Understanding and improving water sanitation practices to improve health outcomes in Malawi

Abstract

www.thelancet.com/lancetgh 27 Published Online April 8, 2016 Virginia Tech Carilion School of Medicine, Roanoke, VA, USA (P A Muelenaer MD); Virginia Polytechnic and State University, Blacksburg, VA, USA (K Redican PhD, S W Marmagas MPH); Mzuzu University, Mzuzu, Malawi (R H Holm PhD) Correspondence to: Penelope Muelenaer , 6736 Mallard Lake Drive, Roanoke, VA 24018-6931, USA pamuelenaer@carilionclinic. org Understanding and improving water sanitation practices to improve health outcomes in Malawi Penelope A Muelenaer, Kerry J Redican, Susan W Marmagas, Rochelle H Holm Abstract Background Sustainable Development Goals (SDG) for the universal provision of safe drinking water in the household focus on the need for sustainable, eff ective, and acceptable household water treatment. In this study we aimed to: understand baseline practices and knowledge related to household water supply, safety of drinking water, and hygiene and sanitation; and compare the effi cacy and acceptance of three diff erent point-of-use water treatment interventions.Background Sustainable Development Goals (SDG) for the universal provision of safe drinking water in the household focus on the need for sustainable, eff ective, and acceptable household water treatment. In this study we aimed to: understand baseline practices and knowledge related to household water supply, safety of drinking water, and hygiene and sanitation; and compare the effi cacy and acceptance of three diff erent point-of-use water treatment interventions. Methods We undertook a fi eld study of 30 households in a peri-urban neighbourhood adjacent to the city of Mzuzu, Malawi. We used a random number generator to assign households to one of three water purifi cation interventions: boiling, Waterguard chlorine solution (PSI/Malawi, Blantyre, Malawi) , or Tulip table-top ceramic fi lter. We analysed samples taken from a drinking-water storage container in each household at baseline and 2 weeks after baseline, and recorded total coliform and Escherichia coli count s. Participants completed an initial structured questionnaire about water sources used, sanitation, health, water consumption patterns, and socioeconomic variables in their household. Follow-up questionnaires at 1 week and 2 weeks after the intervention, focused on use and acceptance of the assigned treatment modality. We used WHO health risk standards, and correlated drinking water quality with the questionnaire responses. We used Fisher’s exact test for data analysis. Findings Final data analysis included 28 households: nine from the Tulip fi lter group, 10 from Waterguard chlorination, and nine from the group who boiled water. Two households had incomplete data and were excluded from analysis. Before the intervention, 29 of 30 households were not treating their water. The no-risk WHO standard of 0 CFU/100 mL Escherichia coli was met in eight (89%) samples from households assigned to the Tulip fi lter, four (40%) who used Waterguard , and fi ve (56%) that boiled water. Of the households that boiled water three (30%) met criteria for high, or very high risk. No statistical diff erences were noted between the treatment methods (p=0·081). Ratings of water appearance, smell, and taste were highest in the Tulip fi lter group and lowest in those who boiled water. All households that used the Tulip fi lter intervention expressed satisfaction with the method and wanted to continue to use the fi lter. Interpretation This study provides evidence to inform the development of public health educational programmes that promote household drinking water treatment, improved hygiene and sanitation practices for low-income and middleincome countries working to meet the SDGs. While not statistically signifi cant, there was a trend toward superior performance by the Tulip fi lter in eff ective treatment of household water. Future comparisons of these interventions in a larger study would need to be done to achieve the statistical power to detect a signifi cant diff erence in the three household water treatment methods studied. Funding The Pediatric Medical Device Institute. Copyright © Muelenaer et al. Open Access article distributed under the terms of CC BY. Declaration of interests We declare no competing interests.