A novel theatre-based behaviour change approach for influencing community uptake of schistosomiasis control measures

Background: Appropriate behaviour change with regard to safe water contact practices will facilitate the elimination of schistosomiasis as a public health concern. Various approaches to effecting this change have been trialled in the field but with limited sustainable outcomes. Our case study assessed the effectiveness of a novel theatre-based behaviour change technique (BCT), in combination with cohort awareness raising and capacity training intervention workshops. Methodology: Our study was carried out in Mwanza, Tanzania and Kemise, Ethiopia. We adapted the Risk, Attitude, Norms, Ability, and Self-regulation (RANAS) framework and four phases using a mixed methods approach. Participatory project phase engagement an11 qualitative formative data were used to guide the design of an acceptable, holistic intervention. Initial baseline (BL) data was collected using quantitative questionnaire surveys with 804 participants in Tanzania and 617 in Ethiopia, followed by the theatre-based BCT and capacity training intervention workshops. Post-intervention (PI) survey was carried out after six months, with a participant return rate of 65% in Tanzania and 60% in Ethiopia. Results: The intervention achieved a significant improvement in the knowledge of schistosomiasis transmission being associated with poorly managed sanitation and risky water contact. Participants in Tanzania increased their uptake of preventive chemotherapy (Male: BL:56%; PI:73%, Female: BL:43%; PI:50%). There was a significant increase in the selection of sanitation (Tanzania: BL:13%; PI:21%, Ethiopia: BL:63%; PI:90%), safe water and avoiding/minimising contact with infested waters as prevention methods in Tanzania and Ethiopia. Some of the participants in Tanzania followed on from the study by building their own latrines. Conclusions: This study showed substantial positive behaviour changes in schistosomiasis control can be achieved using theatre-based BCT intervention and disease awareness training. With appropriate sensitisation, education and stakeholder engagement approaches, community members were more open to minimising risk-associated contact with contaminated water sources and were mobilised to implement preventive measures

Predicting the Formation of Haloacetonitriles and Haloacetamides by Simulated Distribution System Tests

© 2017 The Authors. Unintended chemical reactions between disinfectants and natural organic matter (NOM) or anthropogenic compounds in natural waters result in the formation of disinfection by-products (DBPs) during drinking water treatment. To date, numerous groups of disinfection by-products have been identified in drinking water, some of which are suspected to be of public health importance and thus are regulated in the water industry. Recent studies have suggested that some unregulated nitrogen-containing DBPs, such as haloacetonitriles (HANs) and haloacetamides (HAcAms), may have greater toxicity than the currently regulated groups (trihalomethanes, THMs, and haloacetic acids, HAAs). There is only sparse information on the behaviour of the HANs and HAcAms in distribution systems. It is however known that HANs can be hydrolysed to the HAcAms, which in turn can hydrolyse to form dihaloacetic acids (DHAAs). Simulated distribution systems tests (SDS) have been successfully applied to predict the formation of THMs and HAAs using a simple and inexpensive lab-based technique, and have been recommended by the US Environmental Protection Agency (EPA) to American water utilities for collecting information about the levels of DBPs occurring in their distribution systems. SDS tests aim to simulate the water quality, disinfectant residuals, and water ages of a real distribution system, allowing easy sampling at prescribed time intervals for analysis of DBP formation. These tests are also a useful tool for considering the impact of potential changes to distribution practices, such as switching from chlorination to chloramination, for example. Therefore, a sampling survey was conducted in four surface water treatment plants in the UK to examine the formation of HANs and HAcAms in both real distribution systems and SDS tests. The samples were extracted using liquid-liquid extraction and analysed by gas chromatography with electron capture detection (GC-ECD). The research sought to determine whether SDS can be a useful predictive tool for HANs and HAcAms in distribution systems and what levels of prediction error are to be expected

Minimisation of regulated and unregulated disinfection by-products in drinking water

This research, involving a collaboration between Imperial College London and Anglian Water, and had the overall aim to understand the occurrence and fate of a wide range of disinfection by-products (DBPs) during drinking water distribution and to establish operational strategies to simultaneously control them in water supply systems. Therefore, the research is essentially centred on two main issues: i) improving our understanding of the impact of water quality and operational parameters on regulated and unregulated DBPs in water distribution networks, and ii) the validation of a prediction tool to proactively design and adapt operational practices to minimise DBPs. The research explored these issues through a series of experiments focused on the analysis of 29 DBPs upon chlorination and chloramination, under various water ages and water quality conditions, by sampling from four locations in four full-scale distribution systems in four sampling rounds and simultaneously running Simulated Distribution System (SDS) tests. This resulted in one of the most comprehensive databases of the occurrence and behaviour in distribution systems of regulated trihalomethanes (THMs), the likely-to-be-soon-regulated-in-the-UK haloacetic acids (HAAs), as well as unregulated haloacetonitriles (HANs) and haloacetamides (HAcAms) of potential health significance, and their individual species. For the first time, SDS tests were shown to be able to successfully predict the levels and speciation of HANs and HAcAms in chlorinated and chloraminated systems, by direct comparison with actual distribution water samples. The configuration of SDS tests addressed the spatial and temporal variation of the selected DBPs, indicating that even though THM concentrations significantly increase with water age (on average by ~54% between water ages of6-106 h) and present high seasonal dependence. together with HAAs. The latter, HANs, and HAcAms concentrations had fluctuations that resulted in less pronounced overall increases, with the two N-DBPs relatively unaffected by water temperature. To explore the impact of disinfectant alteration in distribution, free chlorine and chloramination were applied in the same real water samples in SDS tests. This showed that the implementation of chloramination minimises the formation not only of THMs and HAAs, but also HANs and HAcAms, though it shifts speciation towards more brominated HAAs, HANs and HAcAms species. Through this research, SDS tests can be recommended to water utilities to both estimate the concentrations of DBPs (those included in this study) in their supply systems and assess the effect of potential DBP minimisation strategies. The interesting behavioural patterns of HAcAms in distribution systems raised questions concerning their formation mechanisms and determining factors. Therefore, a laboratory study was conducted whereby chlorination and chloramination were applied to six model amide compounds to investigate their relative contributions as N-DBPs precursors, under a range of water quality conditions (pH, bromide dose, water age). The findings of this study suggest that the N-oxidation of amide structures, more evident in aromatic moieties, is a potential mechanism for HAcAms formation, which occurs completely separately from HAN hydrolysis. This suggests that if precursor removal is to be used as a treatment strategy for minimising HAcAms and HANs, the success in minimising these groups of N-DBPs may differ based on the relative success in removing their independent precursors.Open Acces