Household Water Treatment Practices Research Articles

Determinants of household safe drinking water practices in Kabul, Afghanistan: New insights from behavioural survey data

More than 2 billion people worldwide lack access to safe drinking water. Household water treatment (HWT) is an interim option for reducing the risk of water born disease. Understanding the factors that influence HWT behaviour is crucial for delivering successful interventions aimed at scaling relevant technologies, but the literature tends to emphasise psychological determinants with little consideration of socioeconomic and contextual factors. This article responds to this literature by using the COM-B model to examine the determinants of HWT practices through a comprehensive and context-sensitive behaviour definition. We informed this model through a cross-sectional survey design in which we collected data from 913 households in two peri‑urban neighbourhoods of Kabul, Afghanistan. Our findings from descriptive statistical and regression analysis highlight the importance of not only psychological but also socio-economic and contextual determinants of HWT behaviour: Especially the COM-B dimensions of reflective and automatic motivation, and physical opportunity – which are heavily influenced by local context and economic circumstances – had statistically significant associations with performing HWT. The practical significance of these dimensions was similarly pronounced. For example, an increase in the physical opportunity index by 0.1 units from an average value of 0.7 to 0.8 would be associated with a 7.7 percentage-point higher likelihood of HWT performance. These results suggest that the COM-B model can be utilised to systematically design interventions aimed at promoting HWT practices, while highlighting the need to broaden behavioural analyses of HWT and consider contextual factors to develop interventions that are tailored to the specific needs and obstacles of different communities.

The effect of a health extension program on improving water, sanitation, and hygiene practices in rural Ethiopia

BackgroundTo make basic primary health care services accessible, especially to the rural community, the government of Ethiopia launched the Health Extension Program (HEP) in 2004. Most of components of HEP are dedicated to hygiene and sanitation. Few studies have assessed the role of the Health Extension Program in improving water, hygiene, and sanitation (WASH) practices in Ethiopia. This study explored the role of health extension workers (HEWs) in influencing household water treatment practices, latrine ownership, latrine use and ownership, and the use of hand-washing facilities on the incidence of diarrheal diseases among the children under five years of age in rural Ethiopia.MethodsUsing a cross sectional design, we conducted a national assessment that covered all nine regions of Ethiopia. We conducted face-to-face interviews among a sample of 6430 rural households using a structured questionnaire and an observation checklist to collect data from March 2018 to May 2019. Multilevel logistic regressions models were used to determine the relationships between the exposure of households to HEWs and WASH practice outcomes such as the use of water from an improved water source, household water treatment practices, availability of hand-washing and hand-washing with soap and water, availability of latrines, and use of latrines as well as the incidence of diarrheal diseases among children age 5 and younger. Our models were adjusted for covariates and confounders and P-values less than 5% were set to determine statistical significance.ResultsWe found that 72.7% of rural households had some type of latrine and 27.3% reported practicing open defecation. A total of 71.5% of rural households had access to drinking water from improved water sources, but only 9.4% reported practicing household water treatment. Exposure to HEWs was positively associated with household water treatment practices (AOR: 1.46; 95% CI = 1.01–2.10) and latrine availability (AOR: 1.44; 95% CI = 1.15–1.80). Among the households who were either visited by HEWs at their home or the that visited health posts to meet with the HEWs, being exposed to WASH health education by HEWs was significantly associated with the availability of a hand-washing facility (AOR: 5.14; 95% CI = 4.11–6.42) and latrine availability (AOR: 1.48; 95% CI = 1.10–2.01). However, we did not find a relationship between the incidence of diarrhea among children age 5 and under and exposure to HEWs (AOR: 2.09; 95% CI = 0.73– 6.62).ConclusionOur results show a significant association between exposure to the Health Extension Program/ HEWs and improved household water treatment practices, latrine construction, and the availability of hand-washing facilities in rural Ethiopia, suggesting the need to strengthen efforts to change WASH behavior through the Heath Extension Program. On the other hand, further investigation is needed regarding the spillover effect of latrine use practices and the reduction of the incidence of diarrheal diseases.

Household water treatment practice and associated factors in Ethiopia: A systematic review and meta-analysis.

