Evaluating In-line Chlorination in Nigeria

NCT07601503 | Not Yet Recruiting

• 1 other identifier: 2025-08-18832
• Study Type: interventional
• Target: 2,655
• Locations: 1 country
• Sites: 2

Brief Summary

This study evaluates the implementation and effectiveness of in-line chlorination (ILC) for improving drinking water quality in rural Nigeria. Unsafe drinking water remains a major contributor to diarrheal disease, particularly among children under five. Inline chlorination is a passive water treatment approach that automatically doses chlorine at community water systems without requiring electricity or daily user action. Two cluster randomized controlled trials will be conducted in Kano State (North-West Nigeria) and Cross River State (South-South Nigeria). Communities will be randomized to either receive in-line chlorination installed at eligible communal water systems or serve as controls with no chlorination. The unit of randomization is a community or a cluster of communities that share water system for drinking water. The primary objective is to estimate the causal impact of in-line chlorination on household drinking water quality. Outcomes include the prevalence of Escherichia coli contamination in tap water and stored household water as well as the presence of free chlorine residual. Secondary objectives assess water source usage and adoption of chlorinated sources, as well as reduction in diarrheal disease. Implementation fidelity and operational performance of chlorination devices will also be monitored.

Conditions

Diarrhea; Water Quality; Adoption

Keywords

Inline Chlorination, Safe Water, Water Practices, Behavior, Diarrhea, Children

Outcome Measures

Primary Outcomes (3)

• Proportion of water source samples with detectable free chlorine residual.

  Measured as \>0.1 ppm.

  About 4-, 8-, and 12-month follow ups after device installations

• Proportion of household stored drinking water samples with detectable free chlorine residual.

  Measured as \>0.1 ppm.

  About 4-, 8-, and 12-month follow ups after device installations

• Proportion of household stored drinking water samples positive for Escherichia coli.

  Measured as \>1 MPN/100 mL of water by culture-based assay

  About 4-, 8-, and 12-month follow ups after device installations

Secondary Outcomes (8)

• Proportion of water source samples with detectable total chlorine residual.

  About 4-, 8-, and 12-month follow ups after device installations

• Concentration of E. coli in water source samples

  About 4-, 8-, and 12-month follow ups after device installations

• Concentration of E. coli in household stored water samples

  About 4-, 8-, and 12-month follow ups after device installations

• Concentration of total coliform bacteria in water source samples

  About 4-, 8-, and 12-month follow ups after device installations

• Concentration of total coliform bacteria in household stored water samples

  About 4-, 8-, and 12-month follow ups after device installations

Other Outcomes (4)

• Proportion of households reporting an ILC-compatible water source as their primary drinking water source

  About 4-, 8-, and 12-month follow ups after device installations

• Proportion of households switching away from ILC-treated water sources

  About 4-, 8-, and 12-month follow ups after device installations

• Proportion of households reporting any household-level water treatment

  About 4-, 8-, and 12-month follow ups after device installations

Study Arms (2)

Arm 1: Inline Chlorination (ILC) with Behavioral Change Communication (BCC)

EXPERIMENTAL

Communities randomized to this arm will receive inline chlorination installed at eligible communal drinking water systems, such as boreholes or handpumps, and behavioral change communication.

Device: In-line Chlorination (ILC) with Behavioral Change Communication (BCC)

Arm 2: Control (No Chlorination)

NO INTERVENTION

Communities randomized to this arm will not receive inline chlorination during the study period and will continue their usual water collection and treatment practices.

Interventions

In-line Chlorination (ILC) with Behavioral Change Communication (BCC) DEVICE

In-line chlorination devices will be installed on all compatible communal water systems within treatment communities. Devices automatically dose chlorine proportional to water flow without requiring electricity or daily user input. Technologies will include TuriTap liquid dosers installed at handpumps and CTI-8 tablet dosers installed at tanks or piped systems. Devices will be calibrated and routinely monitored to maintain chlorine residual within recommended ranges. In addition to device installation, communities will participate in behavior change communication (BCC) activities designed to support understanding and acceptance of chlorinated water. BCC activities will include community sensitization meetings conducted by the implementing partner. Meetings will provide information on the purpose of chlorination through the in-line chlorination devices, expected benefits and limitations, safe water handling practices, and guidance for addressing taste or odor concerns.

Arm 1: Inline Chlorination (ILC) with Behavioral Change Communication (BCC)

Eligibility Criteria

• Age: 15 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult (18+) or emancipated minor (15+) pregnant women and women with children under 5 years old who do not plan to permanently move in the next 12 months.
• Must be knowledgeable about the household's water collection and management practices

You may not qualify if:

• Non-age-eligible women. Men and non-emancipated minors. Women who do not consent.

Sponsors & Collaborators

• University of California, Berkeley: lead
• University of Michigan: collaborator
• Bayero University Kano, Nigeria: collaborator

Study Sites (2)

Yala LGA

Yala, Cross River State, Nigeria

Location

Makoda LGA

Makuda, Kano State, Nigeria

Location

Related Publications (2)

• Pickering AJ, Crider Y, Sultana S, Swarthout J, Goddard FG, Anjerul Islam S, Sen S, Ayyagari R, Luby SP. Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial. Lancet Glob Health. 2019 Sep;7(9):e1247-e1256. doi: 10.1016/S2214-109X(19)30315-8.

  PMID: 31402005 BACKGROUND

• Lindmark M, Cherukumilli K, Crider YS, Marcenac P, Lozier M, Voth-Gaeddert L, Lantagne DS, Mihelcic JR, Zhang QM, Just C, Pickering AJ. Passive In-Line Chlorination for Drinking Water Disinfection: A Critical Review. Environ Sci Technol. 2022 Jul 5;56(13):9164-9181. doi: 10.1021/acs.est.1c08580. Epub 2022 Jun 14.

  PMID: 35700262 BACKGROUND

MeSH Terms

Conditions

Diarrhea; Behavior

Condition Hierarchy (Ancestors)

Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Amy J Pickering

  University of California, Berkeley

  PRINCIPAL INVESTIGATOR

• Elisa M Maffioli

  University of Michigan

  PRINCIPAL INVESTIGATOR

• Adamu I Tanko, PhD

  Bayero University Kano, Nigeria

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Amy J Pickering

CONTACT

+1.510.410.2666; pickering@berkeley.edu

Elisa M Maffioli

CONTACT

+1.443.875.4930; elisamaf@umich.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: May 14, 2026
• First Posted: May 22, 2026
• Study Start (Estimated): May 26, 2026
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2027
• Last Updated: May 22, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

NG (2)