Consumer preferences for household water treatment products in Andhra Pradesh, India

May 17, 2012 · 0 comments

Social Science & Medicine, May 9, 2012

Consumer preferences for household water treatment products in Andhra Pradesh, India

Christine Poulos, et al.

Over 5 billion people worldwide are exposed to unsafe water. Given the obstacles to ensuring sustainable improvements in water supply infrastructure and the unhygienic handling of water after collection, household water treatment and storage (HWTS) products have been viewed as important mechanisms for increasing access to safe water. Although studies have shown that HWTS technologies can reduce the likelihood of diarrheal illness by about 30%, levels of adoption and continued use remain low. An understanding of household preferences for HWTS products can be used to create demand through effective product positioning and social marketing, and ultimately improve and ensure commercial sustainability and scalability of these products. However, there has been little systematic research on consumer preferences for HWTS products.

This paper reports the results of the first state-of-the-art conjoint analysis study of HWTS products. In 2008, we conducted a conjoint analysis survey of a representative sample of households in Andhra Pradesh (AP), India to elicit and quantify household preferences for commercial HWTS products. Controlling for attribute non-attendance in an error components mixed logit model, the study results indicate that the most important features to respondents, in terms of the effect on utility, were the type of product, followed by the extent to which the product removes pathogens, the retail outlet and, the time required to treat 10 liters. Holding all other product attributes constant, filters were preferred to combination products and chemical additives. Department stores and weekly markets were the most favorable sales outlets, followed by mobile salespeople. In general, households do not prefer to purchase HWTS products at local shops.

Our results can inform the types of products and sales outlets that are likely to be successful in commercial HWTS markets in AP, as well as the influence of different pricing and financing strategies on product demand and uptake.

A Summary Catalogue of Microbial Drinking Water Tests for Low and Medium Resource Settings

May 16, 2012 · 0 comments

Int. J. Environ. Res. Public Health, May 2012, 9(5), 1609-1625; doi:10.3390/ijerph9051609

A Summary Catalogue of Microbial Drinking Water Tests for Low and Medium Resource Settings

Robert Bain1 , Jamie Bartram2 , Mark Elliott2 , Robert Matthews1 , Lanakila McMahan3 , Rosalind Tung1 , Patty Chuang2 and Stephen Gundry1,*

1 Water and Health Research Centre/Merchant Venturers Building, University of Bristol, BS8 1UB, UK
2 The Water Institute at UNC/University of North Carolina, Chapel Hill, North Carolina, 27599, USA
3 Department of Environmental and Occupational Health, Florida International University, Miami, Florida, 33199,
* Author to whom correspondence should be addressed.
Received: 29 February 2012; in revised form: 17 April 2012 / Accepted: 17 April 2012 / Published: 4 May 2012
(This article belongs to the Special Issue Drinking Water and Health)

Microbial drinking-water quality testing plays an essential role in measures to protect public health. However, such testing remains a significant challenge where resources are limited. With a wide variety of tests available, researchers and practitioners have expressed difficulties in selecting the most appropriate test(s) for a particular budget, application and setting.

To assist the selection process we identified the characteristics associated with low and medium resource settings and we specified the basic information that is needed for different forms of water quality monitoring. We then searched for available faecal indicator bacteria tests and collated this information. In total 44 tests have been identified, 18 of which yield a presence/absence result and 26 of which provide enumeration of bacterial concentration.

The suitability of each test is assessed for use in the three settings. The cost per test was found to vary from $0.60 to $5.00 for a presence/absence test and from $0.50 to $7.50 for a quantitative format, though it is likely to be only a small component of the overall costs of testing.

This article presents the first comprehensive catalogue of the characteristics of available and emerging low-cost tests for faecal indicator bacteria. It will be of value to organizations responsible for monitoring national water quality, water service providers, researchers and policy makers in selecting water quality tests appropriate for a given setting and application.

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

May 16, 2012 · 0 comments

Public Health Nutrition, March 2012

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

Bridget Fenn1,*, Assaye T Bulti2, Themba Nduna2, Arabella Duffield2 and Fiona Watson3
1Le Rocher, 61210 La Foret Auvray, France: 2Save the Children, Addis Ababa, Ethiopia: 3Save the Children, London, UK

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 (10?33, P50?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.

