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Strategies for building resilience to hazards in water, sanitation and hygiene (WASH) systems: The role of public private partnerships

11 September 2014 9:46 (America/New_York)

Strategies for building resilience to hazards in water, sanitation and hygiene (WASH) systems: The role of public private partnerships. International Journal of Disaster Risk Reduction, 15 July 2014.

Authors: Ase Johannessen, Arno Rosemarin, Frank Thomall, Asa Gerger Swartling, Thor Axel Stenström, Gregor Vulturius.

The aim of this paper is to enhance understanding of how the resilience of water, sanitation and hygiene (WASH) systems to hazards can be improved. In turn, this aims to inform different strategies for public and private partnerships (PPPs). In a new approach, to acknowledge the multi levelled nature of resilience; risk at the relevant levels are taken into account, (regional/river basin, urban area, and individual). For these levels, we first describe the different components of risk, vulnerability and resilience of the WASH system that influence people׳s exposure to hazards. We illustrate these components using examples from case studies in the literature.

Using a social learning lens – a crucial ingredient of resilience – we examine opportunities for reducing risks through improving public–private engagement. These are presented as strategies which could guide investment decisions: As pressures from climate change and development add up, businesses must become aware of the risks involved in operating and investing without considering ecosystem health, both in terms of the services they provide for mitigating floods and droughts, as well as in terms of the development approaches that define how ecosystems are managed (e.g. “making space” for, rather than controlling water). There is a need to develop an institutional culture that strives towards greener and more resilient urban environments with the help of various quality assurance methods. Partnerships must reach the poorer customer base, encourage informal small entrepreneurs, and boost financial mechanisms (e.g. micro-insurance, micro-finance) to support the most vulnerable in society.

 

The effect of increasing grain size in biosand water filters in combination with ultraviolet disinfection

11 September 2014 9:33 (America/New_York)

The effect of increasing grain size in biosand water filters in combination with ultraviolet disinfection. Journal of Water, Sanitation and Hygiene for Development, Vol 4 No 2 pp 206–213

This paper is in the public domain: verbatim copying and redistribution of this paper are permitted in all media for any purpose, provided this notice is preserved along with the paper’s original DOI. Anyone using the paper is requested to properly cite and acknowledge the source as Journal of Water, Sanitation and Hygiene for Development 4(2), 206–213. doi:10.2166/washdev.2013.171

Authors: Timothy E. Frank, Matthew L. Scheie, Victoria Cachro and Andrew S. Muñoz
2354 Fairchild Drive Suite 6J-117, USAF Academy, CO 80840, 01-719-660-6903, USA E-mail: tefrank18@gmail.com

With sand less than 0.70 mm often difficult to source in the field, it is of interest to study larger grained sand for use in biosand water filters (BSF). This study examined how sand grain size affects biological sand water filtration and how the combination of biological sand filtration and ultraviolet (UV) disinfection affects drinking water quality. Two BSFs were built: a control with maximum grain size, dmax = 0.70 mm and an experimental with grain sizes ranging from 0.70 mm to dmax = 2.0 mm. Untreated water was passed through each BSF daily. Results show Escherichia coli and turbidity removal characteristics of the control and experimental BSFs were not significantly different from one another. Both BSFs produced water that met World Health Organization (WHO) drinking water guidelines for turbidity, and although E. coli reduction was over 98% for each BSF, a high initial bacteria concentration resulted in effluent levels above WHO guidelines. Subsequently, effluent from each BSF was placed in clear plastic bottles under UV light, after which water from each BSF met E. coli guidelines. The data yielded promising results for using larger sand in BSFs, but longer duration studies with more data points are needed.

Where There Is No Toilet: Water and Sanitation Environments of Domestic and Facility Births in Tanzania

11 September 2014 9:26 (America/New_York)

Where There Is No Toilet: Water and Sanitation Environments of Domestic and Facility Births in Tanzania. PLoS One, Sep 2014.

Authors: Lenka Benova, Oliver Cumming, Bruce A. Gordon, Moke Magoma, Oona M. R. Campbell

Background – Inadequate water and sanitation during childbirth are likely to lead to poor maternal and newborn outcomes. This paper uses existing data sources to assess the water and sanitation (WATSAN) environment surrounding births in Tanzania in order to interrogate whether such estimates could be useful for guiding research, policy and monitoring initiatives.

