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.

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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.

A critique of boiling as a method of household water treatment in South India. Journal of Water and Health In Press, 2014 | doi:10.2166/wh.2014.010

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Authors: Luke Juran and Morgan C. MacDonaldDepartment of Geography and Virginia Water Resources Research Center, Virginia Tech, 125 Major Williams Hall, Blacksburg, VA 24061, USA E-mail: ljuran@vt.edu; lukejuran@yahoo.com. School of Engineering, University of Guelph, 3120 Thornbrough, Guelph, ON N1G 2W1, Canada

This article scrutinizes the boiling of water in Tamil Nadu and Puducherry, India. Boiling, as it is commonly practiced, improves water quality, but its full potential is not being realized. Thus, the objective is to refine the method in practice, promote acceptability, and foster the scalability of boiling and household water treatment (HWT) writ large. The study is based on bacteriological samples from 300 households and 80 public standposts, 14 focus group discussions (FGDs), and 74 household interviews. Collectively, the data fashion both an empirical and ethnographic understanding of boiling. The rate and efficacy of boiling, barriers to and caveats of its adoption, and recommendations for augmenting its practice are detailed. While boiling is scientifically proven to eliminate bacteria, data demonstrate that pragmatics inhibit their total destruction. Furthermore, data and the literature indicate that a range of cultural, economic, and ancillary health factors challenge the uptake of boiling. Fieldwork and resultant knowledge arrive at strategies for overcoming these impediments. The article concludes with recommendations for selecting, introducing, and scaling up HWT mechanisms. A place-based approach that can be sustained over the long-term is espoused, and prolonged exposure by the interveners coupled with meaningful participation of the target population is essential.

Prevalence, associated risk factors and antimicrobial susceptibility pattern of Campylobacter species among under five diarrheic children at Gondar University Hospital, Northwest Ethiopia. BMC Pediatrics 2013, 13:82.

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Ayalew Lengerh, et al.

Background: Recent reports indicate that Campylobacter species are becoming one of the leading causes of bacterial diarrhoeal disease worldwide and most of the isolates are resistant to different antibiotics. This study aimed at determining the prevalence, associated risk factors and susceptibility pattern of Campylobacter species in under-five diarrheic children.

Methods: A cross-sectional study was conducted from October 2011 to March 2012. Samples were collected from under five diarrhoeic children who visited University of Gondar Teaching Hospital and seeking medical services during the study period. Stool specimens were aseptically inoculated using selective media and species isolation was further processed following standard procedures. Antimicrobial susceptibility test for Campylobacter species was performed using the standard agar disc diffusion method. The data was entered and analyzed using SPSS version 16 packages. Odd ratio was used to see their association between variables and then logistic regression was used to measure strengths of association. P-values less than 0.05 were taken as statistically significant.

Result: A total of 285 under five children with diarrhoea were included in this study. Of these144 (50.5%) were males and 141(49.5%) were females with the age range of one month to five years and mean age of 2.26 years (25months). Among 285 stool specimens cultured, 44(15.4%) of them were positive for Campylobacter species. Culture positivity for Campylobacter was higher in children below 12 months of age. Latrine usage, water source, boiling drinking water, bottle feeding, nutritional status and exposure to domestic animals had statistically significant association. Highest drug resistance rate were found in ampicillin (68.2%), tetracycline (56.8%) and trimethoprim- sulfamethoxazole (54.5%).

Conclusion: Isolation rate of Campylobacter species were frequent among under five children. The frequency was higher in those children who were malnourished, drinking of unprotected water and direct contact with infected animals (especially cats, dogs, pigeons, hens and their products). The antimicrobial resistance patterns for some of the commonly prescribed antibiotics were high. Therefore, awareness of hand washing and proper boiling of drinking water are probably important in preventing infection with Campylobacter species and childhood diarrhea should not be underestimated and effectiveness of the drugs should be continuously monitored by doing antimicrobial susceptibility test.

Sci Total Environ. 2013 Mar 11;452-453C:28-39

Pesticide management and their residues in sediments and surface and drinking water in the Mekong Delta, Vietnam.

Toan PV, Sebesvari Z, Bläsing M, Rosendahl I, Renaud FG. United Nations University, Institute for Environment and Human Security (UNU-EHS), Hermann-Ehlers-Str. 10, 53113, Bonn, Germany; Department of Environmental Engineering, College of Environment and Natural Resources, Can Tho University, 3/2 street, Can Tho City, Viet Nam.

