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DiarrheaNCT03021434

Trial of Low-cost Microbiological Water Test Kits

A study testing Community and household water safety education sessions, Household-specific water quality information and Low-cost microbiological water test kits in people with Diarrhea and E.Coli Infections, run by London School of Hygiene and Tropical Medicine.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The present study is a cluster randomized control trial of low-cost microbiological water test kits in rural and peri-urban communities in the Kanpur region of Uttar Pradesh, India. Read more about this study

Who is it for?
Any ageHealthy volunteers can take part
Conditions the study is for
Diarrhea, E.Coli Infections
What is being tested?
Community and household water safety education sessions, Household-specific water quality information and Low-cost microbiological water test kits
Could I receive a placebo?
No, everyone receives an active treatment
How many people
572 participants
Where
No sites listed yet
Study dates
Jan 2017to 25 May 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult, Older adult

Who may be able to join

  • Village located within the Kanpur district, within
  • Village population between 100 and 1000 households.
  • No chlorinated water sources available in the village.
  • Consent to participate in the study
  • Contain at least one child who is between 29 days and 60 months of age at the time of enrollment

Who cannot join

  • Villages that receive chlorinated water from utility services

About this study

Official title: Cluster Randomized Trial of Low-cost Microbiological Water Test Kits

The present study is a cluster randomized control trial of low-cost microbiological water test kits in rural and peri-urban communities in the Kanpur region of Uttar Pradesh, India.

Read the detailed description

The proposed trial utilizes a cluster randomized controlled methodology, with clustering occurring at the village level. The intervention that will be tested in this cluster randomized controlled trial is informed by the development of a simple, low-cost water quality test kit developed and piloted by J. Brown and colleagues in Nagpur, Maharashtra.

There will be two intervention arms and one control/comparison arm. In all selected villages, the study team will work with local government to conduct a village-level information session on water quality and key water safety behaviours. Informational material on water safety behaviours will be distrubted to all houseohlds following this information session. In the control group, households will be visited to provide water safety informational cards and collect a drinking water sample to be analyzed in the lab. They will not receive the results of the analysis until the conclusion of the study. Households in Intervention Arm 1 (Standard Testing) will have their water sampled and analyzed in the lab, and results of the analysis will be delivered to the households. They will receive informational cards describing water purification strategies. Households in Intervention Arm 2 (Test Kits) will be provided with the materials and training needed to perform water quality testing in their own household using the newly developed testing kits. They will also receive informational cards describing water purification strategies.

Following the initial village-level information session, the study team will randomly sample households for participation in the trial. Participating households will complete a short survey on household demographics and water handling, storage, and use behaviours and a water sample will be taken and tested in the lab for fecal indicator bacteria. At an unannounced follow-up visit, roughly 1 - 2 months after enrollment, households will complete a short survey about changes in water handling, storage, and use behaviours and a second sample of household stored drinking water will be collected for laboratory analysis. The effect of the cluster randomized controlled trial on water quality will be determined by comparing arithmetic mean E. coli count from samples of household water and changes in water safety behaviours between baseline and endline.

Microbiological drinking water quality will be assessed at two time points: baseline and endline. At each visit, a 330 ml sample of household water will be collected for analysis; we will ask participants to fill the sample container as if it were a drinking cup for a child living in the household. Samples will be kept cold (on ice in a cooler) until delivery to the laboratory and thereafter stored at 4oC until processing, to begin within 8 hours of the sampling event.

Being tested
Community and household water safety education sessions, Household-specific water quality information, Low-cost microbiological water test kits
Keywords
Water Supply/standards, Water microbiology, India, Hand disinfection, Escherichia coli Infections/prevention & control, Hygiene, Health behavior, Drinking water, Informational intervention
Medical subject headings
Diarrhea, Escherichia coli Infections, Health Behavior

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Community and household water safety education sessionsOther

    Data collectors will give a short community presentation on water treatment, as well as safe water handling and storage. Then, data collectors will immediately visit households and review this information. Data collectors will return within 72 hours and review this information once more.