Methods – We used the most recent Tanzania Demographic and Health Survey (DHS) to characterise the delivery location of births occurring between 2005 and 2010. Births occurring in domestic environments were characterised as WATSAN-safe if the home fulfilled international definitions of improved water and improved sanitation access. We used the 2006 Service Provision Assessment survey to characterise the WATSAN environment of facilities that conduct deliveries. We combined estimates from both surveys to describe the proportion of all births occurring in WATSAN-safe environments and conducted an equity analysis based on DHS wealth quintiles and eight geographic zones.

Results – 42.9% (95% confidence interval: 41.6%–44.2%) of all births occurred in the woman’s home. Among these, only 1.5% (95% confidence interval: 1.2%–2.0%) were estimated to have taken place in WATSAN-safe conditions. 74% of all health facilities conducted deliveries. Among these, only 44% of facilities overall and 24% of facility delivery rooms were WATSAN-safe. Combining the estimates, we showed that 30.5% of all births in Tanzania took place in a WATSAN-safe environment (range of uncertainty 25%–42%). Large wealth-based inequalities existed in the proportion of births occurring in domestic environments based on wealth quintile and geographical zone.

Conclusion – Existing data sources can be useful in national monitoring and prioritisation of interventions to improve poor WATSAN environments during childbirth. However, a better conceptual understanding of potentially harmful exposures and better data are needed in order to devise and apply more empirical definitions of WATSAN-safe environments, both at home and in facilities.

Cholera at the Crossroads: The Association Between Endemic Cholera and National Access to Improved Water Sources and Sanitation

11 September 2014 9:21 (America/New_York)

Cholera at the Crossroads: The Association Between Endemic Cholera and National Access to Improved Water Sources and Sanitation. Am J Trop Med Hyg. 2014 Sep 8. pii: 14-0331.

Authors: Nygren BL1, Blackstock AJ2, Mintz ED2. 1Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia bnygren@cdc.gov.
2Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

We evaluated World Health Organization (WHO) national water and sanitation coverage levels and the infant mortality rate as predictors of endemic cholera in the 5-year period following water and sanitation coverage estimates using logistic regression, receiver operator characteristic curves, and different definitions of endemicity. Each was a significant predictors of endemic cholera at P < 0.001. Using a value of 250 for annual cases reported in 3 of 5 years, a national water access level of 71% has 65% sensitivity and 65% specificity in predicting endemic cholera, a sanitation access level of 39% has 63% sensitivity and 62% specificity, and an infant mortality rate of 65/1,000 has 67% sensitivity and 69% specificity. Our findings reveal the trade off between sensitivity and specificity for these predictors of endemic cholera and highlight the substantial uncertainty in the data. More accurate global surveillance data will enable more precise characterization of the benefits of improved water and sanitation.

Researchers create novel water purifying filter

27 August 2014 10:12 (America/New_York)

Researchers create novel water purifying filter – Source: SciDevNet, Aug 25, 2014

[CAPE TOWN] A team of researchers have developed a membrane-based water filter that can provide up to 300 litres of clean drinking water.

The WHO says about 780 million people worldwide, especially those in Sub-Saharan Africa, lack access to improved water source.

The researchers from the Swiss Federal Institute of Technology in Zurich (ETHZ) in Switzerland announced last month (22 July) that DrinkPure filter, which they have developed, is based on a simple screw-top design that fits onto any plastic bottle.

Wendelin Stark, a professor of functional materials engineering at ETHZ, who helped create the innovation, says: “It requires no manual, no electricity, and no additional tools or training needs. You simply screw it on, and you drink [the water].”

The researchers say they used a novel porous polymer membrane developed though  nanotechnology, thus making  DrinkPure allow the filtration of particles as small as 90 nanometres, including bacteria and protozoa, at rate of up to one litre a  minute.

They add that the innovation which weighs less than 100 grams, with a target cost of less than US$20 a filter, has two pre-filtration components — a capture filter that separates large particles and an activated charcoal layer that removes odour and chemical contaminants.

“One DrinkPure water filter provides enough drinking water for one person for one year, after which the membrane and activated carbon can be replaced over and over again,” explains Jeremy Nussbaumer, leader of the project and a research assistant, in a release.

In order to fund the tools to manufacture the filters, the researchers launched a crowdfunding campaign last month (17 July) with a goal of raising US$40,000 by this week (26 August), but have as of today raised more than US$71,000.

