Water Hauling and Girls’ School Attendance: Some New Evidence From Ghana, 2013. World Bank Policy Research Working Paper 6443

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Céline Nauges; Jon Strand

In large parts of the world, a lack of home tap water burdens households as the water must be brought to the house from outside, at great expense in terms of effort and time. This paper studies how such costs affect girls’ schooling in Ghana, with an analysis based on four rounds of the Demographic and Health Surveys. Using Global Positioning System coordinates, it builds an artificial panel of clusters, identifying the closest neighbors within each round.

The results indicate a significant negative relation between girls’ school attendance and water hauling activity, as a halving of water fetching time increases girls’ school attendance by 2.4 percentage points on average, with stronger impacts in rural communities. The results seem to be the first definitive documentation of such a relationship in Africa. They document some of the multiple and wide population benefits of increased tap water access, in Africa and elsewhere.

Researchers Discover That The Tulsi Plant Can Be Used To Remove Fluoride From Drinking Water | Source: From the Trenches World Report, April 2013 |

An exciting and new water treatment breakthrough has been announced that will now make the removal of fluoride from the drinking water supplies of the world’s poorest people more affordable than ever.

Researchers from Rajasthan University in India have discovered that the Tulsi plant, also known as Holy Basil, can be used to significantly reduce the amount of fluoride in drinking water. 

At present, the most reliable methods used to remove excessive fluoride from drinking water are either too expensive or not suitable for the environments where they are needed most.

The method discovered by researchers from Rajasthan University is safe, cheap and readily available, making it an ideal alternative for communities who can’t afford to use the more advanced techniques of removing fluoride that are readily available in the West.

An experiment was conducted in the Yellareddyguda village of Narketpally Mandal. The researchers soaked 75mg of Tulsi leaves in 100ml of water that contained 7.4 parts per million of fluoride in the water.

After only soaking the Tulsi leaves for eight hours, it was discovered that the level of fluoride in the water was reduced from 7.4 parts per million, to only 1.1 parts per million.

At present, the World Health Organization recommends that the safe level of fluoride in drinking water is between 0.5 to 1 parts per million.

The dangers of drinking water that contains high levels of fluoride are well known. Some of the known side effects of drinking water that contains fluoride are dental fluorosis, reduced intelligence in children and a damaged nervous system.

This new water treatment option could now provide the world’s poorest people an opportunity to remove excessive fluoride from their drinking water supplies.

However, more research is still needed to identify and validate the effectiveness of using Tulasi leaves as a means of removing fluoride from drinking water supplies.

Considering the cost-prohibitive nature of other more reliable water treatment techniques, if the Tulsi plant is conclusively proven to be effective in removing fluoride from drinking water, then we may witness a revolution in water treatment, providing options to areas where none currently exist.

Int J Hyg Environ Health. 2013 Jun;216(3):355-61.

Risk reduction assessment of waterborne Salmonella and Vibrio by a chlorine contact disinfectant point-of-use device.

Coulliette AD, Enger KS, Weir MH, Rose JB. Michigan State University, Department of Fisheries and Wildlife, East Lansing, MI 48824, USA. ACoulliette@cdc.gov

Unsafe drinking water continues to burden developing countries despite improvements in clean water delivery and sanitation, in response to Millennium Development Goal 7. Salmonella serotype Typhi and Vibrio cholerae bacteria can contaminate drinking water, causing waterborne typhoid fever and cholera, respectively. Household water treatment (HWT) systems are widely promoted to consumers in developing countries but it is difficult to establish their benefits to the population for specific disease reduction.

This research uses a laboratory assessment of halogenated chlorine beads treating contaminated water to inform a quantitative microbial risk assessment (QMRA) of S. Typhi and V. cholerae disease in a developing country community of 1000 people. Laboratory challenges using seeded well water resulted in log10 reductions of 5.44 (± 0.98 standard error (SE)) and 6.07 (± 0.09 SE) for Salmonella serotype Typhimurium and V. cholerae, respectively. In well water with 10% sewage and seeded bacteria, the log10 reductions were 6.06 (± 0.62 SE) and 7.78 (± 0.11 SE) for S. Typhimurium and V. cholerae, respectively.

