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Cycle 6 (2017 Deadline)

Effectiveness of point-of-use water treatment technologies to prevent child stunting in South Africa

PI: Pascal Bessong,, University of Venda
U.S. Partner: James Smith, University of Virginia
Project Dates: February 2018 - February 2021

Project Overview:

In low-resource settings, lack of safe water and adequate sanitation has long-term detrimental consequences for child health and development. Continuous exposure to unclean water can lead to poor linear growth among children. In a recent study conducted on the study population that will be the focus of this PEER project, the Dzimauli community of Limpopo, South Africa, the prevalence of stunting increased from 12% in first month of life to 37% at 2 years of age. Stunting early in life is an important marker of long-term morbidity and has been associated with cognitive impairment, poor school performance, low adult economic productivity, and increased risk of chronic disease later in life. Interventions that improve access to safe water and sanitation have the potential to make a significant impact on child stunting but have not been well-studied towards this aim. The municipal water supply for the Dzimauli community is not consistent, and community-level water treatment systems are not available. Less than 20% of households reported treating their drinking water in 2009, which suggests that there is a clear need for an acceptable drinking water solution.

The U.S. partner Dr. James Smith and his research team at the University of Virginia have participated in the development of two point-of-use water treatment technologies that have demonstrated technical efficacy, sustainability, and social acceptance in several low-resource communities: the silver-impregnated ceramic water filter and the silver-impregnated ceramic disk, called a MadiDrop. However, it is unknown whether the use of these technologies will translate to improvements in child health outcomes. This PEER project will involve a community-based intervention trial that will estimate the effectiveness of the two technologies to reduce pathogen exposure and prevent stunting among children in Limpopo. Dr. Smith will manage use of the technologies during the trial and provide support in developing study materials and laboratory protocols. Estimates of effectiveness demonstrated in this trial will provide the necessary evidence base to support the scale-up of manufacturing and distribution of the products. In this way, this research will support interventions that have the potential to contribute to the World Health Organization target to reduce the number of stunted children under 5 years of age by 40% by 2025. This project will lead to capacity building locally at the University of Venda (UNIVEN), which is a rural and historically disadvantaged university in South Africa. More than 40 students and staff will be trained, including students and trainees from the University of Virginia, our USG-supported partner’s university. The PI and his colleagues also plan to participate in community outreach to generate interest in scientific research among youth (high school students) in Limpopo in collaboration with the Vuwani Science Resource Centre. If the technology is proven effective, it will result in policy recommendations to local agencies. In addition, the project will support local commercialization of the ceramic water filter, thereby increasing opportunities for the highly skilled women who make them from locally-sourced materials.

Summary of Recent Activities

In this reporting period, the PI and his team have completed the testing of stools samples, for targeted viruses and bacteria, for all the participants in all the arms of the study. The last batch of these results is being quality controlled and merged with the previous data, after which they will begin analysis of the microbiological data. Microbiological data from stools will be correlated with microbiological data from water used in the households. Microbiological data analysis for water is ongoing. They also carried out assesment of mothers which included Self Reporting Questionnaire (SRQ) to screen for maternal depression, and RAVENS which assesses mother’s cognitive abilities. They completed the Schooling Form to gather information about the child’s day care, kindergarten, pre-school history (if any). They also assessed children's intellectual functioning in verbal and performance cognitive domains using the WIPPSI tool, as well as providing a composite score that represents a child’s general intellectual ability. So far 326 children have been assessed. Psychology data will be correlated to stool microbiology data and child anthropometric data.

A workshop is planned titled "Infection, molecular identification, and consequences of infection in young children". The PI reports that they have worked with the local Vhembe district of Education to identify high school teachers and grades 11/12 students to participate in 3-day workshop for teachers and a 2-day workshop for students, on molecular detection of microbial contamination, and to review the sequel of microbial intestinal infection in young children. They had hoped to have the workshops beginning in July 2019, but some of the schools were not ready; so they are working towards the end of July 2019. The goal of this outreach is to promote interest in science particular in women, and to advance public understanding of science.

In the next 3 months, they expect to complete their planned outreach activities with high school science teachers and high school students. By end of July 2019, they expect to complete the psychology assessments for all the children and by end of October 2019, they expect to complete the analysis of the water quality data and prepare a manuscript.

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