Nussbaumer says they plan to have the first filters completed and sent to project supporters for distribution by January 2015 in Sub-Saharan Africa.

Nussbaumer adds that Water & pH soluces, a Swiss NGO that works to provide sustainable, affordable access to safe water and sanitation to communities in Sub-Saharan Africa, plans to distribute DrinkPure for testing in five villages in Mali.

Stark tells SciDev.Net: “The aim is to develop partnerships with partners and local companies who can develop the membranes themselves”.

The researchers say DrinkPure water filter could be used as part of relief efforts following natural disasters, such as tsunamis. “We would like to see these membranes and filters used …in places experiencing environmental issues,” says Christop Kellenberger, a member of the DrinkPure research team.

Nonhlanhla Kalebaila, a research manager of drinking water treatment and quality at the South Africa-based Water Research Commission, says the use of small-scale water purification systems in Africa is increasing rapidly. “Water quality and supply in Africa as a whole is a very touchy subject and has been the topic of strikes and protests in South Africa in the last few years,” she says.

But Kalebaila adds that independent research is needed to ensure the accuracy of water filtration devices and the safety of water that flows from such tools.

Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility

27 August 2014 9:59 (America/New_York)

Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility. Int. J. Environ. Res. Public Health 2014, 11(8), 8319-8346.

Marion W. Jenkins 1,2,*, Matthew C. Freeman 3 and Parimita Routray 2
1 Department of Civil and Environmental Engineering, University of California Davis, One Shields Ave., Davis, CA 95616, USA
2 Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
3 Department of Environmental Health, Rollings School of Public Health, Emory University, Atlanta, GA 30322, USA
* Author to whom correspondence should be addressed.

Abstract: Methods to assess household excreta disposal practices are critical for informing public health outcomes of efforts to improve sanitation in developing countries. We present a new metric, the Safe San Index (SSI), to quantify the hygienic safety of a household’s defecation and human feces disposal practices in India, where behavioral outcomes from on-going public expenditures to construct household sanitation facilities and eliminate open defecation are poorly measured. We define hygienic safety of feces disposal as capture in a hygienic sanitation facility.

The SSI consists of 15 self-report items and two sub-scales, Latrine Use Frequency and Seven-Day Open Defecation Rate. Households are scored on a standardized scale from 0 (no defecation safely captured) to 100 (all defecation safely captured). We present results of a pilot study in Odisha, India to apply the Index to assess excreta disposal behaviors among rural households and evaluate the reliability and validity of the Index for estimating the rate of correct and consistent sanitation facility usage of household with an improved latrine.

Diarrhoea prevalence in children under five years of age in rural Burundi: an assessment of social and behavioural factors at the household level

27 August 2014 9:55 (America/New_York)

Diarrhoea prevalence in children under five years of age in rural Burundi: an assessment of social and behavioural factors at the household level. Glob Health Action. 2014 Aug 21;7(1):24895. doi: 10.3402/gha.v7.24895.

Authors: Diouf K1, Tabatabai P2, Rudolph J3, Marx M4.
1Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Katharina.Diouf@gmx.de.
2Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany.
3Programme Sectoriel Eau – German Development Cooperation/Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH, Bujumbura, Burundi.
4Institute of Public Health, University of Heidelberg, Heidelberg, Germany.

BACKGROUND: Diarrhoea is the second leading cause of child mortality worldwide. Low- and middle-income countries are particularly burdened with this both preventable and treatable condition. Targeted interventions include the provision of safe water, the use of sanitation facilities and hygiene education, but are implemented with varying local success.

OBJECTIVE: To determine the prevalence of and factors associated with diarrhoea in children under five years of age in rural Burundi.

DESIGN: A cross-sectional survey was conducted among 551 rural households in northwestern Burundi. Areas of inquiry included 1) socio-demographic information, 2) diarrhoea period prevalence and treatment, 3) behaviour and knowledge, 4) socio-economic indicators, 5) access to water and water chain as well as 6) sanitation and personal/children’s hygiene.