When one infected individual was contributing to the water contamination through fecal material leaking into the water source, the risk of disease associated with drinking untreated water was high according to a Monte Carlo analysis: a median of 0.20 (interquartile range [IQR] 0.017-0.54) for typhoid fever and a median of 0.11 (IQR 0.039-0.20) for cholera. If water was treated, risk greatly decreased, to a median of 4.1 × 10(-7) (IQR 1.6 × 10(-8) to 1.1 × 10(-5)) for typhoid fever and a median of 3.5 × 10(-9) (IQR 8.0 × 10(-10) to 1.3 × 10(-8)) for cholera. Insights on risk management policies and strategies for public health workers were gained using a simple QMRA scenario informed by laboratory assessment of HWT.

Using Tablets in Rural India to Build Demand for Safe Water: A Hi-Tech Approach to Promoting Good Health | Source: by Safe Water Network, Sacramento Bee, May 20, 2013 |

Safe Water Network announced today the launch of its innovative Tablet-based water and health education campaign designed to build awareness of and demand for safe water in rural communities. In one of the first applications of this technology in such a setting, the campaign uses multiple regional dialects and culturally specific marketing content to educate community members on the benefits of safe water and its link to good health. This work is supported by Merck Foundation and builds upon a long-term partnership with Safe Water Network to accelerate the adoption and usage of safe water for drinking and cooking.

“At Merck, we are interested in understanding how innovation can be used to improve global health,” says Danielle Menture, vice president of Global Safety & the Environment at Merck. “This initiative is an excellent example of a new way to use technology to improve access to clean water.” 

Global health experts have been calling for an increased focus on behavior change for many years. Dr. Aidan Cronin, a Water, Sanitation and Hygiene Specialist at UNICEF India, recently stated, “UNICEF realizes the importance of creating awareness about safe drinking water and its multiple benefits.” Dr. Cronin views the Safe Water Network campaign as an important step forward. “In the midst of technology’s growing reach,” he says, “the Tablet campaign is an innovative program that will make people aware about water safety.”

The Tablet approach delivers standardized content which ensures that important messaging remains consistent across users and regions. According to MARI and ECO-Club, Safe Water Network’s local partners in the field, delivering safe water and hygiene messaging on a Tablet is creating a high level of excitement in rural communities. “The enthusiasm I’m met with in the village when using the Tablet allows me to connect with people quickly and hold their attention longer,” says Vedanta from MARI. “The Tablet symbolizes technology and progress; it creates a connection with their urban cousins.”

Safe Water Network’s campaign is gaining speed in unexpected ways. Opinion leaders in the village of Pathipaka are so motivated by the message and lessons, they have become advocates themselves. Rajitha, for example, is a leading health worker with ASHA in the Warangal district, and plays an important role in her community. “Women and children,” she says, “particularly young pregnant women, need to know the importance of always using safe water. In the past I’ve struggled to teach my community alone. Help has finally arrived.”

The campaign was developed in partnership with Dialogue Factory, a GroupM company that specializes in experiential marketing throughout India. The initiative builds on Safe Water Network’s “iJal” safe water brand that was designed to appeal to rural consumers. “We are proud to partner with Safe Water Network in their mission,” says Dalveer Singh, CEO of Dialogue Factory. “We believe that Tablets represent one of the most innovative and powerful tools to educate, entice and engage rural audiences.”

Over the next year, Safe Water Network will introduce additional functionality including educational video games, and an interactive “Project Assessment and Management” application to track safe water site assessments, planning, management and training.

A nine-month impact assessment completed by the consumer insight and market research firm IMRB will measure the campaign’s impact on safe water purchases as well as community attitudes towards safe water and hygiene.

About Safe Water Network

Safe Water Network’s mission is to develop innovative solutions that provide safe, affordable water to those in need. We bring together diverse capabilities to address the challenges of local ownership and sustainability. Working with the private and public sectors, we advance our field initiatives for broad replication. We also document and share this effort through forums, workshops, reports and case studies. Our water systems provide almost a quarter of a million people with safe water access in India and Ghana.

USAID and Dispensers for Safe Water Announce $5.5 million Partnership

by Alexandra Fielden

Women in the remote village of Markuny in Kenya are taking the lead and treating their families’ drinking water. This was not always the case; Markuny used to be one of the many places in the world where waterborne diseases are commonplace. Globally, diarrheal disease is the second leading cause of death in children under five.

