A longitudinal study on fluoride-removal filter use in Ethiopia

October 21, 2013 · 0 comments

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 HWTS with Communicable Disease Prevention Efforts

October 21, 2013 · 0 comments

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

October 9, 2013 · 0 comments

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.
Source
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

October 9, 2013 · 2 comments

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

October 9, 2013 · 0 comments

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.

Designing a handwashing station for infrastructure-restricted communities in Bangladesh

September 24, 2013 · 0 comments

Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). BMC Public Health, Sept 2013, 13:877.

Kristyna RS, et al.

Background – In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations — a dedicated, convenient location where both soap and water are available for handwashing — are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour.

Methods – We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs.

Results – Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials.

Conclusions – A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.

Current practices in manufacturing locally-made ceramic pot filters

September 11, 2013 · 1 comment

Journal of Water, Sanitation and Hygiene for Development Vol 3 No 2 pp 252–261 2013

Current practices in manufacturing locally-made ceramic pot filters for water treatment in developing countries

Justine Rayner, Brian Skinner and Daniele Lantagne

E-mail: jsrayners@yahoo.com

Locally produced ceramic pot filters have been shown to improve the microbiological quality of household drinking water and reduce the burden of diarrheal disease in users. They are considered one of the most promising household water treatment methods. However, overarching manufacturing and quality control guidelines do not exist for the 35 decentralized filter factories in 18 countries that currently produce filters. In this study, we conducted manufacturing process surveys with 25 filter factories worldwide to document production methods and identify areas where manufacturing and quality control guidelines are needed.

Our results show that manufacturing processes vary widely both between and within factories, including the consistency of materials, manufacturing methods, and quality control practices. These variations pose concerns about the consistency and quality of locally produced filters in the absence of standardized quality control procedures.

We propose areas where manufacturing guidelines are needed to assist factories in producing consistently high quality filters, and identify topics where further research is needed to refine manufacturing recommendations. These results guided the development of a best practice manual that described consensus-based recommendations to advance consistent, quality-controlled filter production world-wide.

Development of a quaternized chitosan with enhanced antibacterial efficacy

September 10, 2013 · 1 comment

Journal of Water and Health Vol 11 No 3 pp 410–418 2013.

Development of a quaternized chitosan with enhanced antibacterial efficacy

Gurpreet Kaur Khaira, Rashmi Kumariya, Manmohan Chibber and Moushumi Ghosh. Department of Biotechnology and Environmental Sciences, Thapar University, Patiala-147004, Punjab, India E-mail: mghosh@thapar.edu
School of Chemistry and Biochemistry, Thapar University, Patiala-147004, Punjab, India

The antibacterial activity of a water-soluble chitosan derivative prepared by chemical modification to quaternary ammonium compound N,N,N-trimethylchitosan (TC) was investigated against four selected waterborne pathogens: Aeromonas hydrophila ATCC 35654, Yersinia enterocolitica ATCC 9610, Listeria monocytogenes ATCC 19111 and Escherichia coli O157:H7 ATCC 32150. An inactivation of 4 log CFU/ml of all waterborne pathogens was noted for the quaternized chitosan as compared with chitosan over a short contact time (30 min) and low dosage (4.5 ppm) at ambient temperature. A marked increase in glucose level, protein content and lactate dehydrogenase (LDH) activity was observed concurrently in the cell supernatant to be a major bactericidal mechanism. The results suggest that the TC derivative may be a promising commercial substitute for acid-soluble chitosan for rapid and effective disinfection of water.

Water quality perceptions and willingness to pay for clean water in peri-urban Cambodian communities.

September 10, 2013 · 2 comments

J Water Health. 2013 Sep;11(3):489-506.

Water quality perceptions and willingness to pay for clean water in peri-urban Cambodian communities.

Orgill J, Shaheed A, Brown J, Jeuland M. Sanford School of Public Policy and Nicholas School of the Environment, Duke University, 201 Science Drive, Durham, NC 27705, USA E-mail: jenny.orgill@duke.edu.

This paper studies household demand for improved water quality in peri-urban Cambodia, with particular attention paid to the influence of water quality on willingness to pay (WTP). Utilizing data from 915 household surveys, we analyze responses to a contingent valuation scenario using multivariate logit regression techniques that account for subjective perceptions of water quality. We estimate a mean household WTP for improved water quality of US$3 (roughly 1.2% of mean income) per month for households in this sample. We also find that the majority of households believe that their in-house water after storage, handling, and treatment is safe to drink. Furthermore, beliefs about existing levels of water quality have a significant impact on WTP for improved water quality. However, while perceptions of quality (and thus WTP) are highly related to taste preferences, actual water quality is relatively uncorrelated with water quality perceptions. These findings suggest that interventions aiming to increase the adoption of water treatment should account for underlying perceptions of water quality.

Water and sanitation in the time of cholera

September 10, 2013 · 1 comment

Water and sanitation in the time of cholera: sustaining progress on water, sanitation and health in Haiti, 2013.

Katherine Bliss, Matt Fischer. Center for Strategic International Studies.

This report discusses the recent cholera outbreaks in Haiti and provides recommendations on how to prevent future cholera outbreaks.

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