Evaluating four measures of water quality in clay pots and plastic safe storage containers in Kenya.

Household water treatment with chlorine can improve microbiological quality and reduce diarrhea. Chlorination is typically assessed using free chlorine residual (FCR), with a lower acceptable limit of 0.2 mg/L, however, accurate measurement of FCR is challenging with turbid water. To compare potential measures of adherence to treatment and water quality, we chlorinated recently-collected water in rural Kenyan households and measured total chlorine residual (TCR), FCR, oxidation reduction potential (ORP), and E. coli concentration over 72 h in clay and plastic containers. Results showed that 1) ORP served as a useful proxy for chlorination in plastic containers up to 24 h; 2) most stored water samples disinfected by chlorination remained significantly less contaminated than source water for up to 72 h, even in the absence of FCR; 3) TCR may be a useful proxy indicator of microbiologic water quality because it confirms previous chlorination and is associated with a lower risk of E. coli contamination compared to untreated source water; and 4) chlorination is more effective in plastic than clay containers presumably because of lower chlorine demand in plastic

Does Activated Silver Reduce Recontamination Risks in the Reservoirs of Ceramic Water Filters?

Efforts to provide safe water are challenged by recontamination and regrowth of pathogens in treated water during storage. This study evaluated the potential of metallic silver with a chemically etched surface to reduce recontamination risks during water storage in ceramic water filters. Batch experiments were conducted in the laboratory with water storage buckets containing three configurations of varying amounts of silver. Field trials in a rural area in Kenya assessed the effect of the same configurations in the storage buckets of locally produced ceramic pot filters without colloidal silver coating. The tests revealed that the etched silver slightly reduced microbiological recontamination risks during water storage despite the low diffusion of silver ions (<5 µg Ag/L). The effect was strongly influenced by water chemistry parameters. A statistically significant difference in the removal of E. coli (Δ Log Removal Value (LRV) = 0.6) and total coliforms (Δ LRV = 1.7) was found between households using a filter with silver in the water reservoir and those using a filter without silver. Multivariate regression of water handling factors and hygiene practices on filter performance revealed that the presence of silver in the reservoir and cleaning the filter element with a brush were associated with a better filter performance

Decentralized solar-powered drinking treatment in Kisumu County, Kenya

This record includes an extended abstract and MP4 presentation. Presented at the 42nd WEDC International Conference

Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015

Abstract Background From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya’s 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June–July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers’ (HCW) experiences during outbreak response. Methods Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns. Results Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs’ personal passion to help others. Conclusions The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans