Provision Of Safe Water Supply Research Articles

Update on the Geographic Distribution of the Intermediate Host Snails of Schistosoma mansoni on St. Lucia: A Step Toward Confirming the Interruption of Transmission of Human Schistosomiasis.

To provide information to guide considerations of declaring interruption of transmission of human schistosomiasis due to Schistosoma mansoni on St. Lucia, we undertook an island-wide survey in June-July 2022 to determine the presence of Biomphalaria snails, the intermediate hosts of S. mansoni, and their infection status. Snail surveys were carried out at 58 habitats to determine presence of Biomphalaria snails followed by examination of the collected snails for evidence of infection with S. mansoni. Furthermore, water samples were collected at the snail habitats and screened for presence of S. mansoni DNA using an eDNA approach. We found B. glabrata present in one habitat (Cul de Sac) where it was abundant. Specimens provisionally identified as Biomphalaria kuhniana were recovered from 10 habitats. None of the Biomphalaria specimens recovered were positive for S. mansoni. None of the eDNA water samples screened were positive for S. mansoni. Experimental exposures of both field-derived and laboratory-reared St. Lucian B. glabrata and B. kuhniana to Puerto Rican and Kenyan-derived S. mansoni strains revealed B. glabrata to be susceptible to both and B. kuhniana proved refractory from histological and snail shedding results. We conclude, given the current rarity of B. glabrata on the island and lack of evidence for the presence of S. mansoni, that transmission is unlikely to be ongoing. Coupled with negative results from recent human serological surveys, and implementation of improved sanitation and provision of safe water supplies, St. Lucia should be considered a candidate for declaration of interruption of human schistosomiasis transmission.

Accelerating the Provision of Safe Water Supply in Urban and Rural Areas of Indonesia

Over the past 100 years, the provision of a safe water supply to drink in Indonesia has been slowly progressed with low coverage. The majority of the population does not have access to safe water. Morbidity and mortality of water-related diseases, including diarrhea, are very high. The provision of safe water is not a technological issue but good water management that comprises content, institutional, and communication layer. This paper provided information for strategic and operational decisions to accelerate the provision of safe water services in urban and rural areas. Benchmarking good water management with the characteristics of the water supply location is required to improve the health status of the population, mainly the poor urban and rural areas with limited resources, including time and cost.

Prevalence, Infection Intensity and Associated Factors of Soil-Transmitted Helminthiasis Among School-Aged Children from Selected Districts in Northwest Ethiopia.

BackgroundGlobally, soil-transmitted helminths affect beyond a billion people and cause 1.9 million disability-adjusted life years worldwide. It affects children disproportionately due to their unaware activities like walking barefoot, playing with dirty objects that might be contaminated with feces. The control of soil-transmitted helminths principally relies on periodic deworming using either a single dose of albendazole/mebendazole. To assure the effectiveness of this measure, performing continuous parasitological survey is necessary. Herein, the prevalence, intensity and associated factors of soil-transmitted helminth infections were assessed among school-aged children in northwest Ethiopia.MethodsA cross-sectional study design was conducted among school-aged children (6–14 years old) from January 21st to February 21st/2019. Multistage sampling technique was employed. A Kato-Katz concentration technique was utilized to detect STHs in stool samples. Moreover, risk factors for STH infections were assessed using well-structured questionnaire. Bivariate and multivariate analyses were used to assess the association between explanatory and the outcome variables. The magnitude of the association was measured using the adjusted odds ratio (AOR) and 95% confidence interval (CI). A P-value <0.05 was considered statistically significant.ResultsThe overall STHs prevalence in this study was 32.3% (95% CI: 29–35.6%) with Ascaris lumbricoides being the predominant species (24.3%) followed by hookworm (8.9%) and Trichuris trichiura (1%). Most (80.3%) of the infected school-aged children had light-intensity infections. Age of 11 years and above (AOR, 12.9, 95% CI, 1.6–103.6, P=0.004), being residing in Chuahit district (AOR, 3.9, 95% CI, 2.3–6.5, P<0.001), and untreated water supply (AOR, 1.7, 95% CI, 1.1–2.7, P=0.018) were identified as predictors for the overall STH prevalence.ConclusionOur findings revealed STH infections are considerable health problems in the study areas. Thus, public health interventions such as provision of safe water supply, health education, and de-worming programs should be regularly implemented in the study areas.

