Household Drinking Water Quality Updates

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Effectiveness of Chlorine Dispensers in Emergencies: Case Study Results from Haiti, Sierra Leone, DRC, and Senegal

2 hours 26 min ago

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

2 hours 37 min ago

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

2 hours 44 min ago

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.

WHO; UNICEF – Water, sanitation and hygiene in health care facilities

25 March 2015 12:24 (America/New_York)

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

25 March 2015 12:20 (America/New_York)

Preventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries, 2014. World Health Organization.

Exposures

  • 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

25 March 2015 12:09 (America/New_York)

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

25 March 2015 12:03 (America/New_York)

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

25 March 2015 11:59 (America/New_York)

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

16 March 2015 9:54 (America/New_York)

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

16 March 2015 9:47 (America/New_York)

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

16 March 2015 9:39 (America/New_York)

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

Highlights
• 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

16 March 2015 9:28 (America/New_York)

The Impact of Water, Sanitation, and Hygiene Interventions on the Health and Well-Being of People Living With HIV: A Systematic ReviewJAIDS 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

4 March 2015 10:08 (America/New_York)

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.

Safe Water: It’s a Human Right

24 February 2015 14:10 (America/New_York)

Safe Water: It’s a Human Right, 2015.

Syed Emdadul Haque1,2 | Atsuro Tsutsumi1, | Capon Anthony1

1United Nations University International Institute for Global Health (UNU-IIGH)UNU-IIGH Building, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak,Cheras 56000, Kuala Lumpur, MALAYSIA

2 UChicago Research Bangladesh, Dhaka, Bangladesh.

Already 2–3 billion people lack any access to safe drinking water and 884 million more are without sufficient access to a suitable water source, and yet, the situation could worsen still, (link). Indeed, without significant changes, two-thirds of the world’s population is expected to be living under “severe water stress conditions” by 2025, (link). Severe water stress is when there is less than 1,000 cubic meters of water available per person in a given year. This is an alarming prospect for the world’s population.

Recently published an article where vice minister at the Ministry of Water Recourses, China highlighted that about two-thirds of Chinese cities are “water needy” and nearly 300 million rural people have lack of access to drinking safe water, (link). In addition that, The National Intelligence Council (NIC) reported that “Global Trends 2030: Alternative Worlds” states that, with regard to China, “climate change, urbanization trends and middle-class lifestyles will create huge water demand and crop shortages by 2030.”

These demand and crisis can create big economic, health, and social problems. According to the Ministry of Supervision, about 60,000 premature deaths already are happening due to water pollution accidents annually. Therefore, experts say that Govt. should give more effort for rational use of water and control its pollution.

Water scarcity continues to pose the greatest challenge in the developing world. Even though “water is life”, safe water is very costly. Although large infrastructure-intensive water systems are prevalent in industrialized countries, for many developing nations such systems are too expensive to install and operate. For example, the United States spends about US$29 billion every year (link) to maintain its water and wastewater plants and it is obvious that the developing world does not have the kind of money it takes to provide safe water for its population.

Climate change and impacts on safe water

In many countries, climate change is another factor impacting safe water supplies. Water is a key medium through which climate change affects human populations and ecosystems, especially because of expected changes in water quality and quantity, notes the United Nations Expert on Human Rights, Water and Sanitation, (link). Indeed, in many regions of the world, changes to the supply and quality of freshwater resources resulting from climate change may endanger sustainable development, poverty reduction, and child mortality goals, the Intergovernmental Panel on Climate Change (IPCC) has warned, (link).

IPCC also highlighted that scientist predict nearly one-third of the planet’s land surface will suffer due to extreme drought by the end of this century and 20% of the world population could be affected by severe flooding by 2080. It is therefore essential to consider the direct effects of climate change on water resources as well as its indirect influences on other external drivers of change. Climate change amplifies pressure on governments to deal with the existing threats to the already fragile sustainability of freshwater resources — population growth, socioeconomic and technological changes, and the resulting rising demand for water.

