***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective To compare the effect on prevalence of diarrhoea and mortality of household based treatment of drinking water with flocculant-disinfectant , sodium hypochlorite , and st and ard practice s in areas with turbid water source in Africa . Design Cluster r and omised controlled trial over 20 weeks . Setting Family compounds , each containing several houses , in rural western Kenya . Participants 6650 people in 605 family compounds . Intervention Water treatment : flocculant-disinfectant , sodium hypochlorite , and usual practice ( control ) . Main outcome measures Prevalence of diarrhoea and all cause mortality . Escherichia coli concentration , free residual chlorine concentration , and turbidity in household drinking water as surrogates for effectiveness of water treatment . Results In children < 2 years old , compared with those in the control compounds , the absolute difference in prevalence of diarrhoea was –25 % in the flocculant-disinfectant arm ( 95 % confidence interval –40 to –5 ) and –17 % in the sodium hypochlorite arm ( –34 to 4 ) . In all age groups compared with control , the absolute difference in prevalence was –19 % in the flocculant-disinfectant arm ( –34 to –2 ) and –26 % in the sodium hypochlorite arm ( –39 to –9 ) . There were significantly fewer deaths in the intervention compounds than in the control compounds ( relative risk of death 0.58 , P = 0.036 ) . Fourteen per cent of water sample s from control compounds had E coli concentrations < 1 CFU/100 ml compared with 82 % in flocculant-disinfectant and 78 % in sodium hypochlorite compounds . The mean turbidity of drinking water was 8 nephelometric turbidity units ( NTU ) in flocculant-disinfectant households , compared with 55 NTU in the two other compounds ( P < 0.001 ) . Conclusions In areas of turbid water , flocculant-disinfectant was associated with a significant reduction in  diarrhoea among children < 2 years . This health benefit , combined with a significant reduction in turbidity , suggests that the flocculant-disinfectant is well suited to areas with highly contaminated and turbid water An estimated 1 billion persons in low-income countries do not have access to improved drinking water . Chlorine , a useful water treatment agent , is less effective in turbid water , and lacks a visible effect , limiting its acceptability . A product incorporating precipitation , coagulation , flocculation , and chlorination technology ( combined product ) to reduce microbial , organic and heavy metal contaminants in water was evaluated . The combined product 's microbiological efficacy in Guatemalan villagers ' households was evaluated . One hundred r and omly selected households from four neighboring Guatemalan villages were enrolled . Three groups received the combined product and either the Centers for Disease Control ( CDC ) water storage vessel , a covered bucket with spigot , or no vessel . One group received chlorine bleach and the CDC water storage vessel , and one group no intervention . Household water sample s were collected for 4 weeks and Escherichia coli , chlorine , and turbidity levels were measured . Potable water was defined as having less than one E. coli per 100 ml . Eight ( 8 % ) baseline water sample s were potable . Follow-up water sample s were more likely to be potable than control sample s ( combined product and traditional vessel 83 % ; combined product and CDC vessel 92 % ; combined product and covered bucket with spigot 93 % ; chlorine and CDC vessel 92 % ; versus control 5 % ) . Among combined product users , 98 % reported improved water clarity compared with 45 % of chlorine bleach users ( p < 0.0001 ) . The combined product technology improved water potability as effectively as chlorine bleach ; improved water clarity could motivate more persons to effectively treat their water We conducted a study to determine if use of a new flocculant-disinfectant home water treatment reduced diarrhea . We r and omly assigned 492 rural Guatemalan households to five different water treatment groups : flocculant-disinfectant , flocculant-disinfectant plus a customized vessel , bleach , bleach plus a vessel , and control . During one year of observation , residents of control households had 4.31 episodes of diarrhea per 100 person-weeks , whereas the incidence of diarrhea was 24 % lower among residents of households receiving flocculant-disinfectant , 29 % lower among those receiving flocculant-disinfectant plus vessel , 25 % lower among those receiving bleach , and 12 % lower among households receiving bleach plus vessel . In