Household Drinking Water Quality Updates
The Long-Term Impact of Water and Sanitation on Childhood Cognition. The FASEB Journal, April 2015.
Authors: Nisaa’ Wulan, Emily Smith, et al.
Unsafe water and poor sanitation may negatively affect brain development, however few studies have examined the long-term impact on children’s cognitive function. Our objective was to assess the relationship between household access to safe water and toilet facilities during the prenatal period with childhood cognition 9-12 years later. The Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), conducted in 2001-2004 In Indonesia, compared the health effects of a prenatal multiple micronutrient supplement to an iron and folic acid supplement.
Children of mothers who had access to safe toilet facilities during pregnancy had higher scores in Digit Span Forward (95%CI 0.008-0.17, P<0.03), Information (95%CI 0.08-0.2, P<0.001), Block Design (95%CI 0.01-0.1, P<0.02), and Word List Memory (95%CI 0.006-0.17, P<0.03) tests after adjusting for cluster randomization, data collector, maternal education, socio-economic status and home environment score.
Children of mothers with access to safe water during pregnancy had higher Word List Memory scores (95%CI 0.01-0.19, P<0.02). The finding that safe water and toilet facilities were associated with child cognition even after adjustment for socio-economic status and maternal education suggests that interventions to improve water and sanitation in early life may have long-term benefits on child cognitive abilities.
Water, sanitation, and diarrheal incidence among children: evidence from Guatemala. Water Policy, In Press, Uncorrected Proof, Mar 2015.
Authors: William F. Vásquez and Anna-Maria Aksan
Using household survey data for Guatemala, this paper investigates the role of water and sanitation infrastructure on diarrheal incidence in children. Hierarchical logit models of diarrhea incidence are estimated to account for potential regional heterogeneity of water and sanitation effects. Results indicate that the incidence probability of diarrhea is on average 20% lower in homes connected to a sewage system. The effect of in-home access to tap water is weaker at 11% and subject to regional heterogeneity. Findings also indicate that consumption of bottled water reduces the incidence probability of diarrhea by 20–22%. In-home water treatments have no effect on incidence of diarrhea. Policy implications are discussed.
Piped water flows but sachet consumption grows: The paradoxical drinking water landscape of an urban slum in Ashaiman, Ghana
Piped water flows but sachet consumption grows: The paradoxical drinking water landscape of an urban slum in Ashaiman, Ghana. Habitat International, June 2015.
Authors: Justin Stoler, et al.
- This research explores drinking water perceptions in Old Tulaku, an urban slum in Ashaiman, Ghana.
- The study synthesizes results from 4 focus groups and survey data from 95 households.
- Sachet water consumption is associated with socioeconomic and knowledge factors.
- Drivers of water-seeking behaviour are complex and can inform water provision policy.
Empowerment in action: savings groups improving community water, sanitation, and hygiene services. Enterprise Development and Microfinance, March 2015.
Kaelyn DeVries, Alejandro Rizo, Project Concern International, Guatemala.
Savings groups (SGs) combined with social empowerment strategies can be used to engage communities meaningfully in addressing development challenges such as access to clean water and a functioning latrine. As participants in PCI’s SG initiative entitled Women Empowered (WE), women have independently identified WASH needs in their communities and have organized and carried out collective actions to improve their situation. This paper highlights results from a qualitative study in which PCI looked at SGs within two international development programmes in urban and rural Guatemala.
Do Decentralized Community Treatment Plants Provide Better Water? Evidence from Andhra Pradesh, 2015.
Authors: Marc Jeuland, et al.
Highly advanced, community-level drinking water treatment facilities are increasingly seen as water supply solutions in locations where piped in-house water systems are nonexistent or unreliable. These systems utilize combined technologies, such as advanced filtration plus ultraviolet disinfection or reverse osmosis, which are known to be highly effective for the removal of pathogens and other water contaminants. Yet there is a paucity of rigorous evidence on whether the community-level treatment model delivers water quality, health, or other benefits to households that source water from them.
We find low rates of sourcing water from the facilities (~10%), and little evidence of benefits among households living in villages receiving a community water system (CWS). Particularly among users of the CWS, we also observe short-term increases in the number of drinking water sources used and in monthly expenses on drinking water combined with decreases in in-house water treatment, and higher reported rates of diarrheal diseases among children. These findings suggest that caution and additional scrutiny is warranted before concluding that such systems provide safer water to households in communities facing drinking water quality problems.
