***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: 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 We evaluated whether an educational intervention that was effective in reducing  childhood diarrhea  also improved childhood nutritional status .  Fifty-one communities of 38 families each were r and omized to receive the intervention or no intervention . During 1 y of follow-up the rate of diarrhea ( per 100 wk ) in children less than 6 y in the intervention group was 5.89 episodes whereas that in the nonintervention group was 7.55 episodes ( protective efficacy 22 % ; p less than 0.0001 ) . During the same follow-up period children in both groups exhibited comparable patterns of weight gain ; 1 y after the intervention the mean weight for age of children in both groups was 76 % of the NCHS st and ard . No significant differences were observed in the proportion of each group that experienced a major deterioration or improvement of nutritional status . We conclude that an intervention that reduces rates of  childhood diarrhea  may not necessarily also improve nutritional status 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 BACKGROUND Solar radiation reduces the bacterial content of water , and may therefore offer a method for disinfection of drinking water that requires few re sources and no expertise . METHODS We distributed plastic water bottles to 206 Maasai children aged 5 - 16 years whose drinking water was contaminated with faecal coliform bacteria . Children were instructed to fill the bottle with water and leave it in full sunlight on the roof of the hut ( solar group ) , or to keep their filled bottles indoors in the shade ( control group ) . A Maasai-speaking fieldworker who lived in the community interviewed the mother of each child once every 2 weeks for 12 weeks . Occurrence and severity of diarrhoea was recorded at each follow-up visit . FINDINGS Among the 108 children in households allocated solar treatment , diarrhoea was reported in 439 of the 2-week reporting periods during the 12-week trial ( average 4.1 [ SD 1.2 ] per child ) . By comparison , the 98 children in the control households reported diarrhoea during 444 2-week reporting periods ( average 4.5 [ 1.2 ] per child ) . Diarrhoea severe enough to prevent performance of duties occurred during 186 reporting periods in the solar group and during 222 periods in the control group ( average 1.7 [ 1.2 ] vs 2.3 [ 1.4 ] ) . After adjustment for age , solar treatment of drinking water was associated with a reduction in all diarrhoea episodes ( odds ratio 0.66 [ 0.50 - 0.87 ] ) and in episodes of severe diarrhoea ( 0.65 [ 0.50 - 0.86 ] ) . INTERPRETATION Our findings suggest that solar disinfection of water may significantly reduce morbidity in communities with no other means of disinfection of drinking water , because of lack of re sources or in the event of a disaster BACKGROUND Diarrhoeal disease is a leading cause of morbidity in young children in rural Zaire . Few diarrhoea prevention programmes have been implemented in B and undu Province , where available data suggest an annual prevalence rate of 10 % . The urgent need to reduce diarrhoeal morbidity in Zaire , together with the potential effectiveness and feasibility of hygiene education as a diarrhoea prevention strategy , led to the development of the present research project . METHODS A r and omized , controlled trial of an education intervention to reduce diarrhoea through improved personal and domestic hygiene behaviours was conducted in 18 geographically separate village clusters ( sites ) in rural Zaire . For 12 weeks baseline information on the diarrhoeal morbidity of 2082 children aged 3 - 35 months was collected at weekly home visits , and structured observations of hygiene practice s related to diarrhoea were made on a subset of 300 families . Intervention messages addressed disposal of animal faeces from the yard , h and washing after defecation and before meal preparation and eating , and disposal of children 's faeces . Three months after the start of the intervention and exactly 1 year after the baseline studies , a second diarrhoeal morbidity study and a second observational study were conducted in order to evaluate the intervention . RESULTS Children in intervention communities experienced an 11 % reduction in the risk of reporting diarrhoea during the peak diarrhoeal season , compared to controls ( P < 0.025 ) . The largest differences were seen among children aged 24 - 35 months , with those from intervention communities reporting significantly fewer episodes , shorter mean duration s and hence fewer days of diarrhoea . There was some evidence that greater reductions in diarrhoea occurred in sites where the quality of the intervention , a scored measure of volunteer efficacy and community participation , was highest . CONCLUSIONS The results of this study suggest that hygiene education may be an effective approach to reduce the incidence and duration