Determinants of Caregivers’ Use and Adoption of Household Water Chlorination: A Qualitative Study with Peri-urban Communities in the Peruvian Amazon. Am Jnl Trop Med Hyg, July 2015.

Authors: Jessica D. Rothstein, Elli Leontsini, et al.

The gap between the efficacy and the effectiveness of household water treatment in reducing diarrhea-related morbidity indicates the need for a better understanding of the determinants of long-term behavior change. To explore the barriers to drinking water chlorination in the Peruvian Amazon, where diarrhea is endemic among under-5 children, we conducted qualitative research with 23 caregivers from peri-urban communities of Iquitos, Peru. Our inquiry drew on the Transtheoretical Model of behavior change and the Integrated Behavioral Model for Water, Sanitation, and Hygiene to identify the most relevant contextual, psychosocial, and technological determinants of initial action and long-term adoption of chlorination.

Our findings suggest that the decision to try out this practice resulted from the combined effect of knowledge of chlorination benefits and product availability and affordability. Progress from action to adoption was influenced by caretakers’ understanding of dosage, the packaging of chlorine products, knowledge and skills for multipurpose laundry bleach, the taste of treated water, and reinforcement. This analysis suggests that a focus on these determinants and the household domain may help to improve the sustainability of future intervention efforts.

 

Coping with household water scarcity in the savannah today: Implications for health and climate change into the futureEarth Interact. 2015 doi:10.1175/EI-D-14-0039.1, in press.

Authors: Amber L. Pearson, Jonathan D. Mayer, David J. Bradley

Even as millions live without reliable access to water, very little is known about how households cope with scarcity. The aims of this research were to: 1) understand aspects of water scarcity in three rural villages in southwestern Uganda; 2) examine differences by demographics and type of source; 3) assess relationships between different factors related to water access; and 4) explore coping strategies used. Health implications and lessons learned that relate to future climate change are discussed.

Over half of the households relied on seasonal water sources. Of those accessing ‘permanent’ sources, ~30% experienced inaccessibility within the past two weeks. Self-reported better access to water was correlated with minutes spent walking to source and to some degree with the source being more public or shared. Those without access to public sources tended to migrate as the primary coping strategy. Water sharing and reciprocity appears crucial between wealthy and poor households, however, those from outside ethnic groups appear to be partially excluded. Middle income households followed by the poorest had the largest reliance on purchasing water to cope. These findings underscore how access to water resources, particularly in times of insecurity, involves social networks.

 

Knowledge, Information, and Water Treatment Behavior of Residents in the Kathmandu Valley, Nepal. The Development Journal of the South, Vol. 1, No. 1, 2015.

Authors: Hari Katuwal, Mona K Qassim, José A. Pagán, Jennifer A Thacher, Alok K. Bohara

In this paper, we examine determinants of water treatment behavior using survey data (N=1200) from Kathmandu, Nepal. In particular, this paper focuses on the impacts of knowledge, exposure to information, and community participation on drinking water treatment behavior. Previous research has found that income, education level, awareness, and exposure to media are major factors that impact the individual-level decision to treat water before using it. We contribute to this literature by explicitly examining how knowledge about waterborne diseases, exposure to water quality information campaigns, and participation in community organizations impact drinking water treatment behavior.

The results from probit regression analyses suggest that either a one percentage increase in the knowledge index or community participation index both increase the likelihood of utilizing drinking water treatment methods by about 0.17 percentage points. Households connected to the distribution system are 31 percentage points more likely to treat water compared to those that are not connected to the system. Multinomial results indicate that wealthier households use more than one treatment method.

Silver Dissolution and Release from Ceramic Water Filters. Env Sci Tech, June 2015.

Authors: Anjuliee M. Mittelman, Daniele S. Lantagne, Justine Rayner, and Kurt D. Pennell

Application of silver nanoparticles (nAg) or silver nitrate (AgNO3) has been shown to improve the microbiological efficacy of ceramic water filters used for household water treatment. Silver release, however, can lead to undesirable health effects and reduced filter effectiveness over time. The objectives of this study were to evaluate the contribution of nanoparticle detachment, dissolution, and cation exchange to silver elution, and to estimate silver retention under different influent water chemistries. Dissolved silver (Ag+) and nAg release from filter disks painted with 0.03 mg/g casein-coated nAg or AgNO3 were measured as a function of pH (5–9), ionic strength (1–50 mM), and cation species (Na+, Ca2+, Mg2+).