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Public concern in Vietnam is increasing with respect to pesticide pollution of the environment and of drinking water resources. While established monitoring programs in the Mekong Delta (MD) focus on the analysis of organochlorines and some organophosphates, the environmental concentrations of more recently used pesticides such as carbamates, pyrethroides, and triazoles are not monitored. In the present study, household level pesticide use and management was therefore surveyed and combined with a one year environmental monitoring program of thirteen relevant pesticides (buprofezin, butachlor, cypermethrin, α-endosulfan, β-endosulfan, endosulfan-sulfate, fenobucarb, fipronil, isoprothiolane, pretilachlor, profenofos, propanil, and propiconazole) in surface water, soil, and sediment samples.

The surveys showed that household level pesticide management remains suboptimal in the Mekong Delta. As a consequence, a wide range of pesticide residues were present in water, soil, and sediments throughout the monitoring period. Maximum concentrations recorded were up to 11.24μgl-1 in water for isoprothiolane and up to 521μgkg-1dm in sediment for buprofezin. Annual average concentrations ranged up to 3.34μgl-1 in water and up to 135μgkg-1dm in sediment, both for isoprothiolane.

Occurrence of pesticides in the environment throughout the year and co-occurrence of several pesticides in the samples indicate a considerable chronic exposure of biota and humans to pesticides. This has a high relevance in the delta as water for drinking is often extracted from canals and rivers by rural households (GSO, 2005, and own surveys). The treatment used by the households for preparing surface water prior to consumption (flocculation followed by boiling) is insufficient for the removal of the studied pesticides and boiling can actually increase the concentration of non-volatile pollutants.

Soil-Transmitted Helminth Infections and Correlated Risk Factors in Preschool and School-Aged Children in Rural Southwest China. PLoS ONE, Sept 2012.

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Xiaobing Wang et al.

We conducted a survey of 1707 children in 141 impoverished rural areas of Guizhou and Sichuan Provinces in Southwest China. Kato-Katz smear testing of stool samples elucidated the prevalence of ascariasis, trichuriasis and hookworm infections in pre-school and school aged children. Demographic, hygiene, household and anthropometric data were collected to better understand risks for infection in this population. 21.2 percent of pre-school children and 22.9 percent of school aged children were infected with at least one of the three types of STH. In Guizhou, 33.9 percent of pre-school children were infected, as were 40.1 percent of school aged children. In Sichuan, these numbers were 9.7 percent and 6.6 percent, respectively.

Number of siblings, maternal education, consumption of uncooked meat, consumption of unboiled water, and livestock ownership all correlated significantly with STH infection. Through decomposition analysis, we determined that these correlates made up 26.7 percent of the difference in STH infection between the two provinces. Multivariate analysis showed that STH infection is associated with significantly lower weight-for-age and height-for-age zscores; moreover, older children infected with STHs lag further behind on the international growth scales than younger children.

This annotated bibliography has 11 journal articles and 1 fact sheet that were published from 1985 through August 2012 on boiling drinking water. Links to the full-text are included when possible. Please contact WASHplus if you have other studies and reports to add to this bibliography.

2012

1 – Boiling as Household Water Treatment in Cambodia: A Longitudinal Study of Boiling Practice and Microbiological Effectiveness, Am J Trop Med Hyg. 2012 Jul 23.

Brown J, Sobsey MD.Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.

This paper focuses on the consistency of use and microbiological effectiveness of boiling as it is practiced in rural Cambodia. We followed 60 randomly selected households in Kandal Province over 6 months to collect longitudinal data on water boiling practices and effectiveness in reducing Escherichia coli in household drinking water.

Despite > 90% of households reporting that they used boiling as a means of drinkingwater treatment, an average of only 31% of households had boiled water on hand at follow-up visits, suggesting that actual use may be lower than self-reported use. We collected 369 matched untreated and boiled water samples. Mean reduction of E. coli was 98.5%; 162 samples (44%) of boiled samples were free of E. coli (< 1 colony-forming unit [cfu]/100 mL), and 270 samples (73%) had < 10 cfu/100 mL. Storing boiledwater in a covered container was associated with safer product water than storage in an uncovered container.

