Use, microbiological effectiveness and health impact of a household water filter intervention in rural Rwanda—A matched cohort study

Abstract

Kirby, M.A.; Nagel, C.L.; Rosa, G.; Umupfasoni, M.M.; Iyakaremye, L.; Clasen, T.F. (2017) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Graphical abstract ABSTRACTUnsafe drinking water is a substantial health risk contributing to child diarrhoea. We investigated impacts of a program that provided a water filter to households in rural Rwandan villages. We assessed drinking water quality and reported diarrhoea 12-24 months after intervention delivery among 269 households in the poorest tertile with a child under 5 from 9 intervention villages and 9 matched control villages. We also documented filter coverage and use. In Round 1 (12-18 months after delivery), 97.4% of intervention households reported receiving the filter, 84.5%were working, and 86.0% of working filters contained water. Sensors confirmed half of households with working filters filled them at least once every other day on average. Coverage and usage was similar in Round 2 (19-24 months after delivery). The odds of detecting faecal indicator bacteria in drinking water were 78% lower in the intervention arm than the control arm (odds ratio (OR) 0.22, 95% credible interval (CrI) 0.10-0.39, p<0.001). The intervention arm also had 50% lower odds of reported diarrhoea among children <5 than the control arm (OR=0.50, 95% CrI 0.23-0.90, p=0.03). The protective effect of the filter is also suggested by reduced odds of reported diarrhoea-related visits to community health workers or clinics, although these did not reach statistical significance.

Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda

“…The intervention’s impact may also be due in part to extensive planning and piloting; the involvement of CHWs; engagement with local, regional, and national leaders; the development of culturally appropriate training and promotional materials, including skits and radio songs; and incorporating feedback from community focus groups into programmatic activities [29]. A previous study of the pilot intervention in Rwanda suggests filter use can persist 1–2 years after receipt in the context of ongoing programmatic engagement [28].…”

“…The program, which was financed by anticipated carbon credits [25], was implemented by the UK-based social enterprise DelAgua Health in collaboration with the Rwanda Ministry of Health (MOH) and targeted households in Ubudehe categories 1 and 2—roughly the government-designated poorest 25% of households in the province [26]. Previous pilot studies in similar settings found the filter and stove to be effective in improving drinking water quality and cooking area air quality [27,28].…”

“…The sample size was calculated based on the primary outcomes of 7-day period prevalence of caregiver-reported diarrhea and ARI. We assumed a baseline diarrhea prevalence of 12% and a baseline ARI prevalence of 12% among children under 5 years in Western Province based on analysis of data from the 2010 Rwandan DHS and our pilot work in the study population [28]. We calculated the required sample size necessary to detect a 25% reduction in prevalence of each of diarrhea and ARI as being both clinically significant and consistent with previous studies examining the impact of household water treatment on diarrhea [12] and cookstoves on respiratory health.…”

Use, Acceptability, Performance, and Health Impact of Hollow Fiber Ultrafilters for Water Treatment in Rural Kenyan Households, 2009–2011

“…A recent study in Rwanda found higher usage with the Lifestraw Family 2.0 than Lifestraw Family 1.0 that we used in this study. 30 These findings highlight that convenience and ease of use are important factors contributing to the consistent use of water treatment technologies. However, a review by the WHO found that Lifestraw Family 1.0 might be slightly more effective at removing bacteria, protozoa, and viruses than Lifestraw Family 2.0.…”

“…Responses from study participants suggested that improvements to the HFU design, including improved flow rate, increased reservoir size, and more convenient installation in the home could make the HFUs more desirable, and perhaps lead to increased use. In fact, recent improvements to the HFU, including a tabletop design with a larger reservoir, have resulted in higher levels of use in one evaluation, 30 although questions about performance of the new design remain. Further study is necessary to assess filter efficacy, acceptability, and health impact.…”