Household Drinking Water Quality Updates
(Im)Proving global impact: How the integration of remotely reporting sensors in water projects may demonstrate and enhance positive change, 2013. GWF Discussion Paper 1349, Global Water Forum, Canberra, Australia.
This article argues that improved feedback on the actual impact of development programs may ensure the success of poverty reduction interventions such as water filters, water pumps, latrines, and cookstoves. Rather than infrequent data collection, more continuous feedback may improve community partnerships through continuous engagement and improved responsiveness. We hope to enable greater cooperation in these programs by separating evidence from advocacy.
Counting heads: case study. DEMAND: ASME Global Development Review, 2013.
Evan Thomas; Kay Mattson.
The objectives of this Case Study were to:
- Compare and contrast the findings from two complementary approaches to field evaluations of a water, sanitation and hygiene program in greater Jakarta.
- Highlight the complementary nature of monitoring instrumentation and traditional survey methods.
- Assess how instrumentation might provide important program feedback not normally available with traditional survey tools.
- Assess the potential impact of sensor acquired data on traditional survey tools.
Use of Remotely Reporting Electronic Sensors for Assessing Use of Water Filters and Cookstoves in Rwanda
Use of Remotely Reporting Electronic Sensors for Assessing Use of Water Filters and Cookstoves in Rwanda. Env Sci Technol, Nov 2013.
Evan Thomas, et al.
Remotely reporting electronic sensors offer the potential to reduce bias in monitoring use of environmental health interventions. In the context of a five-month randomized controlled trial of household water filters and improved cookstoves in rural Rwanda, we collected data from intervention households on product compliance using (i) monthly surveys and direct observations by community health workers and environmental health officers, and (ii) sensor-equipped filters and cookstoves deployed for about two weeks in each household.
The adoption rate interpreted by the sensors varied from the household reporting: 90.5% of households reported primarily using the intervention stove, while the sensors interpreted 73.2% use, and 96.5% of households reported using the intervention filter regularly, while the sensors interpreted no more than 90.2%. The sensor-collected data estimated use to be lower than conventionally collected data both for water filters (approximately 36% less water volume per day) and cookstoves (approximately 40% fewer uses per week).
An evaluation of intrahousehold consistency in use suggests that households are not using their filters or stoves on an exclusive basis, and may be both drinking untreated water at times and using other stoves (“stove-stacking”). These results provide additional evidence that surveys and direct observation may exaggerate compliance with household-based environmental interventions.
The Impact of School Water, Sanitation, and Hygiene Interventions on the Health of Younger Siblings of Pupils: a Cluster-Randomized Trial in Kenya. Am J Public Health. 2013 Nov 14.
Dreibelbis R, Freeman MC, Greene LE, Saboori S, Rheingans R.
Objectives. We examined the impact of school water, sanitation, and hygiene (WASH) interventions on diarrhea-related outcomes among younger siblings of school-going children.
Methods. We conducted a cluster-randomized trial among 185 schools in Kenya from 2007 to 2009. We assigned schools to 1 of 2 study groups according to water availability. Multilevel logistic regression models, adjusted for baseline measures, assessed differences between intervention and control arms in 1-week period prevalence of diarrhea and 2-week period prevalence of clinic visits among children younger than 5 years with at least 1 sibling attending a program school.
Results. Among water-scarce schools, comprehensive WASH improvements were associated with decreased odds of diarrhea (odds ratio [OR] = 0.44; 95% confidence interval [CI] = 0.27, 0.73) and visiting a clinic (OR = 0.36; 95% CI = 0.19, 0.68), relative to control schools. In our separate study group of schools with greater water availability, school hygiene promotion and water treatment interventions and school sanitation improvements were not associated with differences in diarrhea prevalence between intervention and control schools.
Conclusions. In water-scarce areas, school WASH interventions that include robust water supply improvements can reduce diarrheal diseases among young children.
Heavy Rainfall Events and Diarrhea Incidence: The Role of Social and Environmental Factors. Am J Epidemiol. 2013 Nov 19.
Carlton EJ, Eisenberg JN, Goldstick J, Cevallos W, Trostle J, Levy K.