of diarrhoeal episodes in rural Zaire . Children aged 2 years appear to benefit the most . A Hawthorne effect of the education may contribute to diarrhoeal reductions Simple , effective and affordable methods are needed to treat and safely store non-piped , gathered household water . This study evaluated point-of-use chlorination and storage in special plastic containers of gathered household water for improving microbial quality and reducing diarrhoeal illness of consumers living under conditions of poor sanitation and hygiene . Community families were recruited and r and omly divided into intervention ( household water chlorination and storage in a special container ) and  control ( no intervention ) households . Microbes in stored household water were extensively inactivated by 1 - 5-mg/L doses of hypochlorite . Escherichia coli levels in stored household waters were < 1/100 mL in most intervention households but readily detectable at high levels in control households . Stored water of intervention households was also lower in Clostridium perfringens and heterotrophic plate count bacteria than in control households . The intervention reduced household diarrhoeal illness . In Bolivia , monthly episodes of household diarrhoeal illness were 1.25 and 2.2 in intervention and control families , respectively ( P = < 0.002 ) indicating that 43 % of community diarrhoea was preventable by using the intervention . In Bangladesh , mean episodes of child diarrhoea/1,000 d were 19.6 and 24.8 in intervention and control groups respectively ( P = < 0.03 ) indicating that about 24 % of observed diarrhoea was preventable by using the intervention . Chlorine disinfection and storage in an appropriate container significantly improved the microbiological quality of non-piped household drinking water and reduced community diarrhoeal disease . Widespread use of this simple treatment and storage system for non-piped domestic water has the potential to dramatically reduce the global burden of waterborne diarrhoeal disease A community-based prospect i ve study of diarrhoeal morbidity of weaning-age children in 18 geographically separate village clusters was conducted as the baseline phase of a controlled trial of a hygiene education intervention to reduce diarrhoeal diseases in rural Zaire . For 12 weeks trained interviewers collected information at weekly home visits about the diarrhoeal morbidity of 2082 children aged 3 - 35 months . Included in the analyses were 1914 children ( 92 % ) with 9 or more complete weeks of data . Mothers ' reporting of the existence or otherwise of episodes appeared reliable , and more than 70 % of children had at least one episode of diarrhoea during the 12-week study period , the mean number of episodes being 1.9 per child . Reporting of the start and termination of diarrhoeal episodes was , however , irregularly distributed among the 7 days between successive home interviews , with 36 % of all episodes reported as starting on interview days , and 29 % reported as ending the day before an interview : in each case , only 14 % would have been expected . After adjusting for these reporting biases , 61 % of the episodes lasted 2 - 4 days , but a number of very long duration were also reported , and the mean duration of the episodes was 4.8 days . Children , had , on average , 9.2 days of diarrhoea during the study period . Contrasts with previous characterizations of reporting error in diarrhoeal studies are noted An integrated water supply , sanitation and hygiene ( WSH ) education intervention project was run by the International Centre for Diarrhoeal Disease Research , Bangladesh , over the period 1983 - 87 . In the intervention area the project provided h and pumps , pit latrines , and hygiene education to about 800 households . The control population did not receive any interventions , but had access to the usual government and private WSH facilities . After 1987 no external support was provided to maintain these provisions . A cross-sectional follow-up survey , which was carried out in 1992 , involved about 500 r and omly selected households from the intervention and control areas . In 1992 about 82 % of the pumps were still in good functional condition and of these , 94 % had been functioning well in 1987 . Fewer latrines were functional in 1992 ( 64 % ) than at the end of 1987 ( 93 % ) . In the former intervention area about 84 % 
    Output:
    
All of the interventions studied were found to reduce significantly the risks of diarrhoeal illness .
The results generally agree with those from previous review s , but water quality interventions ( point-of-use water treatment ) were found to be more effective than previously thought , and multiple interventions ( consisting of combined water , sanitation , and hygiene measures ) were not more effective than interventions with a single focus .
There is some evidence of publication bias in the findings from the hygiene and water treatment interventions