There is growing awareness that drinking-water can become contaminated following its collection from communal sources such as wells and tap-stands, as well as during its storage in the home. This study evaluated the post-supply drinking-water quality in three rural Honduran communities using either a protected hand-dug well or borehole supply. Water management practices were documented as a basis for further research to improve household drinking-water quality. Membrane filtration was used to compare thermotolerant coliform levels in samples taken from community wells and household drinking-water storage containers. Over a 2-year period, water quality was examined in 43 households and detailed observation made of typical collection, storage and usage practice. Substantial water quality deterioration occurred between the points of supply and consumption. Deterioration occurred regularly and frequently, and was experienced by the majority of study households. Only source water quality appeared to be a significant factor in determining household water quality. None of the storage factors examined, i.e. covering the container, type of container, the material from which the container was made, and hours stored, made any significant difference to the stored water quality. Observation of household water management shows that there are multiple points during the collection to use sequence where pollution could occur. The commonality of water management practice would be an asset in introducing appropriate intervention measures.

The deterioration of drinking water quality following its collection from a community well or standpipe and during storage in the home has been well documented. However, there is a view that post-supply contamination is of little public health consequence. This paper explores the potential health risk from consuming re-contaminated drinking water. A conceptual framework of principal factors that determine the pathogen load in household drinking water is proposed. Using this framework a series of hypotheses are developed in relation to the risk of disease transmission from re-contaminated drinking water and examined in the light of current literature and detailed field observation in rural Honduran communities. It is shown that considerable evidence of disease transmission from re-contaminated drinking water exists. In particular the type of storage container and hand contact with stored drinking water has been associated with increased incidence of diarrhoeal disease. There is also circumstantial evidence linking such factors as the sanitary conditions in the domestic environment, cultural norms and poverty with the pathogen load of household stored drinking water and hence the risk of disease transmission. In conclusion it is found that re-contaminated drinking water represents a significant health risk especially to infants, and also to those with secondary immunodeficiency.

Drinking water can become contaminated following its collection from communal sources such as wells and tap stands, as well as during its storage in the home. However, the mechanisms leading to contamination between the points of supply and consumption have not been well documented. This study carried out field-based experiments in three rural Honduran communities to investigate the potential for contamination through hand contact, method used to draw water, and dirty collection containers. The possibility of bacterial growth occurring in stored water was also considered. Hand-water contact was observed frequently during the collection and drawing of drinking water. Faecal contamination was present on 44% of women's fingertips tested during normal household activities, and this faecal material was easily transferred to water. An immediate deterioration in water quality was observed on filling collection containers. Faecal material was detected on cups and beakers used for drawing stored drinking water. Evidence was produced indicating that thermotolerant coliforms remain attached to the inner surface of clay storage containers after rinsing. Drinking-water quality deteriorates during collection and storage as a result of multiple factors linked to hygiene practices and circumstances. However, hands have the greatest potential to introduce contamination because of the constant risk of contact during household water management.

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IntroductionIn Kenya’s Kitui County, 46% of children under 5 years are stunted. Sanitation and nutrition programmes have sought to reduce child undernutrition, though they are typically implemented separately. We evaluate the effectiveness of an integrated sanitation and nutrition (SanNut) intervention in improving caregiver sanitation and nutrition knowledge and behaviours.MethodsWe conducted a cluster-randomised controlled trial to evaluate the impact of the SanNut intervention on caregiver knowledge, sanitary and hygiene practices, sanitation outcomes and nutrition outcomes. The evaluation included caregivers of children under 5 years across 604 villages in Kitui County. 309 treatment villages were randomly assigned to receive both the SanNut intervention and the standard Community-Led Total Sanitation (CLTS) intervention, while 295 control villages only received the CLTS intervention. 8 households with children under 5 years were randomly selected from each evaluation village to participate in the endline survey, for a total of 4322 households.ResultsSanNut led to modest improvements in sanitary knowledge and practices emphasised by the programme. Caregivers in treatment villages were 3.3 pp (+32%) more likely to mention lack of handwashing after handling child faeces as a potential cause of diarrhoea, and 4.9 pp (+7.8%) more likely to report safe disposal of child faeces than caregivers in control villages. Treatment households were 1.9 pp (+79%) more likely to have a stocked handwashing station and 2.9 pp (−16%) less likely to report incidences of child diarrhoea. However, SanNut appears to have had no impact on nutritional practices, such as breastfeeding, vitamin A supplementation or deworming. Non-child outcomes traditionally associated with CLTS, including latrine use and homestead sanitary conditions, were similar in treatment and control groups.ConclusionChild-focused messaging can potentially be integrated into CLTS programming, though this integration was more successful for topics closer to CLTS objectives (sanitation practices, including limiting faecal contamination and handwashing) than for more disparate topics (nutritional practices).Trial registrationPan-African Clinical Trials Registry (PACTR201803003159346) and American Economic Association registry for randomised controlled trials (AEARCTR-0002019).