The impact of heavy rainfall events on waterborne diarrheal diseases is uncertain. We conducted weekly, active surveillance for diarrhea in 19 villages in Ecuador from February 2004 to April 2007 in order to evaluate whether biophysical and social factors modify vulnerability to heavy rainfall events. A heavy rainfall event was defined as 24-hour rainfall exceeding the 90th percentile value (56 mm) in a given 7-day period within the study period. Mixed-effects Poisson regression was used to test the hypothesis that rainfall in the prior 8 weeks, water and sanitation conditions, and social cohesion modified the relationship between heavy rainfall events and diarrhea incidence. Heavy rainfall events were associated with increased diarrhea incidence following dry periods (incidence rate ratio = 1.39, 95% confidence interval: 1.03, 1.87) and decreased diarrhea incidence following wet periods (incidence rate ratio = 0.74, 95% confidence interval: 0.59, 0.92).
Drinking water treatment reduced the deleterious impacts of heavy rainfall events following dry periods. Sanitation, hygiene, and social cohesion did not modify the relationship between heavy rainfall events and diarrhea. Heavy rainfall events appear to affect diarrhea incidence through contamination of drinking water, and they present the greatest health risks following periods of low rainfall. Interventions designed to increase drinking water treatment may reduce climate vulnerability.
Assessing Appropriate Technology Handwashing Stations in Mali, West Africa, 2013.
Colleen Claire Naughton
This study developed and implemented a comprehensive monitoring strategy of five usage variables (i.e., soap usage, functionality, presence of cleansing agent, ground wetness under station, amount of water in the jug) for 42-64 appropriate technology handwashing stations. These stations were monitored throughout 2011-2013 in two communities in Mali, West Africa. Statistically significant (p < 0.05) results include: 1) a 29% decrease in soap usage from dry (October-June) to rainy seasons (July-September), 2) 35% decrease in stations with presence of cleansing agent between 2011 and 2012, 3) higher station usage for stations in households with higher scores on the Progress out of Poverty Index® , 4) 27% less of the stations far from a water source (35 meters-172 meters away) had a cleansing agent present than stations close to a water source (less than 35 meters) during the rainy season. Station usage also differed based on gender of the handwashing station owner in the two communities where stations built by women were used more in Zeala than those in Nci’bugu. In contrast to Zeala, handwashing stations built by men in Nci’bugu had higher soap usage and usage variable proportions than those built by women. Handwashing training and promotions resulted in 98% of households reporting that they wash their hands with soap in 2012 from 0% in 2011. Altogether, this study designed and
implemented a robust monitoring system that succeeded in quantifying handwashing station usage for over two years. In-depth analysis of the data established six sustainability factors for handwashing stations (gender, training, water, seasonality, wealth, and monitoring) that are critical for lasting handwashing behavior change and successful hygiene interventions to save lives.
Mainstreaming disability and ageing in water, sanitation and hygiene programmes; A mapping study carried out for WaterAid UK, 2013.
Hazel Jones, WEDC.
WEDC was commissioned by WaterAid to carry out a desk study to present an overview of the current state of disability and ageing issues in WASH, from the perspective of the WASH sector. This report presents the findings from this study. Both disabled and older people were looked at together, because many frail older people, although they may reject the label ‘disabled’, experience impairments that limit their daily activities, which result in them facing similar kinds of barriers to accessing WASH.
The Added Value of Water, Sanitation, and Hygiene Interventions to Mass Drug Administration for Reducing the Prevalence of Trachoma
The Added Value of Water, Sanitation, and Hygiene Interventions to Mass Drug Administration for Reducing the Prevalence of Trachoma: A Systematic Review. Journal of Environmental and Public HealthVolume 2013, Article ID 682093.
A Travers, et al.
Trachoma is the leading cause of infectious blindness worldwide.The SAFE strategy, the World Health Organization recommended method to eliminate blinding trachoma, combines developments in water, sanitation, surgery, and antibiotic treatment. Current literature does not focus on the comprehensive effect these components have on one another.
The present systematic review analyzes the added benefit of water, sanitation, and hygiene education interventions to preventive mass drug administration of azithromycin for trachoma. Trials were identified from the PubMed database using a series of search terms. Three studies met the completecriteria for inclusion.Though all studies found a significant change in reduction of active trachoma prevalence, the research is still too limited to suggest the impact of the “F” and “E” components on trachoma prevalence and ultimately its effects on blindness.