A Review of Heterogeneous Photocatalysis for Water and Surface Disinfection. Molecules 2015, 20, 5574-5615.
Authors: John Anthony Byrne, et al.
Photo-excitation of certain semiconductors can lead to the production of reactive oxygen species that can inactivate microorganisms. The mechanisms involved are reviewed, along with two important applications. The first is the use of photocatalysis to enhance the solar disinfection of water. It is estimated that 750 million people do not have accessed to an improved source for drinking and many more rely on sources that are not safe. If one can utilize photocatalysis to enhance the solar disinfection of water and provide an inexpensive, simple method of water disinfection, then it could help reduce the risk of waterborne disease.
Chlorine dispensers in Kenya: scaling for results, 3ie Grantee Final Report, 2015.
Authors: Amrita Ahuja, et al.
We conducted three studies: one survey experiment and two large-scale randomized evaluations, to investigate how a particular community-level water treatment device, the chlorine dispenser, is valued and allocated by local government officials, and how best it can be financed and managed.
The first study involved 179 elected county councilors in rural Kenya, who chose between different public goods packages in an incentivized survey. The public goods varied with respect to two attributes: how the location of the infrastructure was decided and who controlled the funding associated with maintaining it. We found that on average, councilors valued the opportunity to target the water treatment technology, but not the ability to control funding for maintenance.
The second study, Community Financed Dispensers (CFD) concerned how to finance the chlorine refills required to keep chlorine dispensers functional. The chlorine dispenser is a classic common good in that chlorine is rival in consumption, yet it is not practical to restrict access to it. 104 communities were randomly assigned to a free provision arm or one of four community financing arms. In the community financing arms, water source users were responsible for purchasing chlorine refills. In half of these, an upfront contribution to the cost of the dispenser was required prior to installation (“up-front payment” treatment); cross-cut with this was a “threat of removal” treatment, in which the dispenser was a portable model that could be removed if the community failed to stock it with chlorine. In free provision communities, permanent dispensers were installed and chlorine refills were provided at no cost. We found no effect of up-front payment on household chlorine usage three months after installation, nor on whether the dispenser contained chlorine at unannounced visits over a period of eleven months. In contrast, threat of removal led to a 20 percentage point increase in the probability that a dispenser was stocked relative to permanent community-financed dispensers, which were stocked 41% of the time. Further, we estimate that in communities receiving free refills, enough doses were consumed to consistently treat all households’ drinking water. Households in threat of removal communities consumed 28-30% of the
recommended doses and households in other communities consumed 20% of the recommended doses.
Effectiveness of Chlorine Dispensers in Emergencies: Case Study Results from Haiti, Sierra Leone, DRC, and Senegal
Effectiveness of Chlorine Dispensers in Emergencies: Case Study Results from Haiti, Sierra Leone, DRC, and Senegal. Environ. Sci. Technol., March 2015.
Authors: Travis Yates , Elise Armitage , Lilian V. Lehmann , Ariel J. Branz , and Daniele S. Lantagne
Dispensers are a source-based water quality intervention with promising uptake results in development contexts. Dispenser programs include a tank of chlorine with a dosing valve that is installed next to a water source, a local Promoter who conducts community education and refills the Dispenser, and chlorine refills. In collaboration with response organizations, we assessed the effectiveness of Dispensers in four emergency situations.
In the three initial and four sustained response phase evaluations, 70 Dispenser sites were visited, 2,057 household surveys were conducted, and 1,676 water samples were analyzed. Across the evaluations, reported Dispenser use ranged from 9-97%, confirmed Dispenser use (as measured by free chlorine residual) ranged from 5-87%, and effective use (as measured by improvement in household water quality to meet international standards) ranged from 0-81%.
More effective Dispenser interventions installed Dispensers at point-sources, maintained a high-quality chlorine solution manufacturing and distribution chain, maintained Dispenser hardware, integrated Dispensers projects within larger water programs, remunerated Promoters, had experienced project staff, worked with local partners to implement the project, conducted ongoing monitoring, and had a project sustainability plan. Our results indicate that Dispensers can be, but are not always, an appropriate strategy to reduce the risk of waterborne diseases in emergencies.
Effects of Source versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial
Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial. PLoS One, March 2015
Authors: Ayse Ercumen , Abu Mohd. Naser , Leanne Unicomb, Benjamin F. Arnold, John M. Colford Jr., Stephen P. Luby
Background - Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh.