  • Household-specific water quality informationOther

    Household specific water quality data will be provided in two ways. In the Standard Testing Arm, water quality data will be analyzed in a laboratory by standard methods and results will be delivered to households. In the Test Kit arm, water quality data will be analyzed in households using provided water test kits.

  • Low-cost microbiological water test kitsOther

    Intervention component consists of low-cost, biodegradable that tests for the presence of E. coli in water samples. The test uses Aquatest broth medium with resorufin methyl ester chromogen. Presence of E. coli (positive test) imparts bright red color, making it easy to use/interpret at the household level with minimal training

Study groups in NCT03021434
Study groupRoleWhat they receive
Standard TestingExperimentalHouseholds will participate in community and household water safety education sessions, during which they will be given generalized information on water quality and safe water handling. A water sample from these households will be collected for laboratory analysis. Household-specific water quality information will be delivered to households within 72 hours, and households will be informed whether their drinking water was found to be contaminated. A study team member will review the information from the laboratory tests with the household and review information covered in the informational materials on safe water handling, storage, and use behaviours.
Receives: Other: Community and household water safety education sessions; Other: Household-specific water quality information
Test KitsExperimentalHouseholds will participate in community and household water safety education sessions, during which they will be given generalized information on water quality and safe water handling. Data collectors will demonstrate the use of the low-cost microbiological water test kits and test household stored drinking water. A study team member will return to the household within 72 hours and review the household-specific water quality information from the initial test with household members. Households will be given 10 water test kits to use at their discretion over the 1-2 month follow up period. They will be appropriately trained in how to both perform the test and interpret the results. Households will also review information on safe water handling, storage, and use behaviours.
Receives: Other: Community and household water safety education sessions; Other: Household-specific water quality information; Other: Low-cost microbiological water test kits
ComparisonActive comparatorHouseholds will participate in community and household water safety education sessions, during which they will be given generalized information on water quality and safe water handling. A water sample from these households will be collected for laboratory analysis. Results from this analysis will be returned to the household at project endline. A study team member will return to the household within 72 hours to review the information on safe water handling, storage, and use behaviours.
Receives: Other: Community and household water safety education sessions

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Arithmetic mean E. coli count from sample of stored household drinking water

    A sample of household drinking water will be collected and analyzed in a standard laboratory using membrane filtration.

    Measured: 1-2 month follow up visit post initial household information session

Secondary outcomes (2)
  1. Water storage, handling, and use behaviors

    Self-reported water treatment practices, verifiable water treatment practices, water handling and water storage practices in the home, and changes in primary water source. This outcome is measured using baseline and follow up survey questionnaires, as well as direct observation of handwashing station and water storage containers

    Measured: 1-2 month follow up visit post initial household information session

  2. Intervention uptake/use

    For households participating in the Test Kit Arm, intervention update will be assessed visual inspection of the number of test kits remaining in the household at end line (to determine utilization) as well as targeted survey question on the ease of use and perceived utility of the test kits.

    Measured: 1-2 month follow up visit post initial household information session

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Jan 2017 (estimated)
  2. Study startJan 2017
  3. Primary completion25 May 2017
  4. Study completion25 May 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
572 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03021434
Sponsor's protocol ID
11920/RR/5743
Status last verified
Jan 2017
First submitted
12 Jan 2017
Last updated
29 Jun 2017
Results posted
No
Data monitoring committee
No
Individual data sharing
No

Publications

  • Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, Wu Y, Sow SO, Sur D, Breiman RF, Faruque AS, Zaidi AK, Saha D, Alonso PL, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ochieng JB, Omore R, Oundo JO, Hossain A, Das SK, Ahmed S, Qureshi S, Quadri F, Adegbola RA, Antonio M, Hossain MJ, Akinsola A, Mandomando I, Nhampossa T, Acacio S, Biswas K, O'Reilly CE, Mintz ED, Berkeley LY, Muhsen K, Sommerfelt H, Robins-Browne RM, Levine MM. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet. 2013 Jul 20;382(9888):209-22. doi: 10.1016/S0140-6736(13)60844-2. Epub 2013 May 14.

    PubMed 23680352
  • Million Death Study Collaborators; Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, Shet A, Ram U, Gaffey MF, Black RE, Jha P. Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet. 2010 Nov 27;376(9755):1853-60. doi: 10.1016/S0140-6736(10)61461-4. Epub 2010 Nov 12.