Water quality risks of ‘improved’ water sources: evidence from Cambodia. Trop Med Intl Health, Nov 2013. A. Shaheed, et al.
Objectives -The objective of this study was to investigate the quality of on-plot piped water and rainwater at the point of consumption in an area with rapidly expanding coverage of ‘improved’ water sources.
Methods - Cross-sectional study of 914 peri-urban households in Kandal Province, Cambodia, between July–August 2011. We collected data from all households on water management, drinking water quality and factors potentially related to post-collection water contamination. Drinking water samples were taken directly from a subsample of household taps, stored tap water, other stored water and treated stored water for basic water quality analysis for Escherichia coli and other parameters.
Results – Household drinking water management was complex, with different sources used at any given time and across seasons. Rainwater was the most commonly used drinking water source. Households mixed different water sources in storage containers, including ‘improved’ with ‘unimproved’ sources. Piped water from taps deteriorated during storage. Stored non-piped water (primarily rainwater) had a mean E. coli count of 1500 cfu/100 ml (CV: 4.1), not significantly different from stored piped water. Microbial contamination of stored water was significantly associated with observed storage and handling practices, including dipping hands or receptacles in water, and having an uncovered storage container
Conclusions - The microbial quality of ‘improved’ water sources in our study area was not maintained at the point of consumption, possibly due to a combination of mixing water sources at the household level, unsafe storage and handling practices, and inadequately treated piped-to-plot water. These results have implications for refining international targets for safe drinking water access as well as the assumptions underlying global burden of disease estimates, which posit that ‘improved’ sources pose minimal risks of diarrhoeal diseases.
Opportunities to improve domestic hygiene practices through new enabling products: a study of handwashing practices and equipment in rural Cambodia. Int Health. 2013 Nov 8.
Jenkins MW, Anand AR, Revell G, Sobsey MD.
Department of Civil and Environmental Engineering, University of California at Davis, Davis, CA, USA.
BACKGROUND: Lack of a dedicated place and equipment for handwashing has been associated with poor practice of handwashing with soap in the home in developing communities where the practice is needed to reduce diarrhea diseases and respiratory infections.
METHODS: We conducted formative research on handwashing knowledge, attitudes, practices and equipment and investigated the need and demand for dedicated handwashing equipment to enable improved hygiene practices and enhance handwashing performance for health in rural Cambodian homes where water is collected and stored. Responses to closed and open-ended questions and structured observation of a demonstration of handwashing by the mother or another female adult child caretaker in 79 households were used to identify handwashing occasions, evaluate handwashing equipment and competency, investigate attitudes and structural barriers to handwashing with soap, and assess use of and interest in dedicated handwashing equipment.
RESULTS: We found significant evidence of the need for handwashing enabling equipment to eliminate unsafe domestic water handling during handwashing and reduce structural barriers to routine handwashing with soap in Cambodian homes dependent on stored water supplies. Substantial interest in dedicated handwashing equipment and in specific equipment features was measured.
CONCLUSIONS: Findings suggest household demand for and uptake of affordable household handwashing facilities incorporating desired features and functionality could be generated in Cambodia to support improved domestic hygiene practices.
Understanding household water practices using ethnographic research methods, 2013.
Water Information Network (WIN-SA), South Africa.
This study had no hidden agenda or desired outcome. It was non-interventionist. Its only aim was to provide the community with different perspectives on their own practices. What they decided to do with the information was entirely up to them.
This study was innovative in a number of ways, due to its non-interventionist nature: It was designed to give a visual tool to a rural community to capture, analyse, interpret and present their household practices from their own as well as from other perspectives.
The community had the opportunity to interrogate, analyse and interpret other perspectives against their own perspective. This generated debate and learning about their own practices.
This study has clearly shown that the ethno-visual tool can be used in a participatory noninterventionist manner in rural communities. Apart from the film footage, other material collected was graphically and visually provided to the elders in the community, allowing for debate on a level previously unknown to them.