Methods - We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants’ source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions.
Findings - Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias.
Conclusions - Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.
Sustainability and scale-up of household water treatment and safe storage practices: Enablers and barriers to effective implementation
Sustainability and scale-up of household water treatment and safe storage practices: Enablers and barriers to effective implementation. International Journal of Hygiene and Environmental Health, March 2015.
Authors: Edema Ojomo, Mark Elliott, b, Lorelei Goodyear, Michael Forson, Jamie Bartram
Household water treatment and safe storage (HWTS) options provide a solution, when employed correctly and consistently, for managing water safety at home. However, despite years of promotion by non-governmental organizations (NGOs), governments and others, boiling is the only method to achieve scale. Many HWTS programs have reported strong initial uptake and use that then decreases over time. This study maps out enablers and barriers to HWTS sustainability and scale-up.
Interviews were carried out with 72 HWTS practitioners who had direct experience with HWTS programs in over 25 countries. A total of 47 enablers and barriers important to sustaining and scaling up HWTS practices were identified. These were grouped into six domains: (1) user guidance on HWTS products; (2) resource availability; (3) standards, certification and regulations; (4) integration and collaboration; (5) user preferences; and (6) market strategies.
Collectively, the six domains cover the major aspects of moving products from development to the consumers. It is important that each domain is considered in all programs that aim to sustain and scale-up HWTS practices. The findings described in this paper can aid governments, NGOs, and other organizations involved in HWTS to approach programs more effectively and efficiently.
Water, sanitation and hygiene in health care facilities: Status in low- and middle-income countries and way forward, 2015. WHO; United Nations’ Children’s Fund.
The findings in this first multi-country review of water, sanitation and hygiene (WASH) services in health care facilities are sobering. Drawing on data from 54 low- and middle-income countries, the report concludes that 38% lack access to even rudimentary levels of water, 19% lack sanitation and 35% do not have water and soap for handwashing.
When a higher level of service is factored in, the situation deteriorates significantly. A number of areas require urgent action and WHO will work with UNICEF, Governments and other partners to develop a global plan to address the most pressing needs and ensure that all health care facilities have WASH services.
WHO – Preventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries
Preventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries, 2014. World Health Organization.
- Direct use of drinking-water from unimproved sources (without household water treatment)ranged from 3% to 38% by region, with an overall average of 12% among LMICs. Regional averages for access to piped water on premises ranged from 19% to 88%, with an LMIC average of 49% (Table 1), although this figure includes intermittent and poorly managed piped supplies which may be microbially compromised.
- Use of unimproved sanitation facilities ranged from 13% to 65% by region (Table 2). This proportion includes those who share an improved facility among two or more households.
- Approximately 19% of the world’s population washes hands with soap after contact with excreta. This proportion is estimated to range between 13% and 17% in LMIC regions, and from 43% to 49% in high-income regions (Figure 13).
Impacts of interventions
- A modest reduction in diarrhoea (e.g. 11–16%) can be achieved through use of basic improved water or sanitation facilities, such as protected wells or improved latrines (Figures 6 and 11). The health benefit is limited because these drinking-water sources may be microbially contaminated and because basic sanitation may not adequately protect the wider community from exposure to excreta.
- Diarrhoea can be reduced significantly if water quality can be ensured up to the point-of-consumption. Effective and consistent application of household water treatment and safe storage can reduce diarrhoeal disease by between 28% and 45%, depending on the type of water supply (Figure 6).
- Limited evidence suggests that major diarrhoea reductions (e.g. 73%) can be achieved by transitioning to services that confer safe and continuous piped water supply (Figure 6).
- Similarly, limited evidence suggests that connection to a sewerage system that safely removes excreta from both the household and community yields great health benefits. • Handwashing reduces the risk of diarrhoeal disease by 40%, however when an adjustment for unblinded studies was included, the effect estimate was reduced to 23% and became statistically nonsignificant.
Global burden of disease
- 842 000 deaths in LMICs are caused by inadequate WASH, representing 58% of total diarrhoeal deaths, and 1.5% of the total disease burden.
- Separated out by individual risk factor, 502 000 deaths can be attributed to unsafe and insufficient drinking-water, 280 000 deaths result from inadequate sanitation, and another 297 000 are due to inadequate handwashing. Because some people are exposed to multiple risk factors, the sum of deaths attributable to individual risk factors is different from when the risk factors are considered together.
