***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: Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries . We conducted a 5-month household r and omised controlled trial among 566 households in rural Rw and a to assess uptake , compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free . Compliance was measured monthly by self-report and spot-check observations . Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a r and om sub sample of 121 households to assess household air pollution  , while sample s of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms . Adoption was generally high , with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove . However , some householders continued to drink untreated water and most continued to cook on traditional stoves . The intervention was associated with a 97.5 % reduction in mean faecal indicator bacteria ( Williams means 0.5 vs. 20.2 TTC/100 mL , p<0.001 ) and a median reduction of 48 % of 24-h PM2.5 concentrations in the cooking area ( p = 0.005 ) . Further studies to increase compliance should be undertaken to better inform large-scale interventions . Trial registration : Clinical trials.gov ; NCT01882777 ; http:// clinical trials.gov/ct2/ results ? term = NCT01882777 & Search = Background Household water treatment can improve the microbiological quality of drinking water and may prevent diarrheal diseases . However , current methods of treating water at home have certain shortcomings , and there is evidence of bias in the reported health impact of the intervention in open trial design s. Methods and Findings We undertook a r and omised , double-blinded , placebo-controlled trial among 240 households ( 1,144 persons ) in rural Democratic Republic of Congo to assess the field performance , use and effectiveness of a novel filtration device in preventing diarrhea . Households were followed up monthly for 12 months . Filters and placebos were monitored for longevity and for microbiological performance by comparing thermotolerant coliform ( TTC ) levels in influent and effluent water sample s. Mean longitudinal prevalence of  diarrhea  was estimated among participants of all ages . Compliance was assessed through self-reported use and presence of water in the top vessel of the device at the time of visit . Over the 12-month follow-up period , data were collected for 11,236 person-weeks of observation ( 81.8 % total possible ) . After adjusting for clustering within the household , the longitudinal prevalence ratio of diarrhoea was 0.85 ( 95 % confidence interval : 0.61–1.20 ) . The filters achieved a 2.98 log reduction in TTC levels while , for reasons that are unclear , the placebos achieved a 1.05 log reduction ( p<0.0001 ) . After 8 months , 68 % of intervention households met the study 's definition of current users , though most ( 73 % of adults and 95 % of children ) also reported drinking untreated water the previous day . The filter maintained a constant flow rate over time , though 12.4 % of filters were damaged during the course of the study . Conclusions While the filter was effective in improving water quality , our results provide little evidence that it was protective against diarrhea . The moderate reduction observed nevertheless supports the need for larger studies that measure impact against a neutral placebo . Trial Registration Current Controlled Trials IS RCT To assess the impact on child growth of the nutrition-counseling component of the Integrated Management of Childhood Illnesses ( IMCI ) strategy , a r and omized trial was implemented . All 28 government health centers in a Southern Brazil city were paired according to baseline nutritional indicators . One center from each pair was r and omly selected and its doctors received 20-h training in nutrition counseling .  Thirty-three doctors were included and 12 - 13 patients < 18 mo of age from each doctor were recruited . The study included testing the knowledge of doctors , observing consultations and visiting the children at home 8 , 45 and 180 d after the initial consultation . Maternal knowledge , practice s and adherence to nutritional recommendations were assessed , and anthropometric measurements were taken . Day-long dietary intake was evaluated on a sub sample of children . Doctors in the intervention group had better knowledge of child nutrition and improved assessment and counseling practice s. Maternal recall of recommendations was higher in the intervention than in the control group , as was satisfaction with the consultation . Reported use of recommended foods was also increased . Daily fat intake was higher in the intervention than in the control group ; mean daily intakes of energy and zinc also tended to improve . Children 12 mo of age or older had improved weight gain and a positive but nonsignificant improvement in length .  Nutrition-counseling training  improved doctors ' performances , maternal practice s and the diets and weight gain of children . The r and omized design with blind outcome evaluation strongly supports a causal link . These results should be replicated in other setting Lack of access to safe water and sanitation contributes to diarrhoea moribidity and mortality in developing countries . We evaluated the impact of household water treatment , latrines , shallow wells , and rainwater harvesting on  diarrhoea incidence in rural Kenyan children . We compared diarrhoea rates in 960 children aged < 5 years in 556 households in 12 r and omly selected intervention villages and six r and omly selected comparison villages during weekly home visits over an 8-week period . On multivariate analysis , chlorinating stored water  [ relative risk ( RR ) 0.44 , 95 % confidence interval ( CI ) 0.28 - 0.69 ] , latrine presence ( RR 0.71 , 95 % CI 0.54 - 0.92 ) , rainwater use ( RR 0.70 , 95 % CI 0.52 - 0.95 ) , and living in an intervention village ( RR 0.31 , 95 % CI 0.23 - 0.41 ) , were independently associated with lower diarrhoea risk . Diarrhoea risk was higher among shallow well users ( RR 1.78 , 95 % CI 1.12 - 2.83 ) . Chlorinating stored water , latrines  , and  rainwater use all decreased diarrhoea risk ; combined interventions may have increased health impact Point of use drinking water treatment with the BioS and filter ( BSF ) allows people to treat their water in the home . The purpose of this research was to document the ability of the Hydraid plastic-housing BSF to reduce diarrheal disease in households who received a BSF  in a r and omized controlled trial . The trial of the Hydraid plastic-housing BSF was carried out in rural , mountainous communities in Copan , Honduras during April of 2008 to February of 2009 . A logistic regression adjusting for clustering showed that the incidence of diarrheal disease in children under 5 years  was reduced by approximately 45 % ( odds ratio = 0.55 , 95 % confidence interval = 0.28 , 1.10 ) in households that had a BSF compared with those households without a BSF , but this finding fluctuated depending on season and was not statistically significant . Households with a BSF had significantly better drinking water quality regardless of water source or season In developing countries , the burden of diarrhoea is still enormous . One way to reduce transmission of pathogens is by water quality interventions . Solar water disinfection ( SODIS ) is a low-cost and simple method to improve drinking water quality on household level . This paper evaluates the implementation of SODIS in slum areas of Yaoundé , Cameroon . Promoters trained 2,911 households in the use of SODIS .  