Urogenital Schistosomiasis among Primary School Children in Rural Communities in Obudu, Southern Nigeria.

Background:Schistosomiasis is a Neglected Tropical Disease (NTD) that constitutes a public health problem in Sub-Saharan Africa (SSA), including Nigeria. There is need for updated information on the extent of the disease burden at community level to facilitate effective prioritization and monitoring of the disease.Methods:A cross-sectional study was conducted among school-aged children in Obudu Local Government Area (LGA), one of the 18 LGAs in Cross River State, Southern Nigeria. Seven schools from seven communities were randomly selected for this study. A total of 1,113 urine samples obtained from school-aged children were screened for Schistosoma haematobium (S. haematobium) eggs using standard parasitological method of diagnosis. Proteinuria and hematuria were evaluated using reagent test strips.Results:In this study, 153 (13.7%) children were infected with S. haematobium. More males (86 or 14.7%) were infected than females (67 or 12.7%); the differences were not statistically significant. The overall geometric mean intensity of infection was 13.3 eggs/10ml of urine. Females (13.69 eggs/10ml of urine) had the highest intensity of infection than males (12.91eggs/10ml of urine). Prevalence of hematuria was 152 (13.7%) (95% C.I. = 10.649 – 18.751%) while the prevalence of proteinuria was 172 (15.5%) (95% C.I. = 5.162 – 38.712%). Prevalence of infection significantly (p<0.001) varied among the schools from 7.8% to 28.9%. Children aged 5-9 years old had the highest prevalence of infection 46 (17.1%). The prevalence of urogenital schistosomiasis was 28.9%, 20.5% and 13.2%, respectively, among Betukwel, Ibong, and Ohong communities.Conclusion and Global Health Implications:Urinary schistosomiasis is still endemic in Obudu, Southern Nigeria but with decreased prevalence. Public health mitigation efforts such as mass chemotherapy, provision of safe water supply and sanitation facilities are recommended. Furthermore, health education should be encouraged within schools and communities.

Stepped solar still: A review on designs analysis

Everyone’s rights to get clean, safe, and fresh drinking water. As we know almost 71% of water covered in the Earth's surface. It may be in the form of oceans (covers almost 96.5% of all Earth's water), rivers, lakes, glaciers, icecaps, and also exists in the form of water vapor as well as soil moistures. The percentage of freshwater on earth is about 3% in which almost 2.5% fresh water is not available (locked in polar ice caps, atmosphere, glaciers, highly polluted, in soil, or lie too deep below the surface of the earth and not to be collected at a reasonable cost. Fresh water is available only 0.5% of the earth's atmosphere. Solar desalination from a solar still is a renewable method used to fulfill the provision of safe water supply in distant locations at a very affordable cost. However, due to its lower awareness solar still technology is not standardized and commercialized. The factors that influence solar still productivity are wind velocity, solar intensity, depth of water, an inlet water temperature, ambient temperature, and absorber plate area etc. ambient temperature, solar intensities and wind velocity are unable to control because these are metrological variables while the left standing variables could be changed to enhance solar stills productivity. Water depth in solar still inversely affects solar still productivity. Investigations suggest that reduction in brine depth productivity increases, because of higher temperatures in the basin. Minimum depth is maintained by stepped solar still, so stepped solar stills can improve the distillate Productivity. Throughout this review, we attempt to study the various types of stepped solar stills.

Soil-transmitted Helminths and Urinary Schistosomiasis Co-infection: Risk Factors among School Children in Riverine Areas of Wamakko Local Government, Sokoto State, Nigeria

Epidemiological study was conducted to determine the prevalence of urinary schistosomiasis and intestinal helminth co-infection among primary school pupils in Wamakko Local Government, Sokoto State, Nigeria. Urine and stool samples were collected from 400 pupils and analyzed using filtration and formol-ether concentration techniques respectively. Out of 400 samples, 63(32.8%) were co-infected with Schistosoma haematobium and one or more intestinal helminths. The co-infection of S. haematobium with Ascaris lumbricoides was most prevalent (74.6%), while S. haematobium with A. lumbricoides, hookworm, and S. haematobium with A. lumbricoides and S. mansoni had the least prevalence (1.6% each). Being male, 10-12 years of age and not washing hands before and after meals were the major risk factors for the spread of urinary schistosomiasis and intestinal helminths co-infection in the study area. An integrated strategy that involves the provision of health education to the communities, regular treatments, provision of safe water supply and sanitation facilities is highly recommended.