- Diarrhoeal deaths among children under-five have more than halved from 1.5 million in 1990 to 622 000 in 2012. Inadequate WASH accounts for 361 000 of these deaths, or over 1000 child deaths per day.
- The current global burden of disease estimate of the impact of inadequate WASH (i.e. 58% of total diarrhoeal deaths) is substantially lower than the WHO 2000 estimate of 88%. This is attributed to a number of factors including the fall in global diarrhoeal deaths from 2.2 million in 2000 to 1.5 million in 2012 and the use of a far more conservative counterfactual, which retains a significant risk of diarrhoeal illness.
- Health impacts of poor WASH on diseases other than on diarrhoea have not been updated in this study. However, earlier work showed that poor water, sanitation, and hygiene have a major impact on undernutrition, and also on a number of neglected tropical diseases including schistosomiasis, trachoma and soil-transmitted helminths (intestinal worms).
- Water resource management also impacts on vector-borne diseases such as malaria and dengue fever, and accidental deaths through drowning. The findings of this report underscore the importance of enabling universal access to at least a basic level of drinkingwater and sanitation service.
The report also suggests that that there are likely to be major health benefits from raising service levels to safe and continuous water supply and to connection to a sewerage system. Limited data suggest that these higher levels of services could significantly reduce diarrhoeal disease. These findings are consistent with WHO Guidelines which emphasize continuous improvements to protect public health.
Reducing childhood illness – fostering growth : an integrated home-based intervention package (IHIP) to improve indoor-air pollution, drinking water quality and child nutrition
Reducing childhood illness – fostering growth : an integrated home-based intervention package (IHIP) to improve indoor-air pollution, drinking water quality and child nutrition, 2014.
Author: Hartinger Peña.
The goal of this PhD thesis was to assess the efficacy of an Integrated Environmental Home-based-Intervention Package (IHIP), comprised of an improved chimney stoves, access to safe drinking water from solar radiation household water treatment (SODIS), and hygiene education interventions, to reduce morbidity of acute respiratory infections, diarrhoea and poor growth of rural Peruvian children under three years of age. We implemented a community-randomised control field trial (cRCT) in 51 community’s clusters of the San Marcos Province, Cajamarca Region, Peru.
The cRCT was divided as follows: * Set-up, community selection and participatory intervention development: A pilot study was carried out for the selection of the interventions. These were adapted to local customs. The participatory phase is described in detail in Chapters 4 & 5. * Randomization, enrolment and baseline data collection: Chapter 6 describes the randomisation, enrolment and baseline in detail. * Carbon monoxide (CO) and Particulate Matter (PM2.5) household air quality assessment: Chapter 7 & 8 describe the efficacy of the OPTIMA-improved stove in improving household air quality in comparison to traditional open fire stoves. * Morbidity surveillance and field data acquisition: Morbidity data on the daily occurrence of signs and symptoms diarrhoea and respiratory illnesses of children was collected weekly. Anthropometric every two months and microbial data every 6 months. Chapter 9 describes the IHIP impact on morbidity reduction. * Workshops for a community-driven sustainable dessimination: Chapter 10 describes the community workshops and dissemination processes and dynamics within a socio-ecological framework.
Our community-randomised control trial demonstrated that IHIP reduced 22% per year of child diarrhoea (RR 0.78, 95% CI: 0.49-1.05) and found an odds ratio of 0.71 for diarrhoea prevalence (OR 0.71, 95%, CI: 0.47, 1.06). No effects on the frequency of acute lower respiratory infections (RR 0.99, 95% CI: 0.59, 1.65) or child’s growth rates were found when comparing study arms. We identified three reasons for this moderate diarrhoea reduction: i) hand-washing promotion was universally found in our setting, since it is being promoted by the health care centre; ii) SODIS compliance was moderate: only one third of the beneficiaries were using the method regularly; and iii) the increased awareness for the child’s needs linked to the control intervention, could induce improved child care behaviour.
The lack of effect on ALRI, could be linked to insufficient reduction in exposure to household air pollutants and high health service utilisation due to cultural beliefs and health seeking behavoiur. The household air pollution assessment study revealed only moderate reductions of 45% and 27% reduction of PM2.5 and CO, respectively for mothers’ personal exposure. This result was achieved in the best working stoves only. This may most likely not be sufficient to reduce impact on physician-diagnosed pneumonia. Community participatory meetings and surveys revealed that people’s decisions on adopting household-level environmental and hygiene interventions, was not only based on individual perceptions of their potential gains, but also depended on peer pressure and social network relations.
