Global water research and monitoring typically focus on the household's “main source of drinking‐water.” Use of multiple water sources to meet daily household needs has been noted in many developing countries but rarely quantified or reported in detail. We gathered self‐reported data using a cross‐sectional survey of 405 households in eight communities of the Republic of the Marshall Islands (RMI) and five Solomon Islands (SI) communities. Over 90% of households used multiple sources, with differences in sources and uses between wet and dry seasons. Most RMI households had large rainwater tanks and rationed stored rainwater for drinking throughout the dry season, whereas most SI households collected rainwater in small pots, precluding storage across seasons. Use of a source for cooking was strongly positively correlated with use for drinking, whereas use for cooking was negatively correlated or uncorrelated with nonconsumptive uses (e.g., bathing). Dry season water uses implied greater risk of water‐borne disease, with fewer (frequently zero) handwashing sources reported and more unimproved sources consumed. Use of multiple sources is fundamental to household water management and feasible to monitor using electronic survey tools. We contend that recognizing multiple water sources can greatly improve understanding of household‐level and community‐level climate change resilience, that use of multiple sources confounds health impact studies of water interventions, and that incorporating multiple sources into water supply interventions can yield heretofore‐unrealized benefits. We propose that failure to consider multiple sources undermines the design and effectiveness of global water monitoring, data interpretation, implementation, policy, and research.

The routine use of multiple water sources to meet household water needs is widely practiced and has been reported in many developing countries. However, it is typically neglected by implementers, development organizations, and researchers who tend to focus exclusively on the "main source of drinking water." In this Perspective, we explain the nature and scope of multiple water source use (MWSU) at the household level in developing countries. We also describe the implications of MWSU for human health and water resilience, and identify key knowledge gaps, risks, and opportunities associated with MWSU. Finally, we argue that understanding MWSU is feasible for researchers and implementers and is essential for properly designing research studies and water supply projects.npj Clean Water (2019) 2:6 ; https://doi.

The Pacific region presents some of the lowest water and sanitation coverage figures globally, with some countries showing stagnating or even declining access to improved water and sanitation. In addition, Pacific Island Countries (PICs) are among the most vulnerable countries on the globe to extreme and variable climatic events and sea-level rise caused by climate change. By exploring the state of water and sanitation coverage in PICs and projected climatic variations, we add to the growing case for conserving water, sanitation and hygiene (WASH) interventions within a holistic integrated water resource management (IWRM) framework. PICs face unique challenges of increasing variability in rainfall (leading to drought and flooding), increasing temperatures, and likely higher than average sea-level rise, all of which impact on freshwater security. Add to this geographic and economic isolation, and limited human and physical resources, and the challenge of WASH provision increases dramatically. In this setting, there is a stronger case than ever for adopting a holistic systems understanding, as promoted by IWRM frameworks, to WASH interventions so that they consider past and current challenges as well as future scenarios.

Pacific Island Countries (PICs) lag behind global trends in water, sanitation and hygiene (WaSH) development. We conducted a systematic search of all English language papers (published before February 2015) about WaSH in PICs to evaluate the state of the peer-reviewed literature and explore thematic findings. A total of 121 papers met the criteria for full-text review following an initial search result of more than 6000 papers. Two reviewers independently assessed the quality and relevance of each article and consolidated their findings according to four emergent themes: public health, environment, emergency response and interventions, and management and governance. Findings indicate a knowledge gap in evidence-guided WaSH management strategies that advocate for human health while concurrently protecting and preserving drinking water resources. Extreme weather events threaten the quantity and quality of limited freshwater resources, and cultural factors that are unique to PICs present challenges to hygiene and sanitation. This review highlights the strengths and weaknesses of the peer-reviewed literature on WaSH in PICs, addresses spatial and temporal publication trends, and suggests areas in need of further research to help PICs meet development goals.

This article scrutinizes the boiling of water in Tamil Nadu and Puducherry, India. Boiling, as it is commonly practiced, improves water quality, but its full potential is not being realized. Thus, the objective is to refine the method in practice, promote acceptability, and foster the scalability of boiling and household water treatment (HWT) writ large. The study is based on bacteriological samples from 300 households and 80 public standposts, 14 focus group discussions (FGDs), and 74 household interviews. Collectively, the data fashion both an empirical and ethnographic understanding of boiling. The rate and efficacy of boiling, barriers to and caveats of its adoption, and recommendations for augmenting its practice are detailed. While boiling is scientifically proven to eliminate bacteria, data demonstrate that pragmatics inhibit their total destruction. Furthermore, data and the literature indicate that a range of cultural, economic, and ancillary health factors challenge the uptake of boiling. Fieldwork and resultant knowledge arrive at strategies for overcoming these impediments. The article concludes with recommendations for selecting, introducing, and scaling up HWT mechanisms. A place-based approach that can be sustained over the long-term is espoused, and prolonged exposure by the interveners coupled with meaningful participation of the target population is essential.