By Aparna Rau, Source: UNICEF Media Center : http://www.unicef.org/uganda/media_16796.html

Communities in the Dei fish landing site in the Panyamur Sub County of Uganda’s Nebbi District were falling prey to cholera outbreaks on a daily basis, due to consistently drinking contaminated water from Lake Albert. To tackle this troubling issue Water, Sanitation and Hygiene (WASH) experts at UNICEF Uganda sought to find innovative water solutions far different from those used in the past. Taking India’s idea of the Milk ATM one step further, UNICEF Uganda in partnership with Water Mission Uganda (WMU), created one of the first Water ATM’s in the country, launching the first pilot project in the Dei parish of Panyamur in December of 2013, which serves a population of over 8,000.

LifeLink, the Water ATM designed by the Danish  company Grundfos, enables villagers to purchase between 5 and 20 litres of clean water (100 UGX, or $3 cents for 20 litres), using a water key that allows for both mobile banking and point of sale payment. The ATM machine dispenses safe water. Raw surface water is directly pumped from Lake Albert through a filtered water treatment system, engineered by Water Missions International, which chlorinates to disinfect water from germs that cause water borne diseases; the clean water is then delivered to an elevated gravity pressure water tank, all using solar power technology.

Both a Water Agent and a security guard, selected from Dei parish community, have been trained to manage day-to-day ATM operations. The Water Agent is paid UGX 200,000 (or $58) as a monthly salary and 10 per cent of the sales made from the ATM. A Water Agent Manager from WMU supports the overall running of the system. When a key is used LifeLink automatically captures the data, enabling the system to monitor clean water usage, as well as its own performance from anywhere in the world, using a remote management web application. If an issue occurs that requires maintenance, an SMS and email message is sent to operations services staff to ensure that a consistently reliable water supply is available year round.

With the aim to inspire positive behaviour change, the Water ATM project includes a village health and hygiene promotion component, in which WASH volunteers from the community are trained to go door to door creating awareness on good practices in: hand washing, household and food cleanliness, and latrine usage. Since the introduction of both the Water ATM project and social mobilization campaign, there have been almost no incidents of cholera for the past two years, while over 60 per cent of households in the Dei parish have built and started using latrines.

Efficacy of Handwashing with Soap and Nail Clipping on Intestinal Parasitic Infections in School-Aged Children: A Factorial Cluster Randomized Controlled Trial. PLoS Medicine, June 2015.

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Authors: Mahmud Abdulkader Mahmud, Mark Spigt, et al.

Background - Intestinal parasitic infections are highly endemic among school-aged children in resource-limited settings. To lower their impact, preventive measures should be implemented that are sustainable with available resources. The aim of this study was to assess the impact of handwashing with soap and nail clipping on the prevention of intestinal parasite reinfections.

Methods and Findings - In this trial, 367 parasite-negative school-aged children (aged 6–15 y) were randomly assigned to receive both, one or the other, or neither of the interventions in a 2 × 2 factorial design. Assignment sequence was concealed. After 6 mo of follow-up, stool samples were examined using direct, concentration, and Kato-Katz methods. Hemoglobin levels were determined using a HemoCue spectrometer. The primary study outcomes were prevalence of intestinal parasite reinfection and infection intensity. The secondary outcome was anemia prevalence. Analysis was by intention to treat. Main effects were adjusted for sex, age, drinking water source, latrine use, pre-treatment parasites, handwashing with soap and nail clipping at baseline, and the other factor in the additive model. Fourteen percent (95% CI: 9% to 19%) of the children in the handwashing with soap intervention group were reinfected versus 29% (95% CI: 22% to 36%) in the groups with no handwashing with soap (adjusted odds ratio [AOR] 0.32, 95% CI: 0.17 to 0.62). Similarly, 17% (95% CI: 12% to 22%) of the children in the nail clipping intervention group were reinfected versus 26% (95% CI: 20% to 32%) in the groups with no nail clipping (AOR 0.51, 95% CI: 0.27 to 0.95). Likewise, following the intervention, 13% (95% CI: 8% to 18%) of the children in the handwashing group were anemic versus 23% (95% CI: 17% to 29%) in the groups with no handwashing with soap (AOR 0.39, 95% CI: 0.20 to 0.78). The prevalence of anemia did not differ significantly between children in the nail clipping group and those in the groups with no nail clipping (AOR 0.53, 95% CI: 0.27 to 1.04). The intensive follow-up and monitoring during this study made it such that the assessment of the observed intervention benefits was under rather ideal circumstances, and hence the study could possibly overestimate the effects when compared to usual conditions.