There is considerable variation among the projections and scenarios concerning the impact of climate change on water resources. However, it is clear that it will increase water stress in already dry areas and will undermine water quality in areas flooded by rain or seawater. Also, rising water temperatures, both higher and lower groundwater levels, floods and droughts can all increase the threats from pathogens, chemical substances and radiological hazards in drinking water.

For example, flooding can cause overflows from sewage treatment plants into freshwater sources, which could contaminate certain food crops with pathogen-containing feces, (link). In addition, many scientists predict that sea-level rise can lead to saltwater interruption into groundwater drinking supplies, especially in low-lying, gently sloping coastal areas which will creates scarcity of safe water. On the other hand, droughts affecting agriculture can impact food production and might cause severe malnutrition, (link).

The right to clean water

Access to clean water was declared a human right on 28 July 2010 by the UN General Assembly (A/RES/64/292), receiving 122 votes in favour and zero votes against, (link). The right to water is also implicit in Article 11 of the International Covenant on Economic, Social and Cultural Rights as interpreted by the Committee on Economic, Social and Cultural Rights, which comments that, (link) “the human right to water entitles everyone to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses”.

However, safe water is a vital human rights concern in urban slums worldwide. Rapidly growing urbanization and overcrowding increase already heavy demands for fresh water. The Asia-Pacific region is home to 60 percent of the world’s population but it possesses only 36 percent of Earth’s water resources. Water availability, allocation, and quality remain major issues in the Asian region. Access to safe drinking water is limited and water shortages can pose a real threat to the daily life and the health of communities.

For many of those who have access to water, it is either too expensive or not suitable for consumption, often exposed to dangerous levels of biological contaminants and chemical pollutants. This is due in part to inadequate management of urban, industrial, and agricultural wastewater.

Simply put, for many people water is not yet a human right within comprehension. In coming years, water challenges will increase significantly as because of population growth and rising incomes will lead to greater water consumption, as well as more waste. According to the UN World Water Development Report, (link), by 2050 at least one in four people are likely to live in a country affected by chronic or recurring shortages of fresh water.

Access to safe water should therefore no longer be seen as a service, but, since it is a human right, states and organizations must work towards using economic resources and technology to provide safe, clean, accessible and affordable water, particularly in developing countries. Thus, it is urgent to think about the national and global water consumption policy for the decision-makers to tackle the future crisis. In addition, policy-driven researchers may introduce low cost solutions through public private partnerships.

Household Water Treatment and Safe Storage to Prevent Diarrheal Disease in Developing Countries

18 February 2015 10:45 (America/New_York)

Household Water Treatment and Safe Storage to Prevent Diarrheal Disease in Developing Countries. Current Environmental Health Reports, January 2015

Author: Thomas Clasen JD, PhD

Household water treatment and safe storage (HWTS), such as boiling, filtering, or chlorinating water at home, have been shown to be effective in improving the microbiological quality of drinking water. However, estimates of their protective effect against diarrhea, a major killer, have varied widely.

While results may be exaggerated because of reporting bias, this heterogeneity is consistent with other environmental interventions that are implemented with varying levels of coverage and uptake in settings where the source of exposure represents one of many transmission pathways.

Evidence suggests that the effectiveness of HWTS can be optimized by ensuring that the method

  • is microbiologically effective;
  • making it accessible to an exposed population; and
  • securing their consistent and long-term use.

Water bags as a potential vehicle for transmitting disease in a West African capital, Bissau

18 February 2015 10:37 (America/New_York)

Water bags as a potential vehicle for transmitting disease in a West African capital, Bissau. Int. Health (2015) 7 (1): 42-48. doi: 10.1093/inthealth/ihu056, August 27, 2014

Authors: Adriano A. Bordaloa,b,* and Ana Machadoa,b

aLaboratory of Hydrobiology and Ecology, Institute of Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira, 228, 4050–313 Porto, Portugal
bCiimar-Centre of Marine and Environmental Research, Porto, Portugal
↵*Corresponding author: Tel: +351 220428181; Fax: +351 222062284; E-mail: bordalo@icbas.up.pt

Background – Street vendors of chilled packaged water have an increasing role in meeting the drinking water demand of people on the move in developing nations. Hygienic conditions can be questionable, and water quality screening scarce or non-existent.

