Global Waters – July 2014

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Global Waters Archive

A case study of income generation activities in Nairobi with the LifeStraw Community filter, 2014.

Author: Felix Nyakundi Mangera

The LifeStraw Community filter is a 25 liter capacity filtration device which used hollow fiber membrane technology and does not need cartridges, electricity, chemicals and is easy to maintain and operate. The filter has a lifetime capacity of 80,000 liters. Access to safe drinking water is a challenge in many areas and this filter could be a solution for small scale water supply. We wanted to pilot different business models around Nairobi to see if the filter could be used for income generation. This would make the filter more interesting for microfinance projects and potential customers of the filter who would become micro-entrepreneurs.

The power of creative thinking: working within and around challenging institutional frameworks

Join WSUP and the WASHplus project for this webinar and discussion

  • Date:  Wednesday, July 23, 2014
  • Time: 10:00 AM – 11:00 AM EDT (New York);  15.00 PM – 16:00 PM BST (London)

Register today and reserve your webinar seat:

Regardless of the setting, the local institutional framework for water and sanitation services will have a huge impact on the design and effectiveness of a WASH programme. These frameworks are not always functioning well, so the implementing organisation must answer some basic questions: who has the mandate to provide these services and how can we help them? What is the regulatory framework and which services does it cover? What are the bottlenecks to change? In many cases, creative thinking is required to find solutions and provide essential services that comply with regulations. Drawing upon case studies from WSUP and the USAID-funded WASHplus project, this webinar will explore how service provision can be improved in contexts with less-than-perfect institutional frameworks: we invite you to participate and share your experience!


  • Baghi Baghirathan, Programme Director, WSUP, will talk about “Breaking the barriers to water connections in low-income urban communities: experience from Mozambique”
  • Orlando Hernandez, Monitoring & Evaluation Specialist, WASHplus, will talk about “Flexible institutional partnerships to support sustainable WASH services in Madagascar”

An interactive panel discussion will follow the presentations. Questions are welcome!


  • Baghi Baghirathan, Programme Director, WSUP
  • Orlando Hernandez, Monitoring & Evaluation Specialist, WASHplus
  • Andy Narracott, Deputy CEO, WSUP
  • Jonathan Annis, Sanitation and Innovation Adviser, WASHplus

ModeratorGuy Norman, Head of Evaluation, Research and Learning, WSUP

Impact of the Provision of Safe Drinking Water on School Absence Rates in Cambodia: A Quasi-Experimental Study. PLoS One, March 2014.

Paul R. Hunter, Helen Risebro, Marie Yen, et al.

Background – Education is one of the most important drivers behind helping people in developing countries lift themselves out of poverty. However, even when schooling is available absenteeism rates can be high. Recently interest has focussed on whether or not WASH interventions can help reduce absenteeism in developing countries. However, none has focused exclusively on the role of drinking water provision. We report a study of the association between absenteeism and provision of treated water in containers into schools.

Methods and Findings – We undertook a quasi-experimental longitudinal study of absenteeism rates in 8 schools, 4 of which received one 20 L container of treated drinking water per day. The water had been treated by filtration and ultraviolet disinfection. Weekly absenteeism rates were compared across all schools using negative binomial model in generalized estimating equations. There was a strong association with provision of free water and reduced absenteeism (Incidence rate ratio = 0.39 (95% Confidence Intervals 0.27–0.56)). However there was also a strong association with season (wet versus dry) and a significant interaction between receiving free water and season. In one of the intervention schools it was discovered that the water supplier was not fulfilling his contract and was not delivering sufficient water each week. In this school we showed a significant association between the number of water containers delivered each week and absenteeism (IRR = 0.98 95%CI 0.96–1.00).

Conclusion – There appears to be a strong association between providing free safe drinking water and reduced absenteeism, though only in the dry season. The mechanism for this association is not clear but may in part be due to improved hydration leading to improved school experience for the children.