To address the global challenge of sickness from cholera, diarrhea and typhoid, Innovations for Poverty Action developed the chlorine dispenser system – a low-cost technology proven to dramatically increase rates of household water treatment, decreasing the burden of waterborne disease.  Today, USAID’s Administrator, Rajiv Shah, announced an award from USAID’s Development Innovation Ventures (DIV) to support the scale-up of the Dispensers for Safe Water program. The $5.5 million grant, supported by DIV’s WASH for Life partnership with the Bill and Melinda Gates Foundation, is DIV’s first Stage 3 award. Stage 3 funding is reserved for innovative solutions that have credible and rigorous evidence of development impacts at significant scale. Stage 3 projects transition an innovation from large scale implementation to widespread adoption; this grant will help Dispensers for Safe Water provide five million people with access to dispensers. 

Chlorine dispensers are installed next to communal water sources, and supported by community education activities to encourage use, and a consistent supply of chlorine. To treat their water, community members simply turn the valve to release a metered dose of chlorine, then fill their container as they normally would with water from the source. The chlorine disinfects the water and provides ongoing protection from recontamination for up to 72 hours.

The dispenser allows community members to conveniently and easily treat their water, and its physical presence provides a visual reminder to do so.  A randomized trial in Western Kenya found 50 – 61% of households in the treatment group adopted the water treatment, compared with only 6 – 14% in the control group. Impressively, the program has been able to maintain high usage, seeing 43% adoption rates at scale.

Director of Programs for Dispensers for Safe Water, Eric Kouskalis, said “we are thrilled to be partnering with DIV on the scale-up of dispensers. DIV’s objective is to find, test, and scale interventions that get the biggest bang for the buck, and at a cost of less than $0.50 per person per year at scale, dispensers fit the bill perfectly.”

Dispensers for Safe Water critically evaluates the program to drive improvements throughout the expansion. DIV and Dispensers for Safe Water will measure success along metrics such as the number of dispenser users (by gender), the percentage of households with chlorine present in their drinking water, the percentage of individuals who understand the benefits and correct usage of dispensers, and the dispenser manufacturing and chlorine delivery costs. This data will provide valuable feedback to help the program maximize adoption, sustain dispenser usage, and increase operational efficiencies.

Maura O’Neill, Chief Innovation Officer at DIV, congratulated DSW on the award. “Results based on rigorous evidence is the hallmark of DIV. Through this award with Dispensers for Safe Water, we will avert 3.3 million cases of diarrhea, save 3,200 children’s lives and that is just in the first three years.”

• Read the evidence: http://www.poverty-action.org/safewater/impact
• Watch a video of how chlorine dispensers work: http://www.poverty-action.org/safewater
• Apply for DIV funding:http://www.usaid.gov/div/apply

To tackle the alarming resurgence of cholera, UNICEF has launched a new comprehensive Cholera Toolkit on 15 May 2013.

The toolkit launch [...] will be the culmination of a thorough review of existing guidance and global consultation with UNICEF at all levels and from all divisions in Africa, along with main partners in the fight against cholera, such as the World Health Organization as the lead agency.

There are 3-5 million cholera cases each year, killing 100,000 to 120,000 people, half of whom are children under 5 years old. Only 5-10% of cases are reported. In Western and Central Africa, there were more than 80,000 cases of cholera in 2012 resulting in nearly 1,500 deaths.

The Toolkit provides the health and WASH sectors an integrated approach to cholera prevention, preparedness and response. In addition it includes specific content linked to education, nutrition, communication for development (C4D), child protection and other relevant sectors.

UNICEF Cholera Kit, p. 41

“What the toolkit does is harvest the best and most up-to-date knowledge in the field and brings it together in one location,” said UNICEF Chief of Water, Sanitation and Hygiene Sanjay Wijesekera. “It looks at the evidence. It looks at practices that have produced results.”

Download the Toolkit at: www.unicef.org/cholera

Related websites:

• WHO – Cholera
• CDC – Cholera
• MSF Field Research – Cholera

Source: UNICEF, 15 May 2013

Progress on sanitation and drinking-water – 2013 update: Joint Monitoring Programme for Water Supply and Sanitation.