The provision of potable water is crucial to ensuring the health and dignity of individuals. In many developing countries, including Ethiopia, waterborne disease has become a major public health problem. There is a significant gap in accessing comprehensive national-wide evidence on Household Water Treatment (HWT) practices and associated factors in Ethiopia. Therefore, this study aims to assess the pooled HWT practice and associated factors in Ethiopia. A comprehensive search of published studies before October 15, 2022, was identified using databases and other sources. Data were extracted using Microsoft Excel, and analysis was performed using STATA 14/SE software. A random-effects model was used to estimate the pooled proportion of HWT practices and the odds ratio of associated factors. The funnel plot and Egger's regression test were used to assess publication bias, and I2 test statistics was used to assess heterogeneity. Duval and Tweedie's "trim and fill" method was performed to adjust the pooled estimate. A subgroup analysis was also conducted to identify the sources of heterogeneity. In this study, a total of 708 articles were retrieved, and 16 eligible studies were included. The pooled proportion of HWT practice in Ethiopia was found to be 21% (95% CI: 17-24). Having a formal education (OR: 2.42, 95% CI (2.11-2.74)), being male (OR: 1.32, 95% CI (1.13-1.51)), owning radio (OR: 1.33, 95% CI (1.18-1.47)), having a higher income (OR: 1.73, 95% CI (1.41-2.04)), unimproved water source (OR: 1.71, 95% CI (1.41-2.01)), fetching water at more frequently (OR: 3.31, 95% CI (1.99-4.64)), dipping methods of water drawing (OR: 2.08, 95% CI (1.66-2.51)), and taken training of water treatment (OR: 2.15, 95% CI (1.55-2.75)) were all found to be associated with HWT practice. Based on the findings of this study, the pooled proportion of HWT practice in Ethiopia was found to be one-fifth, which indicated that it was significantly low. Therefore, the authors recommend that households could better receive adequate information about HWT practices through strengthened health education and intensive training on HWT.

Assessment of drinking water quality and various household water treatment practices in rural areas of Northern India

Assessment of drinking water quality and various household water treatment practices in rural areas of Northern India

Estimating the Global Target Market for Passive Chlorination

Deploying passive (in-line) chlorinators is one strategy for improving access to microbially safe drinking water without requiring electricity or daily user input. Using Joint Monitoring Programme data, we calculate the population in low- and middle-income countries (n = 135 LMICs) using drinking water sources that are compatible (piped water and kiosks) or potentially compatible (packaged and/or delivered water, rainwater, boreholes and/or tube wells, and protected springs) with passive chlorinators. Leveraging water quality data from the Multiple Indicator Cluster Surveys (n = 37 LMICs), we estimate that 2.32 [95% confidence interval (CI): 2.19, 2.46] billion people use microbially contaminated water sources that are compatible [1.51 (1.42, 1.60) billion] or potentially compatible [817 (776, 858) million] with passive chlorinators. The largest target market for passive chlorinators is in South Asia [551 (532, 571) million rural users and 401 (384, 417) million urban users], where >77% of compatible drinking water sources are contaminated. However, self-reported household water treatment practices (n = 54 LMICs) indicate that chlorination is more common in the African and Latin American regions, suggesting passive chlorination would have higher acceptance in these regions than in Asia. Reaching the full potential of passive chlorinators will require establishing compatability of technologies with hand pump chlorination and identifying financially viable implementation models.

Access to basic drinking water services, safe water storage, and household water treatment practice in rural communities of northwest Ethiopia

Protecting water from cross contamination at source and point of use is an important strategy to improve water quality. However, water safety measures at the source and point of use may not be implemented in the rural communities. This community-based cross-sectional study was, therefore, conducted among 1190 randomly selected households in a rural setting of northwest Ethiopia to assess access to basic drinking water services, safe water storage, and household water treatment practices. Water service level was determined using JMP criteria and practices that prevent cross contamination of water at point of use were used to determine safe water storage. Results showed that 23.0% of the households had access to basic water services; 37.0% practiced safe water storage; and 15.4% practiced one or more household water treatment methods. Public taps (54.5%) and protected spring (25.1%) were the common water sources to rural communities in northwest Ethiopia. Boiling (43.2%), chlorination or water guard (26.8%), and plain sedimentation (23.0%) were among the household water treatment methods commonly practiced in the area. In conclusion, rural households in the studied region has low access to basic water services. Safe water storage practice was also low in the area and household water treatment is not commonly practiced.

