Cross-sectional epidemiological study on water and sanitation practices in the northern region of Ghana

Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Civil and Environmental Engineering, 2006.Includes bibliographical references (p. 85-89).A cross-sectional epidemiological study was conducted to obtain baseline data on drinking water and sanitation practices in the Northern Region of Ghana. This study was performed in conjunction with Pure Home Water (PHW) which aims to provide safe drinking water to the Northern Region of Ghana by selling household water treatment and safe storage devices as a sustainable business. Currently ceramic filters constitute PHW's major sales. In the study, fifty households were surveyed, including both homes that had and had not purchased the PHW products in order to obtain baseline data and product feedback. Targeted participants were mothers of the households with children under five. At each household, drinking water samples were collected and analyzed for bacterial contamination with hydrogen sulfide (H2S) and membrane filtration testing techniques. This data is analyzed as an epidemiological cross-sectional study and basic risk assessment. In general, the surveys were well received within the communities, resulting in 100% participation. The product users responded positively to the PHW technologies, with 93% of customers still using the products within six months of purchase.(cont.) From the overall survey results, there is a great need for safe water and sanitation in the Northern Region of Ghana, with 36% of respondents not having access to an improved water source, and 54% not having access to an improved sanitation facility. In the rural traditional communities, households were more likely to suffer from diarrheal illness, lack improved drinking water, and lack sanitation facilities. A variety of factors were compared in analysis, such as community type, district, diarrheal illness, and ownership of the PHW products.by Rachel Louise Peletz.M.Eng

Assessing water filtration and safe storage in households with young children of HIV-positive mothers: a randomized, controlled trial in Zambia.

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 (-0.26; 95% CI: -0.37 to -0.14, 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. TRIAL REGISTRATION: Clinicaltrials.gov NCT01116908

Results from household ceramic filter evaluation in northern Ghana

This paper outlines Pure Home Water’s efforts to promote household drinking water treatment and safe storage (HWTS) products to low income customers in the Northern Region of Ghana and describes the research performed to improve upon PHW’s success. Epidemiological surveys and water quality testing were conducted in January 2006 and January 2007 in order to obtain baseline data on drinking water and sanitation practices and to evaluate the effectiveness of PHW’s program. It was found that traditional communities have a great need for access to improved water supplies, and PHW is effectively reaching these households by offering ceramic filters at a segmented market price and by managing several marketing campaigns. The surveys found that users are satisfied with the product. According to the water quality tests, the filters are performing well in the field; in traditional households, for example, E. coli removal rates averaged 99.7% when tested with membrane filtration

Follow-up study to assess the use and performance of household filters in Zambia.

Effective household water treatment can improve drinking water quality and prevent disease if used correctly and consistently over time. One year after completion of a randomized controlled study of water filters among households in Zambia with children < 2 years old and mothers who were human immunodeficiency virus (HIV)-positive, we conducted a follow-up study to assess use and performance of new filters distributed at the conclusion of the study; 90% of participating households met the criteria for current users, and 75% of participating households had stored water with lower levels of fecal contamination than source water. Microbiologically, the filters continued to perform well, removing an average of 99.0% of fecal indicator bacteria. Although this study provides some encouraging evidence about the potential to maintain high uptake and filter performance, even in the absence of regular household visits, additional research is necessary to assess whether these results can be achieved over longer periods and with larger populations

Constraints to microbial water quality testing

Microbial water quality testing is critical for the provision of safe drinking water, yet microbial testing activity is limited in much of the developing world. This briefing note provides insight into the status of microbial testing programs in developing countries and introduces the Monitoring for Safe Water Program, a study that will examine constraints to microbial water quality testing faced by water suppliers and surveillance agencies in sub-Saharan Africa

Measuring the Impacts of Water Safety Plans in the Asia-Pacific Region

This study investigated the effectiveness of Water Safety Plans (WSP) implemented in 99 water supply systems across 12 countries in the Asia-Pacific region. An impact assessment methodology including 36 indicators was developed based on a conceptual framework proposed by the Center for Disease Control (CDC) and before/after data were collected between November 2014 and June 2016. WSPs were associated with infrastructure improvements at the vast majority (82) of participating sites and to increased financial support at 37 sites. In addition, significant changes were observed in operations and management practices, number of water safety-related meetings, unaccounted-for water, water quality testing activities, and monitoring of consumer satisfaction. However, the study also revealed challenges in the implementation of WSPs, including financial constraints and insufficient capacity. Finally, this study provided an opportunity to test the impact assessment methodology itself, and a series of recommendations are made to improve the approach (indicators, study design, data collection methods) for evaluating WSPs

Follow up study to assess the use and performance of household water filters in Zambia

Effective household water treatment has the potential to improve drinking water quality and prevent diarrhoeal disease if used correctly and consistently over time. We previously conducted a randomized, controlled trial of water filters among households in Zambia with children under two years of HIV-positive mothers. One year after completion of the trial, we conducted a follow up study to assess use and performance the household filters. Ninety percent of participating households met the criteria for current users, and 75% had stored water with lower levels of faecal contamination than source water. Although this study provides some encouraging evidence about the potential to maintain HWTS use and performance, further research is necessary to assess whether these results can be achieved over longer periods and with larger populations

