Bibliography of 2012 HWTS studies by Robert Quick

July 25, 2012 · 0 comments

This is an annotated bibliography of 2012 HWTS studies authored or co-authored by Robert Quick so far in 2012. Ths bibliography will be updated on a periodic basis.

1 – Soc Sci Med. 2012 Aug;75(4):622-33.

Systematic review of behavior change research on point-of-use water treatment interventions in countries categorized as low- to medium-development on the human development index.

Parker Fiebelkorn A, Person B, Quick RE, Vindigni SM, Jhung M, Bowen A, Riley PL.

Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS A-34, Atlanta, GA 30333, USA.

Point-of-use water treatment (i.e., water purification at the point of consumption) has proven effective in preventing diarrhea in developing countries. However, widespread adoption has not occurred, suggesting that implementation strategies have not motivated sustained behavior change. We conducted a systematic literature review of published behavioral research on factors influencing adoption of point-of-use water treatment in countries categorized as low- to medium-development on the United Nations Development Programme Human Development Index.

We used 22 key words to search peer-reviewed literature from 1950 to 2010 from OVID Medline, CINAHL, and PsycINFO. Twenty-six (1.7%) of 1551 papers met our four inclusion criteria: 1) implemented a point-of-use water treatment intervention, 2) applied a behavioral intervention, 3) evaluated behavior change as the outcome, and 4) occurred in a low- or medium-development country. We reviewed these 26 publications for detailed descriptions of the water treatment intervention, theoretical rationales for the behavioral intervention, and descriptions of the evaluation.

In 5 (19%) papers, details of the behavioral intervention were fully specified. Seven (27%) papers reported using a behavioral theory in the design of the intervention and evaluation of its impact. Ten (38%) studies used a comparison or control group; 5 provided detailed descriptions. Seven (27%) papers reported high sustained use of point-of-use water treatment with rates >50% at the last recorded follow-up.

Despite documented health benefits of point-of-use water treatment interventions in reducing diarrheal diseases, we found limited peer-reviewed behavioral research on the topic. In addition, we found the existing literature often lacked detailed descriptions of the intervention for replication, seldom described the theoretical and empirical rationale for the implementation and evaluation of the intervention, and often had limitations in the evaluation methodology. The scarcity of papers on behavior change with respect to point-of-use water treatment technologies suggests that this field is underdeveloped.

2 – Am J Trop Med Hyg. 2012 May;86(5):860-5.

Water treatment and handwashing behaviors among non-pregnant friends and relatives of participants in an antenatal hygiene promotion program in Malawi.

Russo ET, Sheth A, Menon M, Wannemuehler K, Weinger M, Kudzala AC, Tauzie B, Masuku HD, Msowoya TE, Quick R.

Access to safe drinking water and improved hygiene are essential for preventing diarrheal diseases. To integrate hygiene improvement with antenatal care, free hygiene kits (water storage containers, water treatment solution, soap) and educational messages were distributed to pregnant women at antenatal clinics in Malawi. We assessed water treatment and hygiene practices of 275 non-pregnant friends and relatives of the hygiene kit recipients at baseline and follow-up nine months later to measure program impact on non-participants in the same communities. At follow-up, friends and relatives who did not receive kits or education were more likely than at baseline to purchase and use water treatment solution (25% versus 1%; P < 0.0001) and demonstrate correct handwashing practices (60% versus 18%; P < 0.0001). This antenatal clinic-based program resulted in improved water treatment and hygiene behaviors among non-pregnant friends and relatives living in the same communities as hygiene kit recipients, suggesting that program benefits extended beyond direct beneficiaries.

3 – J Infect Dis. 2012 Mar;205 Suppl 1:S56-64.

Impact of integration of hygiene kit distribution with routine immunizations on infant vaccine coverage and water treatment and handwashing practices of Kenyan mothers.

Briere EC, Ryman TK, Cartwright E, Russo ET, Wannemuehler KA, Nygren BL, Kola S, Sadumah I, Ochieng C, Watkins ML, Quick R.

