Effects of adding household water filters to Rwanda's Community-Based Environmental Health Promotion Programme: a cluster-randomized controlled trial in Rwamagana district

Unsafe drinking water remains a major cause of mortality and morbidity. While Rwanda's Community-Based Environmental Health Promotion Programme (CBEHPP) promotes boiling and safe storage, previous research found these efforts to be ineffective in reducing fecal contamination of drinking water. We conducted a cluster randomized control led trial to determine if adding a household water filter with safe storage to the CBEHPP would improve drinking water quality and reduce child diarrhea. We enrolled 1,199 households with a pregnant person or child under 5 across 60 randomly selected villages in Rwamagana district. CBEHPP implementers distributed and promoted water purifiers to a random half of villages. We conducted two unannounced follow-up visits over 13-16 months after the intervention delivery. The intervention reduced the proportions of households with detectable E. coli in drinking water samples (primary outcome) by 20% (PR 0.80, 95% CI 0.74-0.87, p < 0.001) and with moderate and higher fecal contamination (≥10 CFU/100 mL) by 35% (PR 0.65, 95% CI 0.57-0.74, p < 0.001). The proportion of children under 5 experiencing diarrhea in the last week was reduced by 49% (aPR 0.51, 95%CI 0.35-0.73, p < 0.001). Our findings identify an effective intervention for improving water quality and child health that can be added to the CBEHPP.

Otitis media seen in Yekatit 12 Hospital

Two thousand three hundred and thirty four selected patients with ear problem were seen in one of the ENT out patients department of Yekatit 12 Hospital from September 1994 to August 1996 were prospectively studied. Most of the patients came from Addis Ababa. Major clinical presentations were ear pain, purulent ear discharge, uni or bilateral decreased hearing ability. Patients were carefully evaluated by physical examination, otoscopy examination of the ear, schuilers view of the mastoid bone, audiometry findings and pus culture results. Diagnosis of these patients revealed that 1,630 (69.8%) had otitis while the rest 704 (30.16%) had other ear problems like ear wax, tinnitus and otitis external. One hundred two hundred thirty two patients (52.8%) had chronic otitis media with purulent discharge and decreased hearing ability, while 245 patients (10.5%) had chronic otitis media with out purulent discharge but with decreased hearing ability. Ninety six patients (4.1%) had acute otitis media and 57 patients (2.4%) had chronic seromucinous otitis media with decreased hearing ability. The micro-organisms identified include klebsiella spp. (28.97%), E. coli (10.7%), Citrobacter (3.6%), Acinetobacter (4.7%), S. aureus (3.57%), P. Valgaris (4.3%), S. Epidermidis (4.54%) and Dephtheroids (7.3%). Eighty nine patients with acute otitis media were completely cured and regained their hearing ability, the rest did not regain their hearing ability despite treatment. A combination of antibiotics and surgical treatment is recognized as the most effective intervention in this situation. The management of the chronic draining ear are: 1). To achieve a clean healed dry ear, 2) to obtain an air-containing middle ear space, 3) to rehabilitate hearing. The prevention of deafness and treatment of chronic draining ear disease especially in children is surgery which is not yet fully practiced in our centers.