Evaluation of a household water treatment and handwashing intervention in rural Guatemala and other recent studies
Campbell, Dan
Below are citations and abstracts of 9 recently published studies. I will try to obtain re-prints from the authors if you need the complete article for any of these:
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1: Int J Epidemiol. 2009 Jul 2.
Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala.
Arnold B, Arana B, Mäusezahl D, Hubbard A, Colford JM Jr.
Division of Epidemiology, University of California, Berkeley, CA, USA.
BACKGROUND: The promotion of household water treatment and handwashing with soap has led to large reductions in child diarrhoea in randomized efficacy trials. Currently, we know little about the health effectiveness of behaviour-based water and hygiene interventions after the conclusion of intervention activities.
METHODS: We present an extension of previously published design (propensity score matching) and analysis (targeted maximum likelihood estimation) methods to evaluate the behavioural and health impacts of a pre-existing but non-randomized intervention (a 3-year, combined household water treatment and handwashing campaign in rural Guatemala). Six months after the intervention, we conducted a cross-sectional cohort study in 30 villages (15 intervention and 15 control) that included 600 households, and 929 children <5 years of age.
RESULTS: The study design created a sample of intervention and control villages that were comparable across more than 30 potentially confounding characteristics. The intervention led to modest gains in confirmed water treatment behaviour [risk difference = 0.05, 95% confidence interval (CI) 0.02-0.09]. We found, however, no difference between the intervention and control villages in self-reported handwashing behaviour, spot-check hygiene conditions, or the prevalence of child diarrhoea, clinical acute lower respiratory infections or child growth.
CONCLUSIONS: To our knowledge this is the first post-intervention follow-up study of a combined household water treatment and handwashing behaviour change intervention, and the first post-intervention follow-up of either intervention type to include child health measurement. The lack of child health impacts is consistent with unsustained behaviour adoption. Our findings highlight the difficulty of implementing behaviour-based household water treatment and handwashing outside of intensive efficacy trials.
2 - Water Res. 2009 May 13.
Bacterial treatment effectiveness of point-of-use ceramic water filters.
Bielefeldt AR, Kowalski K, Summers RS.
Department of Civil, Environmental, and Architectural Engineering, University of Colorado at Boulder, 428 UCB, Boulder, CO 80309-0428, USA.
Laboratory experiments were conducted on six point-of-use (POU) ceramic water filters that were manufactured in Nicaragua; two filters were used by families for ca. 4years and the other filters had limited prior use in our lab. Water spiked with ca. 10(6)CFU/mL of Escherichia coli was dosed to the filters. Initial disinfection efficiencies ranged from 3 - 4.5log, but the treatment efficiency decreased with subsequent batches of spiked water. Silver concentrations in the effluent water ranged from 0.04 - 1.75ppb. Subsequent experiments that utilized feed water without a bacterial spike yielded 10(3)-10(5)CFU/mL bacteria in the effluent. Immediately after recoating four of the filters with a colloidal silver solution, the effluent silver concentrations increased to 36 - 45ppb and bacterial disinfection efficiencies were 3.8-4.5log. The treatment effectiveness decreased to 0.2 - 2.5log after loading multiple batches of highly contaminated water. In subsequent loading of clean water, the effluent water contained <20-41CFU/mL in two of the filters. This indicates that the silver had some benefit to reducing bacterial contamination by the filter. In general these POU filters were found to be effective, but showed loss of effectiveness with time and indicated a release of microbes into subsequent volumes of water passed through the system.
3 - Environmental Health Perspectives, July 2009
Sustainable Control of Water-Related Infectious Diseases: A Review and Proposal for Interdisciplinary Health-Based Systems Research
Full-text; http://www.ehponline.org/members/2009/0800423/0800423.pdf
Stuart Batterman,1 Joseph Eisenberg,2 Rebecca Hardin,3 Margaret E. Kruk,4 Maria Carmen Lemos,3 Anna M. Michalak,5 Bhramar Mukherjee,6 Elisha Renne,7 Howard Stein,8 Cristy Watkins,9 and Mark L. Wilson2
1Department of Environmental Health Sciences, 2Department of Epidemiology, 3School of Natural Resources and the Environment, 4Department of Health Management and Policy, 5Department of Civil and Environmental Engineering, 6Department of Biostatistics, 7Department of Environmental Engineering, 8Center for African American Studies, and 9School of Natural Resources and Environment, University of Michigan, Ann Arbor, Michigan, USA
ABSTRACT - Objective: Even when initially successful, many interventions aimed at reducing the toll of water-related infectious disease have not been sustainable over longer periods of time. Here we review historical practices in water-related infectious disease research and propose an interdisciplinary public health‒oriented systems approach to research and intervention design.
Data sources: On the basis of the literature and the authors’ experiences, we summarize contributions from key disciplines and identify common problems and trends. Practices in developing countries, where the disease burden is the most severe, are emphasized.
Data extraction: We define waterborne and water-associated vectorborne diseases and identify disciplinary themes and conceptual needs by drawing from ecologic, anthropologic, engineering, political/economic, and public health fields. A case study examines one of the classes of water-related infectious disease.