Although further development and/or shaping of the tool may be required to fit the profiles and problems of specific communities, it is envisaged that the ethno-visual tool would have substantial value in similar situations in other communities, specifically to contribute to the discourse on community led participation. It would also allow for comparison of the use of the tool with other participatory rural research methods.
Post 2015 WASH Targets and Indicators, 2013.
Joint Monitoring Programme
When consolidated, the proposals developed by each of the four working groups – Water, Sanitation, Hygiene, and Equity and Non-Discrimination – yield the following, detailed targets.
Target 1: By 2025, no one practices open defecation, and inequalities in the practice of open defecation have been progressively eliminated.
Target 2: By 2030, everyone uses a basic drinking water supply and handwashing facilities when at home, all schools and health centres provide all users with basic drinking water supply and adequate sanitation, handwashing facilities and menstrual hygiene facilities, and inequalities in access to each of these services have been progressively eliminated.
Target 3: By 2040, everyone uses adequate sanitation when at home, the proportion of the population not using an intermediate drinking water supply service at home has been reduced by half, the excreta from at least half of schools, health centres and households with adequate sanitation are safely managed, and inequalities in access to each of these services have been progressively reduced.
Target 4: All drinking water supply, sanitation and hygiene services are delivered in a progressively affordable, accountable, and financially and environmentally sustainable manner.
Unsubsidised Self-Supply in Eastern Madagascar. Water Alternatives, 6(3) 2013
Michael F. MacCarthy, Dept. of Civil & Environmental Engineering, University of South Florida, Tampa, Florida, USA; email@example.com
Jonathan E. Annis, WASHplus, CARE International, Washington, DC, USA;
James R. Mihelcic, Dept. of Civil & Environmental Engineering, University of South Florida, Tampa, Florida, USA; firstname.lastname@example.org
Self-supply is widely reported across various contexts, filling gaps left by other forms of water supply provision. This study assesses mature and unsubsidised Self-supply markets in an urban context in Madagascar. Locally manufactured drilling and pumping technologies are widely provided by the local private sector, enabling households to access shallow groundwater. The market for Pitcher Pump systems (suction pumps fitted onto hand-driven boreholes) has developed over several decades, reaching a level of maturity and scale. In the eastern port city of Tamatave, 9000 of these systems are estimated to be in use and Self-supply constitutes a primary domestic water source for the majority of the city’s 280,000 inhabitants.
The market is supplied by more than 50 small businesses that manufacture and install the systems at lower cost (US$35-100) than a connection to the piped water supply system. Mixed methods are used to assess the performance of the Pitcher Pump system and the characteristics of the market. Discussion includes a description of the manufacturing process and sales network that supply Pitcher Pump systems, environmental health concerns related to water quality, pump performance, and system management. In a context where urban piped water supplies are unlikely to be accessible to all anytime soon, recommendations are made for further research and potential technology developments to improve the performance of Self-supply.
Household Water Chlorination Reduces Incidence of Diarrhea among Under-Five Children in Rural Ethiopia: A Cluster Randomized Controlled Trial. PLoS ONE, Oct. 2013.
Bezatu Mengistie, et al.
Background – Household water treatment has been advocated as a means of decreasing the burden of diarrheal diseases among young children in areas where piped and treated water is not available. However, its effect size, the target population that benefit from the intervention, and its acceptability especially in rural population is yet to be determined. The objective of the study was to assess the effectiveness of household water chlorination in reducing incidence of diarrhea among children under-five years of age.
Method – A cluster randomized community trial was conducted in 36 rural neighborhoods of Eastern Ethiopia. Households with at least one child under-five years of age were included in the study. The study compared diarrhea incidence among children who received sodium hypochlorite (liquid bleach) for household water treatment and children who did not receive the water treatment. Generalized Estimation Equation model was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval.
Result – In this study, the incidence of diarrhea was 4.5 episodes/100 person week observations in the intervention arm compared to 10.4 episodes/100 person week observations in the control arm. A statistically significant reduction in incidence of diarrhea was observed in the intervention group compared to the control (Adjusted IRR = 0.42, 95% CI 0.36–0.48).
Expanding access to household water chlorination can help to substantially reduce child morbidity and achieve millennium development goal until reliable access to safe water is achieved.
Effectiveness, Scale and Sustainability in WASH Programmes – A Review, 2013.
