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Luoto J.,RAND Corporation | Najnin N.,International Center for Diarrheal Disease Research | Mahmud M.,International Center for Diarrheal Disease Research | Mahmud M.,Bangladesh Institute of Development Studies | And 5 more authors.
PLoS ONE | Year: 2011

Background: There is evidence that household point-of-use (POU) water treatment products can reduce the enormous burden of water-borne illness. Nevertheless, adoption among the global poor is very low, and little evidence exists on why. Methods: We gave 600 households in poor communities in Dhaka, Bangladesh randomly-ordered two-month free trials of four water treatment products: dilute liquid chlorine (sodium hypochlorite solution, marketed locally as Water Guard), sodium dichloroisocyanurate tablets (branded as Aquatabs), a combined flocculant-disinfectant powdered mixture (the PUR Purifier of Water), and a silver-coated ceramic siphon filter. Consumers also received education on the dangers of untreated drinking water. We measured which products consumers used with self-reports, observation (for the filter), and chlorine tests (for the other products). We also measured drinking water's contamination with E. coli (compared to 200 control households). Findings: Households reported highest usage of the filter, although no product had even 30% usage. E. coli concentrations in stored drinking water were generally lowest when households had Water Guard. Households that self-reported product usage had large reductions in E. coli concentrations with any product as compared to controls. Conclusion: Traditional arguments for the low adoption of POU products focus on affordability, consumers' lack of information about germs and the dangers of unsafe water, and specific products not meshing with a household's preferences. In this study we provided free trials, repeated informational messages explaining the dangers of untreated water, and a variety of product designs. The low usage of all products despite such efforts makes clear that important barriers exist beyond cost, information, and variation among these four product designs. Without a better understanding of the choices and aspirations of the target end-users, household-based water treatment is unlikely to reduce morbidity and mortality substantially in urban Bangladesh and similar populations. © 2011 Luoto et al.

Luoto J.,RAND | Mahmud M.,International Center for Diarrheal Disease Research | Mahmud M.,Bangladesh Institute of Development Studies | Albert J.,Aquaya Institute | And 4 more authors.
Environmental Science and Technology | Year: 2012

Low-cost point-of-use (POU) safe water products have the potential to reduce waterborne illness, but adoption by the global poor remains low. We performed an eight-month randomized trial of four low-cost household water treatment products in Dhaka, Bangladesh. Intervention households (n = 600) received repeated educational messages about the importance of drinking safe water along with consecutive two-month free trials with each of four POU products in random order. Households randomly assigned to the control group (n = 200) did not receive free products or repeated educational messages. Households' willingness to pay for these products was quite low on average (as measured by bids in an incentive-compatible real-money auction), although a modest share was willing to pay the actual or expected retail price for low-cost chlorine-based products. Furthermore, contrary to our hypotheses that both one's own personal experience and the influence of one's peers would increase consumers' willingness to pay, direct experience significantly decreased mean bids by 18-55% for three of the four products and had no discernible effect on the fourth. Neighbor experience also did not increase bids. Widespread dissemination of safe water products is unlikely until we better understand the preferences and aspirations of these at-risk populations. © 2012 American Chemical Society.

Arnold B.F.,University of California at Berkeley | Khush R.S.,Aquaya Institute | Ramaswamy P.,Sri Ramachandra Medical College and Research Institute | Rajkumar P.,Sri Ramachandra Medical College and Research Institute | And 4 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2015

Discreet collection of spot check observations to measure household hygiene conditions is a common measurement technique in epidemiologic studies of hygiene in low-income countries. The objective of this study was to determine whether the collection of spot check observations in longitudinal studies could itself induce reactivity (i.e., change participant behavior). We analyzed data from a 12-month prospective cohort study in rural Tamil Nadu, India that was conducted in the absence of any hygiene or toilet promotion activities. Our data included hygiene and toilet spot checks from 10,427 household visits. We found substantial evidence of participant reactivity to spot check observations of hygiene practices that were easy to modify on short notice. For example, soap observed at the household's primary handwashing location increased from 49%at enrollment to 81%by the fourth visit and remained at or above 77% for the remainder of the study. Copyright © 2015 by The American Society of Tropical Medicine and Hygiene.

Kumpel E.,University of California at Berkeley | Kumpel E.,Aquaya Institute | Nelson K.L.,University of California at Berkeley
Environmental Science and Technology | Year: 2016

Intermittent water supplies (IWS), in which water is provided through pipes for only limited durations, serve at least 300 million people around the world. However, providing water intermittently can compromise water quality in the distribution system. In IWS systems, the pipes do not supply water for periods of time, supply periods are shortened, and pipes experience regular flow restarting and draining. These unique behaviors affect distribution system water quality in ways that are different than during normal operations in continuous water supplies (CWS). A better understanding of the influence of IWS on mechanisms causing contamination can help lead to incremental steps that protect water quality and minimize health risks. This review examines the status and nature of IWS practices throughout the world, the evidence of the effect of IWS on water quality, and how the typical contexts in which IWS systems often exist-low-income countries with under-resourced utilities and inadequate sanitation infrastructure-can exacerbate mechanisms causing contamination. We then highlight knowledge gaps for further research to improve our understanding of water quality in IWS. © 2015 American Chemical Society.

Rahman Z.,Aquaya Institute | Aleru L.,Riara Corporation
36th WEDC International Conference: Delivering Water, Sanitation and Hygiene Services in an Uncertain Environment | Year: 2013

Microbial water quality testing is critical for the provision of safe drinking water, yet microbial testing activity is limited in much of the developing world. This briefing note provides insight into the status of microbial testing programs in developing countries and introduces the Monitoring for Safe Water Program, a study that will examine constraints to microbial water quality testing faced by water suppliers and surveillance agencies in sub-Saharan Africa.

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