***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 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 ' 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 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 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 ( 95 % CI 0.40 to 0.79 ) ; dysentery episodes IRR = 0.55 ( 95 % CI 0.42 to 0.73 ) ; nondysentery days IRR = 0.70 ( 95 % CI 0.59 to 0.84 ) ; nondysentery episodes IRR = 0.73 ( 95 % CI 0.63 to 0.84 ) . Anthropometry measurements of weight and height showed median height-for-age was significantly increased in those on SODIS , corresponding to an average of 0.8 cm over a 1-year period over the group as a whole ( 95 % CI 0.7 to 1.6 cm , P = 0.031 ) . Median weight-for-age was higher in those on SODIS , corresponding to a 0.23 kg difference in weight over the same period ; however , the confidence interval spanned zero and the effect fell short of statistical significance ( 95 % CI -0.02 to 0.47 kg , P = 0.068 ) . SODIS and control households did not differ in the microbial quality of their untreated household water over the follow-up period ( P = 0.119 ) , but E. coli concentrations in SODIS  bottles were significantly lower than those in storage containers over all follow-up visits ( P < 0.001 ) . This is the first trial to show evidence of the effect of SODIS on childhood anthropometry , compared with children in the control group and should alleviate concerns expressed by some commentators that the lower rates of dysentery associated with SODIS are the product of biased reporting rather than reflective of genuinely decreased incidence A r and omized , controlled intervention trial of two household-scale drinking water filters was conducted in a rural village in Cambodia . After collecting four weeks of baseline data on household water quality , diarrheal disease , and other data related to water use and h and ling practice s , households were r and omly assigned to one of three groups of 60 households : those receiving a ceramic water purifier ( CWP ) , those receiving a second filter employing an iron-rich ceramic ( CWP-Fe ) , and a control group receiving no intervention .  Households were followed for 18 weeks post-baseline with biweekly follow-up . Households using either filter reported significantly less diarrheal disease during the study compared with a control group of households without filters as indicated by longitudinal prevalence ratios CWP : 0.51 ( 95 % confidence interval [ CI ] : 0.41 - 0.63 ) ; CWP-Fe : 0.58 ( 95 % CI : 0.47 - 0.71 ) , an effect that was observed in all age groups and both sexes after controlling for clustering within households and within individuals over time Daniel Maeusezahl and colleagues conducted a cluster-r and omized controlled trial in rural Bolivia of solar drinking water disinfection  , and find only moderate compliance with the intervention and no evidence of reduction in diarrhea among children 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 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 
    Output:
    
Improvements to the water supply and water disinfection at source did not show significant effects on diarrhea risk , nor did the one eligible study examining the effect of latrine construction .
Conclusions Various WASH interventions show diarrhea risk reductions between 27 % and 53 % in children 0–5 years old , depending on intervention type , providing ample evidence to support the scale-up of WASH in low and middle-income countries ( LMICs ) .