Every year 2800 deaths in Pacific island countries result from diarrhoea, and most are children under five years of age. These tragic diarrheal deaths are preventable as they are often linked to unsafe water, lack of proper sanitation facilities and poor hygienic practices. Effective preventive management through the framework of a drinking Water Safety Plan (WSP) is an efficient mechanism for ensuring the safe quality of drinking water thereby reducing the burden of water related diseases. The large proportion (81%) of people in Pacific island countries living in rural or outer island communities mostly have their own water supply (for example rainwater tanks or hand-dug wells), and often the water is consumed untreated. The remoteness and isolation of these rural communities prevent national surveillance authorities to regularly visit and provide advice on drinking water safety issues. In such circumstances empowering rural communities to ensure the safety of their drinking water, through trained local facilitators, could be promoted and utilised effectively. However, WSPs for rural communities have to be relatively simple hence tools such as modified sanitary inspections and the presence/absence hydrogen sulfide test could be used. The approach of empowering communities through trained local facilitators to promote the WSP framework has been implemented in the Republic of Marshall Islands (RMI). Positive feedback has been received by trained facilitators in RMI on the use of modified sanitary inspections (translated into Marshallese) and the hydrogen sulfide test. It is believed that the approach of empowering communities on WSPs through training local facilitators and equipping them with the above mentioned simple tools is effective and has potential for further replication in rural Pacific communities to improve drinking water quality and reduce the burden of water related diseases.
A non-governmental organisation has distributed point-of-use water filtering units in the Western Division of Fiji. We sought to understand filter utilisation and water quality: both water flowing directly out of filters and stored water. We surveyed 270 households and 6 schools on filter use and performed hydrogen sulphide bacterial indicator testing on 24 water samples directly from filters and 37 stored water samples. Our response rate was 95%. Of these, only half (52%) reported consistently filtering their drinking water. Very few (8%) reported consistent use when preparing kava, a traditional drink. Factors associated with limited filter use included lost or broken filter parts (22%) (p < 0.05) and perception of source water quality as 44% of respondents who believed their source water was safe to drink reported consistent filter use compared to 68% of respondents who did not (p < 0.01). Bacterial indicator testing using hydrogen sulphide paper-strips showed that most water samples directly from the filter (71%) and from storage vessels (76%) were contaminated. Limited levels of use and high levels of contamination in both water directly from the filter and stored water raise serious questions as to the benefit of the filter even as an interim water quality solution in this setting.
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