Individual perceptions regarding pollution levels of water and household air (transparent, odourless water vs dirty air environments) influenced perceived gains and the adoption of certain interventions. Access to information and encouragement from health-care providers and programme implementers also increased adoption. The IHIP had several additional benefits beyond health outcomes. Mother’s expressed that the stoves could reduce cooking time and wood consumption, which translated into cost saving. They also could perform other task while cooking. Regarding the kitchen sink, the mothers expressed it facilitated handwashing, and washing of utensils with detergent, generating a cleaner kitchen environment that fostered home and food hygiene.
We believe that the IHIP package motivated families to improve the kitchen living area in general. The high acceptance and sustained use was not only observed in the IHIP families but also in non-participating families that had copied the OPTIMA-improved stove after the community engagement in the desimination activities. We can also conclude that the IHIP package added to the family status, improved quality of life and impacted on their livelihoods, by empowering the beneficiary families. In conclusion, through this project we envisaged to demonstrate how an integrated package could be implemented at the household level in rural areas of Peru and its effect on health, quality of life and livelihoods. However, behaviour change for keeping maintanence of the interventions and use is necessary to achieve compliance, replication and sustainability.
Differences in Field Effectiveness and Adoption between a Novel Automated Chlorination System and Household Manual Chlorination of Drinking Water in Dhaka, Bangladesh
Differences in Field Effectiveness and Adoption between a Novel Automated Chlorination System and Household Manual Chlorination of Drinking Water in Dhaka, Bangladesh: A Randomized Controlled Trial. PLoS One, March 2015.
Authors: Amy J. Pickering , Yoshika Crider, Nuhu Amin, Valerie Bauza, Leanne Unicomb, Jennifer Davis, Stephen P. Luby
The number of people served by networked systems that supply intermittent and contaminated drinking water is increasing. In these settings, centralized water treatment is ineffective, while household-level water treatment technologies have not been brought to scale. This study compares a novel low-cost technology designed to passively (automatically) dispense chlorine at shared handpumps with a household-level intervention providing water disinfection tablets (Aquatab), safe water storage containers, and behavior promotion.
Twenty compounds were enrolled in Dhaka, Bangladesh, and randomly assigned to one of three groups: passive chlorinator, Aquatabs, or control. Over a 10-month intervention period, the mean percentage of households whose stored drinking water had detectable total chlorine was 75% in compounds with access to the passive chlorinator, 72% in compounds receiving Aquatabs, and 6% in control compounds. Both interventions also significantly improved microbial water quality. Aquatabs usage fell by 50% after behavioral promotion visits concluded, suggesting intensive promotion is necessary for sustained uptake. The study findings suggest high potential for an automated decentralized water treatment system to increase consistent access to clean water in low-income urban communities.
Laboratory development and field testing of sentinel toys to assess environmental faecal exposure of young children in rural India
Laboratory development and field testing of sentinel toys to assess environmental faecal exposure of young children in rural India. Trans R Soc Trop Med Hyg, March 16, 2015.
Authors: Belen Torondel, Yaw Gyekye-Aboagye, Parimita Routray, Sophie Boisson, Wolf Schimdt and Thomas Clasen
Background – Sentinel toys are increasingly used as a method of assessing young children’s exposure to faecal pathogens in households in low-income settings. However, there is no consensus on the suitability of different approaches.
Methods – We evaluated three types of toy balls with different surfaces (plastic, rubber, urethane) in the laboratory to compare the uptake of faecal indicator bacteria (Escherichia coli) on their surface. We performed bacteria survival analysis under different environmental conditions and tested laboratory methods for bacteria removal and recovery. In a field study we distributed sterile urethane balls to children <5 from 360 households in rural India. After 24 hours, we collected and rinsed the toys in sterile water, assayed for thermotolerant coliforms (TTC) and explored associations between the level of contamination and household characteristics.
Results – In the laboratory, urethane foam balls took up more indicator bacteria than the other balls. Bacteria recovery did not differ based on mechanic vs no agitation. Higher temperatures and moisture levels increased bacterial yield. In the field, the only factor associated with a decreased recovery of TTC from the balls was having a soil (unpaved) floor.
