It is logical that the scientific community in the absence of the appropriate infrastructure, would support the use of decentralized filtration devices as a viable solution in terms of providing clean water in rural communities. Both governments and communities would be expected to embrace such a solution to reduce the risk of infectious diseases associated with the consumption of water with potential bacterial, viral, or protozoal contamination.
However, to this date success in preventing infectious illness has been confirmed only in small underpowered studies, and large-scale assessments are still lacking. It is imperative to find ways to demonstrate the effect of the provision of clean water on public health, with a focus on the incidence of diarrhea and consequent illnesses. We therefore consider that one of the main objectives of our project is to satisfy the need to supply this information to the scientific community and to government health organizations.
We have also formulated a number of research projects to collect and examine data from the community and healthcare facilities at various levels (i.e. primary, secondary, and tertiary healthcare facilities), before and after the implementation of the water purification devices. We have designed case report forms, which are being used by community workers and clinical research coordinators for data collection in the studied communities and the respective healthcare facilities.
To assess for effect modifiers and factors modulating the relationship between provision of clean water and health outcomes, we collect additional data such as the demographics of households, household size, and presence of sanitation facilities etc. We also collect data on the use of electrolyte replacement packages at the village level and referrals to local healthcare facilities (including primary, secondary, and tertiary level facilities) to confirm trends we might see in our community data.
Given the paucity of availability of existing data on seasonality of infectious diseases in Sub-Saharan countries, baseline and follow-up data must be collected for each study site over a period long enough to account for all relevant seasonal differences. Therefore, we propose a follow-up length of 12 months for studies which should allow us to capture referral dynamics within the public health network in the studied region and to ensure the most accurate interpretation of the captured data.
Construction of longitudinal models will allow analysis of trends and account for factors potentially modulating the public health effect in a larger area, such as the presence of sanitation facilities, village size, proximity to larger urban areas, healthcare facilities and schools, amongst several other potential relevant factors. We have sought approval for this endeavor from local Institutional Review Boards (IRB) and the Ethical Commission of the Ghana Health Services. (The School of Medical Sciences/Komfo Anokye Teaching Hospital has given IRB approval for our project. We still await approval by the Ethical Commission which is expected shortly.)
Preliminary house-to-house community surveys have already been initiated, after approval by the local Institutional Review Board in Kumasi area and will be initiated in Big Ada after final approval by Ghana Health Services. Further installations await such approval.