2 – Prevalence of Anemia and Its Risk Factors Among Children 6–36 Months Old in Burma, Amer Jnl Trop Med Hyg, Aug 2012.

Ai Zhao, Yumei Zhang*, Ying Peng, Jiayin Li, Titi Yang, Zhaoyan Liu, Yanli Lv and Peiyu Wang*

Address correspondence to Yumei Zhang or Peiyu Wang, School of Public Health, Peking University Health Science Center, Beijing, 100191 China. E-mails: zhangyumei111@gmail.com or wpeiyupku@gmail.com

Anemia is a common nutritional problem, and it has a remarkably high prevalence rate in Southeast Asia. In this study, children from 6 to 36 months were investigated to determine (1) the prevalence of anemia and (2) risk factors associated with anemia. Convenience sampling was used to select three villages in three different regions in Burma. Hemoglobin and anthropometric indicators were measured for 872 children. Logistic regression analyses were used to determine factors associated with anemia.

The overall prevalence of anemia was 72.6%, with 40.0% having severe anemia. Predictors of anemia are a young age (P < 0.001), mother with anemia (P < 0.001), height-for-age Z score < −2 (P = 0.017), low family income (P < 0.001), mothers without primary education (P = 0.007), drinking unboiled water (P = 0.029), and fever in the last 3 months (P = 0.001). There is a high prevalence of anemia in children, and their nutritional status is quite poor. To control anemia, humanitarians and governments should launch comprehensive interventions.

2011

3 – Coping with poor water supplies: empirical evidence from Kathmandu, Nepal, J Water Health. 2011 Mar;9(1):143-58.

Katuwal H, Bohara AK. 1915 Roma Ave NE, University of New Mexico, MSC05 3060, Albuquerque, NM 87131, USA. katuwalh@unm.edu

The authors examined the demand for clean drinking water using treatment behaviors in Kathmandu, Nepal. Water supply is inadequate, unreliable and low quality. Households engage in several strategies to cope with the unreliable and poor quality of water supplies. Some of the major coping strategies are hauling, storing, and point-of-use treatment. Boiling, filtering, and use of Uro-guard are some of the major treatment methods.

Using Water Survey of Kathmandu, the authors estimated the effect of wealth, education, information, gender, caste/ethnicity and opinion about water quality on drinking water treatment behaviors. The results show that people tend to increase boiling and then filtering instead of only one method if they are wealthier. In addition, people boil and then filter instead of boiling only and filtering only if they think that waterdelivered to the tap is dirty. Exposure to information has the strongest effect in general for the selection of all available treatment modes.

4 – Assessing the microbiological performance and potential cost of boiling drinking water in urban Zambia, Environ Sci Technol. 2011 Jul 15;45(14):6095-101.

Psutka R, Peletz R, Michelo S, Kelly P, Clasen T. London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7H, United Kingdom.

Boiling is the most common method of disinfecting water in the home and the benchmark against which other point-of-use water treatment is measured. In a six-week study in peri-urban Zambia, we assessed the microbiological effectiveness and potential cost of boiling among 49 households without a water connection who reported “always” or “almost always” boiling their water before drinking it. Source and householddrinking water samples were compared weekly for thermotolerant coliforms (TTC), an indicator of fecal contamination. Demographics, costs, and other information were collected through surveys and structured observations. Drinking water samples taken at the household (geometric mean 7.2 TTC/100 mL, 95% CI, 5.4-9.7) were actually worse in microbiological quality than source water (geometric mean 4.0 TTC/100 mL, 95% CI, 3.1-5.1) (p < 0.001), although both are relatively low levels of contamination.

Only 60% of drinking water samples were reported to have actually been boiled at the time of collection from the home, suggesting over-reporting and inconsistent compliance. However, these samples were of no higher microbiological quality. Evidence suggests that water quality deteriorated after boiling due to lack of residual protection and unsafe storage and handling. The potential cost of fuel or electricity for boiling was estimated at 5% and 7% of income, respectively. In this setting where microbiological water quality was relatively good at the source, safe-storage practices that minimize recontamination may be more effective in managing the risk of disease from drinking water at a fraction of the cost of boiling.

5 – Microbiologic effectiveness of boiling and safe water storage in South Sulawesi, Indonesia, J Water Health. 2011 Sep;9(3):577-85.

