Luwe, Kondwani, Lungu, Kingsley, Morse, Tracy, McGuigan, Kevin G, Conroy, Ronan M, Buck, Lyndon and Sambala, Evanson Z (2025) Adherence to solar disinfection water treatment reduces diarrheal incidence among children in Malawi: a secondary analysis of a cluster quasi-experimental study. Journal of Water and Health, 23 (10), 1255-1268, [jwh2025092]. (doi:10.2166/wh.2025.092).
Abstract
Background: diarrheal diseases are a leading cause of morbidity and mortality among children under-five in low-income regions. This study evaluated the effectiveness of household (Hh) Solar Disinfection (SODIS) in reducing diarrhoeal incidence among under-five children.
Methods: we conducted a secondary analysis based on a cluster quasi-experimental trial conducted in Chikwawa district Malawi (March 2019 to March 2020) involving 369 children from 271 Hh in a control group and two intervention groups: one using 20 L transparent polypropylene SODIS buckets (336 children, 258 Hh) and another using a combined 20 L transparent polypropylene SODIS bucket and cloth filter system (380 children, 264 Hh). Variables of interest included household water sources, child age, sex, rotavirus vaccination, SODIS adherence, and the outcome variable was diarrhoeal incidence. Descriptive statistics, Chi-square tests, Kruskal-Wallis tests, and Poisson regression with robust standard errors were used as statistical methods in Stata 17.
Results: the study revealed an overall incidence of 2 cases per child year at risk and decreased over time. Households using SODIS buckets had an 88% reduction in diarrhoeal incidence, adjusted Incidence Rate Ratios (IRRs) 0.12 (95% CI: 0.04, 0.23); those using the combined SODIS bucket and cloth filter had a 70% reduction, adjusted IRR 0.30 (95% CI: 0.18, 0.50). SODIS adherence significantly impacted diarrhoeal reduction; high SODIS adherent households saw a 90% reduction in incidence compared to low adherent ones, adjusted IRR of 0.13 (95% CI: 0.02, 0.81). Those with medium adherence did not experience a significant reduction.
Conclusion: the research suggests that SODIS is an effective method to reduce the incidence of diarrhoea in children living in the Chikwawa district. Its success depended on how well people followed SODIS practices; efforts to increase adoption and adherence should be considered.
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