Household water treatment practice and associated factors among households dependent on unimproved water sources in Ameya district, Oromia, Ethiopia

Abstract Globally, about 435 million people depend on unimproved drinking water sources, and 144 million people still rely on surface water. Specifically, a significant part of the population in Ethiopia depends on unimproved water sources. Studies have examined household water treatment practices in the country, but there is limited research regarding the population that depends on unimproved water sources. Therefore, this study aims to evaluate household water treatment practices and related factors for the households that depend on unimproved water sources in the Ameya district of the Oromia Regional State in Southwest Ethiopia. A community-based, cross-sectional study was used to assess the water treatment practices and related factors for the households that use an unimproved water source in the Ameya district of the Oromia Regional State in Ethiopia. The study used a multistage sampling technique and included a total of 413 households. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) 26 statistical package. A multivariable logistic regression was applied to identify the factors related to household water treatment practices at a 95% confidence interval (CI). Variables with a p-value of less than 0.05 in the multivariable regression were considered to be significantly related to the water treatment practice. The current study showed that 125 (30.3%) of the households that used unimproved water sources practiced household water treatment at the household level. These water treatment methods include boiling (60.8%) the water or using cloth filters (23.2%) or chlorine-based products (13.6%). When considering the training and formal education of the respondents, the water treatment practices were significantly related to the respondents’ water treatment training (adjusted odds ratio (AOR) = 2.99; 95% CI 1.97–4.94) and educational status, specifically secondary education (AOR = 1.61; 95% CI 1.02–2.93). Less than one-third of the households that depend on unimproved water sources treated their water prior to drinking. Providing training to teach individuals how to treat household water is essential to improving water treatment practices.

Household Water Treatment Practice and Associated Factors in Rural Households of Sodo Zuria District, Southern Ethiopia: Community-Based Cross-Sectional Study.

Introduction:In Ethiopia, access to safe drinking water is very low, and even safe water at the point of distribution is subjected to frequent and substantial contamination during collection, transport, and storage. The purpose of this study was to assess the level of household water treatment practices and associated factors in rural households of the Sodo Zuria district, southern Ethiopia.Methods:A community-based cross-sectional study was conducted in 836 households using a multistage sampling technique. A structured and pre-tested questionnaire was used. Binary and multivariate logistic regression analysis was used.Results:The household water treatment practice was 44.1%. Households having a higher estimated monthly income, AOR = 1.5 (1.23, 3.47), older age greater than 45 years, AOR = 1.69 (1.08, 2.64), fetching water twice a day, AOR = 2.8 (1.21, 9.17), weekly washing of the water storage container, AOR = 0.3 (0.11, 0.83), and using the dipping technique to draw water from the collection jar, AOR = 1.67 (1.14, 2.42) were significant factors in the practice of household water treatment in the study.Conclusions:The household water treatment practice was low. Higher estimated monthly income, older household heads, fetching water twice per day, washing the water storage container weekly, and dipping techniques to draw water from water storage containers were significant factors of household water treatment practices. Thus, proper hygiene of water storage, and engaging the community in income-generating activities were recommended.

Socio-Economic and Psychological Determinants for Household Water Treatment Practices in Indigenous–Rural Indonesia

Household water treatment (HWT) is one of the possible technologies to improve the quality of potable water in low–middle-income countries. However, many households still drink untreated water that leads to negative health consequences, highlighting the need for a behavioral study. This study explores the role of eight socio-economic characteristics (SECs) and five psychological factors on the practices of HWT, using a combination of statistical analyses and Bayesian Belief Network (BBN) modeling. The findings were based on 377 household interviews in East Sumba, Indonesia, an area where indigenous belief is still common. Self-reported answers and observed practices of HWT were combined, and 51% of the respondents were categorized as regular users of HWT. Furthermore, favorable socio-economic conditions, e.g., wealthier or more educated parents, facilitated psychological factors that led to regular use of HWT. This suggests the importance of reducing SEC inequalities to improve the HWT adoption. Mother's education was the most influential SEC (ΔP = 8), and people who followed indigenous beliefs tend not to use HWT on a regular basis. Moreover, easy access to water positively influenced the household's ability to operate the HWT technology. Attitude toward the HWT practice, especially the perception of treated water's taste (β = 0.277), was the most significant psychological factor, influencing HWT adoption. An interpretation of complex interlinkages between socio-economic conditions and psychological factors that drive the practice of HWT was therefore offered, alongside recommendations for conservative interventions to change the household's behavior in a culturally unique area with difficult access to water.

