In the absence of blinding��unavoidable in many behavioural change interventions or household water treatment studies��we believe that data Cabozantinib cancer collection independent from the implementation is a crucial factor. Future reviews should include reporting on such additional quality parameters. In our study the lack of blinding may have reduced motivation in the control communities. However, the number of households lost during follow-up and the number of days under observation were almost identical in both arms. Additionally, the control communities knew that they would receive the intervention after study end. Finally, a reduction of diarrhoea frequency of 20% might be insufficient to be well perceived, i.e., have a noticeable impact in a population with a high burden of child diarrhoea and will, thus, not result in a sustainable behavioural change.
Faecal contamination in about 60% of the yards indicates a highly contaminated environment with presumably a large potential for transmission pathways other than consuming contaminated water. This simultaneous exposure to a multiplicity of transmission pathways may explain why we found no significant diarrhoea reduction due to SODIS. On the other hand, our result of a 19% reduction in diarrhoeal episodes appears to be roughly consistent with results of the two other SODIS trials both from Maasai cultural settings conducted by Conroy and colleagues among children <6 y and 5�C16 y of age. They report a 16% reduction (in <6 y olds, 2-wk prevalence of 48.8% in intervention, and 58.1% in control group) [8] and a 10.
3% reduction in the 2-wk diarrhoea prevalence (in 5�C16 y olds) [7]. However, these randomized controlled trials were undertaken in a socio-cultural setting assuring a 100% compliance (as stated by the authors) in water treatment behaviour through social control by Maasai elders who promoted the method [7],[8]. In the results presented in these studies adjusted models with post hoc selected covariates were presented (i.e., no unadjusted models were provided). These trials were carried out in conditions of heavily contaminated drinking water and very high diarrhoea rates��important considerations when attempting to generalize these results. The only other��quasi-randomized��trial to estimate the effect of solar water disinfection was carried out in the urban slum in Vellore and resulted in a remarkable reduction of diarrhoea among children <5 y (IR ratio, 0.
64; 95% CI 0.48�C0.86) despite 86% of SODIS users also drinking untreated water [9]. To our knowledge this is the first community-randomized trial and the largest study so far to assess the effectiveness of the SODIS method under typical social and environmental conditions in a general rural population setting where children drink untreated Carfilzomib water.
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