Two surveys with r and omly selected households were conducted before ( N=2,193 ) and after ( N=783 ) the intervention . Using a question naire , interviewers collected information on the health status of children under five , on liquid consumption , hygiene and other issues . Prior to the intervention , diarrhoea prevalence amounted to 34.3 % among children . After the intervention , it remained stable in the control group ( 31.8 % ) but dropped to 22.8 % in the intervention group . Households fully complying with the intervention exhibited even less diarrhoea prevalence ( 18.3 % ) and diarrhoea risk could be reduced by 42.5 % . Multivariate analyses revealed that the intervention effects are also observed when other diarrhoea risk factors , such as hygiene and cleanliness of household surroundings , are considered . According to the data , adoption of the method was associated with marital status . Findings suggest health benefits from SODIS use . Further promotional activities in low-income setting s are recommended Vitamin A deficiency ( VAD ) persists in Ug and a and the consumption of β-carotene-rich orange sweet potato ( OSP ) may help to alleviate it . Two large-scale , 2-y intervention programs were implemented among Ug and an farmer households to promote the production and consumption of OSP . The programs differed in their inputs during year 2 , with one being more intensive ( IP ) and the other being reduced ( RP ) . A r and omized , controlled effectiveness study compared the impact of the IP and RP with a control on  OSP  and  vitamin A intakes among children aged 6 - 35 mo ( n = 265 ) and 3 - 5 y ( n = 578 ) , and women ( n = 573 ) , and IP compared with control on vitamin A status of 3- to 5-y-old children ( n = 891 ) and women ( n = 939 ) with serum retinol < 1.05 μmol/L at baseline . The net OSP intake increased in both the IP and RP groups ( P < 0.01 ) , accounting for 44 - 60 % of vitamin A intake at follow-up . The prevalence of inadequate vitamin A intake was reduced in the IP and RP groups compared with controls among children 6 - 35 mo of age ( > 30 percentage points ) and women ( > 25 percentage points ) ( P < 0.01 ) , with no differences between the IP and RP groups of children ( P = 0.75 ) or women ( P = 0.17 ) . There was a 9.5 percentage point reduction in prevalence of serum retinol < 1.05 μmol/L for children with complete data on confounding factors ( n = 396 ; P < 0.05 ) . At follow-up , vitamin A intake from OSP was positively associated with vitamin A status ( P < 0.05 ) . Introduction of OSP to Ug and an farming households  increased vitamin A intakes among children and women and was associated with improved vitamin A status among children The impact on vitamin A deficiency ( VAD ) , wasting malnutrition , and excessive childhood mortality of two alternative approaches-nutrition education and mega-dose capsule distribution  ( 6 - 12-month-olds : 100,000 IU ; 1 - 5-year-olds : 200,000 IU)-in communities in Nepal are compared . Approximately 40,000 children from 75 locations in seven districts in two ecological setting s ( lowl and and hills ) took part in the study and were r and omly allocated to intervention cohorts or a control group . At 24 months after the implementation of the project the reduction of risk for xerophthalmia was greater among children whose mothers were able to identify vitamin-A-rich foods ( relative risk ( RR ) = 0.25 ; 95 % confidence interval ( CI ) = 0.10 - 0.62 ) than among the children who received mega-dose capsules ( RR = 0.59 ; 95 % CI = 0.41 - 0.84 ) . The risk of mortality at 2 years was reduced for both the nutrition education ( RR = 0.64 ; 95 % Cl = 0.48 - 0.86 ) and capsule distribution ( RR = 0.57 ; 95 % CI = 0.42 - 0.77 ) cohorts . The nutrition education programme was , however , more expensive to deliver than the capsule distribution programme .  High rates of participation for children in the supplementation programme were achieved quickly . The nutrition education messages also spread rapidly throughout the study population ( regardless of intervention cohort assignment ) . Practice s , however , were slower to change . In communities where maternal literacy was low and channels of communication were limited the capsule distribution programme appeared to be more economical . However , there are economies of scale for nationwide education programmes that do not exist for capsule distribution programmes . Although nutrition education provides economies of scale and the promise of long-term sustainability , a comprehensive national programme requires both dietary supplementation and nutrition education components Abstract Objective : To evaluate the effect of a nutrition improvement project based on home garden production and nutrition education on morbidity from acute respiratory infection and diarrhoeal disease in preschool children . Design : The morbidity survey comprised five data collection s undertaken by trained interviewers to ascertain the incidence and severity of respiratory infections and the incidence of diarrhoeal disease in children in two communes . Setting : A project commune and a control commune in Vietnam . Subjects : Preschool children to 6 years of age living in the project commune Khai Xuan ( average 469 children ) and the control commune Ching Cong ( average 251 children ) . Main outcome measures : Differences between the two communes over time in the incidence and severity of respiratory infections and the incidence of diarrhoeal disease . Results : 
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Conclusions It is clear that very little trans-disciplinary research has been done with the majority of studies still being discipline specific .
It also appears that certain low and middle income countries seem to focus on domain-specific interventions .