Effectiveness of Chlorine Dispensers in Emergencies: Case Study Results from Haiti, Sierra Leone, Democratic Republic of Congo, and Senegal

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.

Impact of WASH interventions during disease outbreaks in humanitarian emergencies: A systematic review protocol

“…Previous knowledge of the intervention, existing behaviors, or type of outbreak are just some of the contextual factors that can carry a large influence. For example, similar chlorine Dispensers interventions carried out in four different emergency contexts (cholera in Sierra Leone, food security in Senegal, cholera in the Democratic Republic of Congo, and cholera in Haiti) resulted in a wide range of effective use (0-81%) [31]. There is no 'silver bullet' of WASH programs that is applicable in all situations [32].…”

Short-term WASH interventions in emergency response: a systematic review

“…In an evaluation of household water treatment (HWT) in four separate acute emergencies (cholera in Nepal, earthquake in Indonesia, flooding in Kenya, and displacement in Haiti), effective use of different treatment strategies ranged from 0- 67.5% [18]. Installing chlorine Dispensers as a source-based treatment had a similar wide range of effective use (0-81%) in four emergency contexts (cholera in Sierra Leone, food security in Senegal, cholera in the Democratic Republic of Congo, and cholera in Haiti) [19].…”

“…Lantagne and Clasen (2012) and Yates et al (2015) are two examples of non-experimental design field research that draws strength from consistency, rather than evaluation methodology. Both papers utilized the same or similar evaluations in different contexts to highlight differences in use and also barriers and facilitators for a specific intervention.…”

WASH Interventions in Disease Outbreak Response

“…Dispensers were used in three different cholera contexts: Haiti, Sierra Leone and Democratic Republic of Congo (DRC) with three different NGOs (Yates, Armitage, et al, 2015). Results over two acute evaluations (2-8 weeks after installation) and three sustained evaluations (4-7 months after installation) focused on reported use, confirmed use and effective use (Figure 3.7).…”

“… Reduced transmission risk -More common than disease reduction evaluations, interventions that evaluate the risk of transmission included: well disinfection Libessart and Hammache, 2000;Garandeau et al, 2006;Guevart et al, 2008;Cavallaro et al, 2011), chlorine dispensers (Yates, Armitage, et al, 2015), HWT (liquid chlorine (Mong et al, 2001;Dunston et al, 2001;Lantagne and Clasen, 2012;ACF 2014b), chlorine tablets (Imanishi et al, 2014;Lantagne and Clasen, 2012;ACF, 2009;Tokplo, 2015;ACF, 2014a) and flocculant/disinfectants (Doocy and Burnham, 2006;Lantagne and Clasen, 2012;ACF 2014a)). Environmental hygiene interventions using chlorine to clean jerry cans also reduced short-term transmission risk Walden et al, 2005;Roberts et al, 2001).…”