Amer Jnl Trop Med Hyg, Nov 2012
Relationship between Use of Water from Community-Scale Water Treatment Refill Kiosks and Childhood Diarrhea in Jakarta
Laura C. Sima, et al.
In developing countries, safe piped drinking water is generally unavailable, and bottled water is unaffordable for most people. Purchasing drinking water from community-scale decentralized water treatment and refill kiosks (referred to as isi ulang depots in Indonesia) is becoming a common alternative. This study investigates the association between diarrhea risk and community-scale water treatment and refill kiosk. We monitored daily diarrhea status and water source for 1,000 children 1–4 years of age in Jakarta, Indonesia, for up to 5 months.
Among children in an urban slum, rate of diarrhea/1,000 child-days varied significantly by primary water source: 8.13 for tap water, 3.60 for bottled water, and 3.97 for water kiosks. In multivariable Poisson regression analysis, diarrhea risk remained significantly lower among water kiosk users (adjusted rate ratio [RR] = 0.49, 95% confidence interval [CI] = 0.29–0.83) and bottled water users (adjusted RR = 0.45, 95% CI = 0.21–0.97), compared with tap water users.
In a peri-urban area, where few people purchased from water kiosk (N = 28, 6% of total population), diarrhea rates were lower overall: 2.44 for well water, 1.90 for bottled water, and 2.54 for water kiosks. There were no significant differences in diarrhea risk for water kiosk users or bottled water users compared with well water users. Purchasing water from low-cost water kiosks is associated with a reduction in diarrhea risk similar to that found for bottled water.
Journal of Water and Health In Press, Nov 2012 | doi:10.2166/wh.2012.199
Calibrating an optimal condition model for solar water disinfection in peri-urban household water treatment in Kampala, Uganda
Kenan Okurut, Eleanor Wozei, Robinah Kulabako, Lillian Nabasirye and Joel Kinobe
Department of Civil and Environmental Engineering, School of Engineering; College of Engineering, Design, Art and Technology, Makerere University, P. O. Box 7062 Kampala, Uganda E-mail: okenan@tech.mak.ac.ug
In low income settlements where the quality of drinking water is highly contaminated due to poor hygienic practices at community and household levels, there is need for appropriate, simple, affordable and environmentally sustainable household water treatment technology. Solar water disinfection (SODIS) that utilizes both the thermal and ultra-violet effect of solar radiation to disinfect water can be used to treat small quantities of water at household level to improve its bacteriological quality for drinking purposes.
This study investigated the efficacy of the SODIS treatment method in Uganda and determined the optimal condition for effective disinfection. Results of raw water samples from the study area showed deterioration in bacteriological quality of water moved from source to the household; from 3 to 36 cfu/100 mL for tap water and 75 to 126 cfu/100 mL for spring water, using thermotolerant coliforms (TTCs) as indicator microorganisms. SODIS experiments showed over 99.9% inactivation of TTCs in 6 h of exposure, with a threshold temperature of 39.5 ± 0.7°C at about 12:00 noon, in the sun during a clear sunny day. A mathematical optimal condition model for effective disinfection has been calibrated to predict the decline of the number of viable microorganisms over time.
J Water Health. 2012 Dec;10(4):531-8. doi: 10.2166/wh.2012.128.
The efficacy of simulated solar disinfection (SODIS) against coxsackievirus, poliovirus and hepatitis A virus.
Heaselgrave W, Kilvington S.
Department of Infection, Immunity & Inflammation, University of Leicester, Medical Sciences Building PO Box 138, University Road, Leicester LE1 9HN, UK E-mail: w.heaselgrave@worc.ac.uk; University of Worcester, Institute of Science and the Environment, Henwick Grove, Worcester WR2 6AJ, UK.
The antimicrobial activity of simulated solar disinfection (SODIS) against enteric waterborne viruses including coxsackievirus-B5, poliovirus-2 and hepatitis A virus was investigated in this study. Assays were conducted in transparent 12-well polystyrene microtitre plates containing the appropriate viral test suspension. Plates were exposed to simulated sunlight at an optical irradiance of 550 Wm(-2) (watts per square metre) delivered from a SUNTEST™ CPS+ solar simulator for 6 hours. Aliquots of the viral test suspensions were taken at set time points and the level of inactivation of the viruses was determined by either culture on a HeLa cell monolayer for coxsackievirus-B5 and poliovirus-2 or by utilising a chromogenic antibody-based approach for hepatitis A virus.