RESULTS: A total of 903 children were enrolled. The overall diarrhoea prevalence was 32.6%. Forty-six per cent (n=255) of households collected drinking water from improved water sources and only 3% (n=17) had access to improved sanitation. We found a lower prevalence of diarrhoea in children whose primary caretakers received hygiene education (17.9%), boiled water prior to its utilisation (19.4%) and were aged 40 or older (17.9%). Diarrhoea was associated with factors such as the mother’s age being less than 25 and the conviction that diarrhoea could not be prevented. No gender differences were detected regarding diarrhoea prevalence or the caretaker’s decision to treat.

CONCLUSIONS: Diarrhoea prevalence can be reduced through hygiene education and point-of use household water treatment such as boiling. In order to maximise the impact on children’s health in the given rural setting, future interventions must assure systematic and regular hygiene education at the household and community level.

The Drivers of Non-Revenue Water How Effective Are Non-Revenue Water Reduction Programs?

21 August 2014 11:18 (America/New_York)

The Drivers of Non-Revenue Water How Effective Are Non-Revenue Water Reduction Programs? 2014

Caroline van den Berg, World Bank.

This paper applies a panel data analysis with fixed effects to determine the major drivers of non-revenue water, which is define as the volume of water losses per kilometer of network per day. The analysis uses data from the International Benchmarking Network for Water and Sanitation Utilities, covering utilities in 68 countries between 2006 and 2011. The analysis finds that non-revenue water is driven by many factors. Some of the most important drivers are beyond the control of the utility, such as population density per kilometer of network, the
type of distribution network, and the length of the network, which are largely the result of urbanization and settlement patterns in the localities that the utility serves. The opportunity costs of water losses are also key in explaining what drives non-revenue water. The paper finds that very low opportunity costs of water losses have an adverse effect on the reduction of non-revenue water. Country fixed effects turn out to be important, meaning that the environment in which the utility operates has an important impact on non-revenue water levels. An important conclusion is that the design of non-revenue water reduction programs should study the main drivers of non-revenue water to provide utility managers with a better understanding of what can be achieved in terms of non-revenue water reduction and whether the benefits of these reductions exceed their costs.

Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls?

20 August 2014 12:19 (America/New_York)

Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls? Water 2014, 6(5).

Kelly T. Alexander, et al. Email: kel4@cdc.gov

Water, sanitation and hygiene (WASH) programs in African schools have received increased attention, particularly around the potential impact of poor menstrual hygiene management (MHM) on equity for girls’ education. This study was conducted prior to a menstrual feasibility study in rural Kenya, to examine current WASH in primary schools and the resources available for menstruating schoolgirls. Cross-sectional surveys were performed in 62 primary schools during unannounced visits. Of these, 60% had handwashing water, 13% had washing water in latrines for menstruating girls, and 2% had soap. Latrines were structurally sound and 16% were clean. Most schools (84%) had separate latrines for girls, but the majority (77%) had no lock. Non-governmental organizations (NGOs) supported WASH in 76% of schools. Schools receiving WASH interventions were more likely to have: cleaner latrines (Risk Ratio (RR) 1.5; 95% Confidence Intervals [CI] 1.0, 2.1), handwashing facilities (RR 1.6, CI 1.1, 2.5), handwashing water (RR 2.7; CI 1.4, 5.2), and water in girls’ latrines (RR 4.0; CI 1.4, 11.6). Schools continue to lack essential WASH facilities for menstruating girls. While external support for school WASH interventions improved MHM quality, the impact of these contributions remains insufficient. Further support is required to meet international recommendations for healthy, gender-equitable schools.

Improving performance of WASH actors: Capacity Self-Assessments of SHAW partner NGOs

20 August 2014 12:12 (America/New_York)

Improving performance of WASH actors: Capacity Self-Assessments of SHAW partner NGOs, 2014. IRC.

Implementing large-scale water, sanitation and hygiene programmes requires expert technical and management skills to ensure that programme goals and targets are realised. Capacity self-assessments help organisations deepen their understanding of their existing capacities and future capacity needs and enable them to formulate capacity development action plans. These plans guide them in the continuous strengthening of their capacities. This paper describes IRC’s experience and lessons learned in conducting Capacity Self-Assessment workshops as part of the SHAW programme.

CSAs can be a powerful tool to help organisations take responsibility for improving individual skills as well as organisational capabilities. A well-designed, flexible and guided workshop enables participants to embrace change towards their own capacity development. Impact of the CSA is heavily dependent on quality facilitation and follow up support after the initial assessment workshop.

