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NCT Number: NCT07601503

Evaluating In-line Chlorination in Nigeria

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.

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Key information

Conditions

Diarrhea Adoption Behavior Pathological Conditions, Signs and Symptoms Signs and Symptoms Signs and Symptoms, Digestive Water Quality

Age range

15 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Yala LGA, Yala, Cross River State, Nigeria

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Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • 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

Exclusion criteria

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

Treatment and study plan

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.

Primary outcomes

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

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

    Measured as >0.1 ppm.

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

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

    Measured as >0.1 ppm.

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

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

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

Secondary outcomes

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

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

    Measured as >0.1 ppm.

  2. Concentration of E. coli in water source samples

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

    Concentration of E. coli (in log10 MPN/100ml) in water source samples by culture-based assay

  3. Concentration of E. coli in household stored water samples

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

    Concentration of E. coli (in log10 MPN/100ml) in household stored water samples by culture-based assay

  4. Concentration of total coliform bacteria in water source samples

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

    Concentration of total coliform bacteria (MPN/100mL) in water source samples

  5. Concentration of total coliform bacteria in household stored water samples

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

    Concentration of total coliform bacteria (MPN/100mL) in household stored water samples

  6. Prevalence of caregiver-reported diarrhea among children under five years of age

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

    Measured as the proportion of children under five reported by caregivers to have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey.

  7. Prevalence of caregiver-reported diarrhea among household members, any age

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

    Measured as the proportion of individuals surveyed in the household that have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey. Measured for subset of available respondents.

  8. Prevalence of diarrhea among female caregivers

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

    Measured as the proportion of respondents that have experienced diarrhea, defined as three or more loose or watery stools within a 24-hour period, during the 7 days preceding the survey.

Other outcomes

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

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

    Measured as the percentage of surveyed households identifying an ILC-compatible water system as their source of drinking water. ILC-compatible water systems (boreholes, piped systems, or handpumps have chlorinated water in treatment)

  2. Proportion of households switching away from ILC-treated water sources

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

    Measured as the percentage of households that discontinue use of a chlorinated water system for drinking water compared to baseline.

  3. Proportion of households reporting any household-level water treatment

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

    Measured as the percentage of households reporting treatment of drinking water prior to consumption (e.g., boiling, filtration, manual chlorination).

  4. Time spent on household-level water treatment

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

    Time (minutes) reported by households per day on making water safer to drink (gender stratified)

Study contacts

Contact information is provided by the study sponsor or research team.

Amy J Pickering

CONTACT

[email protected]

+1.510.410.2666

Elisa M Maffioli

CONTACT

[email protected]

+1.443.875.4930

Sponsors and collaborators

Lead sponsor

University of California, Berkeley

Other

Collaborators

  • Bayero University Kano, Nigeria
  • University of Michigan

Registry information

Official study title

In-line Chlorination for Drinking Water Treatment in Nigeria

Important dates

Study start
2026
Primary completion
2027
Study completion
2027
First posted
May 22, 2026
Registry last updated
May 22, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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