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Free Provision of Drinking Water Treatment and Child Survival: Evidence from Kenya
Last registered on July 13, 2020

Pre-Trial

Trial Information
General Information
Title
Free Provision of Drinking Water Treatment and Child Survival: Evidence from Kenya
RCT ID
AEARCTR-0005969
Initial registration date
July 05, 2020
Last updated
July 13, 2020 3:56 PM EDT
Location(s)
Primary Investigator
Affiliation
Harvard University
Other Primary Investigator(s)
PI Affiliation
Harvard University
Additional Trial Information
Status
Completed
Start date
2012-11-01
End date
2018-05-01
Secondary IDs
Abstract
We investigate whether free provision of drinking water treatment solution through an approach designed to incorporate insights from behavioral economics can cost effectively improve child survival. While few households in low-income countries purchase water treatment solution, Kremer et al. (2011) find that approximately half of households use a free point-of-collection water treatment dispenser designed to be convenient, salient, and public. However, Ashraf et al (2009) argue that free provision may lead to waste; Schmidt and Cairncross (2009) argue that positive impacts of water treatment on caregiver reports of child diarrhea may be subject to reporting bias and call for data on objective outcomes; and recent studies yield little evidence of child development outcomes (Stewart et al. 2018. Our study exploits the random variation in chlorine solution availability induced by the Kenya WASH Benefits study (Null et al., 2018), and uses supplementary survey data recently collected from the study areas (Haushofer et al., 2018). We study the impact of free community-wide provision of dilute chlorine solution on all-cause under 5 mortality over a 4-year period and across a sample of children over twice as large as previously analyzed (Null et al., 2018).
External Link(s)
Registration Citation
Citation
Kremer, Michael and Brandon Tan. 2020. "Free Provision of Drinking Water Treatment and Child Survival: Evidence from Kenya." AEA RCT Registry. July 13. https://doi.org/10.1257/rct.5969-1.0.
Experimental Details
Interventions
Intervention(s)
The intervention was implemented by the Kenya Wash Benefits Study (Null et al. 2018).

See the original trial at ClinicalTrials.gov, number NCT01704105.
Intervention Start Date
2012-11-01
Intervention End Date
2014-05-01
Primary Outcomes
Primary Outcomes (end points)
All-cause under-5 mortality, All-cause under-2 mortality
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Chlorination
Secondary Outcomes (explanation)
Chlorination (Self-reported)
- "Usually chlorinate water"
- "Chlorinated water in the past 30 days"
- "Obtaining chlorine from dispensers at the water source"

Chlorination (Objective):
- Free Residual Score
- Indicator for free chlorine residual score above 0.1
Experimental Design
Experimental Design
We examine the effect of the community-wide provision of dilute chlorine solution on all-cause child mortality. Our study exploits the random variation in chlorine solution availability induced by the Kenya WASH Benefits study (Null et al., 2018), and uses supplementary survey data recently collected from the study areas (Haushofer et al., 2018). We examine mortality effects over a 4-year period and across a sample of children over twice as large as previously analyzed (Null et al., 2018).
Experimental Design Details
Our setting is a subset of villages covered by Evidence Action’s Dispensers for Safe Water (DSW) program. Evidence Action, starting with a pilot of 20 dispensers in western Kenya in 2007, has since grown to operating 27,500 dispensers serving 4 million people across Kenya, Uganda, and Malawi today. We focus on their operations in western Kenya, specifically Kakamega and Bungoma county, where we are able to exploit random variation in dispenser provision from the Kenya WASH Benefits study (Null et al., 2018), a RCT which examined the effects of water chlorination on early child development. In particular, we study children born to women after January 2008, living in 132 villages (grouped into 82 “clusters” of 1-3 villages each). Of these villages, 65 had been assigned to a “water” (W) treatment and 67 to a “passive control” (C) condition in the WASH study. In the W villages, the study randomly allocated the provision of dilute chlorine solution in two ways: through point-of-collection chlorine dispensers, and provision of dilute chlorine solution (“WaterGuard”) to households with children for one year. Specifically, chlorine dispensers were installed at a subset of public water sources in each village, on average 5 per cluster. The dispensers provided a dosed amount of chlorine solution, enough to safely disinfect the typical amount of water collected. In addition, all family compounds in dispenser villages which had children under 5 years of age at the time of the original WASH study were given 1-liter bottles of dilute chlorine solution for point-of-use water disinfection every 6 months for the first year of the intervention, where each 1-liter bottle expires within 6 months. Our analysis uses survey data (Haushofer et al., 2018) that allow us to examine mortality for a sample of children over twice as large as that of Null et al. (2018) and for a longer period of time (between 1 to 3 additional years, depending on the area). This study estimates the intention-to-treat effect of the community-wide provision of dilute chlorine solution through dispensers and household delivery on all-cause child mortality. Following McKenzie (2012), we condition on the pre-intervention under-5 (under-2) mortality rate of the cluster to improve statistical power (ANCOVA framework). The pre-intervention mortality rate is computed with all children born between January 1, 2008 and before the roll-out of the intervention. We also estimate a difference-in-difference model which compares changes in mortality rates (before and after the intervention) across treatment and control areas for children born since January 1, 2008. For each model, we first estimate the effect of the community-wide provision of dilute chlorine solution through dispensers and WaterGuard on under-2 and under-5 (years) mortality. , We will look at the impact of both bottled chlorination and dispensers together, as well as just dispensers by focusing on children born at least one year after the rollout of the intervention, who therefore would not have benefitted from the provision of WaterGuard. Because it is possible that the provision of WaterGuard during the first year of the WASH-B study also influenced these women’s use of WaterGuard later on, we also conduct a robustness check in which we exclude these women from the sample entirely (including all of their children, rather than just those born shortly after the beginning of the intervention). Second, we split up the previous results further in order to examine mortality effects at different times after birth among children who survived until a certain age. In particular, we examine effects on neonatal (< 1 month), post-neonatal (1≤ months <12) and child (1 ≤ years <5) mortality. We chose these periods following the analysis of the global burden of disease due to diarrhea (and other infectious diseases) by Gakidou et al. (2017). This strategy will identify the post-natal periods where observed mortality is reduced and shed insight on survival dynamics.
Randomization Method
See Kenya Wash Benefits (Null et al. 2018)
Randomization Unit
Cluster of villages
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
82 clusters of 1-3 villages each
Sample size: planned number of observations
4,437 children
Sample size (or number of clusters) by treatment arms
2,293 treatment, 2,144 control
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
56% decrease in percentage point (1.3 pp decrease; standard deviation=0.15) for ITT without controls. We expect greater power with ANCOVA specification.
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Princeton University
IRB Approval Date
2019-09-04
IRB Approval Number
0000007367
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
May 01, 2018, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
May 01, 2018, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
82 clusters of 1-3 villages each
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
4,437 children
Final Sample Size (or Number of Clusters) by Treatment Arms
2,293 treatment, 2,144 control
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
No
Reports, Papers & Other Materials
Relevant Paper(s)
REPORTS & OTHER MATERIALS