• Full text

JMP 2013 update presents country, regional and global estimates for the year 2011. Drinking-water coverage in 2011 remains at 89% – which is 1% above the MDG drinking-water target. In 2011, 768 million people relied on unimproved drinking-water sources. The report covers the following chapters: 

• Global sanitation trends 1990-2011
• Trends in open defecation 1990-2011
• Global drinking-water trends 1990-2011
• Towards a post-2015 development agenda
• The JMP method.

New WASH resources website: http://resources.cawst.org

CAWST just launched a new website to make all of its education and training resources available.

WASH Education & Training Resources

In an effort to provide practicable and accessible WASH Education & Training resources to implementers, CAWST – The Centre for Affordable Water and Sanitation Technology has launched a new website with resources in English, French and Spanish.  These resources have been used to educate and training over 1.5 million people worldwide.

Key resources include:

• Community education resources with 6 regional styles: Africa, Caribbean, Latin America, South Asia, South East Asia, and South West Asia.: http://resources.cawst.org/search/Community%20Education
• Water quality and household water treatment resources: http://resources.cawst.org/topic/household-water-treatment-and-safe-storage

The website will soon include trainer resources on how to use these materials and deliver effective training on various WASH subjects with NGO & Government field workers.All of CAWST resources are free and licensed under the Creative Commons by Attribution, meaning you can share, remix and adapt the content provided you attribute CAWST for the original work.

• http://resources.cawst.org

The full website is also available on USB flash drive, for offline use and low internet bandwidth countries. CAWST provides training, education and consulting support to over 400 WASH organizations in over 63 countries. For more information visit http://www.cawst.org

Water Quality and Health Strategy 2013-2020. WHO

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This strategy, centred on primary prevention of waterborne and water-related diseases, has the following five strategic objectives for the period 2013 to 2020:

1. Obtain the most rigorous and relevant evidence regarding water quality and health

2. Provide up-to-date, harmonized water quality management guidelines and supporting resources

3. Strengthen capacity of Member States to most effectively manage water quality to protect public health

4. Facilitate implementation of water quality and health activities through partnerships and support to Member States

5. Monitor the impact of these activities on policies and practice to more effectively inform decision making

Prevalence of rotavirus and adenovirus associated with diarrhea among displaced communities in Khartoum, Sudan. BMC Infectious Diseases 2013, 13:209.

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Wafa I Elhag, et al.

Background – Diarrheal diseases represent a major worldwide public health problem particularly in developing countries. Each year, at least four million children under five years of age die from diarrhea. Rotavirus, enteric adenovirus and some bacterial species are the most common identified infectious agents responsible for diarrhea in young children worldwide. This study was conducted to determine prevalence of rotavirus and adenovirus associated with diarrhea among displaced communities in Khartoum state, Sudan.

Methods – A total of seven hundred and ten patients, children and adults, suffering from diarrhea were examined. The clinical history, socio-demographic characteristics, physical examination findings and laboratory investigations were recorded. Stool samples or rectal swabs were collected and tested for rotavirus and adenovirus antigens using the immuno-chromatography test (ICT). Characterization of the identified Rotaviruses, as a major cause of diarrhea, was then made using real time-reverse transcription PCR. To make the study legal, an ethical clearance was obtained from Sudan Ministry of health- Research Ethical Committee. Written consent was taken from adult subjects, and also from children mothers. The participants were informed using simple language about the infection, aim of the research and the benefits of the study.

Results – Out of the 710 patients, viral pathogens were detected in only 99 cases (13.9%). Of the 99 cases of viral diarrhea, 83 (83.8%) were due to rotaviruses while 16 (16.2%) attributed to adenovirus. Of the 83 rotaviruses identified, 42 were characterized by RT-PCR, of these 40 (95.2%) were proved as type A (VP6), and 2 (4.8%) type C (VP7). Type C (VP7) rotavirus was detected in samples collected from children under 5years only.

Conclusions – In conclusion, most cases of viral diarrhea are found to be caused by rotavirus especially among children less than five years. Most of the identified rotavirus belonged to type A (VP6). It was also evident that most patients are those who drank untreated water obtained from donkey carts source and who had no access to latrines, and lived in poor environmental conditions would acquire diarrheal infection.