A Qualitative Analysis of Factors Influencing Household Water Treatment Practices Among Consumers of Self-Supplied Water in Rural Ethiopia.

BackgroundThe health of a community depends greatly on the availability of sufficient and clean water. Rural households relying on self-supplied drinking water must take full responsibility for the treatment of their drinking water. Globally, not many inquiries appear to have been carried out to satisfactorily inform us regarding how and why improvements in behavior related to water treatment occur in some selected individuals and not in others. Related investigations in Ethiopia are even fewer.MethodsIn the rural Aleta Wondo district of Ethiopia, a total of fifteen focus group discussions were conducted with community members. Similarly, ten key informant interviews were conducted with officers responsible for organizing water and hygiene programs. To gather data for this study, two qualitative data collection methods, viz., key informant interviews and focus group discussions, were used. Open code software 4.03 was used for thematic analysis.ResultsFactors influencing household water treatment practices were categorized into individual-level factors (eg cognitive factors, emotional factors), household-level factors (household means and decision-making balance), community-level factors (the value that is given for water quality and Public resources) and, environment and context-related factors (access to products and reliance on external sources).ConclusionHousehold water treatment practice has a range of multilevel influences. Beyond the model of providing ongoing safe water education by health extension workers, potential initiatives could be improved by community mobilization activities that include community leaders, women’s groups, etc., in promoting water treatment at community engagements. Also, the results of the present study indicate that it could be beneficial to provide health extension staff with additional training to improve their ability to encourage community members across, a wide range of user types or levels of readiness, to treat their water.

Household Water Treatment and Storage Practices Among Residents in Mogadishu Somalia

Background: Consumption of contaminated water can affect human health and even lead to high morbidity and mortality, particularly among under-five children. Thus, determining household water treatment and proper management is vital to eliminate contamination. This study aimed to assess the household water treatment and storage practices among Warta-Nabada residents in Mogadishu, Somalia. Methods: A community-based cross-sectional study was conducted in 386 households from the April to June 2018 period. A multistage cluster sampling technique was used to select sample units from the households to obtain accurate data. Data were collected using structured questionnaires. Also, SPSS version 21 was used for data entry and analysis, respectively. The univariate, bivariate, and multivariate levels were analyzed to see a significant association between variables. The statistical significance was declared at a value < 0.05 with 95% confidence intervals in the final model. Results: The majority of participants, 291 (75.4%), used plastic containers for water storage at a household level, while 48 (12.4%) used clay pots, followed by 47 (12.2%) cement tanks. Most containers used for water storage were plastic containers due to their availability and low cost. Participants who had containers were 227 (58.8%). Approximately 114 (29.5%) had two containers. The number of people who practice boiling water was relatively low (15.8%). The distance of the water source from household 143 (37.0%) were more than 50 meters, regards to methods for water treatment, 91 (23.6%) were used for chlorination, and 61 (15.8%) were used for boiling, but 45 (11.7%) were used for filtration, and 22 (5.7%) used solar disinfection as well. Therefore, the most common water treatment method used was chlorination, accounting for (23.6%) of the total water treated. Conclusion: According to the results, it can be concluded there were significant variables for age, marital status, occupational, and education of the husband of the household water treatment level. When there was a high risk of acute water diarrhea or cholera, drinking water chlorination, boiling, and filtration were the most common household water treatment practices. Among a group of good practices, there were (73%) while the poor practices group had (27%). However, the majority of residents practice precisely. This study recommended developing a comprehensive national plan for scaling up the household water treatment system with a holistic approach, allowing adequate service provision and addressing the need to provide for the most vulnerable groups with better practices.

Boiled or Bottled: Regional and Seasonal Exposures to Drinking Water Contamination and Household Air Pollution in Rural China.

