Findings Final data analysis included households nine from
Findings Final data analysis included 28 households: nine from the Tulip filter group, 10 from Waterguard chlorination, and nine from the group who boiled water. Two households had incomplete data and were excluded from analysis. Before the intervention, 29 of 30 households were not treating their water. The no-risk WHO standard of CFU/100 mL Escherichia coli was met in eight (89%) samples from households assigned to the Tulip filter, four (40%) who used Waterguard, and five (56%) that oleuropein boiled water. Of the households that boiled water three (30%) met criteria for high, or very high risk. No statistical differences were noted between the treatment methods (p=0·081). Ratings of water appearance, smell, and taste were highest in the Tulip filter group and lowest in those who boiled water. All households that used the Tulip filter intervention expressed satisfaction with the method and wanted to continue to use the filter.
Interpretation This study provides evidence to inform the development of public health educational programmes that promote household drinking water treatment, improved hygiene and sanitation practices for low-income and middle-income countries working to meet the SDGs. While not statistically significant, there was a trend toward superior performance by the Tulip filter in effective treatment of household water. Future comparisons of these interventions in a larger study would need to be done to achieve the statistical power to detect a significant difference in the three household water treatment methods studied.
Funding The Pediatric Medical Device Institute.
Declaration of interests
Abstract Background Pneumonia is the leading cause of child mortality worldwide and respiratory viruses are an important cause of childhood pneumonia. However, household transmission of respiratory viruses is not well described in resource-limited settings and more information might guide preventative efforts by identifying individuals at risk of transmission. We aimed to characterise the transmission of respiratory viruses within households and identify risk factors for household transmission. Methods We used data from a randomised controlled study of influenza vaccine in pregnant women in rural Nepal. Members of households were prospectively enrolled and surveyed weekly for symptoms of respiratory illness. At the time of illness, nasal swabs were collected, and subsequently tested by real-time PCR for nine respiratory viruses: respiratory syncytial virus (RSV), human metapneumovirus (hMPV), human rhinovirus (HRV), coronavirus, adenovirus, and parainfluenza virus (PIV) 1–4. Household transmission was defined as two or more household members with the same virus detected within 28 days. We used a multivariate logistic regression model to compare households with and without transmission. Findings Between May, 2011, and May, 2012, 593 households were enrolled and 625 (54%) of 1156 illness episodes were positive for one or more of the included respiratory viruses. Most illness episodes occurred in children aged under 16 years (n=952; 82%). HRV was detected in 421 (67%) of virus-positive illness episodes. Household transmission was documented in 60 episodes in 51 (9%) households. HRV was the most commonly transmitted virus (n=42), followed by RSV (8), hMPV (7), PIV 1–3 (7), and coronavirus (3). The virus was first detected in children aged 1–4 years in 24 (40·0%) transmission episodes. Infants were involved in the transmission network in 7 (88%) RSV, 34 (79%) HRV, 4 (57%) PIV, and 3 (42%) hMPV episodes. A comparison of households with and without transmission showed that virus transmission was associated with presence of a low birthweight infant (39·2% vs 19·1%; OR 2·57, 95% CI 1·27–5·15), and more children aged 1–4 years (mean number of children 1·04 vs 0·71; 1·64, 1·11–2·43). Interpretation In a household surveillance study in Nepal, children younger than 5 years were the most common introducer of respiratory viruses to households. Infants were frequently involved in RSV and HRV transmission networks. A vaccine strategy to immunise young children aged 1–4 years in the household to protect infants younger than 6 months should be considered to prevent RSV.