Conclusions – Sentinel toys may be an effective tool for assessing young children’s exposure to faecal pathogens. However, even using methods designed to increase bacterial recovery, limited sensitivity may require larger sample sizes.
Microbial Removals by a Novel Biofilter Water Treatment System. Am Jnl Trop Med Hyg, March 2015.
Authors: Christopher Wendt, Rebecca Ives, Anne L. Hoyt, Ken E. Conrad, Stephanie Longstaff, Roy W.Kuennen, and Joan B. Rose
Two point-of-use drinking water treatment systems designed using a carbon filter and foam material as a possible alternative to traditional biosand systems were evaluated for removal of bacteria, protozoa, and viruses. Two configurations were tested: the foam material was positioned vertically around the carbon filter in the sleeve unit or horizontally in the disk unit. The filtration systems were challenged with Cryptosporidium parvum, Raoultella terrigena, and bacteriophages P22 and MS2 before and after biofilm development to determine ALR for each organism and the role of the biofilm.
There was no significant difference in performance between the two designs,and both designs showed significant levels of removal (at least 4 log10 reduction in viruses, 6 log10 for protozoa, and 8 log10 for bacteria). Removal levels meet or exceeded Environmental Protection Agency (EPA) standards for microbial purifiers. Exploratory test results suggested that mature biofilm formation contributed 1–2 log10 reductions. Future work is recommended to determine field viability.
Monitoring Drinking Water, Sanitation, and Hygiene in Non-Household Settings: Priorities for Policy and Practice
Monitoring Drinking Water, Sanitation, and Hygiene in Non-Household Settings: Priorities for Policy and Practice. International Journal of Hygiene and Environmental Health, 11 March 2015.
Authors: Ryan Cronk, Tom Slaymaker, Jamie Bartram
Inadequate drinking water, sanitation, and hygiene (WaSH) in non-household settings, such as schools, health care facilities, and workplaces impacts the health, education, welfare, and productivity of populations, particularly in low and middle-income countries. There is limited knowledge on the status of WaSH in non-household settings. To address this gap, we reviewed international standards, international and national actors, and monitoring initiatives; developed the first typology of non-household settings; and assessed the viability of monitoring.
Based on setting characteristics, non-household settings include seven types: schools, health care facilities, workplaces, temporary use settings, mass gatherings, and dislocated populations. To-date national governments and international actors have focused monitoring of non-household settings on schools and health care facilities with comparatively little attention given to other settings such as workplaces and markets. Nationally representative facility surveys and national management information systems are the primary monitoring mechanisms. Data suggest that WaSH coverage is generally poor and often lower than in corresponding household settings.
Definitions, indicators, and data sources are underdeveloped and not always comparable between countries. While not all countries monitor non-household settings, examples are available from countries on most continents suggesting that systematic monitoring is achievable in most countries. Monitoring WaSH in schools and health care facilities is most viable. Monitoring WaSH in other non-household settings would be viable with: technical support from local and national actors in addition to international organizations such as WHO and UNICEF; national prioritization through policy and financing; and including WaSH indicators into monitoring initiatives to improve cost-effectiveness.
International consultations on targets and indicators for global monitoring of WaSH post-2015 identified non-household settings as a priority. National and international monitoring systems will be important to better understand status, trends, to identify priorities and target resources accordingly, and to improve accountability for progressive improvements in WaSH in non-household settings.
Presence of Pseudomonas aeruginosa in coliform-free sachet drinking water in Ghana. Food Control, 11 March 2015
Authors: Justin Stoler, Hawa Ahmed, Lady Asantewa Frimpong, Mohammed Bello
• We tested the microbiological quality of 80 sachet water samples in low-income areas.
• Zero samples tested positive for fecal coliforms or E. coli.
• Poor-reputation brands were associated with higher heterotrophic bacteria plate counts.
• 41% of samples contained P. aeruginosa, regardless of brand reputation.
• The results signal an opportunity to revisit packaged water standards in West Africa.
Sachet water is now an important source of drinking water security in West Africa, and the sachet industry continues to mature as market share increasingly shifts from cottage industry players to high-volume corporate producers. Modern sachet production lines are prone to the development of biofilms, and traditional microbiological indicators of fecal water contamination may not capture all the potential risks to human health in such a widely-consumed product.