Silver elution was controlled by dissolution as Ag+ and subsequent cation exchange reactions regardless of the applied silver form. Effluent silver levels fell below the drinking water standard (0.1 mg/L) after flushing with 30–42 pore volumes of pH 7, 10 mM NaNO3 at pH 7. When the influent water was at pH 5, contained divalent cations or 50 mM NaNO3, silver concentrations were 5–10 times above the standard. Our findings support regular filter replacement and indicate that saline, hard, or acidic waters should be avoided to minimize effluent silver concentrations and preserve silver treatment integrity.

Efficacy of Handwashing with Soap and Nail Clipping on Intestinal Parasitic Infections in School-Aged Children: A Factorial Cluster Randomized Controlled Trial. PLoS Medicine, June 2015.

Authors: Mahmud Abdulkader Mahmud, Mark Spigt, et al.

Background - Intestinal parasitic infections are highly endemic among school-aged children in resource-limited settings. To lower their impact, preventive measures should be implemented that are sustainable with available resources. The aim of this study was to assess the impact of handwashing with soap and nail clipping on the prevention of intestinal parasite reinfections.

Methods and Findings - In this trial, 367 parasite-negative school-aged children (aged 6–15 y) were randomly assigned to receive both, one or the other, or neither of the interventions in a 2 × 2 factorial design. Assignment sequence was concealed. After 6 mo of follow-up, stool samples were examined using direct, concentration, and Kato-Katz methods. Hemoglobin levels were determined using a HemoCue spectrometer. The primary study outcomes were prevalence of intestinal parasite reinfection and infection intensity. The secondary outcome was anemia prevalence. Analysis was by intention to treat. Main effects were adjusted for sex, age, drinking water source, latrine use, pre-treatment parasites, handwashing with soap and nail clipping at baseline, and the other factor in the additive model. Fourteen percent (95% CI: 9% to 19%) of the children in the handwashing with soap intervention group were reinfected versus 29% (95% CI: 22% to 36%) in the groups with no handwashing with soap (adjusted odds ratio [AOR] 0.32, 95% CI: 0.17 to 0.62). Similarly, 17% (95% CI: 12% to 22%) of the children in the nail clipping intervention group were reinfected versus 26% (95% CI: 20% to 32%) in the groups with no nail clipping (AOR 0.51, 95% CI: 0.27 to 0.95). Likewise, following the intervention, 13% (95% CI: 8% to 18%) of the children in the handwashing group were anemic versus 23% (95% CI: 17% to 29%) in the groups with no handwashing with soap (AOR 0.39, 95% CI: 0.20 to 0.78). The prevalence of anemia did not differ significantly between children in the nail clipping group and those in the groups with no nail clipping (AOR 0.53, 95% CI: 0.27 to 1.04). The intensive follow-up and monitoring during this study made it such that the assessment of the observed intervention benefits was under rather ideal circumstances, and hence the study could possibly overestimate the effects when compared to usual conditions.

Conclusions - Handwashing with soap at key times and weekly nail clipping significantly decreased intestinal parasite reinfection rates. Furthermore, the handwashing intervention significantly reduced anemia prevalence in children. The next essential step should be implementing pragmatic studies and developing more effective approaches to promote and implement handwashing with soap and nail clipping at larger scales.

 

Factors Determining Water Treatment Behavior for the Prevention of Cholera in Chad. Am Jnl Trop Med Hyg, Apr 2015.

Authors: Jonathan Lilje, Hamit Kessely and Hans-Joachim Mosler

Cholera is a well-known and feared disease in developing countries, and is linked to high rates of morbidity and mortality. Contaminated drinking water and the lack of sufficient treatment are two of the key causes of high transmission rates. This article presents a representative health survey performed in Chad to inform future intervention strategies in the prevention and control of cholera.

To identify critical psychological factors for behavior change, structured household interviews were administered to N = 1,017 primary caregivers, assessing their thoughts and attitudes toward household water treatment according to the Risk, Attitude, Norm, Ability, and Self-regulation model. The intervention potential for each factor was estimated by analyzing differences in means between groups of current performers and nonperformers of water treatment. Personal risk evaluation for diarrheal diseases and particularly for cholera was very low among the study population. Likewise, the perception of social norms was found to be rather unfavorable for water treatment behaviors.

n addition, self-reported ability estimates (self-efficacy) revealed some potential for intervention. A mass radio campaign is proposed, using information and normative behavior change techniques, in combination with community meetings focused on targeting abilities and personal commitment to water treatment.

