Effect of safe water delivery plus water and sanitation hygiene behavior change communication on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya: a quasi-experimental study.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Diarrhea*/epidemiology ; Diarrhea*/prevention & control ; Hygiene*/standards ; Sanitation*/standards ; Water Supply*/standards ; Poverty Areas*; Kenya/epidemiology ; Humans ; Child, Preschool ; Infant ; Prevalence ; Female ; Male

Background: Diarrheal diseases are prevalent among children under five years of age in slum areas. We evaluated the effect of safe water delivery plus water, sanitation, and hygiene (WASH)-Behavior Change Communication (WASH-BCC on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya.
Methods: We designed a quasi-experimental study, with the intervention as safe water delivery plus WASH-BCC. The intervention arm consisted of 2 slum villages that received safe water plus WASH-BCC, while the comparison arm comprised 2 slum villages that did not receive the intervention. The primary outcome was diarrheal disease in a child under five years of age in the past 2 weeks in both study arms, defined as the passage of ≥ 3 watery stools in the past 24 h. Data were collected at the baseline and endline from a random sample of eligible households in the villages. Propensity score weighting was used to achieve similarity in measured covariates between both arms. Binary logistic regression analysis, adjusting for propensity-score weights, was utilized to estimate the causal effect of the intervention, reported as odds ratio (OR) and 95% confidence interval (CI).
Results: We analyzed data from 1,876 participants in a 1:1 ratio and found 382 (20.4%) children under five years of age had diarrheal disease at the endline. Diarrheal disease prevalence declined in the intervention villages (33.3% baseline vs. 23.5% endline) but increased in the comparison villages (15.7% baseline vs. 17.5% endline). We found a 31% decline in diarrheal disease in the intervention villages relative to the comparison villages (OR 0.69, 95% CI 0.55-0.86). In a difference-in-differences analysis, the decline was 11.4%. The findings remained robust in a sensitivity analysis.
Conclusion: The intervention significantly reduced diarrheal disease prevalence in children under five years of age in the slum setting. Therefore, there is a need to expand the intervention to the remaining areas to reduce diarrheal disease morbidity and mortality.
(© 2025. The Author(s).)

Declarations. Ethics approval and consent to participate: We obtained ethical approval from the APHRC Internal Review Board (reference number: DOR/2022/057) and the African Medical and Research Foundation Research Ethics Committee (reference number: P1302-2022), and a research permit from the National Commission of Science, Technology and Innovation (NACOSTI reference number: NACOSTI/P/22/22045). All participants gave informed consent, either in writing or by thumbprint, after receiving information on the purpose of the evaluation study, voluntary participation, possible risks and benefits, privacy and confidentiality of information, and dissemination of the findings. The study was conducted in accordance with the Declaration of Helsinki, which emphasizes the ethical principles for human subject research, namely beneficence, nonmaleficence, autonomy, and justice. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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Keywords: Access to safe water; Behavior change communication; Diarrheal disease; Kenya; Slum

Date Created: 20251029 Date Completed: 20251029 Latest Revision: 20251031

20260130

PMC12570634

10.1186/s12889-025-24951-y

41152841