Approximately 1.7 million children < 5 years old (yo) die annually due to diarrhea. Consuming unsafe drinking water contributes substantially to these deaths. Point of use (POU) chlorination products for household drinking, which are socially marketed in Kenya, have been shown to reduce diarrhea risk; however, use rates remain low. The Nyando Integrated Child Health and Education (NICHE) project promotes POU chlorination through women’s groups, schools, clinics, and churches in rural villages in western Kenya to motivate water treatment behaviors and decrease diarrhea rates in children < 5 yo. We evaluated the impact of the NICHE project on POU chlorination and diarrhea rates by randomly selecting 60 villages and allocating them into intervention and comparison groups. The intervention villages received the NICHE and social marketing activities while the comparison villages received only social marketing. We visited a random sample of households biweekly to collect data on use of water treatment products, chlorine residuals in stored water, and diarrhea episodes. We collected data from 1395 households with 1750 children < 5yo. Respondents’ median age was 30 years (range 16-90y); 84% had a primary school education or less and 86% were in the poorest socioeconomic quintile. Over 16 rounds of biweekly home visits, a median proportion of 20% (range 11-34%) of intervention households and 14% (range 7-43%) of comparison households reported chlorinating stored water the day of the visit. Measurement of residual chlorine in stored water confirmed chlorination in 13% of all intervention home visits and 12% of comparison home visits (p>0.05). The median proportion of children < 5yo with diarrhea in the preceding 24h over 16 rounds was 4% in both intervention and comparison groups. Although reported POU water treatment was higher in intervention than comparison households, confirmed chlorination and diarhea rates were similar in the two groups, suggesting that, in the first 8 months of the project, the impact of NICHE interventions did not exceed that of social marketing alone. Biweekly home visits will continue for another year to assess the impact of the NICHE project on behavior change and diarrheal rates over time.