Designing Programme Implementation Strategies to Increase the Adoption and Use of Biosand Water Filters in Rural India

18 August 2014 10:13 (America/New_York)

Designing Programme Implementation Strategies to Increase the Adoption and Use of Biosand Water Filters in Rural India. Water Alternatives, 7(2) 2014.

Authors: Tommy K.K. Ngai. Centre for Affordable Water and Sanitation Technology (CAWST), Calgary, Alberta, Canada; tngai@cawst.org

Richard A. Fenner. Centre for Sustainable Development, Department of Engineering, University of Cambridge, Cambridge, England; raf37@cam.ac.uk

Abstract: Low-cost household water treatment systems are innovations designed to improve the quality of drinking water at the point of use. This study investigates how an NGO can design appropriate programme strategies in order to increase the adoption and sustained use of household sand filters in rural India. A system dynamics computer model was developed and used to assess 18 potential programme strategies for their effectiveness in increasing filter use at two and ten years into the future, under seven scenarios of how the external context may plausibly evolve. The results showed that the optimal choice of strategy is influenced by the macroeconomic situation, donor funding, presence of alternative options, and the evaluation time frame.

The analysis also revealed some key programme management challenges, including the trade-off between optimising short- or long-term gains, and counter-intuitive results, such as higher subsidy fund allocation leading to fewer filter distribution, and technology advances leading to fewer sales. This study outlines how an NGO can choose effective strategies in consideration of complex system interactions. This study demonstrated that small NGOs can dramatically increase their programme outcomes without necessarily increasing operational budget.

Two CAWST reviews on biosand filter design

18 August 2014 10:04 (America/New_York)

Chapter 42: Global review of the adoption, use, and performance of the biosand filter
Chapter 43: Recent advances in household biosand filter design

Authors: Tommy Ngai and Derek Baker, CAWST.

Impact studies: The importance of safe drinking water at the point of consumption

13 August 2014 14:34 (America/New_York)

Impact studies: The importance of safe drinking water at the point of consumption; Impact on diarrhoeal diseases for children under 5 and school absence rates for children between 6 to 12, 2014. 1001Fontaines.

1001fontaines, a non-profit organisation created in 2004, contributes to the global effort of international solidarity improving access to safe drinking water in small rural communities. It aims to improve the health of these populations by enabling them to meet their needs for safe drinking water in a sustainable manner and without any specific infrastructure or expertise.The major objective of these studies was to measure to what extent the health of the beneficiaries of the 1001fontaines services were improved by such services.

More specifically, two populations were observed:- Children between 6 and 12, where attendance at school (School study) was measured;- Children under 5, within their families (Cohort study), for whom episodes of diarrhoeal diseases were reported and correlated to the water source used by the family.

For the School study, attendance rates were extracted from the attendance reports of each school.These groups were observed during a 6 month period, during which each family of the Cohort study was visited twice a month in order to record potential diarrhoeal diseases.

Mobile phones, rent-to-own payments & water filters: Evidence from Kenya

13 August 2014 14:19 (America/New_York)

Mobile phones, rent-to-own payments & water filters Evidence from Kenya, 2014.

Authors: Jill E. Luoto and David I. Levine. RAND Labor & Population.

Uptake of safe water products remains low, in spite of modest cost. We experimented with a sales offer that combined a free trial and rent-to-own payments for durable filters. Purchase rates doubled under this sales offer to 31% compared to a traditional lump-sum sales contract. To lower transaction costs we collected payments using Kenya’s vast mobile banking network, MPESA. Mobile repayment rates were low; many filters were paid only when a vendor came in-person to request payment, which adds social pressure. While the rent-to-own offer is attractive, more work is needed to reduce transaction costs in rural and peri-urban Kenya.

Heterogeneous Effects of Information on Household Behaviors to Improve Water Quality

13 August 2014 14:13 (America/New_York)

Heterogeneous Effects of Information on Household Behaviors to Improve Water Quality. Working Paper EE 14-July 2014.

