Piloting a Shared Source Water Treatment Intervention among Elementary Schools in Bangladesh.

Farzana Yeasmin,Leanne Unicomb,Humayun Kabir,Mahbubur Rahman,Stephen P Luby,Farhana Sultana,Peter J Winch,Fosiul Alam Nizame

doi:10.4269/ajtmh.18-0984

Abstract

.Hundreds of thousands of children continue to die each year from diarrhea. We piloted a low-cost liquid chlorine point-of-use (POU) water treatment among elementary school children in Bangladesh. We began the 1-month intervention in four schools (two urban and two rural) by introducing POU drinking water hardware and behavior change communication. We trained teachers to deliver sessions encouraging students to drink chlorinated water from their own small plastic bottles to avoid disease transmission. We used cue cards and flip charts as visual aids. We evaluated the acceptability, feasibility, and potential for sustainability after 1 month and after 14 months of the intervention. During 1-month follow-up, among 141 drinking events observed, 141 students (100%) drank chlorinated water. In 93 or 66% of events, students used their own bottles, and in 43 (30%) of the events, they used common cups or hands washed before drinking. During the 14-month follow-up, we observed 732 drinking events. In 653 of 732 events (89%), students drank chlorinated water; in 78 events (11%), they consumed water from untreated drinking water sources. Among those who consumed chlorinated water, 20% (131/653) used their own bottles to drink water, 72% (467/653) used common cups, and 8% (55/653) used both hands to drink water. Most stated that they drank chlorinated water because it is safe, it has health benefits, and treatment reduces germs. Introduction of specific hardware, weekly hygiene sessions, and education materials enabled schools to treat water at POU and students to consume treated water.

Highlights

The number of diarrheal deaths has reduced over recent decades, hundreds of thousands of children continue to die each year from diarrhea.[1]
In contrast to the low uptake found in Bangladeshi households where each individual household decided whether to chlorinate water, we explored how a more centralized decision in an institutional setting would affect water treatment uptake with the potential to impact a larger number of people
We developed a water treatment intervention to address the reported barriers related to POU water treatment methods for safe drinking water

Summary

Introduction

The number of diarrheal deaths has reduced over recent decades, hundreds of thousands of children continue to die each year from diarrhea.[1]. Most studies on promotion of point-of-use (POU) water treatment have focused on households.[5] These studies have documented consistently low uptake, with the exception of some studies on boiling.[6] A key difficulty has been the need to convince each individual household to adopt and use the POU technology. In Dhaka, Bangladesh, low uptake of four low-cost household POU products was noted even among households who received products free of cost and repeated educational messages about the importance of drinking safe water.[7] there was a low willingness to pay for these products.[7] Household water treatment requires individual-level time, effort, and new habit adoption within each household, which might contribute to low chlorinebased POU technology uptake.[3,8]

Methods

Results

Conclusion