With coxsackievirus-B5, poliovirus-2 and hepatitis A virus, exposure to SODIS at an optical irradiance of 550 Wm(-2) for 1-2 hours resulted in complete inactivation of each virus. The findings from this study suggest that under appropriate conditions SODIS may be an effective technique for the inactivation of enteric viruses in drinking water. However, further verification studies need to be performed using natural sunlight in the region where the SODIS technology is to be employed to validate our results.
A Year in the Life of Dispensers for Safe Water by Evan Green-Lowe
THE PROGRAM
Dispensers for Safe Water provides an innovative water treatment service – the Chlorine Dispenser System. We install chlorine dispensers at communal water sources such as wells and boreholes. To use the dispenser, community members simply turn the valve to release a measured dose of chlorine into their container, and then fill up the container with water as usual. The chlorine disinfects the water, and protects against recontamination during transport and storage, helping to ensure that water remains safe for everyone to drink. Our community education and volunteer dispenser promoters help to encourage dispenser usage in our target areas, and we also provide a consistent supply of chlorine to the dispensers. 
OUR REACH
Since the end of 2009, we have installed over 2,000 dispensers in Kenya. These dispensers provide access to safe water for approximately 420,000 people in more than 800 villages across the country. This year, we began piloting in Uganda and achieved high adoption rates and very positive feedback from communities. Through our partners, we worked to reach 20,000 people in Haiti and 80,000 people in Bangladesh.
TECHNOLOGY
In 2012, we expanded the use of technology in our operations, using smart phones to collect, record, and relay information from installations, community meetings and household surveys. This data is now stored on a cloud server that provides the Dispensers for Safe Water team with real-time operational updates. This exciting development has enabled us to efficiently and intelligently manage an ever-growing number of dispensers in the field.
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Household Water Treatment and Safe Storage Abstracts – American Society of Tropical Medicine & Hygiene Conference 2012.
WASHplus complied an annotated bibliography of 21 HWTS presentations at the 2012 ASTMH conference.
Titles of the presentations are:
- 1 – INTEGRATING DENGUE AND DIARRHEA CONTROL IN RURAL SCHOOLS IN COLOMBIA: A CLUSTER RANDOMIZED CONTROLLED TRIAL
- 2 – CRYPTOSPORIDIUM INFECTION IN CHILDREN LESS THAN FIVE YEARS OLD WITH MODERATE-TO-SEVERE DIARRHEA IN RURAL WESTERN KENYA, 2008-2011
- 3 – AN UNUSUAL PARTNERSHIP TO ENSURE SAFE DRINKING WATER TO THE RURAL POPULATION IN INDIA
- 4- PRELIMINARY ASSESSMENT OF THE POTENTIAL EFFECTIVENESS OF WATER FILTERS TO REDUCE DIARRHEAL DISEASE BURDEN IN CHILDREN YOUNGER THAN FIVE YEARS OLD IN A PACIFIC ISLAND NATION
- 5 – MOTIVATING CONTINUED USE OF POINT OF USE WATER TREATMENT IN RURAL BANGLADESH
- 6 – THE NEED FOR POINT OF USE WATER TREATMENTS IN AREAS OF PERI-URBAN POVERTY: CASE STUDY OUTSIDE IQUITOS, PERU
- 7 – DENGUE AND DIARRHEAL DISEASE RISK FACTORS IN RURAL AND SUBURBAN VILLAGES IN THAILAND AND LAOS
- 8 – A COMMUNITY RANDOMIZED CONTROLLED TRIAL OF AN INTEGRATED HOME-BASED INTERVENTION IMPROVING HOUSEHOLD-AIR POLLUTION, DRINKING WATER QUALITY AND HYGIENE IN RURAL PERU
- 9 – THE JOINT EFFECTS OF EFFICACY AND COMPLIANCE: A STUDY OF HOUSEHOLD WATER TREATMENT EFFECTIVENESS