Spatial pattern and determinants of diarrhoea morbidity among under-five-aged children in Lagos State, Nigeria

ABSTRACT Diarrhoeal diseases are major causes of morbidity and mortality among under-fived-aged children globally. In Nigeria, 10% of under-five deaths in 2016 were due to diarrhoea. The diseases were responsible for 9% of childhood deaths in Lagos State in 2011. This study examined the spatial pattern and sociodemographic, environmental, hygiene and behavioural factors associated with diarrhoeal morbidity in Lagos State. Data on reported cases of childhood diarrhoeal diseases in government hospitals was analysed using spatial statistical techniques. Data from 2013 Nigerian Demographic Health Survey was used to determine diarrhoeal disease risk factors through multivariate logistic regression analysis. Lagos Island recorded the highest (34.2%) number of cases, followed by Agege (16.6%) and Somolu (13.2%) local government areas (LGAs). The spatial distribution of diarrhoeal cases is random. The prevalence of diarrhoeal diseases during the two-week period before the survey was 7.5%. Factors significantly associated with diarrhoeal disease morbidity were child’s age, mother’s age, religion, paternal education and occupation, mother’s occupation, source of drinking water, floor material, mixed feeding and mothers not wanting the last child. These findings highlight the need to strengthen the provision of safe water supply. Educational programmes that emphasise treatment of drinking water, safe hygiene and sanitation practices should be implemented.

Trend of cholera in Iraq in the time of unrest

Background: Countries that are facing war disasters are prone to develop outbreak emergencies especially when this is associated with massive displacement of populations or refugees to overcrowded settings, and when the provision of safe water supply and sanitation is a challenge. Objective: To portray the trend of cholera in Iraq for the last 18 years. Methods: Records of cholera cases registered for the last 18 years were reviewed from the Department of Health Statistics of the Iraqi Ministry of Health and categorized according to the 18 Iraqi governorates; the total of each governorate was computed for the whole studied years and then summed to get the total for Iraq. Data were categorized by gender and age. Rates of occurrence were plotted against time (for the period from 2000 to 2017) to define the trend of the disease. Results: The trend of cholera in Iraq showed four peaks, in 2003, 2007, 2012, and 2015, females showed slightly more cases than males, with a higher incidence among adult age group, and more in the southern provinces. Conclusion: The epidemics of cholera in Iraq are getting progressively more frequent, with higher number of cases forming a real burden on the health system and a serious threat to the community. Efficient preventive health plans are needed to overcome this growing problem that may compromise the life of people.

Effect of biological activated carbon filter depth and backwashing process on transformation of biofilm community

The biological activated carbon (BAC) is a popular advanced water treatment to the provision of safe water supply. A bench–scale device was designed to gain a better insight into microbial diversity and community structure of BAC biofilm by using high–throughput sequencing method. Both samples of BAC biofilm (the first, third and fifth month) and water (inlet water and outlet water of carbon filter, outlet water of backwashing) were analyzed to evaluate the impact of carbon filter depth, running time and backwash process. The results showed that the microbial diversity of biofilm decreased generally with the increase of carbon filter depth and biofilm reached a steady–state at the top layer of BAC after three months’ running. Proteobacteria (71.02%–95.61%) was found to be dominant bacteria both in biofilms and water samples. As one of opportunistic pathogen, the Pseudomonas aeruginosa in the outlet water of device (1.20%) was about eight times higher than that in the inlet water of device (0.16%) at the genus level after five–month operation. To maintain the safety of drinking water, the backwash used in this test could significantly remove Sphingobacteria (from 8.69% to 5.09%, p<0.05) of carbon biofilm. After backwashing, the operational taxonomic units (OTUs) number and the Shannon index decreased significantly (p<0.05) at the bottom of carbon column and we found the Proteobacteria increased by about 10% in all biofilm samples from different filter depth. This study reveals the transformation of BAC biofilm with the impact of running time and backwashing.