Integration of immunizations with hygiene interventions may improve use of both interventions. We interviewed 1361 intervention and 1139 comparison caregivers about hygiene practices and vaccination history, distributed water treatment and hygiene kits to caregivers during infant vaccination sessions in intervention clinics for 12 months, and conducted a followup survey of 2361 intervention and 1033 comparison caregivers. We observed significant increases in reported household water treatment (30% vs 44%, P < .0001) and correct handwashing technique (25% vs 51%, P < .0001) in intervention households and no changes in comparison households. Immunization coverage improved in both intervention and comparison infants (57% vs 66%, P = .04; 37% vs 53%, P < .0001, respectively). Hygiene kit distribution during routine immunizations positively impacted household water treatment and hygiene without a negative impact on vaccination coverage. Further study is needed to assess hygiene incentives, implement alternative water quality indicators, and evaluate the impact of this intervention in other settings.

Bibliography of 2012 HWTS studies by Thomas Clasen

July 25, 2012 · 0 comments

Below is an annotated bibliography of 2012 HWTS studies authored or co-authored by Thomas Clasen so far in 2012. This bibliography will be updated on a periodic basis.

1. Environ Sci Technol. 2012 May 1;46(9):5160-7.

Linking quantitative microbial risk assessment and epidemiological data: informing safe drinking water trials in developing countries.

Enger KS, Nelson KL, Clasen T, Rose JB, Eisenberg JN.

Department of Fisheries and Wildlife, 13 Natural Resources Building, Michigan State University, East Lansing, Michigan 48824, USA.

Intervention trials are used extensively to assess household water treatment (HWT) device efficacy against diarrheal disease in developing countries. Using these data for policy, however, requires addressing issues of generalizability (relevance of one trial in other contexts) and systematic bias associated with design and conduct of a study. To illustrate how quantitative microbial risk assessment (QMRA) can address water safety and health issues, we analyzed a published randomized controlled trial (RCT) of the LifeStraw Family Filter in the Congo. The model accounted for bias due to (1) incomplete compliance with filtration, (2) unexpected antimicrobial activity by the placebo device, and (3) incomplete recall of diarrheal disease. Effectiveness was measured using the longitudinal prevalence ratio (LPR) of reported diarrhea. The Congo RCT observed an LPR of 0.84 (95% CI: 0.61, 1.14). Our model predicted LPRs, assuming a perfect placebo, ranging from 0.50 (2.5-97.5 percentile: 0.33, 0.77) to 0.86 (2.5-97.5 percentile: 0.68, 1.09) for high (but not perfect) and low (but not zero) compliance, respectively. The calibration step provided estimates of the concentrations of three pathogen types (modeled as diarrheagenic E. coli, Giardia, and rotavirus) in drinking water, consistent with the longitudinal prevalence of reported diarrhea measured in the trial, and constrained by epidemiological data from the trial. Use of a QMRA model demonstrated the importance of compliance in HWT efficacy, the need for pathogen data from source waters, the effect of quantifying biases associated with epidemiological data, and the usefulness of generalizing the effectiveness of HWT trials to other contexts.

2. PLoS One. 2012;7(5):e36735.

High adherence is necessary to realize health gains from water quality interventions.

Brown J, Clasen T.

Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. joe.brown@lshtm.ac.uk

BACKGROUND: Safe drinking water is critical for health. Household water treatment (HWT) has been recommended for improving access to potable water where existing sources are unsafe. Reports of low adherence to HWT may limit the usefulness of this approach, however.

METHODS AND FINDINGS: We constructed a quantitative microbial risk model to predict gains in health attributable to water quality interventions based on a range of assumptions about pre-treatment water quality; treatment effectiveness in reducing bacteria, viruses, and protozoan parasites; adherence to treatment interventions; volume of water consumed per person per day; and other variables. According to mean estimates, greater than 500 DALYs may be averted per 100,000 person-years with increased access to safe water, assuming moderately poor pre-treatment water quality that is a source of risk and high treatment adherence (>90% of water consumed is treated). A decline in adherence from 100% to 90% reduces predicted health gains by up to 96%, with sharpest declines when pre-treatment water quality is of higher risk.

CONCLUSIONS: Results suggest that high adherence is essential in order to realize potential health gains from HWT.

3. PLoS One. 2012;7(2):e31316.

Integrated HIV testing, malaria, and diarrhea prevention campaign in Kenya: modeled health impact and cost-effectiveness.

Kahn JG, Muraguri N, Harris B, Lugada E, Clasen T, Grabowsky M, Mermin J, Shariff
S.

Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, California, United States of America. jgkahn@ucsf.edu

BACKGROUND: Efficiently delivered interventions to reduce HIV, malaria, and diarrhea are essential to accelerating global health efforts. A 2008 community integrated prevention campaign in Western Province, Kenya, reached 47,000 individuals over 7 days, providing HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals cotrimoxazole prophylaxis and referral for ongoing care. We modeled the potential cost-effectiveness of a scaled-up integrated prevention campaign.

METHODS: We estimated averted deaths and disability-adjusted life years (DALYs) based on published data on baseline mortality and morbidity and on the protective effect of interventions, including antiretroviral therapy. We incorporate a previously estimated scaled-up campaign cost. We used published costs of medical care to estimate savings from averted illness (for all three diseases) and the added costs of initiating treatment earlier in the course of HIV disease.

RESULTS: Per 1000 participants, projected reductions in cases of diarrhea, malaria, and HIV infection avert an estimated 16.3 deaths, 359 DALYs and $85,113 in medical care costs. Earlier care for HIV-infected persons adds an estimated 82 DALYs averted (to a total of 442), at a cost of $37,097 (reducing total averted costs to $48,015). Accounting for the estimated campaign cost of $32,000, the campaign saves an estimated $16,015 per 1000 participants. In multivariate sensitivity analyses, 83% of simulations result in net savings, and 93% in a cost per DALY averted of less than $20.

DISCUSSION: A mass, rapidly implemented campaign for HIV testing, safe water, and malaria control appears economically attractive.

WASHplus Weekly: Focus on HIV/AIDS and WASH

July 20, 2012 · 0 comments

Issue 63 July 20, 2012 | Focus on HIV/AIDS and WASH

This issue contains resources on 2012 HIV/AIDS and WASH events, reports and country studies and updates the July 2011 WASHplus Weekly issue. Resources in this issue include links to the upcoming international AIDS conference, training manuals by the USAID AIDSTAR-One project, a WaterAid lessons learned report and country studies from Equatorial Guinea, Kenya, South Africa and Zimbabwe.

Impact of a School-Based Hygiene Promotion and Sanitation Intervention on Pupil Hand Contamination

July 18, 2012 · 0 comments

Am J Trop Med Hyg. 2012 Jul 16.

Impact of a School-Based Hygiene Promotion and Sanitation Intervention on Pupil Hand Contamination in Western Kenya: A Cluster Randomized Trial.

Greene LE, Freeman MC, Akoko D, Saboori S, Moe C, Rheingans R.

Center for Global Safe Water, Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Tropical Institute of Community Health and Development, Great Lakes University of Kisumu, Kenya; Center for Global Safe Water, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Global and Environmental Health, University of Florida, Gainesville, Florida.

Abstract – Handwashing with soap effectively reduces exposure to diarrhea-causing pathogens. Interventions to improve hygiene and sanitation conditions in schools within low-income countries have gained increased attention; however, their impact on schoolchildren’s exposure to fecal pathogens has not been established.

Our trial examined whether a school-based water, sanitation, and hygiene intervention reduced Escherichia coli contamination on pupils’ hands in western Kenya. A hygiene promotion and water treatment intervention did not reduce risk of E. coli presence (relative risk [RR] = 0.92, 95% confidence interval [CI] = 0.54-1.56); the addition of new latrines to intervention schools significantly increased risk among girls (RR = 2.63, 95% CI = 1.29-5.34), with a non-significant increase among boys (RR = 1.36, 95% CI = 0.74-2.49).

Efforts to increase usage of school latrines by constructing new facilities may pose a risk to children in the absence of sufficient hygiene behavior change, daily provision of soap and water, and anal cleansing materials.

Benefits of Water Safety Plans: Microbiology, Compliance, and Public Health

July 17, 2012 · 0 comments

Environ Sci Technol. 2012 Jun 27.

Benefits of Water Safety Plans: Microbiology, Compliance, and Public Health.

Gunnarsdottir MJ, Gardarsson SM, Elliott M, Sigmundsdottir G, Bartram J.

Faculty of Civil and Environmental Engineering, University of Iceland , Hjardarhaga 2-6, 107 Reykjavik, Iceland.

