Membrane filtration of contaminated water with used dialyzers reduces the incidence of diarrhea in rural communities in developing countries.
Jochen G. Raimann, Joseph Marfo Boaheng, Philip Narh, Seth Johnson, Linda Donald, Hongbin Zhang, Friedrich Port, Nathan W. Levin.
Easy Water for Everyone NGO, New York, USA
Background
Access to clean water remains unavailable for a large fraction of the world population. Consequent infectious diarrhea can lead to dehydration and acute kidney injury too often leading to death. Membrane filtration using recycled hemodialyzers is a recent innovation. We quantified its effect on health outcomes in rural communities in Ghana.
Methods
Between 2015 and 2018 we provided membrane filtration devices (NUFiltration Israel) to 9 communities in Ghana (Greater-Accra region). We calculated incidence rates of self-reported diarrhea and compared monthly counts for 12 months before and 12 after implementation by negative binomial and Poisson regression (Pois) with the log (exposure time) as the offset. Models were compared by likelihood ratio test (LRT) and an Akaike Information Criterion (AIC). Logistic regression for recurrent events on a subject-level (LogReg) was used to determine the effects of device implementation and seasonality (rainy versus dry season).
Results
We studied data of 2605 villagers (10.4% younger than 5 and 5.1 % older than 65 years). Incidence rate was significantly lower after device implementation (0.08 versus 0.03; P<0.01). LRT and AIC determined Pois to fit best and Pois showed a significant treatment effect [0.4 (95% CI 0.3 to 0.5)]. LogREg confirmed a significantly lower OR of diarrhea after implementation [0.3 (95% CI 0.2 to 0.3)] with higher OR of 1.1 (95% CI 1.0 to 1.31) during the rainy season. Lower rates Month -1 and -2 showed can possibly be explained by concomitant handwashing and hygiene education initiatives.
Discussion & Conclusion
Our data shows decrease in the incidence rates and the odds of contracting infectious diarrhea with the use of membrane filtration device in rural villages in West Africa. A possible effect of seasonality should be recognized as a potential risk factor. These data emphasize the remarkable public health effect achievable by provision of these low-cost devices .