Evaluation of A Point-Of Use Water Purification System (Llaveoz) in a Rural Setting of Chiapas, Mexico. J Microbiol Exp 2014, 1(3): 00015

*Corresponding author: Javier Gutierrez-Jimenez, University of Science and Arts of Chiapas, Libramiento norte poniente#1150, Col. Lajas Maciel, Tuxtla Gutierrez, Chiapas, Mexico, Tel: +52-9616170440/ 4303; E-mail:

Access to potable water is a priority for highly-marginalized rural communities of Chiapas, Mexico where consumption of poorly sanitized water has fostered severe diarrheal diseases among children. Interventions aimed to reduce contaminants present in water are necessary to reduce morbidity and mortality rates. In this work we evaluated the efficiency of a point of use water purification system, Llaveoz, to eradicate total coliform (TC) bacteria and diarrheagenic E. coli (DEC) strains in 62 paired water samples obtained from households during the dry and rainy season. TC was determined by the membrane filtration method whereas DEC strains were evaluated by a multiplex PCR approach. After Llaveoz treatment, water samples collected during the dry season (N=20) had an 80.3% reduction of TC counts (p<0.05). Similarly, TC were significantly reduced (72.3%, (p<0.05)) in water samples treated during the rainy season (N=42). A total of 28 E. coli strains were isolated of which 14.3% (N=4) were identified as DEC strains (ETEC (N=2), EAEC (N=1) or EIEC (N=1)) in untreated water samples. Llaveoz-treated water did not contain DEC strains. Thus, the Llaveoz system represents an alternative method to obtain more pure water in regions where potable water sources are not available.

The Llaveoz™ water disinfection system (patent US2011/0215037 A1) consists in a plastic faucet which is placed at the base of a water container used at home for water storage; the faucet contains an ultraviolet light bulb UVC type which uses electricity (110V or 12V). Its light goes on when the faucet is opened in order to pour clean water. To eliminate suspended solids, parasites and bacteria, the faucet is connected to a microfiltration cartridge which contains polypropylene membranes with 0.1µm pore diameter. In vitro studies demonstrate that Llaveoz is able to eliminate ∼99, 100% and ∼99% of parasites, bacteria and virus, respectively. Llaveoz purification system is fabricated and distributed to rural and peri-urban communities by EOZ group, a non-profit organization funded by Flor Cassassuce with a self-funding mechanism.

Heterogeneous Effects of Information on Household Behaviors to Improve Water Quality, 2014.

Joe Brown, Georgia Institute of Technology – School of Civil and Environmental Engineering
Amar Hamoudi, Duke University – Sanford School of Public Policy
Marc Jeuland, Duke University
Gina Turrini, Duke University

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.

Health insurance and health environment: India’s subsidized health insurance in a context of limited water and sanitation services, 2014.

Florence McBain, Zentrum für EntwicklungsforschungCenter for Development ResearchUniversity of Bonn.

Recently, many emerging countries have established subsidized health insurance schemes to provide financial protection and support access to health care to poor households. The challenge to ensure the long term sustainability of such schemes is huge. In this paper, the impact of the health environment on the long term sustainability of a health insurance is explored, focusing on water and sanitation. India offers an interesting case to explore this question.

Indeed, since 2008 India launched a fully subsidized health insurance Rashtriya Swasthya Bima Yojana (RSBY) in a context where 56% of its population does not have access to safe sanitation and 8% do not have access to safe water (JMP, 2012). A framework is proposed linking water supply and sanitation; health status of the insured population; health insurance and the productivity of households. Next, based on a literature review, the outcomes of investments in water and sanitation and health insurance are reviewed and the potential synergies and trade-offs of combing these investments are explored. In a last section, the case of India is analysed in detail, with international comparisons and further research lines are proposed.


Looking beyond Technology: An Integrated Approach to Water, Sanitation and Hygiene in Low Income Countries. Env Sci Tech, July 2014.

Elizabeth Tilley, Linda Strande, Christoph Lüthi, Hans-Joachim Mosler, Kai M. Udert, Heiko Gebauer, and Janet G. Hering

Despite investment stimulated by the Millennium Development Goals (MDGs), sanitation-related diseases, such as diarrhea, cholera and typhus, remain a leading cause of death of children under five in low-income countries. Prevention of diarrhea requires a combination of access to safe drinking water, good hygiene and adequate sanitation. The sanitation problem has proven to be particularly intractable, demonstrating the shortcomings of past efforts that have focused on increasing access to toilets.

