***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: 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 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 BACKGROUND AND AIMS We have previously reported a reduction in risk of diarrhoeal disease in children who used solar disinfected drinking water .  A cholera epidemic , occurring in an area of Kenya in which a controlled trial of solar disinfection and diarrhoeal disease in children aged under 6 had recently finished , offered an opportunity to examine the protection offered by solar disinfection against cholera . METHODS In the original trial , all children aged under 6 in a Maasai community were r and omised by household : in the solar disinfection arm , children drank water disinfected by leaving it on the roof in a clear plastic bottle , while controls drank water kept indoors . We revisited all households which had participated in the original trial . RESULTS There were 131 households in the trial area , of which 67 had been r and omised to solar disinfection ( a further 19 households had migrated as a result of severe drought ) . There was no significant difference in the risk of cholera in adults or in older children in households r and omised to solar disinfection ; however , there were only three cases of cholera in the 155 children aged under 6 years drinking solar disinfected water compared with 20 of 144 controls . CONCLUSIONS Results confirm the usefulness of solar disinfection in reducing risk of water borne disease in children . Point of consumption solar disinfection can be done with minimal re sources , which are readily available , and may be an important first line response to cholera outbreaks . Its potential in chorine resistant cholera merits further investigation Data collected in the late 1980s from eight countries in Sub-Saharan Africa ( Burundi , Ghana , Togo , and Ug and a ) , Asia/North Africa ( Sri Lanka and Morocco ) , and the Americas ( Bolivia and Guatemala ) were combined and analyzed to test whether incremental health effects regarding diarrhea  and  nutritional status result from incremental improvements in water and sanitation conditions . Rural ( n = 11,992 ) and urban ( n = 4,888 ) sample s were analyzed separately . Optimal ( i.e. , on the premises ) and intermediate ( improved public water ) water supplies were compared with unimproved water conditions . Optimal ( flush toilets or water-seal-latrines ) and intermediate ( latrines ) sanitation levels were compared with unimproved sanitation .  Nationally representative ( r and om ) sample s of ever-married women age 15 - 49 years , with or without children , were interviewed in all countries , and children aged 3 - 36 months with available weight and height data were included in the analyses . Multiple linear regression controlled for household , maternal , and child-level variables ; in addition , dummy variables were included for each country . Improvements in sanitation result ed in less diarrhea and in taller and heavier children with each of the three levels of water supply . Incremental benefits in sanitation were associated with less diarrhea and with additional increases in the weights and heights of children . The effects of improved sanitation were greater among urban dwellers than among rural dwellers . Health benefits from improved water were less pronounced than those for sanitation . Benefits from improved water occurred only when sanitation was improved and only when optimal water was present . These findings suggest that public health intervention should balance epidemiologic data with the cost of services and the dem and for water . There should be efforts to develop compatible technologies so that incremental improvements in service can be made 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 To isolate major bacterial pathogens from children 's food and drinking water , a 3-month study was conducted in a suburban community in Yangon , Myanmar . From the morning meals and stored drinking water of 208 r and omly selected children , 775 food and 113 water sample s were collected and were cultured using st and ard methods . Escherichia coli , Vibrio cholerae non-01 , and Salmonella were isolated from 505 , 28 and 6 food sample s respectively , and E. coli and V. cholerae non-01 were isolated from 29 and 5 water sample s respectively . Among the E. coli isolates , 8 produced heat-stable toxin ( ST ) and 3 were enteroinvasive . Nine V. cholerae non-01 produced cholera-like toxin . Of the 29 E. coli isolates from the sample s of drinking water , 3 produced ST . All water sample s were negative for Salmonella . The study underscores the importance of bacterial contamination of children 's food and drinking water and stresses the need to improve environmental sanitation 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 349 Maasai children younger than 6 years old were r and omised by alternate household to drink water either left in plastic bottles exposed to sunlight on the roof of the house or kept indoors ( control ) . The trial was run in Maasai by Maasai community elders . Children drinking solar disinfected water had a significantly lower risk of severe diarrhoeal disease over 8705 two weekly follow up visits ; two week period prevalence was 48.8 % compared with 58.1 % in controls , corresponding to an attributable fraction of 16.0 % . While this reduction is modest , it was sustained over a year in free living children . It confirms solar disinfection as effective in vivo as a free , low technology , point of consumption method of improving water quality . The continuing use of solar disinfection by the community underlines the value of community participation in research Deteriorating water treatment facilities and distribution systems pose a significant public health threat , particularly in republics of the former Soviet Union . Interventions to decrease the disease burden associated with these water systems range from upgrading distribution networks to installing reverse osmosis technology . To provide insight into this decision process , we conducted a r and omized intervention study to provide epidemiologic data for water policy decisions in Nukus , Uzbekistan , where drinking water quality is suboptimal . We interviewed residents of 240 households , 120 with and 120 without access to municipal piped water . Residents of 62 households without piped water were trained to chlorinate their drinking water at home in a narrow-necked water container with a spout . All study subjects ( 1583 individuals ) were monitored biweekly for self-reported diarrheal illness over a period of 9.5 weeks . The home chlorination intervention group had the lowest diarrheal rate ( 28.8/1,000 subjects/month ) despite lack of access to piped water in their homes . Compared with the two groups that did not receive the intervention this rate was one-sixth that of the group with no piped water ( 179.2/1,000 subjects/month ) and one-third that of the households with piped water ( 75.5/1,000 subjects/month ) . More than 30 % of the households with piped water lacked detectable levels of chlorine residues in their drinking water , despite two-stage chlorination of the source water , and were at increased risk of diarrhea . Forty-two percent of these municipal users reported that water pressure had been intermittent within the previous two days . The dramatic reduction in diarrheal rates in the home-chlorination intervention group indicates that a large proportion of diarrheal diseases in N 
    Output:
    
For cholera , a clear relationship was found with contaminated water .
Home water treatment and storage interventions were also found to reduce cholera .
For general diarrhoea , no clear relationship was found with point-of-use water quality , although interventions did significantly reduce diarrhoeal incidence .