Previous research has investigated the impact of water quality, water quantity, sanitation, or hygiene improvements on morbidity and mortality from diarrhea. The limitations of much of this work have been elucidated, including lack of adequate control, one to one comparison, inadequate control for confounders, extended health indicator recall, lack of health indicator definition, failure to analyze by age strata, association between health outcomes and presence of an intervention (rather than its actual use), and inadequate consideration of seasonal impact on health outcomes. Given these gaps in previous analyses, considerable debate persists as to the most promising use of the limited resources available to combat childhood diarrhea in poor countries. We have designed this study to respond to the weaknesses identified in previous work.
The broad research goal is to assess the mechanisms by which household stored water and hands become contaminated with pathogens and cause disease and to identify promising strategies to improve drinking water quality, hand hygiene practices, and health.
