Project Lead(s): Carlton Evans
Diarrheal disease is the second leading cause of mortality among children under five, and is estimated to cause an even greater burden of morbidity because of impairment in cognitive and physical functioning.
Water treatment at the point of use is estimated to reduce diarrhea risk by 42%. However, despite the existence of a number of effective treatment technologies, boiling water remains the primary method of sterilizing water in low- and middle-income countries.
Other household water treatment methods have significant barriers to use, such as cost, lack of availability and cultural barriers.
This project investigated the potential for a low-cost household water treatment intervention – a water pasteurization indicator – to improve household drinking water quality and reduce childhood diarrhea in poor communities in the Peruvian Amazon.
Demand for household water treatment interventions is generally low, even when interventions are provided free of charge, socially marketed or have a demonstrated health benefit in the population.
However, water boiling has shown some potential to increase access to safe drinking water, as it is the only method of treatment that has reached scale in any country.
The use of a water pasteurization indicator leverages the popularity and cultural acceptability of boiling, with a lower associated cost of fuel and shorter time of treatment because, when used correctly, water is heated to the temperature of pasteurization (65C) rather than to the temperature of boiling (100C).
The indicators are also low-cost, as the materials to make the polycarbonate indicating tube cost less than $1.
The research team conducted formative research to understand the barriers and motivating factors influencing household water treatment in two communities (one peri-urban and one rural) lacking access to municipal piped water supplies near Iquitos in the Peruvian Amazon.
A randomized controlled trial was then undertaken to evaluate the water pasteurization indicator.
Although they demonstrated the feasibility of teaching a low-income, Amazonian population to use a pasteurization indicator to treat their drinking water, the team was unable to prove that the intervention reduced diarrhea among children under age five or fecal contamination of household drinking water.
In the randomized trial, the prototype water pasteurization indicator did not reduce the burden of diarrhea among children under five and, although the burden of diarrhea among household members ages five and older was reduced by 30%, the effect was not statistically significant. The intervention also did not reduce the prevalence of E. coli contamination of household drinking water.
Although the team aimed to conduct this study in a population where the popularity of boiling could be leveraged to encourage household water treatment, only 5% of participants reported water boiling at the enrollment visit – far lower than what would have been predicted.
Lastly, the improved water storage container improved water quality and reduced diarrhea in the absence of any other intervention, thus limiting the ability to observe a difference between the intervention and control groups.
Knowledge of the project was disseminated in a conference and to the regional Ministry of Health authorities.