- 10 – THE RELATIONSHIP BETWEEN DISTANCE TO HOUSEHOLD WATER SOURCE AND MODERATE-TO-SEVERE DIARRHEA IN YOUNG CHILDREN IN THE GLOBAL ENTERICS MULTI-CENTER STUDY (GEMS), KENYA, 2009-2011
- 11 – RELATIONSHIP BETWEEN USE OF WATER FROM COMMUNITY-SCALE WATER TREATMENT REFILL KIOSKS AND CHILDHOOD DIARRHEA IN JAKARTA
- 12 – OUTBREAK OF MULTI-DRUG RESISTANT SALMONELLA TYPHI, LUSAKA, ZAMBIA, 2011-2012
- 13 – EVIDENCE THAT MULTISECTOR FOOD SECURITY INTERVENTION PROGRAM IN RURAL PANAMA REDUCES HOOKWORM INFECTION IN PRESCHOOL CHILDREN
- 14 – EVALUATION OF HOUSEHOLD LEVEL INTERVENTIONS DURING A LARGE, URBAN TYPHOID FEVER OUTBREAK – HARARE, ZIMBABWE 2011-2012
- 15 – PROGRESS ON MDG 7.C IN THE MILLENNIUM VILLAGES AFTER THREE YEARS: IMPROVED HOUSEHOLD WATER AND SANITATION
- 16 – POST-IMPLEMENTATION EFFECTIVENESS OF FOUR HOUSEHOLD WATER TREATMENT TECHNOLOGIES IN TYPICAL-USE CONDITIONS IN RURAL KENYA
- 17 – EVALUATION OF THE MICROBIOLOGIC SAFETY OF STORED RAINWATER AS AN IMPROVED DRINKING WATER SOURCE FOR COMMUNITIES IN KHON KAEN, THAILAND
- 18 – REDUCTIONS IN DIARRHEA AND CLINIC VISITS FOR DIARRHEA AMONG CHILDREN UNDER THE AGE OF FIVE ASSOCIATED WITH A SCHOOL-BASED WATER SUPPLY, SANITATION AND HYGIENE INTERVENTION IN WESTERN KENYA: A CLUSTER-RANDOMIZED TRIAL
- 19 – PERSISTENT, WIDESPREAD OUTBREAK OF TYPHOID FEVER ASSOCIATED WITH INTESTINAL PERFORATIONS – BUNDIBUGYO AND KASESE DISTRICTS, UGANDA, 2009-2011
- 20 – THE IMPACT OF IMPROVED SCHOOL WATER, SANITATION AND HYGIENE ACCESS ON PUPIL DIARRHEA: A CLUSTERRANDOMIZED TRIAL
- 21 – EVALUATION OF EDUCATION THROUGH LISTENING, A COMMUNITY ENGAGEMENT METHODOLOGY, TO PROMOTE THE ADOPTION OF SAFE HOUSEHOLD WATER TREATMENT BEHAVIORS IN COMMUNITIES IN WESTERN KENYA
Am Jnl Trop Med Hyg, Nov 2012
Evaluating the Sustained Health Impact of Household Chlorination of Drinking Water in Rural Haiti
Eric Harshfield, Daniele Lantagne, Anna Turbes and Clair Null
The Jolivert Safe Water for Families program has sold sodium hypochlorite solution (chlorine) and conducted household visits in rural Haiti since 2002. To assess the impact of the program on diarrheal disease, in 2010 we conducted a survey and water quality testing in 201 program participants and 425 control households selected at random.
Fifty-six percent of participants (versus 10% of controls) had free chlorine residuals between 0.2 and 2.0 mg/L, indicating correct water treatment. Using intention-to-treat analysis, we found that significantly fewer children < 5 in participant households had an episode of diarrhea in the previous 48 hours (32% versus 52%; P < 0.001) with 59% reduced odds (odds ratio = 0.41, 95% confidence interval = 0.21–0.79).
Treatment-on-treated estimates of the odds of diarrhea indicated larger program effects for participants who met more stringent verifications of participation. Diarrheal disease reduction in this long-term program was comparable with that seen in short-term randomized, controlled interventions, suggesting that household chlorination can be an effective long-term water treatment strategy.
PLoS ONE, Oct 2012.
Assessing Water Filtration and Safe Storage in Households with Young Children of HIV-Positive Mothers: A Randomized, Controlled Trial in Zambia
Rachel Peletz, et al.
Background: Unsafe drinking water presents a particular threat to people living with HIV/AIDS (PLHIV) due to the increased risk of opportunistic infections, diarrhea-associated malabsorption of essential nutrients, and increased exposure to untreated water for children of HIV-positive mothers who use replacement feeding to reduce the risk of HIV transmission. This population may particularly benefit from an intervention to improve water quality in the home.