Barriers to accessing water, sanitation and hygiene among people living with HIV/AIDS in Gomba and Mpigi districts in Uganda

May 15, 2012 · 0 comments

JOURNAL OF PUBLIC HEALTH, 2012, DOI: 10.1007/s10389-012-0515-x

Barriers to accessing water, sanitation and hygiene among people living with HIV/AIDS in Gomba and Mpigi districts in Uganda: a qualitative study

Richard Kibirango Mugambe, Nazarius Mbona Tumwesigye and Fiona Larkan

Aim -To explore the challenges that people living with HIV/AIDS (PLWHA) experience in accessing water, sanitation and hygiene (WASH) so as to inform policy and promote pro-HIV/AIDS WASH programs as well as equity in WASH investments.

Methods – This was a descriptive study that utilized qualitative methods for data collection. The study population comprised of PLWHA as well as environmental health officers, water officers, medical doctors and HIV/AIDS care providers in Mpigi and Gomba districts, Uganda. Six focus group discussions (FGDs) with PLWHA (three for men and three for women) and twelve key informants (KIs) interviews were conducted. A moderator and a note taker facilitated the FGDs, which were tape recorded with consent from participants. Qualitative content analysis was done.

Results – The KIs interviews and FGDs revealed that PLWHA in the study districts were facing serious challenges in accessing and utilizing WASH services. It was realized that the safe water coverage in the study area was low and PLWHA had limited access to improved water sources. Additionally, they experienced social prejudices that left them in a position where they felt like they were not good enough, inferior and isolated. Such feelings were affecting access to and utilization of WASH services for some PLWHA. Many PLWHA reported that the cost of water per 20-L jerrican (0.04 USD at some improved sources and 0.4–0.6 USD from water vendors) was high and unimproved sources such as ponds and dams were the alternative. They also had a bad attitude towards Water Guard noting that it causes a bad taste in water and does not reduce the turbidity.

Conclusion – PLWHA face financial, attitudinal, knowledge, social, physical as well as institutional and sustainability barriers to accessing and utilizing WASH services. There is, therefore, a need to design and implement appropriate WASH sensitization programs for PLWHA. Water treatment using disinfectants that do not alter taste and can reduce turbidity of water should be promoted and such disinfectants should be made available in health facilities for PLWHA to get either for free or at subsidized prices.

Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage

May 10, 2012 · 0 comments

Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage, 2012.

Guy Hutton. World Health Organization

The present study aimed to estimate global, regional and country-level costs and benefits of drinking-water supply and sanitation interventions to meet the MDG target in 2015, and to attain universal coverage. These economic data will provide further evidence to support investment in water supply and sanitation systems and services, with a focus on services that are both socially efficient and financially sustainable. The results will help donors and governments of low- and middle-income countries to justify allocation of adequate budgets for such systems and services.

This report updates previous economic analyses conducted by the World Health Organization, using new WSS coverage rates, costs of services, income levels and health indicators. Benefit-cost ratios (BCR) and costs are estimated to meet the MDG drinking water and sanitation target and to attain universal access of basic services.

A large range of economic and social benefits can result from improved WSS services. Reductions in cases and deaths associated with diarrhoeal disease and in indirect adverse health impacts (e.g. through malnutrition), as well as time benefits resulting from the proximity of improved WSS services are expected to account for a large share of total benefits. Economic benefits related to savings from the health improvements of upgraded
WSS services relate to seeking less health care, to reduced losses of productive time due to disease and to a reduction in premature mortality.

The total global economic losses associated with inadequate water supply and sanitation were estimated at US$ 260 billion annually, or 1.5% of Gross Domestic Product of the countries included in this study. The total economic benefits of meeting the MDG target amount to US$ 60 billion annually. The benefits are dominated by sanitation, accounting for US$ 54 billion. The three regions where benefits are greatest are S Asia, E Asia and SSA. Attaining universal sanitation will more than triple the benefits compared with current coverage, to US$ 220 billion annually. Other regions contributing importantly to global benefits for universal access are LAC, SE Asia and W Asia.

The main contributor to overall benefits of sanitation is the value of time savings which accounts for more than 70% of total benefits in all regions, and is as high as 80% to 90% of total benefits in most regions. In SSA and S Asia an important contribution comes from health benefits, especially the value of saved lives. Health care savings – which tend to be financial in nature – vary across regions between 5% and 13% of total benefits. In terms of overall value, the global picture on sanitation benefits is dominated by E Asia and S Asia, with over US$ 30 billion combined benefits. SSA contributes an important saving with US$ 10 billion annually.

Sustaining school hand washing and water treatment programmes: Lessons learned and to be learned

May 9, 2012 · 0 comments

Waterlines, 30(4), 2011. 298-311.

Sustaining school hand washing and water treatment programmes: Lessons learned and to be learned.