The Water Safety Plan (WSP) methodology, which aims to enhance safety of drinking water supplies, has been recommended by the World Health Organization since 2004. WSPs are now used worldwide and are legally required in several countries. However, there is limited systematic evidence available demonstrating the effectiveness of WSPs on water quality and health. Iceland was one of the first countries to legislate the use of WSPs, enabling the analysis of more than a decade of data on impact of WSP.

The objective was to determine the impact of WSP implementation on regulatory compliance, microbiological water quality, and incidence of clinical cases of diarrhea. Surveillance data on water quality and diarrhea were collected and analyzed. The results show that HPC (heterotrophic plate counts), representing microbiological growth in the water supply system, decreased statistically significant with fewer incidents of HPC exceeding 10 cfu per mL in samples following WSP implementation and noncompliance was also significantly reduced (p < 0.001 in both cases).

A significant decrease in incidence of diarrhea was detected where a WSP was implemented, and, furthermore, the results indicate that population where WSP has been implemented is 14% less likely to develop clinical cases of diarrhea.

An evaluation of an operations research project to reduce childhood stunting

July 17, 2012 · 0 comments

Public Health Nutr. 2012 Apr 17:1-9.

An evaluation of an operations research project to reduce childhood stunting in a food-insecure area in Ethiopia.

Fenn B, Bulti AT, Nduna T, Duffield A, Watson F. Le Rocher, 61210 La Foret Auvray, France.

OBJECTIVE: To determine which interventions can reduce linear growth retardation (stunting) in children aged 6-36 months over a 5-year period in a food-insecure population in Ethiopia.

DESIGN: We used data collected through an operations research project run by Save the Children UK: the Child Caring Practices (CCP) project. Eleven neighbouring villages were purposefully selected to receive one of four interventions: (i) health; (iii) nutrition education; (iii) water, sanitation and hygiene (WASH); or (iv) integrated comprising all interventions. A comparison group of three villages did not receive any interventions. Cross-sectional surveys were conducted at baseline (2004) and for impact evaluation (2009) using the same quantitative and qualitative tools. The primary outcome was stunted growth in children aged 6-36 months measured as height (or length)-for-age Z-scores (mean and prevalence). Secondary outcomes were knowledge of health seeking, infant and young child feeding and preventive practices.

SETTING: Amhara, Ethiopia. SUBJECTS: Children aged 6-36 months.

RESULTS: The WASH intervention group was the only group to show a significant increase in mean height-for-age Z-score (+0·33, P = 0·02), with a 12·1 % decrease in the prevalence of stunting, compared with the baseline group. This group also showed significant improvements in mothers’ knowledge of causes of diarrhoea and hygiene practices. The other intervention groups saw non-significant impacts for childhood stunting but improvements in knowledge relating to specific intervention education messages given.

CONCLUSIONS: The study suggests that an improvement in hygiene practices had a significant impact on stunting levels. However, there may be alternative explanations for this and further evidence is required.

Comparison of treated laterite as arsenic adsorbent from different locations and performance of best filter under field conditions

July 13, 2012 · 0 comments

J Hazard Mater. 2012 Jun 23.

Comparison of treated laterite as arsenic adsorbent from different locations and performance of best filter under field conditions.

Maiti A, Thakur BK, Basu JK, De S. Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 2G8, Canada.

Arsenic pollution in groundwater is a worldwide concern due to its chronic effects on human health. Numerous studies have been carried out to obtain cost-effective arsenic removal method. Adsorption using natural materials or its treated forms is found to be cost-effective technology. Raw laterite (RL) or its treated form (TL) is studied recently as arsenic adsorbent for aqueous system. Laterite composition varies with geographical location and extent of lateritization.

The study on effects of arsenic adsorption with varying composition of laterite is not explored yet. Four laterite samples with different compositions are examined to remove arsenic from water. These laterite samples are activated using an optimized acid followed by base treatment method in order to determine the effects of RL composition on arsenic adsorption behavior of TL. Higher iron and aluminum containing RL samples show higher arsenic adsorption behavior.

Similarly, TL obtained from higher iron and aluminum containing RL sample shows the higher specific surface area (130-180m(2)g(-1)) and pore volume (0.28-0.35mLg(-1)). Two household filters using TL are deployed in arsenic affected area of Barasat, 24 Parganas (N), West Bengal, India and their performance is monitored for about a year.

