In-line chlorination for drinking water in rural Odisha, India: A randomized controlled implementation trial
Journal
PLOS Water
ISSN
2767-3219
Publisher
Public Library of Science (PLoS)
Date Issued
2026
Author(s)
Lowe, Jeremy
Prathap, Vaishnavi
Kamei, Akito
Giri, Sidhartha
Sahoo, Krushna Chandra
Kremer, Michael
Maffioli, Elisa M.
Pickering, Amy J.
Type
text::journal::journal article
Abstract
In-line chlorination automatically treats drinking water in piped water systems, substantially reducing morbidity and mortality while averting the burden of water treatment on individuals. Approximately 2.3 billion people globally use fecally contaminated drinking water infrastructure that is potentially compatible with in-line chlorination. In India, the Ministry of Jal Shakti’s Jal Jeevan Mission has increased access to piped drinking water among rural households, but water is often supplied intermittently without treatment. The aims of this study were to 1) test installation and operations for two in-line chlorination devices (CTI-8 and PurAll 100), 2) evaluate acceptability and adoption of chlorinated water, and 3) assess reductions in drinking water fecal contamination, including with antibiotic resistant bacteria. We conducted a randomized controlled implementation trial of in-line chlorination in 20 villages in Rayagada district, Odisha, India over one year. Data collection included a baseline and post-intervention census (N = 914) and household surveys over six timepoints (N = 1,041) to assess water quality. In the treatment group, we detected chlorine in 51% of tap water samples; this prevalence rose to 78% after increasing the target dose. Despite taste complaints in treatment communities, participants continued using piped water as their primary drinking water source. Individuals in treatment villages spent less time manually treating their drinking water, a responsibility borne by women in 92% of households. Treatment reduced E. coli prevalence by 70% in tap water (95% CI: 54%, 80%) and by 47% in stored water (95% CI: 32%, 59%). Treatment also reduced the presence of antibiotic resistant E. coli by 67% in stored water (95% CI: 11%, 88%). In-line chlorination can improve water quality, lower the time burden of water treatment, and increase user adoption of chlorinated drinking water, but achieving this requires dedicated implementation and monitoring. © The authors © PLoS.
Subjects
License
Acceso Abierto
How to cite
Lowe, J., Prathap, V., Kamei, A., Giri, S., Sahoo, K. C., Kremer, M., Maffioli, E. M., & Pickering, A. J. (2026). In-line chlorination for drinking water in rural Odisha, India: A randomized controlled implementation trial. PLOS Water, 5(4), e0000440. https://doi.org/10.1371/journal.pwat.0000440