Impact of Improved Water, Sanitation, and Hygiene (WASH) Practices on Rotavirus Infection Rates in Urban Slums of Nairobi, Kenya

Introduction: Rotavirus is a leading cause of severe diarrhea in children under five years old, particularly in low-income settings with inadequate water, sanitation, and hygiene (WASH) infrastructure. This study aimed to evaluate the impact of an integrated WASH intervention program on rotavirus infection rates among children residing in the urban slums of Nairobi, Kenya. Methods: A cluster-randomized controlled trial was conducted in two informal settlements in Nairobi. Households in theintervention arm received a comprehensive WASH intervention package, including household water treatment, improved sanitation facilities, handwashing promotion, and health education. The control arm received routine health services. Stool samples were collected from children under five at baseline and after 12 months of intervention implementation, and tested for rotavirus using enzyme-linked immunosorbent assay (ELISA). Results: A total of 855 children (428 in the intervention arm and 427 in the control arm) were enrolled in the study. At baseline, the prevalence of rotavirus infection was 18.2% in the intervention arm and 19.4% in the control arm.After 12 months, the prevalence significantly decreased to 8.9% in the intervention arm, while remaining relatively stable at 17.1% in the control arm. Multivariable analysis revealed that the WASH intervention was independently associated with a reduced risk of rotavirus infection (adjusted odds ratio [aOR] 0.47, 95% CI 0.31-0.72). Conclusion: This study provides evidence that a comprehensive WASH intervention program can significantly reduce rotavirus infection rates among children in urban slums. These findings underscore the importance of integrating WASH interventions into public health strategies for diarrheal disease prevention in resource-limited settings.