Authors: Joe Brown*Amar Hamoudi‡ Marc Jeuland§ Gina Turrini†

*Faculty of Infectious Disease & Tropical Medicine, London School of Hygiene & Tropical Medicine; joe.brown@lshtm.ac.uk‡Sanford School of Public Policy & Department of Economics, Duke University; amar.hamoudi@duke.edu§Sanford School of Public Policy & Department of Economics, Duke University; marc.jeuland@duke.edu†Department of Economics, Duke University; gina.turrini@duke.edu

Providing information about health risks only sometimes induces protective action. This raises questions about whether and how risk information is understood and acted upon, and how responses vary across contexts. We stratified a randomized experiment across two periurban areas in Cambodia, which differed in terms of socioeconomic status and infrastructure. In one area, showing households specific evidence of water contamination altered their beliefs about health risk and increased their demand for a treatment product; in the other area, it had no effect on these outcomes. These findings highlight the importance of identifying specific drivers of responses to health risk information.

 

 

USAID Ethiopia Water Activities

13 August 2014 13:42 (America/New_York)

USAID Ethiopia Water Activities, July 2014.

Water considerations cut across nearly every aspect of USAID programming. In addition to the need for drinking, for hygiene, and to deliver health care, water is needed to irrigate crops, feed livestock and develop industrial production. A dwindling supply of water is often a potential source of conflict. USAID incorporates water activities within its health, education, agriculture, governance, resilience and emergency assistance programs.

USAID also contributes to national capacity to plan and manage water resources through the Addis Ababa University program with the University of Connecticut.

Increase Prevalence of Key Hygiene Behaviors
USAID Ethiopia promotes three hygiene practices with the greatest demonstrated impact on health: (1) hand washing with soap at critical times, (2) safe disposal and management of excreta, and (3) improving household water storage, handling and treatment. In addition, community based approaches to behavior change, e.g., through health and agriculture extension services, support communities transitioning from open defecation. This includes working with a broad range of providers of hygiene products and services to provide household water treatment and storage technologies and other products to facilitate optimal hygiene behaviors

Increase Access to Sustainable Water Supply Services

  • To accelerate access to water, USAID Ethiopia is helping to strengthen the ability of local governments to engage communities, mobilize financing for both system expansion and operations and maintenance, and oversee service providers. Support to water and sanitation entrepreneurs can increase coverage and generate income, particularly for those who have no alternatives.By focusing on capacity building and leveraging local partners, activities can minimize overreliance on donors and bolster lasting sustainability.

Water Filter Provision and Home-Based Filter Reinforcement Reduce Diarrhea in Kenyan HIV-Infected Adults and Their Household Members

13 August 2014 13:32 (America/New_York)

Water Filter Provision and Home-Based Filter Reinforcement Reduce Diarrhea in Kenyan HIV-Infected Adults and Their Household Members. Am J Trop Med Hyg, 2014 vol. 91 no. 2 273-280, May 2014.

Patricia B. Pavlinac, et al.
E-mail: ppav@uw.edu

Among human immunodeficiency virus (HIV) -infected adults and children in Africa, diarrheal disease remains a major cause of morbidity and mortality. We evaluated the effectiveness of provision and home-based reinforcement of a point-of-use water filtration device to reduce diarrhea among 361 HIV-infected adults in western Kenya by comparing prevalence of self-reported diarrhea before and after these interventions. After provision of the filter, 8.7% of participants reported diarrhea compared with 17.2% in the 3 months before filter provision (odds ratio [OR] = 0.39, 95% confidence interval [95% CI] = 0.23–0.66, P < 0.001). The association was similar among 231 participants who were already taking daily cotrimoxazole prophylaxis before being given a filter (OR = 0.47, 95% CI = 0.25–0.88, P = 0.019). Educational reinforcement was also associated with a modest reduction in self-reported diarrhea (OR = 0.50, 95% CI = 0.20–0.99, P = 0.047). Provision and reinforcement of water filters may confer significant benefit in reducing diarrhea among HIV-infected persons, even when cotrimoxazole prophylaxis is already being used.

A Solar Disinfection Water Treatment System for Remote Communities

7 August 2014 13:18 (America/New_York)

A Solar Disinfection Water Treatment System for Remote Communities. Procedia Engineering, 2014.

Peter Kalt, et al.