    PubMed 21075444
  • Lakshminarayanan S, Jayalakshmy R. Diarrheal diseases among children in India: Current scenario and future perspectives. J Nat Sci Biol Med. 2015 Jan-Jun;6(1):24-8. doi: 10.4103/0976-9668.149073.

    PubMed 25810630
  • Hamoudi A, Jeuland M, Lombardo S, Patil S, Pattanayak SK, Rai S. The effect of water quality testing on household behavior: evidence from an experiment in rural India. Am J Trop Med Hyg. 2012 Jul;87(1):18-22. doi: 10.4269/ajtmh.2012.12-0051.

    PubMed 22764286
  • Davis J, Pickering AJ, Rogers K, Mamuya S, Boehm AB. The effects of informational interventions on household water management, hygiene behaviors, stored drinking water quality, and hand contamination in peri-urban Tanzania. Am J Trop Med Hyg. 2011 Feb;84(2):184-91. doi: 10.4269/ajtmh.2011.10-0126.

    PubMed 21292883
  • Dufour AP, Strickland ER, Cabelli VJ. Membrane filter method for enumerating Escherichia coli. Appl Environ Microbiol. 1981 May;41(5):1152-8. doi: 10.1128/aem.41.5.1152-1158.1981.

    PubMed 7020592
  • Brown J, Stauber C, Murphy JL, Khan A, Mu T, Elliott M, Sobsey MD. Ambient-temperature incubation for the field detection of Escherichia coli in drinking water. J Appl Microbiol. 2011 Apr;110(4):915-23. doi: 10.1111/j.1365-2672.2011.04940.x.

    PubMed 21214694
  • Bain RE, Woodall C, Elliott J, Arnold BF, Tung R, Morley R, du Preez M, Bartram JK, Davis AP, Gundry SW, Pedley S. Evaluation of an Inexpensive Growth Medium for Direct Detection of Escherichia coli in Temperate and Sub-Tropical Waters. PLoS One. 2015 Oct 23;10(10):e0140997. doi: 10.1371/journal.pone.0140997. eCollection 2015.

    PubMed 26495983
  • Magro G, Bain RE, Woodall CA, Matthews RL, Gundry SW, Davis AP. Synthesis and application of resorufin beta-D-glucuronide, a low-cost chromogenic substrate for detecting Escherichia coli in drinking water. Environ Sci Technol. 2014 Aug 19;48(16):9624-31. doi: 10.1021/es502319n. Epub 2014 Jul 29.

    PubMed 25035967
  • Creswell, J.W. and V.L. Plano Clark, Designing and conducting mixed methods research. 2011, Los Angeles: SAGE Publications.

  • Haas, C.N., How to average microbial densities to characterize risk. Water Research, 1996. 30(4): p. 1036-1038.

  • Moher D, Schulz KF, Altman DG; CONSORT Group (Consolidated Standards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. J Am Podiatr Med Assoc. 2001 Sep;91(8):437-42. doi: 10.7547/87507315-91-8-437.

    PubMed 11574648
  • Witte, K., Putting the fear back into fear appeals: The extended parallel process model. Communications Monographs, 1992. 59(4): p. 319-26.

  • Hayes RJ, Bennett S. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol. 1999 Apr;28(2):319-26. doi: 10.1093/ije/28.2.319.

    PubMed 10342698
  • Duflo, E., R. Glennerster, and M. Kremer, Using Randomization in Development Economics Research: A Toolkit, in T. Schultz and John Strauss, eds., Handbook of Development Economics. 2008, North Holland: Amsterdam and New York.

Questions about this trial

What is this clinical trial studying?

A study testing Community and household water safety education sessions, Household-specific water quality information and Low-cost microbiological water test kits in people with Diarrhea and E.Coli Infections, run by London School of Hygiene and Tropical Medicine.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Jun 2017. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Arithmetic mean E. coli count from sample of stored household drinking water (time frame: 1-2 month follow up visit post initial household information session). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03021434, which also lists 19 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jun 2017.

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