Magnitude and determinants of diarrhea among 0-6 year’s children: a cohort study from central India

Background: Inspite of efforts of all the stakeholders, diarrhea still remains a cause of significant morbidity and mortality in developing country like India.Methods: A follow up study was done among 305 children of 0-6 year’s age to estimate the incidence and risk factors of diarrhea. Diarrhea was defined as more than 3 stools in one day that were more liquid than usual. At each monthly follow up enquiry was made about the occurrence of diarrhea, health seeking, infant feeding practices and dietary history etc. Cumulative incidence, attack rates and risk ratio was used to estimate the burden and risk factors of diarrhea.Results: The number of diarrhea episodes per child per year was 0.65 (95% CI=0.62-0.67). The cumulative incidence of diarrhea among 0-6 years children was 485.7 per 1000 children per year (95% CI=430.8–540.9). In terms of attack rate, the diarrhea among 0-6 years children was 63.5 percent (95% CI=58.1–68.7). Age of child, birth weight, total duration of breastfeeding, anaemia and season were found to be significant risk factors of diarrhea.Conclusions: Further substantial changes in diarrhea incidence will require action on multiple factors like improvement of birth weight of child by better maternal and child health (MCH) care, continued breastfeeding of child till two year of age, correction of anaemia and provision of safe water supply and sanitation during summer and raining season.

Urinary schistosomiasis in school aged children of two rural endemic communities in Edo State, Nigeria.

Urinary schistosomiasis is endemic in many rural communities of Nigeria and school aged children are mostly affected. A cross-sectional study was carried out to assess the prevalence and intensity of urinary schistosomiasis infection among 251 school aged children in two communities of Ovia South West LGA of Edo State, Nigeria, as well as their knowledge on the control/elimination measures. Urine samples were collected and examined by microscopy using filtration technique. In addition, a questionnaire survey was conducted among school-aged children and health care providers, probing their knowledge, attitude and practices on on-going control activities. The prevalence of urinary schistosomiasis among the school-aged children was 65.3%. The prevalence was generally higher among females (68.8%) and children in the age groups 10-14 (69.9%). The intensity of infection ranged from 1 to 5044 (mean=449.8) eggs/10ml of urine with a higher proportion having heavy infections (76.8%, P<0.05). Water contact was attested by 123 (49.0%) of the children; of these 123, 74 (60.1%) were infected. The children's knowledge on urinary schistosomiasis was deficient. The high prevalences reported in these communities require integrated approach to control which essentially should incorporate the provision of safe water supply and sanitary facilities, and health education in addition to the annual mass praziquantel distribution, to reduce transmission.

Seroepidemiology of a recent outbreak of Hepatitis E in urban Shimla, Himachal Pradesh, India

Hepatitis E, a major public health problem, continues to cause epidemics in different geographic areas in India and poses multi-sectoral challenges. The aim of the study was to determine the seroepidemiology of the hepatitis outbreak in the urban areas of district Shimla, Himachal Pradesh. Patients presenting with clinical features of acute viral hepatitis during and after the epidemic period were tested for seromarkers; IgM anti-HEV and IgM anti-HAV by enzyme linked immunosorbant assay. The weekly reporting under Integrated Disease and Surveillance Programme (IDSP) for cases of jaundice from Shimla from December 2015 to April 2016 was reviewed. The outbreak of hepatitis due to contamination of drinking water supply in urban Shimla beginning December 12, 2015 was confirmed by IDSP. A total of 425 serum samples (males: 292; females: 133) were tested for IgM anti-HAV and IgM anti-HEV by ELISA. Liver enzymes where deranged in all cases. Serological evidence of infection with HAV and/or HEV was seen in 64%. HEV infection alone was detected in 62.13%. All ages were affected, with one case of HEV infection below ten years. HEV infection alone was 5 times more common than HAV infection and co-infection was detected in 69 cases (m: 47; f:22). Six antenatal mothers were anti-HEV positive and the maternal mortality of 50% (n=3) due to fulminant hepatitis. Since HAV and HEV have a similar faecal-oral route of transmission, this study highlights periodic surveillance of HAV/HEV exposure pattern to improve levels of personal and food hygiene and inter-sectoral collaboration for provision of safe water supply and safe sewage disposal.

