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Household Water Treatment in Developing Countries: Successes, Failures, and Way Forward

Household Water Treatment in Developing Countries: Successes, Failures, and Way Forward. Daniele Lantagne, PE Centers for Disease Control and Prevention. Why do children die of diarrhea?. Youngest children Immature immune system Less physiologic reserve Multiple physiologic insults

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Household Water Treatment in Developing Countries: Successes, Failures, and Way Forward

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  1. Household Water Treatment in Developing Countries: Successes, Failures, and Way Forward Daniele Lantagne, PE Centers for Disease Control and Prevention

  2. Why do children die of diarrhea? Youngest children Immature immune system Less physiologic reserve Multiple physiologic insults Malnutrition Protein & calorie deficient Micronutrient deficient Frequent infections Feces contaminated environment Water, Food, Environment Limited access to effective clinical care

  3. How many child deaths are due to unsafe water? Question ignores: Web of causality Assumes a single cause of death Risks professional groups Arguing for resources Not collaborating to address problem Child mortality from diarrhea is an enormous global public health problem and contaminated water contributes importantly.

  4. Q: How much disease could be prevented by better managing water, sanitation and hygiene ? • A: 10% • "Almost one tenth of the global disease burden could be prevented by improving water supply, sanitation, hygiene and management of water resources"

  5. WSH = disease and poverty ? • Inadequate water supply • Unsafe water resources • Inequitable access • Time, financial cost • Disease burden • Health care costs POVERTY

  6. WSH = motor of development • Improved water supply • Safe water resources • Universal access • Time, financial savings • Averted disease costs • Health & education Development

  7. What is safe water? Safe water is water that is safe to drink in the users’ cup. • Health workers • Water that does not cause morbidity or mortality in children < 5 • Engineers • Water without bacterial contamination at exit of plant or pump • Millennium Development Goals • Protected Sources • Goal: reduce in half those without access to “improved water” by 2015

  8. The World (seen through the lens of diarrheal deaths) Territories are sized in proportion to the absolute number of people who died from diarrheal diseases in one year Source: http://www.worldmapper.org

  9. Goal: Health ImpactDiarrheal Disease Reduction 1992 2004 • Hygiene (handwashing) -33% -42% • Sanitation -36% -24% • Water Supply -19% -23% • Water Treatment -15% -39% ALL are necessary. Start with one. Leverage to others.

  10. Proven HWTS Options • Ceramic Filtration • SWS • SODIS • Biosand Filtration • PuR

  11. Proven Option Comparison Chart

  12. Proven Option Comparison Chart

  13. Proven Option Comparison Chart

  14. Proven Option Comparison Chart

  15. Note: Other Options • Laboratory Testing • Field testing • Health Impact Analysis • Scalability

  16. Safe Rural Water Supply = +

  17. Safe Rural Water Supply +

  18. Safe Rural Water Supply +

  19. When does POU not work? • Poor product • Inappropriate product • Unconvinced users • ??

  20. Poor Product • Zambia • Study showed • 42% said current users • 13% had chlorine residual • Quality control issue • Old generators Solution • Stringent quality control • Moving to company production

  21. Inappropriate Product UV light Ozone Contact Tank 3 micron Filter Flow Meter Chlorine Contact Tank B C D E A Chlorine Pump 1 Pump 2 Influent Holding Tank 1 micron bag filter 0.2 Micron Filter Effluent Ozonator

  22. Unconvinced Users • Nepal • AED study on preference • SODIS • SWS • Ceramic Filtration • BioSand Filtration • “SODIS won’t work” • Culturally inappropriate Solution: education, other option?

  23. What makes HWT work? • Quality product • Distribution, marketing, profit • Behavior change communication • User adoption

  24. 1. Quality (local) product

  25. 2. Distribution, marketing, profit

  26. 3. Behavior Change Communication

  27. 4. Sustained adoption and monitoring

  28. Cost Effective Implementation Sustainability Technological Verification Consumer Demand

  29. Combined estimate of home water treatment products T. Clasen, “Scaling Up Household Water Treatment Among Low-Income Populations” (World Health Organization, 2009).

  30. Coverage - Sobering Statistics (Clasen) 60% Coverage

  31. Nursing Collaboration • Nurses recommend WaterGuard to mothers of children with diarrhea • Chlorine Residual Results • 2 weeks • 68% (67/98) • 1 year • 71% (36/51)

  32. Diffusion of Innovations

  33. Way Forward • Think strategically, assess programs, fix failures. • Keep an open-mind. • Base research on implementation needs. • Think at-scale. • Implement and fund proven technologies. We are having impact BUT we can always improve.

  34. Key questions for future Can we increase demand for improved water quality among the group in highest need? Can we develop sustainable systems that provide point of use approaches to communities in highest need? Can we reduce the burden of disease, particularly among the poorest with this approach?

  35. “The notion that ‘being humanitarian’ and ‘doing good’ are somehow inevitably the same is a hard one to shake off” (Slim, 1997) Thank you. I am happy to take questions. dlantagne@cdc.gov

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