An alternative view positions the toilet within a service chain that extends to the final point of disposal or end-use of excreta-derived products. An integrated perspective that addresses improved planning, takes advantage of economic opportunities, incorporates specialized technology, and follows-up with behavior change could help to ensure not only access but also sustainable use, operation and maintenance of water, sanitation and hygiene interventions.


Association between Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study (GEMS) and Types of Handwashing Materials Used by Caretakers in Mirzapur, Bangladesh. Am J Trop Med Hyg. 2014 Jul 2;91(1):181-9.

Authors: Baker KK, et al.

Abstract: Handwashing practices among caretakers of case and control children < 5 years of age enrolled in the Global Enteric Multicenter Study in Mirzapur, Bangladesh were characterized and analyzed for association with moderate-to-severe diarrhea. Soap or detergent ownership was common, yet 48% of case and 47.7% of control caretakers also kept ashes for handwashing, including 36.8% of the wealthiest households. Soap, detergent, and ash were used for multiple hygiene purposes and were kept together at handwashing areas. Caretakers preferred soap for handwashing, but frequently relied on ash, or a detergent/ash mixture, as a low-cost alternative. Moderate-to-severe diarrhea was equally likely for children of caretakers who kept soap versus those who kept ash (matched OR = 0.91; 0.62-1.32). Contact with ash and water reduced concentrations of bacterial enteropathogens, without mechanical scrubbing. Thus, washing hands with ash is a prevalent behavior in Mirzapur and may help diminish transmission of diarrheal pathogens to children.

Below are abstracts and links to the full-text of articles in the August 2014 issue of  Tropical Medicine and International Healthtmih Focus on the Global Burden of Disease from Water While the methods of Global Burden of Disease (GBD) study continue to evolve, recent changes raise questions about the basis of new estimates of the risk associated with water, sanitation and hygiene and warrant consideration of alternative approaches.

  • ​Inadequate water, sanitation and hygiene are estimated to have caused 842,000 deaths from diarrhoea in 2012, i.e., 1.5% of deaths worldwide. These include 361,000 deaths of children under five years.
  • ​A systematic review of the global prevalence of handwashing with soap and its effect on diarrhoeal diseases estimates that only 19% of the world’s population washes hands with soap after contact with excreta and that handwashing reduces the risk of diarrhoeal disease by 23%–40%.
  • ​Based on over 300 studies from a systematic review, an estimated 1.1 billion people are exposed to a drinking water source of moderate to high risk.
  • ​A meta-regression shows that risks of diarrhoea from inadequate drinking water and sanitation could be reduced considerably through targeted interventions. Risk differences depend on type of intervention.

1 – Authors:  Clasen, Thomas, Pruss-Ustun, Annette, Mathers, Colin D., et al. TI  - Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods Abstract - AB  - The 2010 global burden of disease (GBD) study represents the latest effort to estimate the global burden of disease and injuries and the associated risk factors. Like previous GBD studies, this latest iteration reflects a continuing evolution in methods, scope and evidence base. Since the first GBD Study in 1990, the burden of diarrhoeal disease and the burden attributable to inadequate water and sanitation have fallen dramatically. While this is consistent with trends in communicable disease and child mortality, the change in attributable risk is also due to new interpretations of the epidemiological evidence from studies of interventions to improve water quality. To provide context for a series of companion papers proposing alternative assumptions and methods concerning the disease burden and risks from inadequate water, sanitation and hygiene, we summarise evolving methods over previous GBD studies. We also describe an alternative approach using population intervention modelling. We conclude by emphasising the important role of GBD studies and the need to ensure that policy on interventions such as water and sanitation be grounded on methods that are transparent, peer-reviewed and widely accepted. 2 – Authors: Prüss-Ustün, Annette, Bartram, Jamie, Clasen, Thomas,  et al. TI  - Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries

Objective - To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. Methods - For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Results - In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group. Conclusions - This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene. [click to continue…]

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