Conclusions - Handwashing with soap at key times and weekly nail clipping significantly decreased intestinal parasite reinfection rates. Furthermore, the handwashing intervention significantly reduced anemia prevalence in children. The next essential step should be implementing pragmatic studies and developing more effective approaches to promote and implement handwashing with soap and nail clipping at larger scales.

Evaluation of Microbial Water Quality Tests for Humanitarian Emergency and Development Settings. Procedia Engineering, Volume 107, 2015, Pages 237–246. Humanitarian Technology: Science, Systems and Global Impact 2015, HumTech2015.

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Authors: Susan Murcott, Megan Keegan, Alison Hanson, Akshay Jain, Jason Knutson, Shuyue Liu, Jenny Tanphanich, Teng Ke Wong

How do you know if drinking water is safe? Or which microbial indicator tests work best when few side-by-side performance evaluations exist in real-world field sites? This research compares bacterial indicator test products inlow-resource settings in Ahmedabad, India and Tamale, Ghana. In India, three hydrogen sulfide (H2S) bacteria test products were evaluated: laboratory-made H2S, TARA Aquacheck and ORlab H2S, and compared to an EPA-certified standard, the IDEXX Quanti-Tray® 2000. In Ghana, 3 M Petrifilm™, Aquagenx CBT and Easygel® Cards were included in addition toH2S and Quanti-Tray® 2000. Results are presented in a Consumer Reports-style for easy comprehension.

Sanitary Survey of Public Drinking Water Sources: A Study Conducted in Slums of Bhubaneswar, Odisha, 2015. Health of the Urban Poor (HUP) Program.

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Authors: Biraja Kabi Satapathy, Niladri Chakraborti.

The sanitary survey of drinking water sources was done in Bhubaneswar slums where PFI is running the Health of the Urban Poor Program. The purpose was to understand the risk to public drinking water sources based on onsite inspection and water testing of the source with field test for pipe water supply and H2 S bacteriological contamination test for all the sources. The study report gives details of the survey undertaken, its findings, and suggestions for ensuring drinking water quality in the slums of Odisha. The report tried to capture the result of the indicator-wise sanitary inspection and its relation with other indicators. We hope the study will be useful for the government for making some policy level corrections. We also hope that Government, Non Government and civil society organisations will adopt the sanitary survey as a tool for identifying factors that affect drinking water sources, which is essential for drinking water safety.

E. coli from dishcloths as an indicator of hygienic status in households. Journal of Water, Sanitation and Hygiene for Development In Press, 2015 | doi:10.2166/washdev.2015.119

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Authors: V. Keshav, A. Mathee, N. Naicker, A. Swart and T. G. Barnard

E. coli is routinely used as an indicator of fecal pollution although some strains are capable of causing diarrhea. E. coli was used as a model organism for this study to assess the possibility that dishcloths used in households could contribute to the occurrence of diarrhea. Dishcloths (n = 424) were collected from five suburbs in Johannesburg (South Africa) as part of a larger Health, Environment & Development (HEAD) study. Results for the total coliforms indicated that on average 81% of the samples analyzed had total coliform counts of more than 1,000 cfu/100 ml per 25 cm2 cloth.

The E. coli results indicated that 40% of the samples had culturable E. coli present with 17% of the samples showing the presence of >1,000 cfu/100 ml per 25 cm2 cloth. Except for the samples from Bertrams all the pathogenic E. coli genes could be detected in various combinations in the different samples. Since all the diarrheagenic E. coli strains detected can be accepted as culturable due to the enrichment step, there is a clear danger of contamination of food and surfaces exposed to the contaminated dishcloths. The results indicated that there is a need for public education regarding hygiene in the households, especially if the same dishcloth is used for various tasks.

Handwashing before drawing water: a sixth critical time? Waterlines, Apr 2015.

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Author: Sally Sutton

The promotion of critical times for handwashing has done much to improve knowledge on hygiene, even if rather less on the practice. However while there has long been a recognition of the need to wash hands before preparing food, there has never been any mention of taking the same precautions before drawing water.

With almost half of rural Africa still taking water either by bucket and rope or by scooping water from surface and shallow ground water, lack of handwashing can not only lead to contamination of the water being carried home, but also of the source itself, as demonstrated by source water quality monitoring detailed in this paper.

Even for those taking water from better protected sources, dirty hands can lead to contamination of collected water, especially where bowls and buckets are the main vessels for water transport. Handwashing before water collection is proposed as an additional barrier to faecal-oral contamination, to make a sixth critical time.

Association of Supply Type with Fecal Contamination of Source Water and Household Stored Drinking Water in Developing Countries: A Bivariate Meta-analysis. Env Health Perspec, May 2015.