Evaluation of Microbial Water Quality Tests for Humanitarian Emergency and Development SettingsProcedia Engineering, Volume 107, 2015, Pages 237–246. Humanitarian Technology: Science, Systems and Global Impact 2015, HumTech2015.

Authors: Susan Murcott, Megan Keegan, Alison Hanson, Akshay Jain, Jason Knutson, Shuyue Liu, Jenny Tanphanich, Teng Ke Wong

How do you know if drinking water is safe? Or which microbial indicator tests work best when few side-by-side performance evaluations exist in real-world field sites? This research compares bacterial indicator test products inlow-resource settings in Ahmedabad, India and Tamale, Ghana. In India, three hydrogen sulfide (H2S) bacteria test products were evaluated: laboratory-made H2S, TARA Aquacheck and ORlab H2S, and compared to an EPA-certified standard, the IDEXX Quanti-Tray® 2000. In Ghana, 3 M Petrifilm™, Aquagenx CBT and Easygel® Cards were included in addition toH2S and Quanti-Tray® 2000. Results are presented in a Consumer Reports-style for easy comprehension.

Sanitary Survey of Public Drinking Water Sources: A Study Conducted in Slums of Bhubaneswar, Odisha, 2015. Health of the Urban Poor (HUP) Program.

Authors: Biraja Kabi Satapathy, Niladri Chakraborti.

The sanitary survey of drinking water sources was done in Bhubaneswar slums where PFI is running the Health of the Urban Poor Program. The purpose was to understand the risk to public drinking water sources based on onsite inspection and water testing of the source with field test for pipe water supply and H2 S bacteriological contamination test for all the sources. The study report gives details of the survey undertaken, its findings, and suggestions for ensuring drinking water quality in the slums of Odisha. The report tried to capture the result of the indicator-wise sanitary inspection and its relation with other indicators. We hope the study will be useful for the government for making some policy level corrections. We also hope that Government, Non Government and civil society organisations will adopt the sanitary survey as a tool for identifying factors that affect drinking water sources, which is essential for drinking water safety.

What factors affect sustained adoption of safe water, hygiene and sanitation technologies?A systematic review of literature, June 2015. EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.

Authors: Kristyna Hulland, Nina Martin, Robert Dreibelbis, Julia DeBruicker Valliant, Peter Winch

Among the exciting advances in water, sanitation, and hygiene (WASH) programmes and policies, sustainability counts as a renewed and crucial area of focus for implementers, scientists, policy makers, and donors alike. To further our understanding of the barriers and facilitators to sustained adoption and use of water and sanitation technologies, we conducted a systematic review of studies concerning both initial and sustained adoption of WASH interventions at the individual, household and community levels in low- and middleincome countries. We built on previous reviews of handwashing and point-of-use water treatment, with a comprehensive review that is dramatically larger and broader in scope than previous studies. It is the only review we know of that includes a range of WASH interventions and factors associated with adoption.

 

Fecal Coliform Contamination of Drinking Water: An Evaluation of World Field Assessment Techniques. EWB-USA Technical Paper 104.

Authors: William Fripp, Catherine Dane Woodyard, PhD, and Marina Hanna

A safe, consistent, and reliable water supply is a universal need. However, a large number of the world’s population lives in areas that are suffering from water quality problems and water shortages. Many areas have contaminated water with fecal coliform bacteria as the primary contaminant of concern. As a result, there are many aid groups that are actively working to develop and improve the water supply in the developing world.

An important first step in such work is an accurate appraisal of the existing water supply. This appraisal often requires a rapid, onsite field assessment of possible fecal coliform contamination with minimal equipment. This paper summarizes a qualitative evaluation of five field assessment techniques undertaken by an interdisciplinary team of students involved in aid work. The focus of this evaluation is on Presence/Absence testing.

The evaluation examines usability, accuracy, cost, speed of results, and ease of explaining results to the local population. Advantages and disadvantages of each technique have been identified and discussed. The purpose of this paper is to provide guidance that will aid in the selection of a suitable rapid fecal coliform field test. The team performed their assessments of the five techniques in the United States under controlled situations, as well as during an evaluation trip to Belize.

All of the evaluations were conducted under the oversight of a professional engineer with experience in water quality assessments and water treatment design. This study and paper is of value to aid groups involved in the assessment of water projects in the developing world.