Promoting household water treatment through women's self help groups in Rural India: assessing impact on drinking water quality and equity.

Matthew C Freeman,Thomas Clasen,Victoria Trinies,Sophie Boisson,Gregory Mak,A Mark Ibekwe

doi:10.1371/journal.pone.0044068

Matthew C Freeman, Thomas Clasen + Show 4 more

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https://doi.org/10.1371/journal.pone.0044068

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Abstract

Household water treatment, including boiling, chlorination and filtration, has been shown effective in improving drinking water quality and preventing diarrheal disease among vulnerable populations. We used a case-control study design to evaluate the extent to which the commercial promotion of household water filters through microfinance institutions to women's self-help group (SHG) members improved access to safe drinking water. This pilot program achieved a 9.8% adoption rate among women targeted for adoption. Data from surveys and assays of fecal contamination (thermotolerant coliforms, TTC) of drinking water samples (source and household) were analyzed from 281 filter adopters and 247 non-adopters exposed to the program; 251 non-SHG members were also surveyed. While adopters were more likely than non-adopters to have children under 5 years, they were also more educated, less poor, more likely to have access to improved water supplies, and more likely to have previously used a water filter. Adopters had lower levels of fecal contamination of household drinking water than non-adopters, even among those non-adopters who treated their water by boiling or using traditional ceramic filters. Nevertheless, one-third of water samples from adopter households exceeded 100 TTC/100ml (high risk), and more than a quarter of the filters had no stored treated water available when visited by an investigator, raising concerns about correct, consistent use. In addition, the poorest adopters were less likely to see improvements in their water quality. Comparisons of SHG and non-SHG members suggest similar demographic characteristics, indicating SHG members are an appropriate target group for this promotion campaign. However, in order to increase the potential for health gains, future programs will need to increase uptake, particularly among the poorest households who are most susceptible to disease morbidity and mortality, and focus on strategies to improve the correct, consistent and sustained use of these water treatment products.

Highlights

Unsafe drinking water is a leading cause of preventable disease, among the young, the immuno-compromised and the poor [1]
During the initial 18 months of the program, 3,651 filters were purchased among 41,290 self-help group (SHG) members exposed to the program in the four microfinance institutions (MFIs) included in the study, an adoption rate of 8.8% (Table 1)
The pilot program resulted in increased water quality among households that had adopted a Pureit water filter; the program had only limited success in achieving its aim of providing safe drinking water to a vulnerable population

Summary

Introduction

Unsafe drinking water is a leading cause of preventable disease, among the young, the immuno-compromised and the poor [1]. Diarrhea represents a significant share of this burden, causing an estimated 4 billion cases and 1.9 million deaths each year of children under 5 years, or 19% of all such deaths in developing countries [2]. Because they lack safe water and sanitation, low-income populations bear much of this disease burden [3]. India has made considerable progress in recent years in improving water supplies in both rural and urban settings [5]. Surveys of microbial water quality throughout India have shown extensive fecal contamination of drinking water supplies. Even water that is safe at the point of distribution is subject to frequent and substantial contamination during collection, transport, and storage [9]

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