unannounced evaluations of home drinking water , free chlorine was detected in sample s from 27 % of flocculant-disinfectant households , 35 % of flocculant-disinfectant plus vessel households , 35 % of bleach households , and 43 % of bleach plus vessel households . In a setting where diarrhea was a leading cause of death , intermittent use of home water treatment with flocculant-disinfectant decreased the incidence of diarrhea OBJECTIVE This study was undertaken to assess the ability of a water container with a cover and a spout to prevent household contamination of water in a Malawian refugee camp . METHODS A r and omized trial was conducted in a refugee population that had experienced repeated outbreaks of cholera and diarrhoea and where contamination of water in the home was found to be a significant cause of cholera . Four hundred Mozambican refugee households were systematic ally identified and followed over a 4-month period , one fourth of the households were r and omly assigned to exclusively use the improved container for water collection . FINDINGS Water flowing from the source wells had little or no microbial contamination although the water collectors quickly contaminated their water , primarily through contact with their h and s. Analysis of water sample s demonstrated that there was a 69 % reduction in the geometric mean of faecal coliform levels in household water and 31 % less diarrhoeal disease ( P = 0.06 ) in children under 5 years of age among the group using the improved bucket . Regression models examining diarrhoea among under 5-year-olds confirmed the protective effect of the bucket and found that visible faeces in the family latrine and the presence of animals were significantly associated with an increased diarrhoeal incidence in children . CONCLUSION Household contamination of drinking-water significantly contributed to diarrhoea in this population . Proper chlorination is a less expensive and more effective means of water quality protection in comparison with the improved bucket , but was unpopular and rarely utilized by the camp inhabitants A water quality intervention that consists of water treatment , safe storage , and community education was field tested in Kitwe , Zambia . A total of 166 intervention households were r and omly selected from one community and 94 control households from another . Baseline surveys were conducted and the intervention was distributed . Weekly active diarrhea surveillance , biweekly water testing , and a follow-up survey were conducted . Compliance was high in intervention households : 97 % reported using disinfectant and 72 - 95 % had measurable chlorine in their water in biweekly testing . The percentage of intervention households storing water safely increased from 41.5 % to 89.2 % . Stored water in intervention households was significantly less contaminated with Escherichia coli than water in control households ( P < 0.001 ) . Diarrheal disease risk for individuals in intervention households was 48 % lower than for controls ( 95 % confidence interval = 0.3 , 0.9 ) . This intervention is a useful tool for preventing waterborne diseases in families in developing countries who lack access to potable water A novel water quality intervention that consists of point-of-use water disinfection , safe storage and community education was field tested in Bolivia . A total of 127 households in two periurban communities were r and omized into intervention and control groups , surveyed and the intervention was distributed . Monthly water quality testing and weekly diarrhoea surveillance were conducted . Over a 5-month period , intervention households had 44 % fewer diarrhoea episodes than control households ( P = 0.002 ) . Infants < 1 year old ( P = 0.05 ) and children 5 - 14 years old ( P = 0.01 ) in intervention households had significantly less diarrhoea than control children . Campylobacter was less commonly isolated from intervention than control patients ( P = 0.02 ) . Stored water in intervention households was less contaminated with Escherichia coli than stored water in control households ( P < 0.0001 ) . Intervention households exhibited less E. coli contamination of stored water and less diarrhoea than control households . This promising new strategy may have broad applicability for waterborne disease prevention OBJECTIVES To evaluate the effectiveness of point of use water treatment with flocculent-disinfectant on reducing  diarrhoea  and the additional benefit of promoting h and washing with soap . METHODS The study was conducted in squatter settlements of Karachi , Pakistan , where diarrhoea is a leading cause