Data synthesis: The limited success in designing sustainable interventions is attributable to factors that include the complexity and interactions among the social, ecologic, engineering, political/economic, and public health domains ; incomplete data ; a lack of relevant indicators ; and most important, an inadequate understanding of the proximal and distal factors that cause water-related infectious disease. Fundamental change is needed for research on water-related infectious diseases, and we advocate a systems approach framework using an ongoing evidence-based health outcomes focus with an extended time horizon. The examples and case study in the review show many opportunities for interdisciplinary collaborations, data fusion techniques, and other advances.
Conclusions: The proposed framework will facilitate research by addressing the complexity and divergent scales of problems and by engaging scientists in the disciplines needed to tackle these difficult problems. Such research can enhance the prevention and control of water-related infectious diseases in a manner that is sustainable and focused on public health outcomes.
4 - Journal of Water and Health Vol 07 No 3 pp 527–534 2009 doi:10.2166/wh.2009.063
Increasing equity of access to point-of-use water treatment products through social marketing and entrepreneurship: a case study in western Kenya
Matthew C. Freeman, Robert E. Quick, Daniel P. Abbott, Paul Ogutu and Richard Rheingans
Center for Global Safe Water, Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, GCR 767, Atlanta, GA 30322, USA E-mail: mcf...@sph.emory.edu
Enteric Diseases Epidemiology Branch, Division of Foodborne, Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, GA 30333, USA
Save the Children USA, Department of Education and Child Development, 2000 L ST NW, Suite 500, Washington, DC 20009, USA
Great Lakes University of Kenya, PO Box 2224, Kisumu 40100, Kenya
Abstract - Point-of-use water chlorination reduces diarrhoea risk by 25–85%. Social marketing has expanded access to inexpensive sodium hypochlorite for water treatment, at a cost of less than US$0.01 per day, in Kenya. To increase product access, women's groups in western Kenya were trained to educate neighbours and sell health products to generate income. We evaluated this programme's impact on equity of access to water treatment products in a cross-sectional survey. We surveyed 487 randomly selected households in eight communities served by the women's groups. Overall, 20% (range 5–39%) of households in eight communities purchased and used chlorine, as confirmed by residual chlorine observed in stored water. Multivariate models using illiteracy and the poorest socioeconomic status as a referent showed that persons with at least some primary education (OR 2.5, 95% CI 1.8, 3.5) or secondary education (OR 5.4, 95% CI 1.6, 17.5) and persons in the four wealthiest quintiles (OR 2.5, 95% CI 1.0, 6.0) were more likely to chlorinate stored water. While this implementation model was associated with good product penetration and use, barriers to access to inexpensive water treatment remained among the very poor and less educated.
5 - Martina Winker, Bjorn Vinneras, Andreas Muskolus, Ute Arnold, Joachim Clemens,
Fertiliser products from new sanitation systems: Their potential values and risks, IN: Bioresource Technology, Volume 100, Issue 18, September 2009, Pages 4090-4096, ISSN 0960-8524, DOI: 10.1016/j.biortech.2009.03.024.
The plant nutrients consumed in human society today are lost through the established wastewater treatment systems in industrialised countries as well as via insufficient or non-existent handling of sewage in the developing world. New sanitation systems have been designated to overcome this failure. The source separated wastewater streams collected within these systems contain a high nutrient content, and can be used as fertiliser as well as soil conditioner after appropriate storage and/or treatment. Application in agriculture with existing techniques is feasible. However, pathogens and pharmaceuticals contained in these fertiliser types are a potential hazard. Nevertheless, storage and appropriate treatment can minimise the risks. The products deriving from these systems have a high potential to preserve available plant nutrient resources and deficiencies in agriculture as well as being able to substitute synthetic plant nutrients and at the same time prevent unwanted environmental nutrient over-enrichment.
Keywords: New sanitation systems; Pathogens; Pharmaceuticals; Fertiliser; Agriculture
6 - Hipolito Gomez-Couso, Maria Fontan-Sainz, Kevin G. McGuigan, Elvira Ares-Mazas,
Effect of the radiation intensity, water turbidity and exposure time on the survival of Cryptosporidium during simulated solar disinfection of drinking water, IN: Acta Tropica, In Press, Uncorrected Proof, Available online 17 June 2009, ISSN 0001-706X, DOI: 10.1016/j.actatropica.2009.06.004.
The solar disinfection (SODIS) technique is a highly effective process that makes use of solar energy to inactivate pathogenic microorganisms in drinking water in developing countries. The pathogenic protozoan parasite Cryptosporidium parvum is often found in surface waters and is associated with waterborne outbreaks of cryptosporidiosis. In the present study, a complete multi-factorial mathematical model was used to investigate the combined effects of the intensity of solar radiation (200, 600 and 900 W/m2 in the 320 nm to 10 [mu]m range), water turbidity (5, 100 and 300 NTU) and exposure time (4, 8 and 12 h) on the viability and infectivity of C. parvum oocysts during simulated SODIS procedures at a constant temperature of 30 [degree sign]C. All three factors had significant effects (p < 0.05) on C. parvum survival, as did the interactions of water turbidity with radiation intensity and radiation intensity with exposure time. However, the parameter with the greatest effect was the intensity of radiation; levels >=600 W/m2 and times of exposure between 8 and 12 h were required to reduce the oocyst infectivity in water samples with different degrees of turbidity.