Dr. Ben Taylor, The Springfield Centre for Business in Development
This paper provides a review of current WASH programmes together with a new framework for their analysis. This framework focuses on effectiveness, sustainability and scale; approaches to intervention will therefore be assessed against these criteria. Using this, the paper finds a predominance of direct delivery approaches to
WASH sector interventions, and a systematic bias against the inclusion of failed and of less direct forms of intervention in their analysis.
The paper presents some emerging data from interventions that have implemented elements of systemic change in the WASH sector. It demonstrates their successes but also their failures in the context of broader politicaland economic constraints within a system. Ultimately, the paper argues for the adoption of systemic approaches to
development programming in the WASH sector with a view to providing sustainable and large-scale change for poor people.
Does the implementation of hardware need software? A longitudinal study on fluoride-removal filter use in Ethiopia. Environ Sci Technol. 2013 Oct 11.
Sonego IL, Huber AC, Mosler HJ.
Abstract – Evidence suggests that the effectiveness of technology designed to provide safe and healthy water is dependent on the degree of its use. In addition to providing safe water “hardware” (i.e., new infrastructure or equipment) to populations at risk, it might be necessary to also provide suitable “software” programs (behavior change strategies) to support use. A longitudinal survey was conducted in rural Ethiopia following the distribution of fluoride-removal household filters. Three intervention groups were evaluated. Group 1 only received the hardware, i.e., the fluoride-removal filter. Groups 2 and 3 also received software in the form of two evidence-based psychological interventions: a planning and social prompt intervention and an educational workshop with pledging. Group 2 received both software interventions and Group 3 only received the educational workshop.
The effects of the hardware and software on behavior and thus filter use were analyzed along with specific psychological factors. The results showed that the provision of the hardware alone (the fluoride-removal filter) was not enough to ensure sufficient use of the equipment. The addition of a software component in the form of psychological interventions increased filter use up to 80%. An increase in filter use was measured following each intervention resulting in the health-risk being minimized. We conclude that it is necessary that the implementation of hardware of this nature is accompanied by evidence-based intervention software.
WHO – Considerations for Policy Development and Scaling-Up HWTSwith Communicable Disease Prevention Efforts
Considerations for Policy Development and Scaling-Up Household Water Treatment and Safe Storage with Communicable Disease Prevention Efforts, 2013. World Health Organization.
The overall consensus from the group was that existing meta-analyses, individual research reports, and WHO Guidelines provide sufficient support for scaling-up HWTS. Participants thought more can and should be done to integrate HWTS into HIV, child and maternal health, dengue and vector control, and other targeted efforts. The three specific conclusions were:
• Correct and consistent use of proven household water treatment technologies and safe storage results in health gains;
• Optimal selection of household water treatment and safe storage should consider several contextual and performance factors; and
• Integration of HWTS with health efforts offers “quick wins” for reducing diarrhoea and co-morbidity, providing incentives to seek health services, and makes efficient use of health resources.
During the discussion, a statement articulating important opportunities for integration of HWTS with health efforts was drafted. Following the meeting the statement was revised with input from all meeting participants for publication in a peer-reviewed journal (publication forthcoming).
The recommendations from the discussion (provided in greater detailed in the statement) include:
• Highlight linkages between HWTS and priority health programmes in WHO and national strategies;
• Link HWTS (and other public health goods) with efforts to rapidly expand HIV testing in order to reach the global HIV target of treating 15 million by 2015;
• Increase implementation of HWTS to end preventable child deaths from pneumonia and diarrhoea by 2025;
• Develop and implement preventive interventions that jointly address faecal contamination and vector breeding in household water storage containers;
• Select household water treatment technologies that meet WHO performance criteria and are most likely to be used correctly and consistently;
• Implement household water treatment in tandem with existing health interventions and channels;
• Monitor and track progress in effective implementation of HWTS alongside other health interventions (i.e. improvements in antenatal care, HIV care and counselling, etc);
• Invest in operational research on uptake of environmental health interventions;
• Establish straightforward and ambitious global HWTS targets to drive scaling-up efforts.
Water, sanitation, and hygiene interventions to improve health among people living with HIV/AIDS: a systematic review. AIDS. 2013 Oct 23;27(16):2593-2601.
