{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:41:58Z","timestamp":1793104918200,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020171","name":"Foreign and Commonwealth Development Office","doi-asserted-by":"publisher","award":["215674Z19Z"],"award-info":[{"award-number":["215674Z19Z"]}],"id":[{"id":"10.13039\/501100020171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R01AI148332-01"],"award-info":[{"award-number":["1R01AI148332-01"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100024021","name":"Reckitt Global Hygiene Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100024021","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Johns Hopkins School of Public Health"},{"name":"Dr Thomas D. Rees and Natalie B. Rees Presidential Endowed Chair in Global Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We assessed whether the Preventative Intervention for Cholera for 7 Days (PICHA7) WASHmobile program reduced diarrhea and cholera serological responses and improved child growth in the Democratic Republic of the Congo (DRC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PICHA7 WASHmobile cluster-randomized controlled trial enrolled diarrhea patient households in urban Bukavu, DRC. Households were randomized into 2 arms: single in-person visit for the DRC government's diarrhea patient standard message on oral rehydration solution use and a basic water, sanitation, and hygiene (WASH) message (standard arm); or this standard message and the PICHA7 program with weekly voice and text mobile health (mHealth) messages and quarterly in-person visits (PICHA7 arm). The primary outcome was diarrhea in the past 2 weeks assessed monthly for 12 months. Secondary outcomes were healthcare facility visits for diarrhea, Vibrio cholerae serological response, stunting, underweight, wasting, and diarrhea with rice water stool over 12 months. A Vibrio cholerae serological response was defined by a rise in serum V. cholerae O1 O-specific polysaccharide (OSP) immunoglobulin A (IgA) or immunoglobulin G (IgG) from baseline to the 1-month follow-up. Generalized estimating equations were used for regression models to account for clustering at the individual and household level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between December 2021 and December 2022, 2334 participants were randomly allocated to 2 arms: 1138 standard arm and 1196 PICHA7 arm. Diarrhea prevalence during the 12-month surveillance period was significantly lower among PICHA7 arm participants compared to standard arm participants (prevalence ratio, 0.39 [95% confidence interval {CI}: .32\u2013.48]). PICHA7 arm participants had lower odds of visiting a healthcare facility for diarrhea during the 12-month surveillance period (OR: 0.44 [95% CI: .25\u2013.77]) and lower odds of diarrhea with rice water stool (OR: 0.48 [95% CI: .27\u2013.86]). Significantly lower V. cholerae IgA serological responses were observed in the PICHA7 arm compared to the standard arm, defined by a change in serum IgA to V. cholerae O1 OSP from baseline to the 1-month follow-up (coefficient of between-arm difference from baseline to 1 month: \u22120.85 [95% CI: \u22121.60 to \u2212.09]). PICHA7 arm children aged &amp;lt;5 years were significantly less likely to be stunted (52% vs 63% standard arm) (OR: 0.65 [95% CI: .43\u2013.99]) at the 12-month follow-up. All WASH components had high adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The PICHA7 WASHmobile program, which combines mHealth with quarterly in-person visits, lowered healthcare facility visits for diarrhea, cholera serological responses, and stunting in the DRC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trials Registration<\/jats:title>\n                    <jats:p>NCT05166850.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf417","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T11:51:45Z","timestamp":1755085905000},"page":"785-796","source":"Crossref","is-referenced-by-count":4,"title":["Effects of a Water, Sanitation, and Hygiene Program on Diarrhea, Cholera, and Child Growth in the Democratic Republic of the Congo: A Cluster-Randomized Controlled Trial of the Preventative Intervention for Cholera for 7 Days (PICHA7 WASHmobile) Mobile Health Program"],"prefix":"10.1093","volume":"81","author":[{"given":"Christine Marie","family":"George","sequence":"first","affiliation":[{"name":"Department of International Health, Program of Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8240-2562","authenticated-orcid":false,"given":"Presence","family":"Sanvura","sequence":"additional","affiliation":[{"name":"Center for Tropical Diseases and Global Health, Universit\u00e9 Catholique de Bukavu , Bukavu ,","place":["Democratic Republic of the Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8906-7653","authenticated-orcid":false,"given":"Jean-Claude","family":"Bisimwa","sequence":"additional","affiliation":[{"name":"Center for Tropical Diseases and Global Health, Universit\u00e9 Catholique de Bukavu , Bukavu ,","place":["Democratic Republic of the Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3427-298X","authenticated-orcid":false,"given":"Kelly","family":"Endres","sequence":"additional","affiliation":[{"name":"Department of International Health, Program of Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alves","family":"Namunesha","sequence":"additional","affiliation":[{"name":"Center for Tropical Diseases and Global Health, Universit\u00e9 Catholique de Bukavu , Bukavu ,","place":["Democratic Republic of the Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willy","family":"Felicien","sequence":"additional","affiliation":[{"name":"Center for Tropical Diseases and Global Health, Universit\u00e9 Catholique de Bukavu , Bukavu ,","place":["Democratic Republic of the Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6459-0841","authenticated-orcid":false,"given":"Blessing Muderhwa","family":"Banywesize","sequence":"additional","affiliation":[{"name":"Center for Tropical Diseases and Global Health, Universit\u00e9 Catholique de Bukavu , Bukavu ,","place":["Democratic Republic of the Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of International Health, Program of Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health , Baltimore, 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