No abstract

Dispensers are a source-based water quality intervention with promising uptake results in development contexts. Dispenser programs include a tank of chlorine with a dosing valve that is installed next to a water source, a local Promoter who conducts community education and refills the Dispenser, and chlorine refills. In collaboration with response organizations, we assessed the effectiveness of Dispensers in four emergency situations. In the three initial and four sustained response phase evaluations, 70 Dispenser sites were visited, 2057 household surveys were conducted, and 1676 water samples were analyzed. Across the evaluations, reported Dispenser use ranged from 9 to 97%, confirmed Dispenser use (as measured by free chlorine residual) ranged from 5 to 87%, and effective use (as measured by improvement in household water quality to meet international standards) ranged from 0 to 81%. More effective Dispenser interventions installed Dispensers at point-sources, maintained a high-quality chlorine solution manufacturing and distribution chain, maintained Dispenser hardware, integrated Dispensers projects within larger water programs, remunerated Promoters, had experienced project staff, worked with local partners to implement the project, conducted ongoing monitoring, and had a project sustainability plan. Our results indicate that Dispensers can be, but are not always, an appropriate strategy to reduce the risk of waterborne diseases in emergencies.

Household water treatment (HWT) can reduce the diarrheal disease burden in populations without access to safe water. We evaluated five programs that distributed biosand, ceramic, or Sawyer filters in Haiti after the 2010 earthquake and cholera outbreak. We conducted household surveys and tested Escherichia coli and turbidity in stored household untreated and treated water in ∼50 randomly selected households from each program. Across programs, self-reported filter use ranged from 27 to 78%; confirmed use (participants with reported use who also showed the filter with water currently in it) ranged from 20 to 76%; and effective use (participants who used the filter to improve water quality to international guideline values) ranged from 0 to 54%. Overall, programs that more successfully met evaluation metrics: (1) distributed an effective technology; (2) provided safe storage; (3) required cash investment; (4) provided initial training; (5) provided follow-up; (6) provided supply-chain access; (7) targeted households relying on contaminated water sources; and, (8) had experience working in the local context. These findings, similar to results of previous research on HWT, suggest that well-implemented programs have the potential to result in sustained household filter use in Haiti.

Globally, approximately two billion people drink contaminated water. Use of household water treatment (HWT) methods, such as locally manufactured ceramic filters, reduces the diarrheal disease burden associated with unclean water. We evaluated the quality, effectiveness, and acceptability of ceramic filters in two communities in Arusha, Tanzania, by conducting: 1) baseline household surveys with 50 families; 2) filter flow rate testing; 3) filter distribution with training sessions; 4) follow-up surveys at 2, 4, and 6 weeks after distribution; and 5) project end focus group discussions. We tested Escherichia coli (E. coli) and turbidity at baseline and the first two follow-ups. We found: 1) filter quality was low, as only 46% of filters met recommended flow rate guidelines and 18% of filters broke during the 6-week study; 2) filter effectiveness was moderate, with 8% and 35% of filters effectively reducing E. coli to <1 CFU/100 mL and <10 CFU/100 mL, respectively, at follow-ups; and, 3) filter acceptability was high, with 94% overall satisfaction and 96–100% reported use in the previous day. These results highlight the importance of mixed methods research as HWT product quality, effectiveness, and acceptability all impact product efficacy, and the need for quality assurance/quality control and certification schemes for locally manufactured HWT products.