Assessing the Impact of Water Filters and Improved Cook Stoves on Drinking Water Quality and Household Air Pollution: A Randomised Controlled Trial in Rwanda

Ghislaine Rosa,Sophie Boisson,Fiona Majorin,Miles Kirby,Fidele Ngabo,Christina Barstow,Thomas Clasen,Evan Thomas,Michael Johnson,Robert K. Hills

doi:10.1371/journal.pone.0091011

Abstract

Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions.Trial registration: Clinicaltrials.gov; NCT01882777; http://clinicaltrials.gov/ct2/results?term=NCT01882777&Search=Search

Highlights

Environmental contamination at the household level is a major cause of death and disease, among rural populations in low-income countries
We found high reported use of the intervention filter, which was associated with significantly higher microbiological quality of drinking water when consumed directly from the filter
We found improved household air quality among intervention households despite continued use of the traditional stove

Summary

Introduction

Environmental contamination at the household level is a major cause of death and disease, among rural populations in low-income countries. The Global Burden of Disease (GBD) 2010 project found HAP from solid fuels to be responsible for 3.5 million premature deaths globally [1] In this same assessment, smoke from household cooking fuels was responsible for another half a million premature deaths due to contributions to outdoor air pollution [1]. Smoke from household cooking fuels was responsible for another half a million premature deaths due to contributions to outdoor air pollution [1] These environmental hazards are aggravated among rural inhabitants of sub-Saharan Africa who are more likely to rely on unsafe water supplies and cook using biomass fuels on inefficient stoves [4,5,6]

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