Clinical trial NCT03021434: Trial of Low-cost Microbiological Water Test Kits
Official title: Cluster Randomized Trial of Low-cost Microbiological Water Test Kits
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diarrhea
E.Coli Infections
Keywords: Water Supply/standards
Water microbiology
India
Hand disinfection
Escherichia coli Infections/prevention & control
Hygiene
Health behavior
Drinking water
Informational intervention
Lead sponsor: London School of Hygiene and Tropical Medicine
Sponsor class: OTHER
Collaborators: name: Indian Institute of Technology Kanpur
First posted: 2017-01-16
Enrollment: 572
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: The present study is a cluster randomized control trial of low-cost microbiological water test kits in rural and peri-urban communities in the Kanpur region of Uttar Pradesh, India.

Detailed description: The proposed trial utilizes a cluster randomized controlled methodology, with clustering occurring at the village level. The intervention that will be tested in this cluster randomized controlled trial is informed by the development of a simple, low-cost water quality test kit developed and piloted by J. Brown and colleagues in Nagpur, Maharashtra.

There will be two intervention arms and one control/comparison arm. In all selected villages, the study team will work with local government to conduct a village-level information session on water quality and key water safety behaviours. Informational material on water safety behaviours will be distrubted to all houseohlds following this information session. In the control group, households will be visited to provide water safety informational cards and collect a drinking water sample to be analyzed in the lab. They will not receive the results of the analysis until the conclusion of the study. Households in Intervention Arm 1 (Standard Testing) will have their water sampled and analyzed in the lab, and results of the analysis will be delivered to the households. They will receive informational cards describing water purification strategies. Households in Intervention Arm 2 (Test Kits) will be provided with the materials and training needed to perform water quality testing in their own household using the newly developed testing kits. They will also receive informational cards describing water purification strategies.

Following the initial village-level information session, the study team will randomly sample households for participation in the trial. Participating households will complete a short survey on household demographics and water handling, storage, and use behaviours and a water sample will be taken and tested in the lab for fecal indicator bacteria. At an unannounced follow-up visit, roughly 1 - 2 months after enrollment, households will complete a short survey about changes in water handling, storage, and use behaviours and a second sample of household stored drinking water will be collected for laboratory analysis. The effect of the cluster randomized controlled trial on water quality will be determined by comparing arithmetic mean E. coli count from samples of household water and changes in water safety behaviours between baseline and endline.

Microbiological drinking water quality will be assessed at two time points: baseline and endline. At each visit, a 330 ml sample of household water will be collected for analysis; we will ask participants to fill the sample container as if it were a drinking cup for a child living in the household. Samples will be kept cold (on ice in a cooler) until delivery to the laboratory and thereafter stored at 4oC until processing, to begin within 8 hours of the sampling event.

Eligibility criteria: Inclusion Criteria (for villages) :

* Village located within the Kanpur district, within
* Village population between 100 and 1000 households.
* No chlorinated water sources available in the village.

Inclusion Criteria (for households) :

* Consent to participate in the study
* Contain at least one child who is between 29 days and 60 months of age at the time of enrollment

Exclusion Criteria:

* Villages that receive chlorinated water from utility services

Primary outcomes:
measure: Arithmetic mean E. coli count from sample of stored household drinking water
timeFrame: 1-2 month follow up visit post initial household information session
Secondary outcomes:
measure: Water storage, handling, and use behaviors
timeFrame: 1-2 month follow up visit post initial household information session
measure: Intervention uptake/use
timeFrame: 1-2 month follow up visit post initial household information session
Other outcomes:
Locations:
Study officials:
affiliation: London School of Hygiene and Tropical Medicine
name: Robert Dreibelbis, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, Wu Y, Sow SO, Sur D, Breiman RF, Faruque AS, Zaidi AK, Saha D, Alonso PL, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ochieng JB, Omore R, Oundo JO, Hossain A, Das SK, Ahmed S, Qureshi S, Quadri F, Adegbola RA, Antonio M, Hossain MJ, Akinsola A, Mandomando I, Nhampossa T, Acacio S, Biswas K, O'Reilly CE, Mintz ED, Berkeley LY, Muhsen K, Sommerfelt H, Robins-Browne RM, Levine MM. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet. 2013 Jul 20;382(9888):209-22. doi: 10.1016/S0140-6736(13)60844-2. Epub 2013 May 14.
citation: Million Death Study Collaborators; Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, Shet A, Ram U, Gaffey MF, Black RE, Jha P. Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet. 2010 Nov 27;376(9755):1853-60. doi: 10.1016/S0140-6736(10)61461-4. Epub 2010 Nov 12.
citation: Lakshminarayanan S, Jayalakshmy R. Diarrheal diseases among children in India: Current scenario and future perspectives. J Nat Sci Biol Med. 2015 Jan-Jun;6(1):24-8. doi: 10.4103/0976-9668.149073.
citation: Hamoudi A, Jeuland M, Lombardo S, Patil S, Pattanayak SK, Rai S. The effect of water quality testing on household behavior: evidence from an experiment in rural India. Am J Trop Med Hyg. 2012 Jul;87(1):18-22. doi: 10.4269/ajtmh.2012.12-0051.
citation: Davis J, Pickering AJ, Rogers K, Mamuya S, Boehm AB. The effects of informational interventions on household water management, hygiene behaviors, stored drinking water quality, and hand contamination in peri-urban Tanzania. Am J Trop Med Hyg. 2011 Feb;84(2):184-91. doi: 10.4269/ajtmh.2011.10-0126.
citation: Dufour AP, Strickland ER, Cabelli VJ. Membrane filter method for enumerating Escherichia coli. Appl Environ Microbiol. 1981 May;41(5):1152-8. doi: 10.1128/aem.41.5.1152-1158.1981.
citation: Brown J, Stauber C, Murphy JL, Khan A, Mu T, Elliott M, Sobsey MD. Ambient-temperature incubation for the field detection of Escherichia coli in drinking water. J Appl Microbiol. 2011 Apr;110(4):915-23. doi: 10.1111/j.1365-2672.2011.04940.x.
citation: Bain RE, Woodall C, Elliott J, Arnold BF, Tung R, Morley R, du Preez M, Bartram JK, Davis AP, Gundry SW, Pedley S. Evaluation of an Inexpensive Growth Medium for Direct Detection of Escherichia coli in Temperate and Sub-Tropical Waters. PLoS One. 2015 Oct 23;10(10):e0140997. doi: 10.1371/journal.pone.0140997. eCollection 2015.
citation: Magro G, Bain RE, Woodall CA, Matthews RL, Gundry SW, Davis AP. Synthesis and application of resorufin beta-D-glucuronide, a low-cost chromogenic substrate for detecting Escherichia coli in drinking water. Environ Sci Technol. 2014 Aug 19;48(16):9624-31. doi: 10.1021/es502319n. Epub 2014 Jul 29.
citation: Creswell, J.W. and V.L. Plano Clark, Designing and conducting mixed methods research. 2011, Los Angeles: SAGE Publications.
citation: Haas, C.N., How to average microbial densities to characterize risk. Water Research, 1996. 30(4): p. 1036-1038.
citation: Moher D, Schulz KF, Altman DG; CONSORT Group (Consolidated Standards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. J Am Podiatr Med Assoc. 2001 Sep;91(8):437-42. doi: 10.7547/87507315-91-8-437.
citation: Witte, K., Putting the fear back into fear appeals: The extended parallel process model. Communications Monographs, 1992. 59(4): p. 319-26.
citation: Hayes RJ, Bennett S. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol. 1999 Apr;28(2):319-26. doi: 10.1093/ije/28.2.319.
citation: Duflo, E., R. Glennerster, and M. Kremer, Using Randomization in Development Economics Research: A Toolkit, in T. Schultz and John Strauss, eds., Handbook of Development Economics. 2008, North Holland: Amsterdam and New York.
citation: Fleiss, J.L., Appendix: Sample-Size Determination, in The Design and Analysis of Clinical Experiments. 1999, John Wiley & Sons, Inc. p. 369-417.
citation: Zhou H, Taber C, Arcona S, Li Y. Difference-in-Differences Method in Comparative Effectiveness Research: Utility with Unbalanced Groups. Appl Health Econ Health Policy. 2016 Aug;14(4):419-429. doi: 10.1007/s40258-016-0249-y.
citation: Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004 Feb;24(2):105-12. doi: 10.1016/j.nedt.2003.10.001.
citation: Burnard P. A method of analysing interview transcripts in qualitative research. Nurse Educ Today. 1991 Dec;11(6):461-6. doi: 10.1016/0260-6917(91)90009-y.