Integration of Household Water Filters with Community-Based Sanitation and Hygiene Promotion—A Process Evaluation and Assessment of Use among Households in Rwanda

Abigail Bradshaw,Lambert Mugabo,Alemayehu Gebremariam,Laura Macdonald,Evan Thomas

doi:10.3390/su13041615

Abigail Bradshaw, Lambert Mugabo + Show 3 more

Open Access

https://doi.org/10.3390/su13041615

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Abstract

Unsafe drinking water contributes to diarrheal disease and is a major cause of morbidity and mortality in low-income contexts, especially among children under five years of age. Household-level water treatment interventions have previously been deployed in Rwanda to address microbial contamination of drinking water. In this paper, we describe an effort to integrate best practices regarding distribution and promotion of a household water filter with an on-going health behavior messaging program. We describe the implementation of this program and highlight key roles including the evaluators who secured overall funding and conducted a water quality and health impact trial, the promoters who were experts in the technology and behavioral messaging, and the implementers who were responsible for product distribution and education. In January 2019, 1023 LifeStraw Family 2.0 household water filters were distributed in 30 villages in the Rwamagana District of Rwanda. Approximately a year after distribution, 99.5% of filters were present in the household, and water was observed in 95.1% of filters. Compared to another recent water filter program in Rwanda, a lighter-touch engagement with households and supervision of data collection was observed, while also costing approximately twice per household compared to the predecessor program.

Highlights

Unsafe drinking water contributes to diarrheal disease and is a major cause of morbidity and mortality in low-income contexts, especially among children under five years of age [1]
In addition to this overarching objective, the study aimed to determine if distributing and promoting use of the household filter could lead to higher uptake of household water treatment practices than the promotion of water treatment and safe handling practices alone
This paper reports on the findings of the process evaluation, including measures of the first two indicators, coverage and use, as well as a discussion of the effectiveness of integrating the household water filter into Community Based Environmental Health Promotion Program (CBEHPP) in comparison with other water filter programming in Rwanda

Summary

Introduction

Unsafe drinking water contributes to diarrheal disease and is a major cause of morbidity and mortality in low-income contexts, especially among children under five years of age [1]. Access to a basic drinking water service—an improved source less than 30 min round trip, including queuing—in Rwanda increased from 47% in 2000 to 57% in 2015 [3]. In spite of this progress, unsafe water remains a leading risk-factor for disease in Rwanda, where diarrheal diseases cause an estimated 10% of total child mortality [1]. Tubeho Neza engaged Community Health Workers (CHWs) for filter distribution and household-level education. This education included culturally appropriate and locally informed behavior change messaging [11].

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