***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 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 Background Soil-transmitted helminth ( STH ) infections are a public health problem in re source -limited setting s worldwide . Chronic STH infection impairs optimum learning and productivity , contributing to the perpetuation of the poverty-disease cycle . Regular massive drug administration ( MDA ) is the cardinal recommendation for its control ; along with water , sanitation and hygiene ( WASH ) interventions . The impact of joint WASH interventions on STH infections has been reported ; studies on the independent effect of WASH components are needed to contribute with the improvement of current recommendations for the control of STH . The aim of this study is to assess the association of lacking access to water and sanitation with STH infections , taking into account the differences in route of infection among species and the availability of adequate water and sanitation at home . Methods and Findings Cross-sectional study , conducted in Salta province , Argentina . During a deworming program that enrolled 6957 individuals ; 771 were r and omly selected for stool/serum sampling for parasitological and serological diagnosis of STH . Bivariate stratified analysis was performed to explore significant correlations between risk factors and STH infections grouped by mechanism of entry as skin-penetrators ( hookworms and Strongyloides stercoralis ) vs. orally-ingested ( Ascaris lumbricoides and Trichuris trichiura ) . After controlling for potential confounders , unimproved sanitation was significantly associated with increased odds of infection of skin-penetrators ( adjusted odds ratio [ aOR ] = 3.9 ; 95 % CI : 2.6–5.9 ) . Unimproved drinking water was significantly associated with increased odds of infection of orally-ingested ( aOR = 2.2 ; 95 % CI : 1.3–3.7 ) . Conclusions Lack of safe water and proper sanitation pose a risk of STH infections that is distinct according to the route of entry to the human host used by each of the STH species . Interventions aim ed to improve water and sanitation access should be highlighted in the recommendations for the control of STH 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 Sophie Boisson and colleagues conducted a double-blind , r and omized placebo-controlled  trial in Orissa , a state in southeast India , to evaluate the effect of  household water treatment in preventing diarrheal illnesses in children aged under five years of age . Please see later in the article for the Editors ' In Indonesia , where diarrhea remains a major cause of mortality among children < 5 years , the government promotes boiling of drinking water . We assessed the impact of boiling on water quality in South Sulawesi . We surveyed r and omly selected households with at least one child < 5 years old in two rural districts and tested source and stored water sample s for Escherichia coli contamination . Among 242 households , 96 % of source and 51 % of stored water sample s yielded E. coli . Unboiled water sample s , obtained from 15 % of households , were more likely to yield E. coli than boiled sample s [ prevalence ratios ( PR ) = 2.0 , 95 % confidence interval ( CI ) 1.7 - 2.5 ] . Water stored in wide-mouthed ( PR = 1.4 , 95 % CI = 1.1 - 1.8 ) or uncovered ( PR = 1.8 , 95 % CI = 1.3 - 2.4 ) containers , or observed to be touched by the respondent 's h and s ( PR = 1.6 , 95 % CI = 1.3 - 2.1 ) was more likely to yield E. coli . A multivariable model showed that households that did not boil water were more likely to have contaminated stored water than households that did boil water ( PR = 1.9 , 95 % CI = 1.5 - 2.3 ) . Although this study demonstrated the effectiveness of boiling in reducing contamination , overall impact on water quality was suboptimal . Future studies are needed to identify factors behind the success of boiling water in Indonesia to inform efforts to scale up other effective water treatment practice 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 Ceramic water filters have been identified as one of the most promising and accessible technologies for treating water at the household level . In a six-month trial , water filters were distributed r and omly to half of the 50 participating households in a rural community in Bolivia ; the remaining households continued to use customary water h and ling practice s and served as controls . In four rounds of sampling following distribution of the filters , 100 % of the 96 water sample s from the filter households were free of thermotolerant coliforms compared with 15.5 % of the control household sample s. Diarrheal disease risk for individuals in intervention households was 70 % lower than for controls ( 95 % confidence interval [ CI ] = 53 - 80 % ; P < 0.001 ) . For children less than five years old , the reduction in risk was 83 % ( 95 % CI = 51 - 94 % ; P < 0.001 ) . These results show that affordable ceramic water filters enable low-income households to treat and maintain the microbiologic quality of their drinking water In response to a recorded increasing incidence of diarrhoea in Tumpat District , Malaysia , a case-control study was performed to identify modifiable risk factors for the transmission of diarrhoea , in children aged 4 - 59 months . Ninety-eight pairs of children , matched on age and sex , were recruited prospect ively from health centres . Exposure status was determined during a home visit . Interviewers were ' blinded ' as to the disease status of each child . Odds ratios were measured through matched pair analysis and conditional logistic regression . Risk factors for diarrhoea identified were : reported -- drinking of unboiled water , storage of cooked food before consumption and bottle feeding ; and observations -- animals inside the house and absence of washing water in latrines . Water quality , source of drinking water , reported h and washing behaviour , indiscriminate defecation by children , cup use and the absence of a functional latrine were not associated with diarrhoea . Nonsignificant associations were found for : accessibility of washing water source , type of water storage container and use of fly covers for food The risk factors for acquisition of cryptosporidial infection in re source -poor setting s are poorly understood . A nested case-control study was conducted to assess factors associated with childhood cryptosporidiosis ( detected by stool polymerase chain reaction ) in an endemic , Indian slum community using data from two community-based studies with 580 children followed prospect ively until their second birthday . Factors were assessed for overall cryptosporidiosis ( N = 406 ) , and for multiple ( N = 208 ) , asymptomatic ( N = 243 ) , and symptomatic ( N = 163 ) infections , respectively . Presence of older siblings ( odds ratio [ OR ] = 1.88 , P = 0.002 ) and stunting at 6 months of age ( OR = 1.74 , P = 0.019 ) were important risk factors for childhood cryptosporidiosis . Always boiling drinking water before consumption , the use of a toilet by all members of the family , and maternal age ≥ 23 years were protective . These results provide insights into acquisition of childhood cryptosporidiosis in setting s with poor environmental sanitation , contaminated public water supply systems , and close human-animal contact . Disease control strategies will require a multifaceted approach We report the results of a r and omized controlled intervention study ( September 2007 to March 2009 ) investigating the effect of solar disinfection ( SODIS ) of drinking water on the incidence of  dysentery , nondysentery diarrhea  , and anthropometric measurements of height and weight among children of age 6 months to 5 years living in peri-urban and rural communities in Nakuru , Kenya . We compared 555 children in 404 households using SODIS with 534 children in 361 households with no intervention .  Dysentery was recorded using a pictorial diary . Incidence rate ratios ( IRR ) for both number of days and episodes of dysentery and nondysentery diarrhea were significantly ( P < 0.001 ) reduced by use of solar disinfection : dysentery days IRR = 0.56 ( 
    Output:
    
Although our study was limited by the use of self-reported boiling and non-experimental design s , the evidence suggests that boiling provides measureable health benefits for pathogens whose transmission routes are primarily water based .