Worldwide, approximately 780 million people do not have access to safe and clean water for drinking, cooking or washing.
Consumption of untreated water exposes humans to a range of contaminants including faecal-borne pathogens and chemical pollutants. As a consequence, it is estimated that 1.5 million people die each year as a result of the consumption of untreated or contaminated water. These deaths are preventable with access to clean and safe water, but capital costs and maintenance requirements for large-scale treatment systems are prohibitive and challenging to implement in remote or distributed communities. Such remote communities typically suffer from faecal contamination of transient water sources, rather than chemical or radiological contaminants. To address this problem a low-cost continuous-feed water treatment facility has been designed and developed. The facility utilises solar (UVA) radiation to treat pathogens. Additionally, the facility is designed such that it can be manufactured in-situ from limited or improvised resources at low capital and maintenance costs. The system is modular so that multiple systems can be used to increase water treatment capacity as required. Testing indicates that 3 modules of the design can treat 34L of water in 4 hours producing a 4-log reduction in E. Coli (from 8 × 105 CFU/ml) with a residence time of less than 30 minutes. This is based on an average solar-based UVA flux of ranging from 24 to 36 W/m2 (time average of 28 W/m2).

Biological Sand Filters: Low-Cost Bioremediation Technique for Production of Clean Drinking Water

7 August 2014 13:09 (America/New_York)

Biological Sand Filters: Low-Cost Bioremediation Technique for Production of Clean Drinking Water. Current Protocols in Microbiology, May 2014.

Michael Lea

The burden of microbiologically contaminated water is borne most heavily by the rural (largest, 80%) and peri-urban (fastest-growing) populations without access to safe water in developing countries—all need microbiologically clean water to sustain their lives and secure their livelihoods.

There is conclusive evidence that biological sand (biosand) filters are capable of dramatically improving the microbiological quality of drinking water. Biosand filters are based on a centuries-old bioremediation concept: water percolates slowly through a layer of filter medium (sand), and microorganisms form a bacteriological purification zone atop and within the sand to efficiently filter harmful pathogens from microbiologically contaminated water. Household-scaled biosand filters are a small adaptation of traditional large, slow sand filters such that they can uniquely be operated intermittently.

To use the simple, yet effective, on-demand biofiltration intervention, a person simply pours contaminated water into the household biosand filter and immediately collects treated water.

The purpose of the following comprehensive protocols is to facilitate knowledge transfer with the goal to empower vulnerable, poorest-of-poor populations in rural and peri-urban communities of developing countries, and to also promote using naturally occurring biology and readily available materials that they already possess as a cost-effective practical approach to combat poverty and inequality and achieve the health benefits of safe water by developing their own household water security solutions.

Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries

7 August 2014 13:03 (America/New_York)

Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries. BMJ Open. 2014 Jun 26;4(6):e003987. doi: 10.1136/bmjopen-2013-003987.

Marseille E. et al.

OBJECTIVE: This study estimated the health impact, cost and cost-effectiveness of an integrated prevention campaign (IPC) focused on diarrhoea, malaria and HIV in 70 countries ranked by per capita disability-adjusted life-year (DALY) burden for the three diseases.

METHODS: We constructed a deterministic cost-effectiveness model portraying an IPC combining counselling and testing, cotrimoxazole prophylaxis, referral to treatment and condom distribution for HIV prevention; bed nets for malaria prevention; and provision of household water filters for diarrhoea prevention. We developed a mix of empirical and modelled cost and health impact estimates applied to all 70 countries. One-way, multiway and scenario sensitivity analyses were conducted to document the strength of our findings. We used a healthcare payer’s perspective, discounted costs and DALYs at 3% per year and denominated cost in 2012 US dollars.

PRIMARY AND SECONDARY OUTCOMES: The primary outcome was cost-effectiveness expressed as net cost per DALY averted. Other outcomes included cost of the IPC; net IPC costs adjusted for averted and additional medical costs and DALYs averted.

RESULTS: Implementation of the IPC in the 10 most cost-effective countries at 15% population coverage would cost US$583 million over 3 years (adjusted costs of US$398 million), averting 8.0 million DALYs. Extending IPC programmes to all 70 of the identified high-burden countries at 15% coverage would cost an adjusted US$51.3 billion and avert 78.7 million DALYs. Incremental cost-effectiveness ranged from US$49 per DALY averted for the 10 countries with the most favourable cost-effectiveness to US$119, US$181, US$335, US$1692 and US$8340 per DALY averted as each successive group of 10 countries is added ordered by decreasing cost-effectiveness.

CONCLUSIONS: IPC appears cost-effective in many settings, and has the potential to substantially reduce the burden of disease in resource-poor countries. This study increases confidence that IPC can be an important new approach for enhancing global health.

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