Methods and Findings: We conducted a 12-month randomized, controlled field trial in Zambia among 120 households with children ,2 years (100 with HIV-positive mothers and 20 with HIV-negative mothers to reduce stigma of participation) to assess a high-performance water filter and jerry cans for safe storage. Households were followed up monthly to assess use, drinking water quality (thermotolerant coliforms (TTC), an indicator of fecal contamination) and reported diarrhea (7-day recall) among children ,2 years and all members of the household. Because previous attempts to blind the filter have been unsuccessful, we also assessed weight-for-age Z-scores (WAZ) as an objective measure of diarrhea impact. Filter use was high, with 96% (596/620) of household visits meeting the criteria for users. The quality of water stored in intervention
households was significantly better than in control households (3 vs. 181 TTC/100 mL, respectively, p,0.001). The intervention was associated with reductions in the longitudinal prevalence of reported diarrhea of 53% among children ,2 years (LPR = 0.47, 95% CI: 0.30–0.73, p = 0.001) and 54% among all household members (LPR = 0.46, 95% CI: 0.30–0.70, p,0.001). While reduced WAZ was associated with reported diarrhea (20.26; 95% CI: 20.37 to 20.14, p,0.001), there was no difference in WAZ between intervention and control groups.
Conclusion: In this population living with HIV/AIDS, a water filter combined with safe storage was used correctly and consistently, was highly effective in improving drinking water quality, and was protective against diarrhea.
Hydrol. Earth Syst. Sci., 16, 3791–3816, 2012
Analysing inter-relationships among water, governance, human development variables in developing countries
C. Dondeynaz, et al.
The “Integrated Water Resources Management” principle was formally laid down at the International Conference on Water and Sustainable development in Dublin 1992. One of the main results of this conference is that improving Water and Sanitation Services (WSS), being a complex and interdisciplinary issue, passes through collaboration and coordination of different sectors (environment, health, economic activities, governance, and international cooperation). These sectors influence or are influenced by the access to WSS. The understanding of these interrelations appears as crucial for decision makers in the water sector. In this framework, the Joint Research Centre (JRC) of the European Commission (EC) has developed a new database (WatSan4Dev database) containing 42 indicators (called variables in this paper) from environmental, socio-economic, governance and financial aid flows data in developing countries.
This paper describes the development of the WatSan4Dev dataset, the statistical processes needed to improve the data quality, and finally, the analysis to verify the database coherence is presented. Based on 25 relevant variables, the relationships between variables are described and organised into five factors (HDP – Human Development against Poverty, AP – Human Activity Pressure on water resources, WR – Water Resources, ODA – Official Development Aid, CEC – Country Environmental Concern). Linear regression methods are used to identify key variables having influence on water supply and sanitation. First analysis indicates that the informal urbanisation development is an important factor negatively influencing the percentage of the population having access to WSS. Health, and in particular children’s health, benefits from the improvement of WSS.
Irrigation is also enhancing Water Supply service thanks to multi-purpose infrastructure. Five country profiles are also created to deeper understand and synthetize the amount of information gathered. This new classification of countries is useful in identifying countries with a less advanced position and weaknesses to be tackled. The relevance of indicators gathered to represent environmental and water resources state is questioned in the discussion section. The paper concludes with the necessity to increase the reliability of current indicators and calls for further research on specific indicators, in particular on water quality at national scale, in order to better include environmental state in analysis to WSS.
A toolkit for monitoring and evaluating household water treatment and safe storage programmes, 2012.
WHO; UNICEF.
Integrated planning, combined with effective M&E, is critical to achieving programme aims. M&E of HWTS include 1) process monitoring to assess programme implementation and 2) quantitative analysis through surveys, direct observation and water quality monitoring. As part of this document, a set of 20 indicators is recommended (see table \s-1).
These indicators build upon previous efforts among HWTS stakeholders and are grouped according to the following themes:
- reported and observed use; correct,
- consistent use and storage;
- knowledge and behaviour;
- other environmental health interventions;
- and water quality
Int. J. Environ. Res. Public Health, Oct 2012
Evaluation of the Impact of the Plastic BioSand Filter on Health and Drinking Water Quality in Rural Tamale, Ghana
Christine E. Stauber, et al.
A randomized controlled trial of the plastic BioSand filter (BSF) was performed in rural communities in Tamale (Ghana) to assess reductions in diarrheal disease and improvements in household drinking water quality. Few studies of household water filters have been performed in this region, where high drinking water turbidity can be a challenge for other household water treatment technologies.
During the study, the longitudinal prevalence ratio for diarrhea comparing households that received the plastic BSF to households that did not receive it was 0.40 (95% confidence interval: 0.05, 0.80), suggesting an overall diarrheal disease reduction of 60%.
The plastic BSF achieved a geometric mean reduction of 97% and 67% for E. coli and turbidity, respectively. These results suggest the plastic BSF significantly improved drinking water quality and reduced diarrheal disease during the short trial in rural Tamale, Ghana. The results are similar to other trials of household drinking water treatment technologies.