Methods – In order to ascertain the quality of the packaged water sold by street vendors in Bissau, the capital of the Western African country Guinea-Bissau, water bags were screened in 2011 and during the 2012 cholera outbreak for key physical, chemical and microbiological parameters.

Results – Water used to fill the hand-filled hand-tied bags originated from communal tap water and melted ice. All samples (n=36) were microbiologically contaminated, although levels showed a pronounced variability (e.g. 7–493 372 cfu 250 ml−1 for Escherichia coli). In 2012, the fecal contamination levels increased (p<0.05), and Vibrio cholerae was detected in all water bags obtained from the neighborhood where the outbreak started.

Conclusion – Findings showed that all packaged water samples were unfit for human consumption and during the 2012 cholera outbreak represented a potential vehicle for the spread of the disease. The design of measures to decrease the risk associated to the consumption of highly contaminated chilled water is clearly required.

Biosand water filters for floating villages in Cambodia: safe water does not prevent recontamination

18 February 2015 10:33 (America/New_York)

Biosand water filters for floating villages in Cambodia: safe water does not prevent recontamination. Journal of Water, Sanitation and Hygiene for Development, In Press, Uncorrected Proof © IWA Publishing 2015 | doi:10.2166/washdev.2015.120

Authors: K. D. Curry, M. Morgan, S. H. Peang and S. Seang

Bridgewater State University, 131 Summer Street, Bridgewater, MA 02325, USA E-mail: kcurry@bridgew.edu. Water for Cambodia, Siem Reap, Cambodia Mahidol University, Bangkok, Thailand. Kulara Water Co. Ltd., Tbaeng Kaeut Village, Siem Reap Province, Cambodia

Water for Cambodia used biosand filters (BSFs) to provide microbiologically safe drinking water for people in Moat Khla floating village in 2010 and 2011. All 189 families use the lake, which by WHO standards is deemed unsafe for drinking water. Surveys from December 2010 to February 2011 compared 40 families using BSFs and 40 families not using BSFs. Over 92% of BSF households and 90% of non-BSF households were using high-risk lake source water (>100 colonies Escherichia coli/100 mL). Only 2.5% of BSF households had filtered water with bacteria in the high-risk range and only 5% of these 40 households showed recontamination in their storage water.

Forty percent of non-BSF households had high-risk bacteria levels in their stored water, and most used no treatment. Storage water for non-BSF families showed a significant reduction in mean log10 E. coli levels compared to their lake source water. Stored water for non-BSF families showed recontamination even for UV-treated water and boiled river water. Recontamination occurs in both groups but is much less for BSF households highlighting the value of proper storage containers used by BSF households and the need for water and sanitation education for floating villages in Cambodia.

Explaining low rates of sustained use of siphon water filter: evidence from follow-up of a randomised controlled trial in Bangladesh

18 February 2015 10:29 (America/New_York)

Explaining low rates of sustained use of siphon water filter: evidence from follow-up of a randomised controlled trial in Bangladesh. Trop Med Intl Health, Jan 2015.

Authors: Nusrat Najnin, Shaila Arman, et al.

Objective – To assess sustained siphon filter usage among a low-income population in Bangladesh and study relevant motivators and barriers.

Methods – After a randomised control trial in Bangladesh during 2009, 191 households received a siphon water filter along with educational messages. Researchers revisited households after 3 and 6 months to assess filter usage and determine relevant motivators and barriers. Regular users were defined as those who reported using the filter most of the time and were observed to be using the filter at follow-up visits. Integrated behavioural model for water, sanitation and hygiene (IBM-WASH) was used to explain factors associated with regular filter use.