Background:Inadequate access to safe drinking water remains a global health problem, particularly in rural areas. Boiling is the most commonly used form of point-of-use household water treatment (HWT) globally, although the use of bottled water in low- and middle-income countries (LMICs) is increasing rapidly.Objectives:We assessed the regional and seasonal prevalence of HWT practices (including bottled water use) in low-income rural areas in two Chinese provinces, evaluated the microbiological safety of drinking water and associated health outcomes, and estimated the air pollution burden associated with the use of solid fuels for boiling.Methods:We conducted cross-sectional surveys and collected drinking water samples from 1,033 rural households in Guangxi and Henan provinces. Temperature sensors affixed to pots and electric kettles were used to corroborate self-reported boiling frequencies and durations, which were used to model household air pollution (HAP) in terms of estimated particulate matter in aerodynamic diameter () concentrations.Results:Based on summer data collection in both provinces, after controlling for covariates, boiling with electric kettles was associated with the largest log reduction in thermotolerant coliforms (TTCs) ( TTC most probable number), followed by boiling with pots (), and bottled water use (); all were statistically significant (). Boiling with electric kettles was associated with a reduced risk of TTC contamination [risk ratio , ] and reported diarrhea (, ). TTCs were detected in 51% () of bottled water samples. For households boiling with biomass, modeled concentrations averaged ().Discussion:Our findings suggest that where boiling is already common and electricity access is widespread, the promotion of electricity-based boiling may represent a pragmatic stop-gap means of expanding safe water access until centralized, or decentralized, treated drinking water is available; displacing biomass use for water boiling could also reduce HAP concentrations and exposures. Our results also highlight the risks of increasing bottled water use in rural areas, and its potential to displace other sources of safe drinking water, which could in turn hamper efforts in China and other LMICs toward universal and affordable safe water access. https://doi.org/10.1289/EHP7124

Understanding the effect of socio-economic characteristics and psychosocial factors on household water treatment practices in rural Nepal using Bayesian Belief Networks

About 20 Million (73%) people in Nepal still do not have access to safely managed drinking water service and 22 million (79%) do not treat their drinking water before consumption. Few studies have addressed the combination of socio-economic characteristics and psychosocial factors that explain such behaviour in a probabilistic manner. In this paper we present a novel approach to assess the usage of household water treatment (HWT), using data from 451 households in mid and far-western rural Nepal. We developed a Bayesian belief network model that integrates socio-economic characteristics and five psychosocial factors. The socio-economic characteristics of households included presence of young children, having been exposed to HWT promotion in the past, level of education, type of water source used, access to technology and wealth level. The five psychosocial factors capture households' perceptions of incidence and severity of water-borne infections, attitudes towards the impact of poor water quality on health, water treatment norms and the knowledge level for performing HWT. We found that the adoption of technology was influenced by the psychosocial factors norms, followed by the knowledge level for operating the technology. Education, wealth level, and being exposed to the promotion of HWT were the most influential socio-economic characteristics. Interestingly, households who were connected to a piped water scheme have a higher probability of HWT adoption compared to other types of water sources. The scenario analysis revealed that interventions that only target single socio-economic characteristics do not effectively boost the probability of HWT practice. However, interventions addressing several socio-economic characteristics increase the probability of HWT adoption among the target groups.

Household Water Treatment Practice and Associated Factors Among People Living with HIV, Bahir Dar City Administration, Northwest Ethiopia

Introduction: PLHIV have substantially greater need for access to safe water, for bathing and washing soiled clothing and linen; safe drinking water is necessary for taking medicines. Therefore household water treatment is one of inexpensive and effective technology to make water safe. However the information of household water treatment practices and associated factors on these groups were inadequate. Objective: the: t aim of the study was to assess household water treatment practice and associated factors among PLHIV who are member of the three associations in Bahir Dar city administration, Northwest Ethiopia. Methods: A Community based cross-sectional study was done among PLHIV from April-May 2013. A Simple random sampling technique was used to select the study participants. Pre-tested and structured questionnaire, observation checks list and residual chlorine test was used to collect the data. Binary and multivariate logistic regression analysis were used to determine the separate and confounding effect for variables with p-value <0.2 in binary analysis. Result: of the total respondents 76.3% reported that they treated their drinking water at home. But only 11% of respondents treated water at home within 24 hours of this study. The main reasons for not treating water at home were psycho-social problem 29 (53.7%), unavailability of treatment methods 17 (31.5%), and lack of knowledge how to use treatment methods 8 (14.8%). Occupational status of the respondents (AOR=2.6; 95% CI 0.162-0.903), duration of water storing time (AOR=2.9; 95% CI 1.471-5.692), and use of separate container for water storing (AOR=3.1; 1.008-9.223) were significantly associated variables with household water treatment practice. Conclusion: Household water treatment practices among people living with HIV were found low. Therefore the PLHIV needs special attention to improve household water treatment practice. fee free water treatment methods availability, promotion of household water treatment practice and participate in income generating activities are supreme important.

Effects of a behavior change campaign on household drinking water disinfection in the Lake Chad basin using the RANAS approach

Worldwide, an estimated 700 million people rely on unimproved drinking water sources; even more consume water that is not safe to drink. Inadequate drinking water quality constitutes a major risk factor for cholera and other diarrheal diseases around the globe, especially for young children in developing countries. Household water treatment and safe storage systems represent an intermediate solution for settings that lack infrastructure supplying safe drinking water. However, the correct and consistent usage of such treatment technologies rely almost exclusively on the consumer's behavior.This study targeted at evaluating effects of a behavior change campaign promoting the uptake of household drinking water chlorination in communities along the Chari and Logone rivers in Chad. The campaign was based on formative research using health psychological theory and targeted several behavioral factors identified as relevant. A total of 220 primary caregivers were interviewed concerning their household water treatment practices and mindset related to water treatment six months after the campaign. The Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model was used to structure the interviews as the RANAS approach had been used for designing the campaign.Results show significantly higher self-reported drinking water chlorination among participants of the intervention. Significant differences from a control group were identified regarding several behavioral factors. Mediation analysis revealed that the intervention positively affected participants' individual risk estimation for diarrheal disease, health knowledge, perceived efforts and benefits of water treatment, social support strategies, knowledge of how to perform chlorination, and perceived ability to do so. The campaign's effect on water treatment was mainly mediated through differences in health knowledge, changes in norms, and self-efficacy convictions.The findings imply that water treatment behavior can be successfully promoted using health psychological theory. However, they also indicate opportunities for improvement in the campaign design and implementation.

Knowledge, Attitude, and Practice of Mothers/Caregivers on Household Water Treatment Methods in Northwest Ethiopia: A Community-Based Cross-Sectional Study.

In Ethiopia, ensuring safe drinking water remains a big challenge where waterborne diseases, including diarrhea cause a great harm in many rural communities. Limited knowledge, misinformation, negative attitude, and lack of experience toward best practices of alternative water treatment technologies were among the leading challenges. A community-based cross-sectional study was conducted from June 23 to 30, 2015, in Dabat District. The study participants were selected by using simple random sampling method. Questionnaire-based face-to-face interview technique of data collection was used by 20 data collectors under close supervision with six supervisors. From the total of 845 participants with mother-child paired 49.3%, 95% confidence interval [CI] (45.8, 52.5%) had good knowledge, and 54.8%, 95% CI (51.6, 58.3%) had favorable-attitude toward household water treatment. Only 23.1%, 95%CI (20, 26%) of the study participants had practiced household water treatment. Being an urban resident (adjusted odds ratio [AOR]: 2.58, 95% CI: [1.62, 4.11]), having good-knowledge (AOR: 2.62, 95% CI: [1.81, 3.79]), favorable attitude (AOR: 1.45, 95% CI: [1.01, 2.08]), and used unimproved water source (AOR: 1.67, 95% CI: [1.11, 2.50]) were factors associated with household water treatment practices in the district. Despite mothers/caregivers having a fairly good knowledge and positive attitude, their practice of treating drinking water at household level was quite low. Thus, well designed strategy for health education on effective water treatment methods through the national health extension program is recommended.

Consistency of Use and Effectiveness of Household Water Treatment among Indian Households Claiming to Treat Their Water.

Household water treatment (HWT) can improve drinking water quality and prevent disease if used correctly and consistently by populations at risk. Current international monitoring estimates by the Joint Monitoring Programme for water and sanitation suggest that at least 1.1 billion people practice HWT. These estimates, however, are based on surveys that may overstate the level of consistent use and do not address microbial effectiveness. We sought to assess how HWT is practiced among households identified as HWT users according to these monitoring standards. After a baseline survey (urban: 189 households, rural: 210 households) to identify HWT users, 83 urban and 90 rural households were followed up for 6 weeks. Consistency of reported HWT practices was high in both urban (100%) and rural (93.3%) settings, as was availability of treated water (based on self-report) in all three sampling points (urban: 98.8%, rural: 76.0%). Nevertheless, only 13.7% of urban and 25.8% of rural households identified at baseline as users of adequate HWT had water free of thermotolerant coliforms at all three water sampling points. Our findings raise questions about the value of the data gathered through the international monitoring of HWT as predictors of water quality in the home, as well as questioning the ability of HWT, as actually practiced by vulnerable populations, to reduce exposure to waterborne diseases.

