SAFE WATER SYSTEM FOR DIARRHEA PREVENTION IN PERSONS

WITH HIV

Effect of Home-Based Water Chlorination and Safe Storage on Diarrhea

Among Persons With Human Immunodeficiency Virus in Uganda
John R. Lule and others
The American Society of Tropical Medicine and Hygiene

SAFE WATER SYSTEM FOR DIARRHEA PREVENTION IN PERSONS

WITH HIV

INTRODUCTION
Five to thirty percent of the adult population in rural Uganda is
infected with the human immunodeficiency virus/acquired
immunodeficiency syndrome (HIV/AIDS) because of very scarce and
limited resources to clean, safe drinking water and proper health
facilities for treatment. Such dire circumstances create poor living
habits that lead to an increase in susceptibility of infection, such as
diarrhea, especially to persons already infected with HIV/AIDS. Diarrhea
is very common among persons with HIV and can be a significant
cause to morbidity and mortality as well.
The safe water system (SWS) is a water quality intervention
based in a home developed by the Centers for Disease Control and
Prevention (CDC). The SWS is a system designed to treat and safely
store water that will reduce the risk of water-borne pathogens of
infectious diseases. The SWS in combination with cotrimaxizole
prophylaxis, a medication drug used to decrease the incidence of
bacterial infections, might significantly reduce the incidence of
diarrhea among persons infected with HIV.
MATERIALS AND METHODS
A randomized, controlled trial was performed of the home-based
water system to determine the amount of incidences and severity of
among persons with HIV in rural Uganda. The trial consisted of 509
persons with HIV and 1521 persons who are HIV-negative. A blood

SAFE WATER SYSTEM FOR DIARRHEA PREVENTION IN PERSONS

WITH HIV

sample was taken from participants to determine status of HIV and

household members infected with HIV were assigned to receive a SWS
and hygiene education. For the duration of five months, participants
were instructed to use the SWS and at the end of the five months, HIVpositive participants were given cotrimaxizole prophylaxis and the
experiment continued for another year.
Before the trial, surveys were issued to participants about
household demographic and socioeconomic characteristic as well as
the households practices of water, hygiene and sanitation. During the
trial, participants were required weekly visits for the collection of data
regarding occurrences of diarrhea, days with diarrhea, days lost of
school or work due to diarrhea, and hospitalization or death of a
household member due to diarrhea within the previous week since the
last visitation.
RESULTS
As stated earlier, diarrhea is frequent among those with HIV.
Persons with HIV had more episodes, days with diarrhea and more
missed days of school or work due to diarrhea compared to a person
who is HIV-negative. For persons HIV-positive, the SWS alone, resulted
in a 25% decrease in the number of diarrhea episodes as well as 33%
fewer days with diarrhea. With cotromaxizole prophylaxis alone,
persons HIV-positive resulted in 0.9 episodes per person per year (vs.
2.0 episodes), 7.1 days with diarrhea per person per year (vs. 10.1

SAFE WATER SYSTEM FOR DIARRHEA PREVENTION IN PERSONS

WITH HIV

days) and 3.6 days missed from work or school due to diarrhea per
person per year (vs. 5.1 days). With combination of SWS and
cotrimaxizole prophylaxis, the total reduction of diarrheal episodes was
67%, days with diarrhea decreased by 5.0 days and days missed of
work or school due to diarrhea decreased by 2.1 days.
For persons HIV-negative, SWS only showed reductions in
diarrheal episodes were of certain age groups, those between age 3
and 12 and those older than 59. There was no decrease in the number
of days missed of work and school due to diarrhea.
DISCUSSION
A small, simple home-based water treatment and storage system
resulted in a significant amount of reduction in diarrheal episodes, days
with diarrhea and missed school or work days due to diarrhea. This was
the first study to examine the impact of a safe drinking water system
among persons with HIV in a less industrialized world with limited
resources and infrastructure. Successful treatment of HIV depends of
safe water. Antiretroviral treatment prolongs lives, but winning the war
against the pandemic demands a combination of medicine, food, and
clean water, says Lee Jong-Wook, the Director-General of the World
Health Organization. Simple, inexpensive interventions such as the
SWS and cotrimoxazole prophylaxis should be considered as essential
components of care packages given to people in unindustrialized areas

SAFE WATER SYSTEM FOR DIARRHEA PREVENTION IN PERSONS

WITH HIV
with a limited resources environment to persons whom are HIVpositive.

SAFE WATER SYSTEM FOR DIARRHEA PREVENTION IN PERSONS

WITH HIV
REFERENCES
Lule, J. R., Mermin, J., Ekwaru, J. P., Malamba, S., Downing, R., Ransom, R.,
& ... Bunnell, R. (2005). Effect of home-based water chlorination and safe storage on
diarrhea among persons with human immunodeficiency virus in Uganda. American
Journal Of Tropical Medicine And Hygiene, 73(5), 926-933.