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Authors: Katherine F. Shields, Robert E.S. Bain, Ryan Cronk, Jim A. Wright, and Jamie Bartram

Background: Access to safe drinking water is essential for health. Monitoring access to drinking water focuses on water supply type at the source, but there is limited evidence on whether quality differences at the source persist in water stored in the household.

Objectives: To assess the extent of fecal contamination at the source and in household storedwater (HSW) and explore the relationship between contamination at each of these sampling points and water supply type.

Methods: A bivariate random-effects meta-analysis of 45 studies, identified through asystematic review, that reported either the proportion of samples free of fecal indicator bacteria and/or individual sample bacteria counts for source and HSW, disaggregated by supply type.

Results: Water quality deteriorated substantially between source and stored water. Mean percentage of contaminated samples (noncompliance) at the source was 46% (95% CI: 33, 60%) while mean noncompliance in HSW was 75% (95% CI: 64, 84%). Water supply type was significantly associated with noncompliance at the source (p < .001) and in HSW (p = 0.03). Source water (OR = 0.2; 95% CI: 0.1, 0.5) and HSW (OR = 0.3; 95% CI: 0.2, 0.8) from pipedsupplies had significantly lower odds of contamination when compared to non-piped water,potentially due to residual chlorine.

Conclusions: Piped water is less likely to be contaminated compared to other water supply typesat both the source and in HSW. A focus on upgrading water services to piped supplies may helpimprove safety, including for those drinking stored water.

Microbial quality of domestic water: following the contamination chain in a rural township in Kenya. Journal of Water, Sanitation and Hygiene for Development Vol 5 No 1 pp 39–49 © IWA Publishing 2015 doi:10.2166/washdev.2014.070

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Authors: Pauline W. Macharia, Paul T. Yillia, Wairimu A. Muia, Denis Byamukama and Norbert Kreuzinger

A study was undertaken in Njoro Township, Kenya to evaluate the extent to which drinking water was subjected to post-collection faecal contamination in low-income and high-income households. Boreholes were the main drinking water sources, accounting for roughly 70% singular access. The microbial quality of drinking water from the boreholes deteriorated from the point-of-collection through conveying containers of small-scale water vendors to household storage containers, irrespective of their income status.

The densities of Escherichia coli (EC) were relatively low at the point-of-collection – median (M): 18 CFU/100 mL, range (R): 0–220, n = 60 – increasing considerably in the containers of water vendors (M: 290 CFU/100 mL, R: 30–350) and slightly (M: 360 CFU/100 mL, R: 0–520) between vendors and low-income households, many of whom used the services of vendors unlike high-income households who relied on a piped system on premises (M: 40 CFU/100 mL, R: 0–500). Post-collection contamination was high in low-income households compared to high-income households but differences were not significant between the two household categories with and without household water treatment (HWT).

Different HWT methods in the two household categories significantly reduced faecal contamination, but unhygienic handling and poor storage practices afterwards caused recontamination. HWT and behavioural change measures need not selectively target household groups solely on the basis of their income status.

Contextual and sociopsychological factors in predicting habitual cleaning of water storage containers in rural Benin. Water Resour Res, March 2015.

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Authors: Andrea Stocker and Hans-Joachim Mosler

Recontamination of drinking water occurring between water collection at the source and the point of consumption is a current problem in developing countries. The household drinking water storage container is one source of contamination and should therefore be cleaned regularly. First, the present study investigated contextual factors that stimulate or inhibit the development of habitual cleaning of drinking water storage containers with soap and water. Second, based on the Risk, Attitudes, Norms, Abilities, and Self-regulation (RANAS) Model of behavior, the study aimed to determine which sociopsychological factors should be influenced by an intervention to promote habitual cleaning.

In a cross-sectional study, 905 households in rural Benin were interviewed by structured face-to-face interviews. A forced-entry regression analysis was used to determine potential contextual factors related to habitual cleaning. Subsequently, a hierarchical regression was conducted with the only relevant contextual factor entered in the first step (R2 5 6.7%) and the sociopsychological factors added in the second step (R2 5 62.5%).

Results showed that households using a clay container for drinking water storage had a significantly weaker habit of cleaning their water storage containers with soap and water than did households using other types of containers (b 5 20.10). The most important sociopsychological predictors of habitual cleaning were commitment (b 5 0.35), forgetting (b 5 20.22), and self-efficacy (b 5 0.14). The combined investigation of contextual and sociopsychological factors proved beneficial in terms of developing intervention strategies. Possible interventions based on these findings are recommended.

Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial. PLoS One, March 2015

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Authors: Ayse Ercumen , Abu Mohd. Naser , Leanne Unicomb, Benjamin F. Arnold, John M. Colford Jr., Stephen P. Luby

Background - Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh.

Methods - We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants’ source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions.

Findings - Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias.

Conclusions - Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.