This study tested a sample of 80 sachets purchased along two commercial transects in low-income neighborhoods of Accra, Ghana, for total coliforms (TC), fecal coliforms (FC), Escherichia coli (EC), total heterotrophic bacteria (THB), and Pseudomonas aeruginosa (PA), and examined the relationship with brand reputation.
Just 5% of samples tested positive for TC, and none tested positive for FC and EC, yet 41% of samples tested positive for PA. After controlling for one popular brand, a negative brand reputation was associated with both THB presence (P = 0.015) and the number of samples with THB > 500 CFU/mL (P = 0.038), but PA was found in brands of both positive and negative reputations, and was only correlated with THB counts. The emergence of PA presents an opportunity for the re-evaluation of packaged water quality standards in a rapidly-globalizing, urban environment.
The Impact of Water, Sanitation, and Hygiene Interventions on the Health and Well-Being of People Living With HIV: A Systematic Review
The Impact of Water, Sanitation, and Hygiene Interventions on the Health and Well-Being of People Living With HIV: A Systematic Review. JAIDS Journal of Acquired Immune Deficiency Syndromes: 15 April 2015.
Authors: Yates, Travis MSc*; Lantagne, Daniele PhD*; Mintz, Eric MD†; Quick, Robert MD†
Background: Access to improved water supply and sanitation is poor in low-income and middle-income countries. Persons living with HIV/AIDS (PLHIV) experience more severe diarrhea, hospitalizations, and deaths from diarrhea because of waterborne pathogens than immunocompetent populations, even when on antiretroviral therapy (ART).
Methods: We examined the existing literature on the impact of water, sanitation, and hygiene (WASH) interventions on PLHIV for these outcomes: (1) mortality, (2) morbidity, (3) retention in HIV care, (4) quality of life, and (5) prevention of ongoing HIV transmission. Cost-effectiveness was also assessed. Relevant abstracts and articles were gathered, reviewed, and prioritized by thematic outcomes of interest. Articles meeting inclusion criteria were summarized in a grid for comparison.
Results: We reviewed 3355 citations, evaluated 132 abstracts, and read 33 articles. The majority of the 16 included articles focused on morbidity, with less emphasis on mortality. Contaminated water, lack of sanitation, and poor hygienic practices in homes of PLHIV increase the risk of diarrhea, which can result in increased viral load, decreased CD4 counts, and reduced absorption of nutrients and antiretroviral medication. We found WASH programming, particularly water supply, household water treatment, and hygiene interventions, reduced morbidity. Data were inconclusive on mortality. Research gaps remain in retention in care, quality of life, and prevention of ongoing HIV transmission. Compared with the standard threshold of 3 times GDP per capita, WASH interventions were cost-effective, particularly when incorporated into complementary programs.
Conclusions: Although research is required to address behavioral aspects, evidence supports that WASH programming is beneficial for PLHIV.
Differences in Field Effectiveness and Adoption between a Novel Automated Chlorination System and Household Manual Chlorination of Drinking Water in Bangladesh
Differences in Field Effectiveness and Adoption between a Novel Automated Chlorination System and Household Manual Chlorination of Drinking Water in Dhaka, Bangladesh: A Randomized Controlled Trial. PLoS ONE, Mar 2015.
Authors: Amy J. Pickering , Yoshika Crider, Nuhu Amin, Valerie Bauza, Leanne Unicomb, Jennifer Davis, Stephen P. Luby
The number of people served by networked systems that supply intermittent and contaminated drinking water is increasing. In these settings, centralized water treatment is ineffective, while household-level water treatment technologies have not been brought to scale.
This study compares a novel low-cost technology designed to passively (automatically) dispense chlorine at shared handpumps with a household-level intervention providing water disinfection tablets (Aquatab), safe water storage containers, and behavior promotion. Twenty compounds were enrolled in Dhaka, Bangladesh, and randomly assigned to one of three groups: passive chlorinator, Aquatabs, or control. Over a 10-month intervention period, the mean percentage of households whose stored drinking water had detectable total chlorine was 75% in compounds with access to the passive chlorinator, 72% in compounds receiving Aquatabs, and 6% in control compounds.
Both interventions also significantly improved microbial water quality. Aquatabs usage fell by 50% after behavioral promotion visits concluded, suggesting intensive promotion is necessary for sustained uptake. The study findings suggest high potential for an automated decentralized water treatment system to increase consistent access to clean water in low-income urban communities.