of childhood death . Interventions were r and omly assigned to 47 neighbourhoods . Households in 10 neighbourhoods received diluted bleach and a water vessel ; nine neighbourhoods received soap and were encouraged to wash h and s ; nine neighbourhoods received flocculent-disinfectant water treatment and a water vessel ; 10 neighbourhoods received disinfectant-disinfectant water treatment and soap and were encouraged to wash h and s ; and nine neighbourhoods were followed as controls . Field workers visited households at least once a week from April to December 2003 to promote use of the interventions and to collect data on diarrhoea . RESULTS Study participants in control neighbourhoods had diarrhoea on 5.2 % of days . Compared to controls , participants living in intervention neighbourhoods had a lower prevalence of diarrhoea : 55 % ( 95 % CI 17 % , 80 % ) lower in bleach and water vessel neighbourhoods , 51 % ( 95 % CI 12 % , 76 % ) lower in h and washing promotion with soap neighbourhoods , 64 % lower ( 95 % CI 29 % , 90 % ) in disinfectant-disinfectant neighbourhoods , and 55 % ( 95 % CI 18 % , 80 % ) lower in disinfectant-disinfectant plus h and washing with soap neighbourhoods . CONCLUSIONS With an intense community-based intervention and supplies provided free of cost , each of the home-based interventions significantly reduced diarrhoea . There was no benefit by combining h and washing promotion with water treatment OBJECTIVE To examine the effect of a new point-of-use treatment for drinking-water , a commercially developed flocculant-disinfectant , on the  prevalence of diarrhoea in children . METHODS We conducted a r and omized controlled trial among 514 rural Guatemalan households , divided into 42 neighbourhood clusters , for 13 weeks , from 4 November 2002 through 31 January 2003 . Clusters assigned to water treatment with the flocculant-disinfectant were compared with those using their usual water-h and ling practice s. The longitudinal prevalence of diarrhoea was calculated as the proportion of total days with diarrhoea divided by the total number of days of observation . The prevalence of diarrhoea was compared using the Wilcoxon rank-sum test . FINDINGS The 1702 people in households receiving the disinfectant had a prevalence of diarrhoea  that was 40 % lower than that among the 1699 people using st and ard water-h and ling practice s ( 0.9 % versus 1.5 % ; P = 0.001 ) . In households using the flocculant-disinfectant , children < 1 year of age had a 39 % lower prevalence of diarrhoea than those in households using their st and ard practice s ( 3.7 % versus 6.0 % ; P = 0.005 ) . CONCLUSION In setting s where families rarely treat drinking-water , we introduced a novel flocculant-disinfectant that reduced the longitudinal prevalence of diarrhoea , especially among children aged < 1 year , among whom diarrhoea has been strongly associated with mortality . Successful introduction and use of this product could contribute to preventing diarrhoeal disease globally During the period September 1991 to February 1992 st and ard chlorination packages of calcium hypochloride were provided for the first time to 171 families residing in the catchment area of the Sabt-Bany Bishr Primary Health Care Centre in the rural areas of the Asir region , south-western Saudi Arabia . The villagers added the packages to their home storage water tanks each time they added water from the 220 nearby wells . Analysis of the water sample s taken from these wells showed that all of them were bacteriologically unfit for human use . By the end of the study period there were no bacteriologically unfit water sample s taken from the tanks of the participating families . Children under 5 years of age whose families were not using chlorinated water had twice the risk of diarrhoea compared to children from the participating families ( odds ratio = 1.98 , P = 0.047 ) . The use of chlorinated water was associated with a 48 % reduction in diarrhoea . These results indicate that the chlorination of water can be successfully carried out locally in rural areas to improve the health of the population In March 1999 , cholera appeared in Madagascar after a long hiatus and caused more than 37 000 cases and 2200 deaths . In October 1999 , the Cooperative for Assistance and Relief Everywhere ( CARE ) and the Centers for Disease Control and Prevention ( CDC ) Health Initiative funded CARE Madagascar to implement a household-based safe water intervention . 
    Output:
    
Although not statistically significant , we observed an attenuation of the intervention 's reduction of child diarrhea in longer trials .