WaterSHED laboratory presents water filter study results

July 13, 2012 · 0 comments

Source: WaterSHED, July 5, 2012 – WaterSHED laboratory presents water filter study results to Water & Sanitation (WatSan) sector group

On 03 July 2012, WaterSHED’s Lab Supervisor, Chai Ratana, presented findings from an evaluation of microbiological effectiveness of Mineral Pot Filters (MPFs) during a monthly Water & Sanitation sector meeting at the Cambodian Ministry of Rural Development.

MPFs are widely used in Cambodia, yet until recently their performance and effectiveness had never been systematically and scientifically tested.

Guided by Dr. Joe Brown (London School of Hygiene and Tropical Medicine), Mr. Ratana and his team sampled three popular brands of MPFs available in the local market to test their effectiveness in purifying drinking water using the World Health Organization’s (WHO) Environmental Technology Verification testing protocols.

The purposes of the evaluation were to test MPFs’ ability to remove microbes from water over long-term use, to serve as an initial assessment of their current and future potential role as water treatment devices, and to demonstrate and pilot the capacity of WaterSHED’s laboratory for microbiological testing according to the new WHO testing recommendations. The MPFs were tested for their effectiveness against microbiological elements; however, they were not tested for chemicals or the toxicity of mineral stone elements.

The results showed that the three filter brands were as effective or more effective than other locally available drinking water treatment options, including ceramic filters. However, although the three MPFs were shown to consistently provide microbiologically safer water, only one filter met WHO recommended performance levels for “protective” levels, but not across all potential water sources.

WaterSHED-Cambodia is currently an active contributor/member of the WatSan Sector Group of Cambodia, a network led by the Ministry of Rural Development, that holds monthly meetings to bring together all organizations working on water and/or sanitation to share and discuss experiences and lessons learned in the sector.

Determining behavioral factors for interventions to increase safe water consumption

July 12, 2012 · 0 comments

Int J Environ Health Res. 2012 Jul 10.

Determining behavioral factors for interventions to increase safe water consumption: a cross-sectional field study in rural Ethiopia.

Huber AC, Mosler HJ. Eawag: Swiss Federal Institute of Aquatic Science and Technology , Ueberlandstrasse 133, P.O. Box 611 , Duebendorf , 8600 , Switzerland.

In developing countries, the lack of safe water options leads to many health risks. In the Ethiopian Rift Valley, most water sources are contaminated with an excess of fluoride. The consumption of fluoride-contaminated water leads to dental and skeletal fluorosis.

The article presents an approach to designing community interventions based on evidence from quantitative data. After installing a community filter, a baseline study was conducted in 211 households to survey the acceptance and usage of the filter.

To identify important psychological factors that lead to health behavior change, the Risk, Attitude, Norm, Ability, Self-regulation (RANAS) model was taken into account. Descriptive statistics were calculated for behavioral determinants, and their influence on consumption was analyzed with a linear regression.

For every behavioral factor, an intervention potential (IP) was calculated. It was found that perceived distance, factual knowledge, commitment, and taste strongly influenced participants’ consumption behavior and therefore should be tackled for interventions.

Arsenic removal for ceramic water filters

July 10, 2012 · 1 comment

Journal of Humanitarian Engineering, Volume 1, Issue 1 – May 2012

Arsenic removal for ceramic water filters, 2012.

Mishant Kumar, Faculty of Engineering, University of Technology, Sydney, Australia
Mishant.S.Kumar@gmail.com

Arsenic in drinking water is a hazard to human health and is a known carcinogen (Mass 1992). Resource Development International – Cambodia (RDIC) has researched, developed, and manufactured simple ceramic water filtgers (CWF) which have proved to be extremely effective in removing pathogens from water. These filtershowever, do not remove arsenic from water, which exists in the source water at levels above the World Health Organisation (WHO) guideline of 10μg/L.

The aims of this literature based study were to investigate conventional and non-conventional arsenic removal processes, and to discuss the options for applying an arsenic removal technology to the CWFs produced by RDIC. It was found that conventional arsenic removal technologies are difficult to implement in the context of household water treatment in a developing country. This study suggested that non-conventional arsenic removal technologies shall be more effective and that field studies must be undertaken to verify the success of such methods.

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