A number of household water treatment and safe storage technologies, such as chlorine disinfection, solar disinfection, and ceramic filtration, have been documented for their ability to reduce diarrheal disease and improve microbial water quality. The biosand filter (BSF) is a promising household water treatment technology in use by > 500,000 people globally. The purpose of this research was to document the ability of BSFs to improve water quality and to reduce diarrheal disease in user compared with non-user households in a randomized controlled trial in Bonao, Dominican Republic, during 2005–2006. During the 6-month intervention period, 75 BSF households had significantly improved drinking water quality on average compared with 79 control households ( P < 0.001). Based on random intercepts logistic regression, BSF households had 0.53 times the odds of diarrheal disease as control households, indicating a significant protective effect of the BSF against waterborne diarrheal disease