A Comparative Evaluation of the Prevalence of Urinary Schistosomiasis in Two Contrasting Communities in Benue State, Nigeria

This study comparatively examined the prevalence of Urinary schistosomiasis in a rural and an urban community in Benue State, Nigeria. The sedimentation technique was used to examine 440 urine samples for Schistosoma haematobium. A high prevalence of 194(44.1%) was observed in both populations. The prevalence of infection in the rural community 165(55.0%) was higher than the urban area 29(20.7%). There was a significant difference in the infection among the urban and rural settings (χ2cal=25.41, df=1, p-value 16 in Guma recording the highest infection rate 7(77.8%), while age group 16-18 years recorded the highest prevalence 13(25.5%) in the urban area. When compared to other age groups, these differences were also significantly different (p < 0.05). In both communities, the pattern of infection between male and female participants showed consistency; in both communities males were more infected. Overall, these gender differences were statistically significant (χ2cal=4.223, df=1, p-value <0.05). Individuals who wash in streams or river recorded the highest infection rate of 82(18.6%), compared to individuals who are exposed to other predisposing factors. It was concluded that urinary schistosomiasis is endemic in both communities and that factors that enhance the susceptibility of individuals to the disease are still prevalent in Benue state. The study recommends that breaking the cycle of the disease could be realized through a sustained health enlightenment campaign on the disease, the provision of safe water supplies and sanitation.

Chemical and microbiological analysis of surface and ground drinking water quality

Drinking water has received considerable attention recently. However, misuse and mismanagement have resulted in a rapid and widespread decline in source-water quality and supply. Water quality guidelines can be used to identify constituents of concern in water, to determine the levels to which the constituents of water must be treated for drinking purposes. Membrane technology for the water cycle is playing an important role in the provision of safe water supply and treatment. The aim of this paper is to conduct chemical and microbiological analysis of water samples. The need for standards and guidelines in water quality stems from the need to protect human health. The results revealed that there were several areas polluted chemically by some heavy metals (Ni, Cd, Pb, Mn and Fe) and microbiologically by (Entamoeba Histolytica, Amoeba, Egg of Nematodes and Total count of Bacteria). We conclude and recommended that water treatment could see better membranes with both higher permeability and tighter cutoff. Removal of some chemical constituents must be done and sewage system projects are implemented in all towns and villages.

The First Appearance of Classical-like Phenotype Vibrio cholerae in Nepal.

The First Appearance of Classical-like Phenotype Vibrio cholerae in Nepal.

Prevalence of Intestinal Schistosomiasis and Soil Transmitted Helminthiasis among Primary School Children in Umolante District, South Ethiopia

Introduction: Intestinal Schistosomiasis and Soil transmitted helminthic infections (STIs) are among the major public health problems in the world, especially in Subsaharan Africa. Objective: To determine the prevalence of intestinal schistosomiais and soil transmitted helminthic infections and associated factors among Umolante primary school children, South Ethiopia. Methods: A cross sectional study was conducted among Primary School Children in Umolante Destrict, South Ethiopia. A total of 405 school children were selected at random. For each selected subject interview and stool examination was done. Interviews were used to identify the risk factors. Stool specimens were examined using the Kato-Katz technique. Data was entered and analyzed using SPSS version 16.0 statistical packages software. Results: The overall prevalence of intestinal helminthic infection was 26.9%. The predominant parasites were hookworm 59(14.6%) and S.mansoni 51(12.6%). Prevalence of S.mansoni infection was significantly higher in males (p=0.006) whereas hookworm infection was significantly higher in females (P=0.015). Other helminthes found were E.vermicularis (1%), whipworm (1.5%), tapeworm (1.5%) and A.lumbricoides (0.5%). The highest prevalence of S.mansoni was reported in the age group of 10-14 years (17.8%) followed by the age group 15 and above (11.6%) and the difference was statistically significant (P=0.02). Geometric mean intensity was also highest in the same age group (245 eggs per gram). The overall prevalence of infection was 7.7% for girls and 17.1% for boys and the difference was statistically significant (p=0.006). Bathing practice in the nearby stream was significantly associated with S.mansoni infection (OR, 3.4, 95.0% C.I., 1.5-5.3, P=0.03). Conclusion and recommendation: On the basis of these results, it can be concluded that intestinal helminthic infections are important health problems among school children. Hence, integrated control programme including periodic deworming, shoes wearing, improving sanitation, provision of safe water supply are needed to have a lasting impact on transmission these diseases.