Sodha SV, Menon M, Trivedi K, Ati A, Figueroa ME, Ainslie R, Wannemuehler K, Quick R. Centers for Disease Control and Prevention, Division of Foodborne, Waterborne, and Environmental Diseases, 1600 Clifton Road, MS E-05 Atlanta, GA 30333, USA. ssodha@cdc.gov

In Indonesia, where diarrhea remains a major cause of mortality among children <5 years, the government promotes boiling of drinking water. We assessed the impact of boiling on water quality in South Sulawesi. We surveyed randomly selected households with at least one child <5 years old in two rural districts and tested source and stored water samples for Escherichia coli contamination. Among 242 households, 96% of source and 51% of stored water samples yielded E. coli. Unboiled water samples, obtained from 15% of households, were more likely to yield E. coli than boiled samples [prevalence ratios (PR) = 2.0, 95% confidence interval (CI) 1.7-2.5].

Water stored in wide-mouthed (PR = 1.4, 95% CI = 1.1-1.8) or uncovered (PR = 1.8, 95% CI = 1.3-2.4) containers, or observed to be touched by the respondent’s hands (PR = 1.6, 95% CI = 1.3-2.1) was more likely to yield E. coli. A multivariable model showed that households that did not boil water were more likely to have contaminated stored water than households that did boil water (PR = 1.9, 95% CI = 1.5-2.3).

Although this study demonstrated the effectiveness of boiling in reducing contamination, overall impact on water quality was suboptimal. Future studies are needed to identify factors behind the success of boiling water in Indonesia to inform efforts to scale up other effective water treatment practices.

2010

6 – Microbiological effectiveness of disinfecting water by boiling in rural Guatemala, Am J Trop Med Hyg. 2010 Mar;82(3):473-7.

Rosa G, Miller L, Clasen T. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. ghislaine.rose@lshtm.ac.uk

Boiling is the most common means of treating water in the home and the benchmark against which alternative point-of-use water treatment options must be compared. In a 5-week study in rural Guatemala among 45 households who claimed they always or almost always boiled theirdrinking water, boiling was associated with a 86.2% reduction in geometric mean thermotolerant coliforms (TTC) (N = 206, P < 0.0001).

Despite consistent levels of fecal contamination in source water, 71.2% of stored water samples from self-reported boilers met the World Health Organization guidelines for safe drinking water (0 TTC/100 mL), and 10.7% fell within the commonly accepted low-risk category of (1-10 TTC/100 mL). As actually practiced in the study community, boiling significantly improved the microbiological quality of drinking water, though boiled and stored drinking water is not always free of fecal contaminations.

2009

7 – Boiling: Household Water Treatment Options in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 538KB). CDC/Safewater; USAID.

• Full-text, pdf

Boiling is arguably the oldest and most commonly practiced household water treatment method, and it has been widely promoted for decades. Organizations recommend boiling both for water treatment in developing countries and to provide safe drinking water in emergency situations throughout the world.

2008

8 – Microbiological effectiveness and cost of boiling to disinfect drinking water in rural Vietnam, Environ Sci Technol. 2008 Jun 15;42(12):4255-60.

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Clasen TF, Thao do H, Boisson S, Shipin O. London School of Hygiene and Tropical Medicine, Keppel St., London, WCIE 7H, U.K. thomas.clasen@lshtm.ac.uk

Despite certain shortcomings, boiling is still the most common means of treating water in the home and the benchmark against which alternative household-based disinfection and filtration methods must be measured. We assessed the microbiological effectiveness and cost of boiling among a vulnerable population relying on unimproved water sources and commonly practicing boiling as a means of disinfecting water. In a 12 week study among 50 households from a rural community in Vietnam, boiling was associated with a 97% reduction in geometric mean thermotolerant coliforms (TTCs) (p < 0.001).

Despite high levels of faecal contamination in source water, 37% of stored water samples from self-reported boilers met the WHO standard for safe drinking water (0 TTC/100 mL), and 38.3% fell within the low risk category (1–10 TTC/100 mL). Nevertheless, 60.5% of stored drinking water samples were positive for TTC, with 22.2% falling into the medium risk category (11–100 TTC/100 mL). The estimated cost of wood used to boil water was US$ 0.272 per month for wood collectors and US$ 1.68 per month for wood purchasers, representing approximately 0.48% to 1.04%, respectively, of the average monthly income of participating households.

