Kidney Week

Abstract: FR-OR011

Membrane Filtration of Contaminated Water with Used Dialyzers Reduces the Incidence of Diarrhea in Rural Communities in Developing Countries

Session Information

• AKI: Epidemiology, Processes of Care, and Outcomes
  November 08, 2019 | Location: 201, Walter E. Washington Convention Center
  Abstract Time: 04:30 PM - 04:42 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Raimann, Jochen G., Renal Research Institute, New York, New York, United States

Jochen G. Raimann, MD, PhD, MPH



Dr. Raimann holds a medical degree from the Medical University Graz, a PhD from Maastricht University, and a Master in Public Health from the City University of New York School of Public Health. As the Senior Manager of Clinical Data Analytics at the Renal Research Institute Dr. Raimann conducts and directs epidemiological research in dialysis. Dr. Raimann joined the foundation of the non-profit organization “Easy Water for Everyone” (www.easywaterforeveryone.org) which provides clean water to communities in need and supports the organization’s research efforts together with a diverse team of researchers, epidemiologists and statisticians.

• Boaheng, Joseph Marfo, Easy Water for Everyone, New York, New York, United States

Joseph Marfo Boaheng,

• Narh, Philip Kwaku, Ghana Health Service, Ada Ghana, Ghana

Philip Kwaku Narh,

• Johnson, Seth, Easy Water for Everyone, New York, New York, United States

Seth Johnson,

• Donald, Linda L., Easy Water for Everyone, New York, New York, United States

Linda L. Donald,

• Zhang, Hongbin, Graduate School of Public Health and Health Policy, New York, New York, United States

Hongbin Zhang,

• Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Friedrich K. Port,

• Levin, Nathan W., Easy Water for Everyone, New York, New York, United States

Nathan W. Levin,

Background

Access to clean water remains unavailable for a large fraction of the world population. Consequent infectious diarrhea, dehydration and acute kidney injury too often leads to death. Membrane filtration using recycled hemodialyzers is a recent innovation. We quantified its effect on health outcomes in rural communities in Ghana.

Methods

From 2015 to 2018 we provided membrane filtration devices (NUFiltration Israel) to 9 communities in Ghana (Greater-Accra region). We calculated incidence rates of self-reported diarrhea and compared monthly counts for 12 months before and 12 after implementation by negative binomial and Poisson regression (Pois) with the log(exposure time) as the offset. Models were compared by likelihood ratio test (LRT) and Akaike Information Criterion (AIC). Logistic regression for recurrent events on a subject-level (LogReg) was used to determine the effect of device implementation and seasonality (rainy versus dry season).

Results

We studied 2605 villagers (10.4% younger than 5 and 5.1 % older than 65 yrs). Incidence rates were significantly lower after device implementation (0.08 versus 0.03; P<0.01). LRT and AIC determined Pois to fit best and Pois showed a significant treatment effect [0.4 (95% CI 0.3 to 0.5)]. LogReg confirmed a lower OR of diarrhea after implementation [0.3 (95% CI 0.2 to 0.3)] with a higher OR of 1.1 (95% CI 1.0 to 1.3) during the rainy season. Lower rates during Month -1 and -2 can possibly be explained by concomitant handwashing and hygiene education initiatives.

Conclusion

Our data shows decrease in the incidence rates and odds of contracting infectious diarrhea with the use of membrane filtration device in rural villages in West Africa. A possible effect of seasonality should be recognized as a potential risk factor. These data emphasize the remarkable public health effect achievable by provision of these low-cost devices.