7 - Paul R. Hunter, Kathy Pond, Paul Jagals, John Cameron,
An assessment of the costs and benefits of interventions aimed at improving rural community water supplies in developed countries, IN: Science of The Total Environment, Volume 407, Issue 12, Thematic Issue - BioMicroWorld Conference, 1 June 2009, Pages 3681-3685, ISSN 0048-9697, DOI: 10.1016/j.scitotenv.2009.03.013.
We report a cost benefit analyses (CBA) for water interventions in rural populations of developed country sub-regions. A Bayesian belief network was used to estimate the cost benefit ratio using Monte Carlo simulation. Where possible we used input data from recently published primary research or systematic reviews. Otherwise variables were derived from previous work in the peer-reviewed or grey literature. For these analyses we considered the situation of people with small and very small community supplies that may not be adequately managed. For the three developed country sub-regions Amr-A (America region A), Eur-A (European region A) and Wpr-A (Western Pacific region A), we estimate the costs of acute diarrhoeal illness associated with small community supplies to be U$4671 million (95% CI 1721-9592), the capital costs of intervention to be US$13703 million (95% CI 6670-20735), additional annual maintenance to be US$804 million (95%CI 359-1247) and the CB ratio to be 2.78 (95%CI 0.86-6.5). However, we also estimated the cost of post infectious irritable bowel syndrome (IBS) following drinking water-associated acute gastroenteritis to be US$11896 million (95%CI 3118-22657). When the benefits of reduced IBS are added to the analysis the CB ratio increases to 9.87 (95%CI 3.34-20.49). The most important driver of uncertainty was the estimate of the cost of illness. However, there are very few good estimates of costs in improving management of small rural supplies in the literature. Investments in drinking-water provision in rural settings are highly cost beneficial in the developed world. In the developed world, the CB ratio is substantially positive especially once the impact of IBS is included.
8 - Heather M. Murphy, Edward A. McBean, Khosrow Farahbakhsh,
Appropriate technology - A comprehensive approach for water and sanitation in the developing world, IN: Technology in Society, Volume 31, Issue 2, May 2009, Pages 158-167, ISSN 0160-791X, DOI: 10.1016/j.techsoc.2009.03.010.
Abstract: Appropriate technologies (AT) are only a fraction of the solution in achieving sustainable and safe access to water and sanitation worldwide. The challenges of rapid population increases, urbanization, climate change, poverty, and widespread diseases will affect what are deemed 'appropriate' solutions in addressing needs in the water and sanitation sector. Traditional engineering approaches need to be augmented with more flexible trial and error techniques, user participation, and multi-disciplinary collaborative learning in order to create innovative solutions and empower impoverished communities to achieve their own development goals.
There are countless historical definitions of AT, all of which are accompanied by individual criteria for a technology to be deemed appropriate. This paper presents a comprehensive definition for AT and demonstrates its application and relevance today with regard to the water and sanitation sector in a developing world context. Rather than prescribing strict criteria, considerations for AT will be outlined and examined through three case studies: the Lorena Cookstove-Guatemala, a Women's Outhouse in Nepal, and Innovation Rice Practices in Bangladesh.
9 - Daouda Diakite, Aggey Semenov and, Alban Thomas,
A proposal for social pricing of water supply in Cote d'Ivoire, Journal of Development Economics, Volume 88, Issue 2, March 2009, Pages 258-268, ISSN 0304-3878, DOI: 10.1016/j.jdeveco.2008.03.003.
Abstract: We consider the design of a nonlinear social tariff for residential water in Cote d'Ivoire, which is a case of a monopolistic private operator supplying a population of heterogeneous consumers. The proposed optimal tariff includes an initial 'social' block with a low unit price, and higher consumption blocks with a monopoly pricing rule. This optimal nonlinear tariff is calibrated using econometric estimates of a panel-data residential water demand equation. Welfare changes associated with moving from the actual tariff to approximations of the optimal pricing system are computed under different tariff scenarios. We find that gains in consumer welfare would outweigh losses in producer surplus in a majority of Ivorian local communities.
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Dan Campbell, Web Manager
Environmental Health at USAID
1611 North Kent St., Suite 300
Arlington, VA 22209
Ph: 703-247-8722
Email: dcam...@usaid.gov
Environmental Health at USAID: http://www.ehproject.org
Indoor Air Pollution Updates: http://iapnews.wordpress.com
Sanitation Updates: http://sanitationupdates.wordpress.com
Urban Health Updates: http://urbanhealthupdates.wordpress.com
Cholera Google Group: http://groups.google.com/group/cholera-control
Household Water Treatment Google Group: http://groups.google.com/group/household-water-treatment