Abstract
BackgroundDiarrhoea is the second leading cause of childhood mortality, with an estimated 1.3 million deaths per year. Promotion of Solar Water Disinfection (SODIS) has been suggested as a strategy for reducing the global burden of diarrhoea by improving the microbiological quality of drinking water. Despite increasing support for the large-scale dissemination of SODIS, there are few reports describing the effectiveness of its implementation. It is, therefore, important to identify and understand the mechanisms that lead to adoption and regular use of SODIS.MethodsWe investigated the behaviours associated with SODIS adoption among households assigned to receive SODIS promotion during a cluster-randomized trial in rural Bolivia. Distinct groups of SODIS-users were identified on the basis of six compliance indicators using principal components and cluster analysis. The probability of adopting SODIS as a function of campaign exposure and household characteristics was evaluated using ordinal logistic regression models.ResultsStandardised, community-level SODIS-implementation in a rural Bolivian setting was associated with a median SODIS use of 32% (IQR: 17-50). Households that were more likely to use SODIS were those that participated more frequently in SODIS promotional events (OR = 1.07, 95%CI: 1.01-1.13), included women (OR = 1.18, 95%CI: 1.07-1.30), owned latrines (OR = 3.38, 95%CI: 1.07-10.70), and had severely wasted children living in the home (OR = 2.17, 95%CI: 1.34-3.49).ConclusionsMost of the observed household characteristics showed limited potential to predict compliance with a comprehensive, year-long SODIS-promotion campaign; this finding reflects the complexity of behaviour change in the context of household water treatment. However, our findings also suggest that the motivation to adopt new water treatment habits and to acquire new knowledge about drinking water treatment is associated with prior engagements in sanitary hygiene and with the experience of contemporary family health concerns.Household-level factors like the ownership of a latrine, a large proportion of females and the presence of a malnourished child living in a home are easily assessable indicators that SODIS-programme managers could use to identify early adopters in SODIS promotion campaigns.Trial RegistrationClinicalTrials.gov: NCT00731497
Highlights
Diarrhoea is the second leading cause of childhood mortality, with an estimated 1.3 million deaths per year
To confirm the patterns of Solar Water Disinfection (SODIS)-use we further examined the distribution of the study households in the data defined by the factorial axes of a principal component analysis based on the SODIS-use indicators [33]
The level of SODIS-use varied depending on the indicator used and the source of information
Summary
Diarrhoea is the second leading cause of childhood mortality, with an estimated 1.3 million deaths per year. Recent studies demonstrate that SODIS promotion is unlikely to reduce diarrhoea in children below 5 years of age if there are low adoption rates and limited long-term use by the target population [6,15,19,20]. It is important to identify and understand the mechanisms that attenuate the health impacts of SODIS despite its high efficacy for improving water quality under ideal conditions [12,21]
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