Expanding Access to Safe Water in Nigeria

Summary

Access to safe water remains a pressing public health challenge in Nigeria, where 67% of the population lacks safely managed drinking water and waterborne diseases cause an estimated 70,000 child deaths annually. Building on evidence that point-of-use chlorination is highly cost-effective in reducing diarrheal disease, this study evaluates a scalable, community-based chlorine distribution model through a cluster-randomized controlled trial (RCT) in Kano State. Thirty communities across four Local Government Areas will be randomly assigned to one of three groups: (i) 20 treatment communities receiving community demonstrations and local chlorine redemption points, (ii) 10 control communities where no intervention will be conducted. After 3 months, 5 control communities will receive an individual-level sensitization and a voucher program and 5 will remain pure control communities. The RCT aims to estimate the causal impact of the community-based intervention on household chlorination rates, water quality (E. coli contamination), and knowledge of safe water practices over six months. By rigorously testing a community-led water treatment model, this study contributes new evidence on sustainable and cost-effective approaches to expand safe water access in low-resource settings. The results will inform national and regional strategies for scaling point-of-use chlorination across sub-Saharan Africa.

Conditions

• Chlorination

Interventions

BEHAVIORAL

Community Demonstrations

Facilitators will collaborate with local leaders, WASH officials and health facility staff in conducting community demonstrations introducing the chlorine product (WaterGuard+) to communities in the treatment group. Local leaders in the community will organize the meeting, while facilitators in the country will demonstrate how to use the product, what the correct dosage is, and explain the importance of water treatment. They will also show how village water is contaminated with Ecoli. These meetings will be targeted at eligible women (pregnant women and women with children under the age of 5), however all members of the community will be invited to attend. At the meeting, each attendee will be given one bottle of WaterGuard+, which is enough to treat drinking water for a household of 5 members for about a month, and 1,000 naira. Water Guard + is a 180g bottle of sodium dichloroisocyanurate (NaDCC) in granulated / powder form, produced and distributed by the Society for Family Health.

BEHAVIORAL

Redemption points

Study staff will set up at least one chlorine redemption point for each community. The location of the redemption point will be determined in consultation with the local community during Community Demonstrations. The redemption points could be health facilities, local shops/dispensaries/kiosks, local pharmacies, house of the village leader, CHW, or health staff or other suitable sites. Households will be able to visit the location and redeem a month's supply of a chlorine product. Distributors will use a redemption log to keep track of when participants redeem the chlorine product.

Sponsors & Collaborators

• Princeton University

  collaborator OTHER

• University of Michigan

  lead OTHER

Principal Investigators

• Elisa Maria Maffioli, PhD · University of Michigan

• Pascaline Dupas · Princeton University

• Ana Radu · Princeton University

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Sex

FEMALE

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-09-30

Primary Completion

2026-09-30

Completion

2026-09-30

Countries

• Nigeria

Study Locations