The Current Status of Schistosoma mansoni Infection among School Children around Hizaty Wedicheber Microdam in Merebmieti, Ethiopia

Background: School age children are at particular risk of morbidity caused by schistosomiasis. Objective: To determine the prevalence and intensity of infection; and identify associated risk factors for Schistosoma mansoni infection. Methods: A cross sectional study was conducted in Merebmieti elementary school around Hizaty Wedicheber Microdam in Tigray, northern Ethiopia. A total of 469 school children were selected at random. For each selected subject clinical and stool examination was done. Each subject was also interviewed. Stool samples were examined for Schistosoma eggs by Kato-Katz technique. Data was entered and analyzed using SPSS version 16.0 statistical packages software. Results: The overall prevalence of S.mansoni was 42.4% and the mean (GM) intensity of infection was 86.7 eggs per gram (EPG). The prevalence and intensity of infection was higher in males. The highest prevalence was in the 10-14 year age group (49.2%) while intensity reached peak in the 15-19 years of age (107 eggs per gram). Of the 199 positive cases, about 34% harbored moderate (101-399 eggs per gram) and only 2% harbored heavy infection. The strongest predictors for S.mansoni infection using multiple regressions were proximity to microdam. Logistic regression analysis confirmed that children 5-9 years old and pipe water use for domestic purpose were protective factors. Conclusion: On the basis of these results, it can be concluded that S. mansoni infection is an important health problem among school children of Merbmieti contributing to the transmission of the disease in the community. Hence, integrated control programme including periodic deworming, improving sanitation, provision of safe water supply are needed to have a lasting impact on transmission of S. mansoni.

Seroprevalence of Hepatitis E Among Pregnant Women in Urmia, Iran

BackgroundWhile hepatitis E virus (HEV) mostly causes self-limited disease in general population, it is more severe in pregnant women.ObjectivesThis study aimed to investigate the seroprevalence of anti-HEV IgG among a population of pregnant women in West Azerbaijan of Iran .Patients and MethodsOne hundred thirty six pregnant women referred to urban health centers of Urmia for pursuing pregnancy-related health services were enrolled in a descriptive, cross-sectional study. Anti-HEV IgG antibody was evaluated using enzyme-linked immunosorbent assay (enzyme-linked immunosorbent assay, ELISA; Dia.Pro; Diagnostic Bioprobes).ResultsOnly five (3.6%) of 136 cases had positive results for anti-HEV IgG. There was no significant difference between age (P=0.88), and income level (P = 0.19) of the two seropositive and seronegative groups. All seropositive cases were from urban areas.ConclusionsThe seroprevalence of anti-HEV IgG is low in the population of pregnant women in , similar to the rates reported from developed countries. Effective health services and provision of safe water supplies in Urmia may take role in this low prevalence rate.

Improvement of Drinking Water (Surface and Ground) Quality Beneficial to Human Use

Water quality guidelines can be used to identify constituents of concern in water, to determine the levels to which the constituents of water must be treated for drinking purposes. Membrane technology for the water cycle is playing an important role in the provision of safe water supply and treatment. The aim of this paper is to improve the water quality, to be valid for domestic purposes, through minimizing the health risks associated with either direct or indirect use of water. The need for standards and guidelines in water quality stems from the need to protect human health. The results revealed that there were several areas polluted chemically by some heavy metals (Ni, Cd, Pb, Mn and Fe), and microbiologically by Entamoeba histolytica, Amoeba, Egg of Nematodes and Total count of Bacteria. We conclude and recommend that water must be treated with better membranes, with both higher permeability and tighter cutoff. Removal of chemical constituents must be done, and sewage system projects should be implemented in all towns and villages.

On the road to sustainable sanitation: an overview of practices and lessons learned from a sanitation programme in Malawi

This paper details practices and lessons learned from a sanitation programme implemented at Embangweni and Ekwendeni in Mzimba district, northern Malawi. The programme began in 2002 when the Church of Central Africa Presbyterian (CCAP) Synod of Livingstonia partnered with WaterAid, a British charity exclusively dedicated to provision of safe water supply, sanitation, and hygiene education messages to the world's poorest people. The partnership was established to focus on sanitation and hygiene within the coverage area of the CCAP Synod of Livingstonia's Embangweni and Ekwendeni mission hospitals. In this paper the activities and practices which influenced the success of the programme are highlighted together with the sustainability issues influencing the experimentation, innovations and behavioural change initiatives in the programme. Finally, this paper brings to light a detailed account of what worked and what did not work.