Abstract
AbstractSafe water storage protects household drinking water from microbial contamination, maintaining water quality and preventing diarrhea and other water-borne diseases. However, achieving high adoption and sustained use of safe storage is challenging. Systematic adaptation can address these challenges by improving contextual fit while retaining core functionality to protect water quality. We applied Plan-Do-Study-Act (PDSA) cycles to systematically adapt a safe water storage container (SWSC) intervention for implementation in rural Burkina Faso. This study describes the adaptation process and the impacts of the SWSC on Escherichia coli contamination in household stored water in a cluster-randomized trial with 49 intervention villages (274 households) and 50 no-intervention control villages (290 households). SWSC adoption among intervention households was high (88.9%). The intervention achieved approximately a 0.4 log reduction in E. coli contamination. Intervention impact was likely moderated by differential changes in improved source use across intervention and control households. Safe storage improves water quality when used consistently. PDSA frameworks can guide the adaptation of safe storage interventions to optimize adoption and sustained use in new contexts while preserving core functions that protect water quality.
Highlights
Access to safe drinking water is an important predictor of health
We present the systematic adaptation of a safe water storage container (SWSC) using PDSA cycles
The original SWSC was first designed and implemented in Ghana (Fisher et al 2020), and here we describe its adaption for use in rural Burkina Faso
Summary
Access to safe drinking water is an important predictor of health. Unsafe drinking water is associated with various adverse health outcomes, including diarrheal disease and other enteric infections (Bartram & Cairncross 2010; Clasen et al 2015). 485,000 deaths annually from diarrheal disease are attributable to unsafe drinking water in low- and middleincome countries (Prüss-Ustün et al 2019). Goal 6 under the sustainable development goals sets targets for achieving ‘safely managed’ water for all, where safely managed is defined as a source ‘located on the premises, available when needed, and free of fecal and priority chemical contamination’ (WHO 2017). ‘basic’ services comprise access to a water source that is located within a 30-min round-trip collection time and is protected from contamination due to its construction or design but not tested for chemical or microbial safety. Estimated 1.4 billion people rely on basic services, while further 206 million use a protected source requiring greater than 30-min collection time (WHO/UNICEF 2020)
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