Abstract
BackgroundThere is evidence that household point-of-use (POU) water treatment products can reduce the enormous burden of water-borne illness. Nevertheless, adoption among the global poor is very low, and little evidence exists on why.MethodsWe gave 600 households in poor communities in Dhaka, Bangladesh randomly-ordered two-month free trials of four water treatment products: dilute liquid chlorine (sodium hypochlorite solution, marketed locally as Water Guard), sodium dichloroisocyanurate tablets (branded as Aquatabs), a combined flocculant-disinfectant powdered mixture (the PUR Purifier of Water), and a silver-coated ceramic siphon filter. Consumers also received education on the dangers of untreated drinking water. We measured which products consumers used with self-reports, observation (for the filter), and chlorine tests (for the other products). We also measured drinking water's contamination with E. coli (compared to 200 control households).FindingsHouseholds reported highest usage of the filter, although no product had even 30% usage. E. coli concentrations in stored drinking water were generally lowest when households had Water Guard. Households that self-reported product usage had large reductions in E. coli concentrations with any product as compared to controls.ConclusionTraditional arguments for the low adoption of POU products focus on affordability, consumers' lack of information about germs and the dangers of unsafe water, and specific products not meshing with a household's preferences. In this study we provided free trials, repeated informational messages explaining the dangers of untreated water, and a variety of product designs. The low usage of all products despite such efforts makes clear that important barriers exist beyond cost, information, and variation among these four product designs. Without a better understanding of the choices and aspirations of the target end-users, household-based water treatment is unlikely to reduce morbidity and mortality substantially in urban Bangladesh and similar populations.
Highlights
A number of careful studies suggest that treating household drinking water at the point of use (POU) could prevent many of the infant and child deaths attributable to waterborne illness in developing countries [1,2,3]
Traditional arguments for the low adoption of POU products focus on affordability, consumers’ lack of information about germs and the dangers of unsafe water, and specific products not meshing with a household’s preferences
In this study we provided free trials, repeated informational messages explaining the dangers of untreated water, and a variety of product designs
Summary
A number of careful studies suggest that treating household drinking water at the point of use (POU) could prevent many of the infant and child deaths attributable to waterborne illness in developing countries [1,2,3]. There is little evidence on what does (or could) induce poor consumers to use POU products on a sustained basis. Our knowledge of factors promoting and impeding adoption of POU products is based on anecdotal reporting of field activities, a ‘‘gray’’ literature of unpublished reports [5,6,7,8,9] and a published article that collates the scattered documentation of sustained product use from epidemiological studies [10,11,12]. While each report adds value, there is room to improve our understanding of the preferences for and barriers impeding use of different POU products among poor consumers. There is evidence that household point-of-use (POU) water treatment products can reduce the enormous burden of water-borne illness. Adoption among the global poor is very low, and little evidence exists on why
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