Saboori, S., Mwaki, A., Porter, S.E., Okech, B., Freeman, M.C., Rheingans, R.D.

This study identifies six enabling environment domains: financial capacity; accountability; technical feasibility and availability; community support; school leadership and management; and student engagement. While these domains pertain to the sustaining of the Safe Water System activities in schools, they are likely to be applicable in creating an enabling environment and serve as proxy indicators for other school water, sanitation, and hygiene initiatives as well.

Is soapy water a viable solution for handwashing in schools?

May 9, 2012 · 0 comments

Waterlines, Volume 29, Number 4, October 2010 , pp. 329-336(8)

Is soapy water a viable solution for handwashing in schools?

Authors: Saboori, Shadi; Mwaki, Alex; Rheingans, Richard D.

Despite the known health benefits of washing hands with soap, global handwashing rates are low. In Nyanza Province, Kenya, a follow-up of 55 pilot primary schools three years after the implementation of a safe water and hygiene intervention revealed that only 2 per cent (one school) provided soap for handwashing on the day of the assessment. After identifying barriers to soap provision, SWASH+ partners piloted a handwashing intervention using powdered soap mixed with water to create soapy water in place of bar soap in 11 schools. The first six months of unannounced visits showed high uptake (10 schools). A one-year follow-up visit revealed a decrease of soapy water use (four schools). This paper discusses the soapy water intervention, initial and follow-up monitoring findings, potential sustainability drivers of handwashing programmes in rural primary schools and next steps.

mWASH – Mobile phone applications for the WASH sector

May 9, 2012 · 0 comments

mWASH – Mobile phone applications for the water, sanitation and hygiene sector, 2012.

Misha T. Hutchings, Anurupa Dev, Meena Palaniappan, Veena Srinivasan, Nithya Ramanathan, and John Taylor.
Pacific Institute.

The spread of mobile phones has greatly reduced the time and cost of communication between multiple, often remote areas. Mobile phones are increasingly being used as cost-effective tools for collecting data anddisseminating information. In the past decade, water and sanitation practitioners have begun deploying mobile phones as tools to improve water, sanitation, and hygiene (WASH) services. In studying the deployments of mobile phone for WASH, or mWASH, applications, this paper seeks to identify best practices and help inform future mWASH implementation for current and potential implementers of mobile phone solutions in the WASH sector.

Collecting, aggregating, and analyzing data from remote regions and making the data available in a transparent way can help identify where investments are most urgently needed and can improve the long-term project monitoring. It can also contribute to better water resources planning. Information and communications technologies (ICTs) have the potential to address these information gaps in the WASH sector by transforming the way data is generated, communicated, and shared. Mobile phones are already being used as tools for data collection and dissemination across multiple sectors, such as health, socio-economic development, agriculture, natural resource management, and disaster relief.

Learning to Dislike Safe Water Products: Results from a Randomized Controlled Trial

May 8, 2012 · 0 comments

Environ. Sci. Technol., DOI: 10.1021/es2027967, Publication Date (Web): May 7, 2012

Learning to Dislike Safe Water Products: Results from a Randomized Controlled Trial of the Effects of Direct and Peer Experience on Willingness to Pay

Jill Luoto, Minhaj Mahmud, Jeff Albert, Stephen Luby, Nusrat Najnin, Leanne Unicomb, and David I Levine

Low-cost point-of-use (POU) safe water products have the potential to reduce waterborne illness, but adoption by the global poor remains low. We performed an eight-month randomized trial of four low-cost household water treatment products in Dhaka, Bangladesh.

Intervention households (n=600) received repeated educational messages about the importance of drinking safe water along with consecutive two-month free trials with each of four POU products in random order. Households randomly assigned to the control group (n=200) did not receive free products or repeated educational messages. Households’ willingness to pay for these products was quite low on average (as measured by bids in an incentive-compatible real-money auction), although a modest share was willing to pay the actual or expected retail price for low-cost chlorine-based products.

Furthermore, contrary to our hypotheses that both one’s own personal experience and the influence of one’s peers would increase consumers’ willingness to pay, direct experience significantly decreased mean bids by 18-55% for three of the four products and had no discernable effect on the fourth. Neighbor experience also did not increase bids. Widespread dissemination of safe water products is unlikely until we better understand the preferences and aspirations of these at-risk populations.

High Adherence Is Necessary to Realize Health Gains from Water Quality Interventions

May 8, 2012

PLoS ONE, May 2012

High Adherence Is Necessary to Realize Health Gains from Water Quality Interventions

Joe Brown*, Thomas Clasen. Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

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.

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