Abstract
Risk-based water safety interventions are one approach to improve drinking water quality and consequently reduce the number of people consuming faecally contaminated water. Despite broad acceptance of water safety planning approaches globally, there is a lack of evidence of their effectiveness for community-managed piped water supplies in rural areas of developing countries. Our research, in the form of a cluster-based controlled pre-post intervention analysis, investigated the impact of a combined water safety intervention on outcomes of microbial water quality, users' perceptions and piped system functionality in rural Nepal. The study enrolled 21 treatment systems and 12 control systems across five districts of the Karnali and Sudurpaschim provinces. Treatment group interventions included field laboratories for microbial analysis, regular monitoring of water quality including sanitary inspections, targeted treatment and infrastructure improvements, household hygiene and water filter promotion, and community training. In certain systems, regular system-level chlorination was implemented. Before and after the interventions, the microbial water quality was measured at multiple points within the water system. This information was complemented by household interviews and sanitary inspections. The main result to emerge from this study is that chlorination is the only identified intervention that led to a significant reduction in E. coli concentration at the point of consumption. Secondly, the effectiveness of other interventions was presumably reduced due to higher contamination at endline in general, brought about by the monsoon. All the interventions had a positive impact on users' perceptions about their water system, as measured by expectations for future functionality, satisfaction with the services received, and awareness of the potential health risks of drinking contaminated water. For future applications we would recommend the more broadly applied use of chlorination methods at system level as a key component of the package of risk-based water safety interventions.
Highlights
Access to safe drinking water is a basic human right still denied to many
This study focuses on rural communities in Karnali and Sudurpaschim provinces, in Western Nepal, where the majority of the population relies on a faecally contaminated drinking water source (WHO/UNICEF Joint Monitoring Programme, 2019)
The 33 water systems within this study served 29–250 households [Mean (M) = 67.4, Standard Deviation (SD) = 44.0], of which we interviewed 15 each
Summary
Access to safe drinking water is a basic human right still denied to many. In 2017, 93% of the global population had access to an improved drinking water source, while 579 million people still used unimproved sources such as unprotected springs, open wells and surface water (WHO/UNICEF Joint Monitoring Programme, 2019). An improved water source does not always ensure adequate drinking water quality (Bain et al, 2014a; Shaheed et al, 2014). It has been estimated that around 10% of improved water sources are heavily faecally contaminated, with >100 Escherichia coli (E. coli) colony forming units (CFU)/100 mL (Bain et al, 2014b). This corresponds to 1.8 billion people globally using a faecally contaminated drinking water source (Bain et al, 2014b). Households must use an improved water source that is accessible on premises, available when needed, and free from fecal and priority chemical contamination (WHO/UNICEF Joint Monitoring Programme, 2019)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
