and 181 control households were similar. Intervention and control children had similar rates of diarrhea (1.47 versus 1.48, P = 0.99), respiratory infections (1.38 versus 1.48, P = 0.92), skin infections (1.76 versus 1.79, P = 0.81), and subjective fever (2.62 versus 3.40, P = 0.04) per 100 person-visits. Post-handwashing hand contamination was similar; 67% of towels exhibited E. coli contamination. Antimicrobial hand towels became contaminated over...
Background: Maternal syphilis infection causes perinatal death or disability in about 60% of untr... more Background: Maternal syphilis infection causes perinatal death or disability in about 60% of untreated pregnancies. Nyanza Province has the highest syphilis burden (2.3% among reproductive-aged women) and second highest neonatal mortality rate (39 per 1000 live births) among Kenya’s administrative provinces. Many pregnant women receive their antenatal care (ANC) at facilities not offering syphilis testing. We evaluated how integrating rapid syphilis tests (RSTs) into routine ANC services affected syphilis test uptake in 2 rural districts in Nyanza. Methods: In February 2011, nurses from 25 rural clinics were trained on using RSTs and recording results, and from March 2011–February 2012 RSTs and penicillin treatment kits were provided at no charge to ANC attendees (“intervention”). We used antenatal registry data from 8 priority clinics to compare syphilis and HIV testing and syphilis treatment during the 12 month intervals before and after training and provision of RSTs. Results: Sy...
We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into ro... more We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into routine antenatal clinic (ANC) services in two rural districts in Nyanza Province, Kenya. In February 2011, nurses from 25 clinics were trained in using RSTs and documenting test results and treatment. During March 2011–February 2012, free RSTs and treatment kits were provided to clinics for use during ANC visits. We analyzed ANC registry data from eight clinics during the 12-month periods before and during RST program implementation and compared syphilis testing, diagnosis, and treatment during the two periods. Syphilis testing at first ANC visit increased from 18% (279 of 1,586 attendees) before the intervention to 70% (1,123 of 1,614 attendees) during the intervention (P<0.001); 35 women (3%) tested positive during the intervention period compared with 1 (<1%) before (P<0.001). Syphilis treatment was not recorded according to training recommendations; seven clinics identified 2...
Journal of Water Sanitation and Hygiene for Development, 2020
In developing countries, most households transport water from distant sources, placing physical b... more In developing countries, most households transport water from distant sources, placing physical burdens on women and children, who commonly carry water on their heads. A lightweight backpack was developed to alleviate physical stress from water carriage and provide a safe storage container. In 2015, we conducted a baseline survey among 251 Kenyan households with children <5 years old, distributed one backpack per household, and made 6 monthly home visits to ask about backpack use. At baseline, the median reported water collection time was 40 minutes/round trip; 80% of households reported collecting water daily (median 3 times/day). At follow-up visits, respondents reported backpack use to carry water ranged from 4% to 20% in the previous day; reported backpack use for water storage in the previous day ranged from 31% to 67%. Pain from water carriage was reported at 9% of all followup visits. The odds of backpack use in the past day to collect water were lower during rainy season ...
Uploads
Papers by Jared Oremo