Results – Regular filter usage was 28% at the 3-month follow-up and 21% at the 6-month follow-up. Regular filter users had better quality water at the 6-month, but not at the 3-month visit. Positive predictors of regular filter usage explained through IBM-WASH at both times were willingness to pay >US$1 for filters, and positive attitude towards filter use (technology dimension at individual level); reporting boiling drinking water at baseline (psychosocial dimension at habitual level); and Bengali ethnicity (contextual dimension at individual level). Frequently reported barriers to regular filter use were as follows: considering filter use an additional task, filter breakage and time required for water filtering (technology dimension at individual level).

Conclusion – The technological, psychosocial and contextual dimensions of IBM-WASH contributed to understanding the factors related to sustained use of siphon filter. Given the low regular usage rate and the hardware-related problems reported, the contribution of siphon filters to improving water quality in low-income urban communities in Bangladesh is likely to be minimal.

Changing handwashing behaviour in southern Ethiopia: A longitudinal study on infrastructural and commitment interventions

4 February 2015 11:47 (America/New_York)

Changing handwashing behaviour in southern Ethiopia: A longitudinal study on infrastructural and commitment interventionsSoc Sci Med. 2015 Jan;124:103-14. doi: 10.1016/j.socscimed.2014.11.006.

Authors: Contzen N, Meili IH, Mosler HJ.

Improved hand hygiene efficiently prevents the major killers of children under the age of five years in Ethiopia and globally, namely diarrhoeal and respiratory diseases. Effective handwashing interventions are thus in great demand. Evidence- and theory-based interventions, especially when matched to the target population’s needs, are expected to perform better than common practice. To test this hypothesis, we selected two interventions drawing on a baseline questionnaire-study that applied the RANAS (Risk, Attitudes, Norms, Abilities, Self-regulation) approach and focused on the primary caregivers of households in four rural, water-scarce kebeles (smallest administrative units of Ethiopia) in southern Ethiopia (N = 462).

The two interventions were tested in combination with a standard education intervention in a quasi-experiment, as follows: kebele 1, education intervention, namely an f-diagram exercise, (n = 23); kebele 2, education intervention and public-commitment (n = 122); kebele 3, education intervention and tippy-tap-promotion (i.e. handwashing-station-promotion; n = 150); kebele 4, education intervention, public-commitment and tippy-tap-promotion (n = 113).

In kebeles 3 and 4, nearly 100% of the households followed the promotion and invested material and time to construct for themselves a tippy-tap. Three months after intervention termination, the tippy-taps were in use with water and soap being present in up to 83% of the households (kebele 4). Pre-post data analysis on self-reported handwashing revealed that the population-tailored interventions, and especially the tippy-tap-promotion, performed better than the standard education intervention.

Tendencies in observed behaviour and a recently developed implicit self-measure pointed to similar results. Changing people’s hand hygiene is known to be a challenging task, especially in a water-scarce environment. The present project suggests not only to apply theory and evidence to improve handwashing interventions’ effectiveness, but also emphasizes the relevance of tailoring interventions to the target population.

Reactivity in rapidly collected hygiene and toilet spot check measurements: a cautionary note for longitudinal studies.

4 February 2015 11:42 (America/New_York)

Reactivity in rapidly collected hygiene and toilet spot check measurements: a cautionary note for longitudinal studies. Am J Trop Med Hyg. 2015 Jan 7;92(1):159-62. doi: 10.4269/ajtmh.14-0306.

Authors: Arnold BF, Khush RS, et al.

Discreet collection of spot check observations to measure household hygiene conditions is a common measurement technique in epidemiologic studies of hygiene in low-income countries. The objective of this study was to determine whether the collection of spot check observations in longitudinal studies could itself induce reactivity (i.e., change participant behavior). We analyzed data from a 12-month prospective cohort study in rural Tamil Nadu, India that was conducted in the absence of any hygiene or toilet promotion activities.

Our data included hygiene and toilet spot checks from 10,427 household visits. We found substantial evidence of participant reactivity to spot check observations of hygiene practices that were easy to modify on short notice. For example, soap observed at the household’s primary handwashing location increased from 49% at enrollment to 81% by the fourth visit and remained at or above 77% for the remainder of the study.

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