Peletz R, Mahin T, Elliott M, Harris MS, Chan KS, Cohen MS, Bartram JK, Clasen TF.
aFaculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK bMassachusetts Department of Environmental Protection, Boston, Massachusetts cUNC Water Institute, University of North Carolina dInstitute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.
DESIGN:: People living with HIV/AIDS (PLHIV) are at increased risk of diarrhoeal disease and enteric infection. This review assesses the effectiveness of water, sanitation, and hygiene (WASH) interventions to prevent disease among PLHIV.
METHODS:: We searched MEDLINE, EMBASE, Global Health, The Cochrane Library, Web of Science, LILACS, Africa-wide, IMEMR, IMSEAR, WPRIM, CNKI, and WanFang. We also hand searched conference proceedings, contacted researchers and organizations, and checked references from identified studies. Eligible studies were those involving WASH interventions among PLHIV that reported on health outcomes and employed a controlled study design. We extracted data, explored heterogeneity, sub-grouped based on outcomes, calculated pooled effects on diarrhoeal disease using meta-analysis, and assessed studies for methodological quality.
RESULTS:: Ten studies met the eligibility criteria and are included in the review, of which nine involved water quality interventions and one involved promotion of handwashing. Among eight studies that reported on diarrhoea, water quality interventions (seven studies, pooled RR = 0.57, 95% CI: 0.38-0.86) and the handwashing intervention (one study, RR = 0.42, 95% CI: 0.33-0.54) were protective against diarrhoea. One study reported that household water treatment combined with insecticide treated bednets slowed the progression of HIV/AIDS. The validity of most studies is potentially compromised by methodological shortcomings.
CONCLUSION: No studies assessed the impact of improved water supply or sanitation, the most fundamental of WASH interventions. Despite some evidence that water quality interventions and handwashing are protective against diarrhoea, substantial heterogeneity and the potential for bias raise questions about the actual level of protection.
Follow-Up Study to Assess the Use and Performance of Household Filters in Zambia. Am J Trop Med Hyg. 2013 Oct 7.
Peletz R, Simuyandi M, Simunyama M, Sarenje K, Kelly P, Clasen T.
London School of Hygiene and Tropical Medicine, London, United Kingdom; Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia; Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom.
Effective household water treatment can improve drinking water quality and prevent disease if used correctly and consistently over time. One year after completion of a randomized controlled study of water filters among households in Zambia with children < 2 years old and mothers who were human immunodeficiency virus-positive, we conducted a follow-up study to assess use and performance of new filters distributed at the conclusion of the study; 90% of participating households met the criteria for current users, and 75% of participating households had stored water with lower levels of fecal contamination than source water.
Microbiologically, the filters continued to perform well, removing an average of 99.0% of fecal indicator bacteria. Although this study provides some encouraging evidence about the potential to maintain high uptake and filter performance, even in the absence of regular household visits, additional research is necessary to assess whether these results can be achieved over longer periods and with larger populations.
Quality of Piped and Stored Water in Households with Children Under Five Years of Age Enrolled in the Mali Site of the Global Enteric Multi-Center Study (GEMS). Am Jnl Trop Med Hyg, Aug 2013.
Kelly K. Baker, et al.
Water, sanitation, and hygiene information was collected during a matched case-control study of moderate and severe diarrhea (MSD) among 4,096 children < 5 years of age in Bamako, Mali. Primary use of piped water (conditional odds ratio [cOR] = 0.45; 0.34–0.62), continuous water access (cOR = 0.30; 0.20–0.43), fetching water daily (cOR = 0.77; 0.63–0.96), and breastfeeding (cOR = 0.65; 0.49–0.88) significantly reduced the likelihood of MSD. Fetching water in > 30 minutes (cOR = 2.56; 1.55–4.23) was associated with MSD.
Piped tap water and courier-delivered water contained high (> 2 mg/L) concentrations of free residual chlorine and no detectable Escherichia coli. However, many households stored water overnight, resulting in inadequate free residual chlorine (< 0.2 mg/L) for preventing microbial contamination. Coliforms and E. coli were detected in 48% and 8% of stored household water samples, respectively. Although most of Bamako’s population enjoys access to an improved water source, water quality is often compromised during household storage.