Socio-psychological determinants for safe drinking water consumption behaviors: a multi-country review

The effectiveness of household water treatment practices relies heavily on consumers' compliance. However, what is driving these behaviors from a health psychological perspective is not well understood. A review of studies on safe water collection, treatment, handling and storage practices was conducted to identify important socio-psychological determinants. The objectives are to show which determinants commonly explain safe water consumption practices and how well they do so, and to identify behavior- and population-specific determinants to be targeted in different contexts. The results of the review reveal that all the practices studied can be explained well, with a mean of 62% explained variance between performers and non-performers. Social norms, action knowledge, and perceived self-efficacy were shown to be the most common influential factors for safe water practices. Instrumental beliefs around costs and benefits as well as affective beliefs such as taste are important in a majority of cases but varied more strongly, both for different target behaviors and between specific settings and populations, and are thus to be evaluated from case to case. The review gives clear recommendations on which behavioral factors to address with priority and corresponding behavior change techniques to be made use of in contexts where formative research is not possible.

Consistency of Use and Effectiveness of Household Water Treatment Practices Among Urban and Rural Populations Claiming to Treat Their Drinking Water at Home: A Case Study in Zambia

Household water treatment (HWT) can improve drinking water quality and prevent disease, if used correctly and consistently. While international monitoring suggests that 1.8 billion people practice HWT, these estimates are based on household surveys that may overstate the level of consistent use and do not address microbiological effectiveness. We sought to examine how HWT is practiced among households identified as HWT users according to international monitoring standards. Case studies were conducted in urban and rural Zambia. After a baseline survey (urban: 203 households, rural: 276 households) to identify HWT users, 95 urban and 82 rural households were followed up for 6 weeks. Consistency of HWT reporting was low; only 72.6% of urban and 50.0% of rural households reported to be HWT users in the subsequent visit. Similarly, availability of treated water was low, only 23.3% and 4.2% of urban and rural households, respectively, had treated water on all visits. Drinking water was significantly worse than source water in both settings. Only 19.6% of urban and 2.4% of rural households had drinking water free of thermotolerant coliforms on all visits. Our findings raise questions about the value of the data gathered through the international monitoring of HWT practices as predictors of water quality in the home.

Assessing the consistency and microbiological effectiveness of household water treatment practices by urban and rural populations claiming to treat their water at home: a case study in Peru.

BackgroundHousehold water treatment (HWT) can improve drinking water quality and prevent disease if used correctly and consistently by vulnerable populations. Over 1.1 billion people report treating their water prior to drinking it. These estimates, however, are based on responses to household surveys that may exaggerate the consistency and microbiological performance of the practice—key factors for reducing pathogen exposure and achieving health benefits. The objective of this study was to examine how HWT practices are actually performed by households identified as HWT users, according to international monitoring standards.Methods and FindingsWe conducted a 6-month case study in urban (n = 117 households) and rural (n = 115 households) Peru, a country in which 82.8% of households report treating their water at home. We used direct observation, in-depth interviews, surveys, spot-checks, and water sampling to assess water treatment practices among households that claimed to treat their drinking water at home. While consistency of reported practices was high in both urban (94.8%) and rural (85.3%) settings, availability of treated water (based on self-report) at time of collection was low, with 67.1% and 23.0% of urban and rural households having treated water at all three sampling visits. Self-reported consumption of untreated water in the home among adults and children <5 was common and this was corroborated during home observations. Drinking water of self-reported users was significantly better than source water in the urban setting and negligible but significantly better in the rural setting. However, only 46.3% and 31.6% of households had drinking water <1 CFU/100 mL at all follow-up visits.ConclusionsOur results raise questions about the usefulness of current international monitoring of HWT practices and their usefulness as a proxy indicator for drinking water quality. The lack of consistency and sub-optimal microbiological effectiveness also raises questions about the potential of HWT to prevent waterborne diseases.