Interventions to improve water quality for preventing diarrhoea

Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. Objectives To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Selection criteria Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Main results Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with unimproved water sources (30 studies) and unimproved or unclear sanitation (34 studies). The primary outcome in most studies was self-reported diarrhoea, which is at high risk of bias due to the lack of blinding in over 80% of the included studies. Source-based water quality improvements There is currently insufficient evidence to know if source-based improvements such as protected wells, communal tap stands, or chlorination/filtration of community sources consistently reduce diarrhoea (one cluster-RCT, five CBA studies, very low quality evidence). We found no studies evaluating reliable piped-in water supplies delivered to households. Point-of-use water quality interventions On average, distributing water disinfection products for use at the household level may reduce diarrhoea by around one quarter (Home chlorination products: RR 0.77, 95% CI 0.65 to 0.91; 14 trials, 30,746 participants, low quality evidence; flocculation and disinfection sachets: RR 0.69, 95% CI 0.58 to 0.82, four trials, 11,788 participants, moderate quality evidence). However, there was substantial heterogeneity in the size of the effect estimates between individual studies. Point-of-use filtration systems probably reduce diarrhoea by around a half (RR 0.48, 95% CI 0.38 to 0.59, 18 trials, 15,582 participants, moderate quality evidence). Important reductions in diarrhoea episodes were shown with ceramic filters, biosand systems and LifeStraw® filters; (Ceramic: RR 0.39, 95% CI 0.28 to 0.53; eight trials, 5763 participants, moderate quality evidence; Biosand: RR 0.47, 95% CI 0.39 to 0.57; four trials, 5504 participants, moderate quality evidence; LifeStraw®: RR 0.69, 95% CI 0.51 to 0.93; three trials, 3259 participants, low quality evidence). Plumbed in filters have only been evaluated in high-income settings (RR 0.81, 95% CI 0.71 to 0.94, three trials, 1056 participants, fixed effects model). In low-income settings, solar water disinfection (SODIS) by distribution of plastic bottles with instructions to leave filled bottles in direct sunlight for at least six hours before drinking probably reduces diarrhoea by around a third (RR 0.62, 95% CI 0.42 to 0.94; four trials, 3460 participants, moderate quality evidence). In subgroup analyses, larger effects were seen in trials with higher adherence, and trials that provided a safe storage container. In most cases, the reduction in diarrhoea shown in the studies was evident in settings with improved and unimproved water sources and sanitation. Authors' conclusions Interventions that address the microbial contamination of water at the point-of-use may be important interim measures to improve drinking water quality until homes can be reached with safe, reliable, piped-in water connections. The average estimates of effect for each individual point-of-use intervention generally show important effects. Comparisons between these estimates do not provide evidence of superiority of one intervention over another, as such comparisons are confounded by the study setting, design, and population. Further studies assessing the effects of household connections and chlorination at the point of delivery will help improve our knowledge base. As evidence suggests effectiveness improves with adherence, studies assessing programmatic approaches to optimising coverage and long-term utilization of these interventions among vulnerable populations could also help strategies to improve health outcomes

From data to decisions: understanding information flows within regulatory water quality monitoring programs

Most countries maintain regulatory requirements for testing of drinking water supplies to guide treatment procedures and ensure safe water delivery to consumers. It is unclear, however, if water quality data are always used effectively, particularly in low-resource settings. Efforts to improve the use of water quality data will benefit from a comprehensive understanding of existing systems for managing and sharing information. This study evaluates the methods used to organize, analyze, and transmit drinking water quality data among 26 water supplier or surveillance institutions and two regulatory agencies in six countries of sub-Saharan Africa. Following extensive qualitative and quantitative data collection, we developed data flow diagrams to map formal and informal water quality networks. We found high levels of similarities between the information systems established by different institutions operating under different regulatory structures. We determined that the key barriers to information flows were the limited aggregation and analysis of data and the poor enforcement of data sharing requirements. Our results suggest that broad reforms are necessary to improve the use of these water quality data to manage water safety. These measures could include strengthening enforcement of testing and reporting, building staff capacity for managing and using data, and integrating collection of water quality data with other information systems

Demand for plastic latrine slabs in rural Kenya and Tanzania

Plastic latrine slabs provide a cleanable surface and a coverable squat hole opening. They are a simple option for upgrading unimproved pit latrines. To measure consumer demand for plastic slabs in rural areas, we conducted i) a voucher-based real-money sales trial in Tanzania in 2015 (n=569) and ii) a real-money auction in Kenya in 2017 (n=322). In Tanzania, 60% of respondents were willing to pay 1 USD, and only 4% were willing to pay 12 USD (compared to the market price of 18 USD). In Kenya, 93% of respondents were willing to pay 1 USD, with only 1% willing to pay the market price of 16 USD. These findings show that there is demand for plastic slabs but at a lower price than what is commercially available. Amongst households who purchased the plastic slabs, 67% had installed them nine months later in Tanzania, versus 58% ten months later in Kenya