2007

9 - Fecal contamination of drinking water within peri-urban households, Lima, Peru, Am J Trop Med Hyg. 2007 Oct;77(4):699-704.

Oswald WE, Lescano AG, Bern C, Calderon MM, Cabrera L, Gilman RH. Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Lima, Peru. william.oswald@jhsph.edu

We assessed fecal contamination of drinking water in households in 2 peri-urban communities of Lima, Peru. We measured Escherichia coli counts in municipal source water and, within households, water from principal storage containers, stored boiled drinking water, and water in a serving cup. Source water was microbiologically clean, but 26 (28%) of 93 samples of water stored for cooking had fecal contamination. Twenty-seven (30%) of 91 stored boiled drinking water samples grew E. coli. Boiled water was more frequently contaminated when served in a drinking cup than when stored (P < 0.01).

Post-source contamination increased successively through the steps of usage from source water to the point of consumption. Boiling failed to ensure safe drinking water at the point of consumption because of easily contaminated containers and poor domestic hygiene. Hygiene education, better point-of-use treatment and storage options, and in-house water connections are urgently needed.

1985 – 2000

10 – To boil or not: drinking water for children in a periurban barrio, Soc Sci Med. 2000 Oct;51(8):1211-20.

Mclennan JD. Canadian Centre for Studies of Children at Risk, McMaster University, Hamilton, Ontario. mclennjd@fhs.mcmaster.ca

Boiling water, or other water purification methods, are common recommendations of health promoters in developing countries to improve the quality of drinking water in an attempt to decrease the incidence of childhood diarrhea. Health education programs frequently employ an approach based on knowledge deficits to promote this practice. However, there has been little published about water purification practices or associated variables such as knowledge deficits. We interviewed 266 randomly selected child caregivers about water purification in a poor periurban district of Santo Domingo, Dominican Republic. Though most reported that they provided purified drinking water for their children when they were babies, only half of the children five years of age and under were regularly drinking purified water at the time of the study.

Only one knowledge variable remained significantly related to purifying drinking water in the final multivariate model. Other factors that remained in the final model were level of maternal education, endorsing being too tired to boil water and a global measure of social support. Several other hypothesized variables were not related to purifying water. Knowledge deficits may play only a limited role in determining this prevention practice. Further work is required to better identify key factors to improve this practice and hence guide health promotion efforts.

11 - Boiling drinking water: a critical look, Waterlines, July 1986.

• Full-text, pdf

DeWolfe Miller

One short-term solution to water-related disease control in areas with unsafe water supplies is the implementation of programmes to boil all drinking water. Dr DeWolfe Miller provides evidence that this approach may have drawbacks and limitations

12 – Boiling of drinking-water: can a fuel-scarce community afford it? Bull World Health Organ. 1985;63(1):157-63.

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Gilman RH, Skillicorn P.

In the prevention of diarrhoea, health professionals often advocate boiling as a method of choice to provide safe household drinking-water to villagers in the less developed countries. We have examined the financial feasibility of this recommendation in a village study in Bangladesh. Family income was categorized and the pattern of household fuel consumption was determined. Families in the lowest income quartile would have to spend approximately 22% of their yearly income on fuel, and those in the highest income bracket approximately 10%.

Boiling of drinking-water would result in an 11% increase in the household budget (as a percentage of income) for a typical family in the lowest income quartile, compared with a 3% increase for a family in the highest income quartile. We conclude that recommendations concerning boiling ofdrinking-water in developing countries should not be made until their economic feasibility has been demonstrated.

Am J Trop Med Hyg. 2012 Jul 23.

Boiling as Household Water Treatment in Cambodia: A Longitudinal Study of Boiling Practice and Microbiological Effectiveness.

Brown J, Sobsey MD.

This paper focuses on the consistency of use and microbiological effectiveness of boiling as it is practiced in rural Cambodia. We followed 60 randomly selected households in Kandal Province over 6 months to collect longitudinal data on water boiling practices and effectiveness in reducing Escherichia coli in household drinking water.

Despite > 90% of households reporting that they used boiling as a means of drinking water treatment, an average of only 31% of households had boiled water on hand at follow-up visits, suggesting that actual use may be lower than self-reported use. We collected 369 matched untreated and boiled water samples.

