Unsafe drinking water remains a major cause of mortality and morbidity. While Rwanda’s Community-Based Environmental Health Promotion Programme (CBEHPP) promotes boiling and safe storage, previous research found these efforts to be ineffective in reducing fecal contamination of drinking water. We conducted a cluster randomized control led trial to determine if adding a household water filter with safe storage to the CBEHPP would improve drinking water quality and reduce child diarrhea. We enrolled 1,199 households with a pregnant person or child under 5 across 60 randomly selected villages in Rwamagana district. CBEHPP implementers distributed and promoted water purifiers to a random half of villages. We conducted two unannounced follow-up visits over 13–16 months after the intervention delivery. The intervention reduced the proportions of households with detectable E. coli in drinking water samples (primary outcome) by 20% (PR 0.80, 95% CI 0.74–0.87, p < 0.001) and with moderate and higher fecal contamination (≥10 CFU/100 mL) by 35% (PR 0.65, 95% CI 0.57–0.74, p < 0.001). The proportion of children under 5 experiencing diarrhea in the last week was reduced by 49% (aPR 0.51, 95%CI 0.35–0.73, p < 0.001). Our findings identify an effective intervention for improving water quality and child health that can be added to the CBEHPP.

不安全的饮用水仍然是死亡率和发病率的主要原因。虽然卢旺达的基于社区的环境健康促进计划 (CBEHPP) 提倡煮沸和安全储存，但之前的研究发现这些努力在减少饮用水的粪便污染方面无效。我们进行了一项以集群随机对照为主导的试验，以确定在 CBEHPP 中添加具有安全储存功能的家用滤水器是否会改善饮用水质量并减少儿童腹泻。我们在 Rwamagana 区随机选择的 60 个村庄中招募了 1,199 户有孕妇或 5 岁以下儿童的家庭。CBEHPP 实施者向随机的一半村庄分发和推广净水器。我们在干预实施后的 13-16 个月内进行了两次突击随访。饮用水样本中的大肠杆菌（主要结果）增加 20%（PR 0.80，95% CI 0.74–0.87，p  < 0.001），中度和高度粪便污染（≥10 CFU/100 mL）增加 35%（PR 0.65 , 95% CI 0.57–0.74 , p  < 0.001)。上周发生腹泻的 5 岁以下儿童比例减少了 49%（aPR 0.51，95%CI 0.35–0.73，p  < 0.001）。我们的研究结果确定了可以添加到 CBEHPP 中的改善水质和儿童健康的有效干预措施。