Household-level Treatment Research Articles

"Our desire is to make this village intestinal worm free": Identifying determinants of high coverage of community-wide mass drug administration for soil transmitted helminths in Benin, India, and Malawi.

Soil-transmitted helminth infections (STH) are associated with substantial morbidity in low-and-middle-income countries, accounting for 2.7 million disability-adjusted life years annually. Current World Health Organization guidelines recommend controlling STH-associated morbidity through periodic deworming of at-risk populations, including children and women of reproductive age (15-49 years). However, there is increasing interest in community-wide mass drug administration (cMDA) which includes deworming adults who serve as infection reservoirs as a method to improve coverage and possibly to interrupt STH transmission. We investigated determinants of cMDA coverage by comparing high-coverage clusters (HCCs) and low-coverage clusters (LCCs) receiving STH cMDA in three countries. A convergent mixed-methods design was used to analyze data from HCCs and LCCs in DeWorm3 trial sites in Benin, India, and Malawi following three rounds of cMDA. Qualitative data were collected via 48 community-level focus group discussions. Quantitative data were collected via routine activities nested within the DeWorm3 trial, including annual censuses and coverage surveys. The Consolidated Framework for Implementation Research (CFIR) guided coding, theme development and a rating process to determine the influence of each CFIR construct on cMDA coverage. Of 23 CFIR constructs evaluated, we identified 11 constructs that differentiated between HCCs and LCCs, indicating they are potential drivers of coverage. Determinants differentiating HCC and LCC include participant experiences with previous community-wide programs, communities' perceptions of directly observed therapy (DOT), perceptions about the treatment uptake behaviors of neighbors, and women's agency to make household-level treatment decisions. The convergent mixed-methods study identified barriers and facilitators that may be useful to NTD programs to improve cMDA implementation for STH, increase treatment coverage, and contribute to the successful control or elimination of STH. The parent trial was registered at clinicaltrials.gov (NCT03014167).

Household level Grey Water Treatment in Irbid Area in the North of Jordan

من وسائل تلبية الاحتياجات المائية في مناطق الشح إعادة استعمال ''المياه الرمادية'' التي تتولد على المستوى المنزلي. وهذه هي المياه المبتذلة التي تخرج من بواليع المطبخ وأحواض الاستحمام وغسالات الملابس والصحون. أما المياه المبتذلة التي تخرج من المراحيض فهي ''مياه سوداء". تهدف هده الدراسة إلى معالجة المياه الرمادية - على المستوى المنزلي- في عينة عشوائية مكونة من 5 منازل في منطقة إربد شمال المملكة الأردنية الهاشمية باستخدام فلتر مكون من مواد طبيعية - الرمل والحصى مرتبة عموديا في برميل بحيث تمر المياه من خلاله. وبعد إجراء التجارب المخبرية على عينات المياه الرمادية قبل وبعد المعالجة، تم ملاحظة وجود انخفاض الأكسجين المستهلك حيويا BOD5 بنسبة37.5 %، والأكسجين المستهلك كيميائيا COD بنسبة 10% أما المواد الصلبة الذائبة نقصت TDS بنسبة 69% أما الحموضة pH انخفضت بنسبة 5%. تتأثر معظم معدلات توليد المياه الرمادية بأسلوب الحياة والظروف الجوية. ترتبط الملوثات الموجودة في المياه الرمادية إلى حد كبير بنوع المنظفات المستخدمة وتتأثر بالممارسات المنزلية الأخرى. لا يفضل استعمال المياه الرمادية في ري الخضراوات التي تؤكل ثمارها وأوراقها نيئة وذلك لتجنب انتقال بعض المواد القادمة من المنظفات اليها، فيما يعتبر ري الأشجار بهذه المياه فضل بكثير بسبب نظام التنقية الذاتي الذي تتميز به الأشجار، وفي حال الاضطرار لري الخضراوات يجب غسل إنتاجها من الثمار والأوراق بصورة جيدة عدة مرات.

Arsenic: A Low-Cost Household Level Treatment for Rural Settings in Developing Countries

Arsenic: A Low-Cost Household Level Treatment for Rural Settings in Developing Countries

Provision of well-water treatment units to 600 households in Bangladesh: A longitudinal analysis of urinary arsenic indicates fading utility

BackgroundMillions of villagers in Bangladesh remain exposed to high levels of arsenic (As) from drinking untreated well-water even though the scale of the problem was recognized 15years ago. Water treatment at the household-level has been promoted as a viable complement but few longitudinal studies of their efficacy using an objective measure of exposure have been conducted. Participants (N=622) of a nutrition trial in Araihazar, Bangladesh were each provided with READ-F filters at the beginning of the study and encouraged to use them over the 6month duration of the intervention. Well-water As, treated water As, and urinary As were monitored periodically during the trial and measured again one year after the trial ended. ResultsThe READ-F filters were initially well received and median urinary As levels for participants declined from 117μg/L to 51μg/L within a single week. However, median urinary As levels gradually rose back to 126μg/L by the end of the trial. Fifty filters were replaced over the course of the trial because of insufficient As removal or reduced flow. With these exceptions, most of the treated water met the WHO guideline for As in drinking water of 10μg/L. One year after the nutritional trial ended, 95% of participants had abandoned their filter citing inconvenience as the primary reason. At that time, median urinary As levels for 10 participants who had switched to a nearby low-As well had declined to 63μg/L. ConclusionsParticipants were probably no longer using the READ-F filter long before the 6month nutritional intervention ended despite claiming that they were using them. Household-level treatment is likely to continue to play a minor role in the effort to reduce As exposure in Bangladesh. Understanding the limitations of such expensive interventions is important for future policy regarding As mitigation.

Assessment of Technical and Economic Feasibility of Activated Charcoal Removal of Organic Matter from Different Streams of Grey Water Through Study of Adsorption Isotherms

The feasibility of household level treatment of grey water with activated charcoal was performed using laboratory batch adsorption testing on locally available charcoal media. The study results indicated that the potential for removal of organic matter was significantly high for the high pH cloth wash water compared to the low pH kitchen wastewater which also contained non-adsorbed organics. The addition of ash considerably improved the removal and projected life length of adsorption media for kitchen wastewater treatment. The adsorption isotherms obtained were all modeled adequately using the Freundlich isotherm while the isotherm shapes display different types of adsorption for the different streams of grey water because of the heterogeneous nature of the adsorbates in grey water. The replacement life length of activated charcoal for single drum household level treatment ranged between 7 and 15 months. For family daily flow rates up to 400 lit/day, the replacement costs of a single drum charcoal per cubic meter of grey water treated were calculated to be below the current tariff levels for acquiring water in cities in Swaziland. A considerable part of the grey water pollutant can be removed through pretreatment by sorption alone such as by filtration through sand or other cheap media before adsorption. For complete household level treatment of grey water, a three-step treatment consisting of sand pre-filtration, activated charcoal adsorption and sand post-filtration are recommended.

Community-based Water Quality Improvement in a Rehabilitated Slum Building

The Indian mega-city of Mumbai is undergoing a major makeover through large-scale shifting of slum dwellers from hutments to proper buildings with fixed size of dwelling units. This rehabilitated community of the urban poor is facing a high disease burden, apparently due to its poor sanitation and hygienic practices. This study conducted a baseline health survey, especially with regard to water borne diseases, along with water quality assessment, in a slum rehabilitated building of Mumbai. The health survey and water assessment indicated that while the rehabilitated slum dwellers had poor hygienic practices, the contamination of municipality-supplied water was causing significant health hazards for the residents. Some residents did use basic water disinfection processes like boiling, straining and chlorination, but with little positive impact on health quality. This study highlights the importance of sanitation and hygiene along with the significance of provision of better water quality. Quality of water supplied by the Brihanmumbai Municipal Corporation (BMC) being fairly good, the contamination of drinking water with sewer lines is indicated. For such problems, community-based treatment should augment household-level treatment of water.

Determinants of Use of Household-level Water Chlorination Products in Rural Kenya, 2003–2005

Household-level water treatment products provide safe drinking water to at-risk populations, but relatively few people use them regularly; little is known about factors that influence uptake of this proven health intervention. We assessed uptake of these water treatments in Nyanza Province, Kenya, November 2003–February 2005. We interviewed users and non-user controls of a new household water treatment product regarding drinking water and socioeconomic factors. We calculated regional use-prevalence of these products based on 10 randomly selected villages in the Asembo region of Nyanza Province, Kenya. Thirty-eight percent of respondents reported ever using household-level treatment products. Initial use of a household-level product was associated with having turbid water as a source (adjusted odds ratio [AOR] = 16.6, p = 0.007), but consistent usage was more common for a less costly and more accessible product that did not address turbidity. A combination of social marketing, retail marketing, and donor subsidies may be necessary to extend the health benefits of household-level water treatment to populations most at risk.