Mean reduction of E. coli was 98.5%; 162 samples (44%) of boiled samples were free of E. coli (< 1 colony-forming unit [cfu]/100 mL), and 270 samples (73%) had < 10 cfu/100 mL. Storing boiled water in a covered container was associated with safer product water than storage in an uncovered container.

Amer Jnl Trop Med Hyg, Aug 2012.

Prevalence of Anemia and Its Risk Factors Among Children 6–36 Months Old in Burma

Ai Zhao, Yumei Zhang*, Ying Peng, Jiayin Li, Titi Yang, Zhaoyan Liu, Yanli Lv and Peiyu Wang*

Address correspondence to Yumei Zhang or Peiyu Wang, School of Public Health, Peking University Health Science Center, Beijing, 100191 China. E-mails: zhangyumei111@gmail.com or wpeiyupku@gmail.com

Anemia is a common nutritional problem, and it has a remarkably high prevalence rate in Southeast Asia. In this study, children from 6 to 36 months were investigated to determine (1) the prevalence of anemia and (2) risk factors associated with anemia. Convenience sampling was used to select three villages in three different regions in Burma. Hemoglobin and anthropometric indicators were measured for 872 children. Logistic regression analyses were used to determine factors associated with anemia.

The overall prevalence of anemia was 72.6%, with 40.0% having severe anemia. Predictors of anemia are a young age (P < 0.001), mother with anemia (P < 0.001), height-for-age Z score < −2 (P = 0.017), low family income (P < 0.001), mothers without primary education (P = 0.007), drinking unboiled water (P = 0.029), and fever in the last 3 months (P = 0.001). There is a high prevalence of anemia in children, and their nutritional status is quite poor. To control anemia, humanitarians and governments should launch comprehensive interventions.

Criteria Report for Household Water Treatment Solutions: Community Choices Tool for Water, Sanitation, and Hygiene, 2012.

• Full-text (pdf)

Pacific Institute

Criteria Used for Ranking Household Water Treatment Solutions. Below you can view information that clarifies how your individual answers to the questions impacted the Community Choices Tool’s recommendations for technologies and approaches that are appropriate for your situation and needs.

NOTE: This demonstration prototype of the Community Choices Tool contains rankings for the few solutions we have in the database. We envision that once fully developed, the Community Choices Tool will be able to evaluate and rank hundreds of technologies and approachesfor the entire WASH sector, and from those it will be able to create fully customized solutions for each user (rather than the static solutions it has now).

Journal of Water and Health Vol 9 No 3 pp 577–585

Microbiologic effectiveness of boiling and safe water storage in South Sulawesi, Indonesia

Samir V. Sodha, M. Menon, K. Trivedi, A. Ati, M. E. Figueroa, R. Ainslie, K. Wannemuehler and R. Quick

Centers for Disease Control and Prevention, Division of Foodborne, Waterborne, and Environmental Diseases,
Email: ssodha@cdc.gov
Johns Hopkins Bloomberg School of Public Health, The Center for Communications Program, Baltimore, MD

In Indonesia, where diarrhea remains a major cause of mortality among children <5 years, the government promotes boiling of drinking water. We assessed the impact of boiling on water quality in South Sulawesi. We surveyed randomly selected households with at least one child <5 years old in two rural districts and tested source and stored water samples for Escherichia coli contamination. Among 242 households, 96% of source and 51% of stored water samples yielded E. coli. Unboiled water samples, obtained from 15% of households, were more likely to yield E. coli than boiled samples [prevalence ratios (PR) = 2.0, 95% confidence interval (CI) 1.7–2.5].

Water stored in wide-mouthed (PR = 1.4, 95% CI = 1.1–1.8) or uncovered (PR = 1.8, 95% CI = 1.3–2.4) containers, or observed to be touched by the respondent’s hands (PR = 1.6, 95% CI = 1.3–2.1) was more likely to yield E. coli. A multivariable model showed that households that did not boil water were more likely to have contaminated stored water than households that did boil water (PR = 1.9, 95% CI = 1.5–2.3). Although this study demonstrated the effectiveness of boiling in reducing contamination, overall impact on water quality was suboptimal. Future studies are needed to identify factors behind the success of boiling water in Indonesia to inform efforts to scale up other effective water treatment practices.