Bibliography on household water treatment and safe storage

Environmental Health at USAID has compiled an annotated bibliography of 21 journal articles on household water treatment and safe storage that were published from January-July 2009.

Link: http://www.ehproject.org/PDF/ehkm/bibliography-hwt_july2009.pdf (pdf, 70KB)

Below are 3 of the 21 studies from the bibliography:

1 – Am J Trop Med Hyg. 2009 May; 80(5):819-23.
Laboratory assessment of a gravity-fed ultra-filtration water treatment device designed for household use in low-income settings.

Clasen T, Naranjo J, Frauchiger D, Gerba C.

Interventions to improve water quality, particularly when deployed at the household level, are an effective means of preventing endemic diarrheal disease, a leading cause of mortality and morbidity in the developing world. We assessed the microbiologic performance of a novel water treatment device designed for household use in low-income settings. The device employs a backwashable hollow fiber ultrafiltration cartridge and is designed to mechanically remove enteric pathogenic bacteria, viruses, and protozoan cysts from drinking water without water pressure or electric power. In laboratory testing through 20,000 L (approximately 110% of design life) at moderate turbidity (15 nephelometric turbidity unit [NTU]), the device achieved log(10) reduction values of 6.9 for Escherichia coli, 4.7 for MS2 coliphage (proxy for enteric pathogenic viruses), and 3.6 for Cryptosporidium oocysts, thus exceeding levels established for microbiological water purifiers. With periodic cleaning and backwashing, the device produced treated water at an average rate of 143 mL/min (8.6 L/hour) (range 293 to 80 mL/min) over the course of the evaluation. If these results are validated in field trials, the deployment of the unit on a wide scale among vulnerable populations may make an important contribution to public health efforts to control intractable waterborne diseases.

4 – Environ Sci Technol. 2009 Feb 15; 43(4):986-92.
Household water treatment in poor populations: is there enough evidence for scaling up now?

Schmidt WP, Cairncross S.
Point-of-use water treatment (household water treatment, HWT) has been advocated as a means to substantially decrease the global burden of diarrhea and to contribute to the Millennium Development Goals. To determine whether HWT should be scaled up now, we reviewed the evidence on acceptability, scalability, adverse effects, and nonhealth benefits as the main criteria to establish how much evidence is needed before scaling up. These aspects are contrasted with the evidence on the effect of HWT on diarrhea. We found that the acceptability and scalability of HWT is still unclear, and that there are substantial barriers making it difficult to identify populations that would benefit most from a potential effect. The nonhealth benefits of HWT are negligible. Health outcome trials suggest that HWT may reduce diarrhea by 30-40%. The problem of bias is discussed. There is evidence that the estimates may be strongly biased. Current evidence does not exclude that the observed diarrhea reductions are largely or entirely due to bias. We conclude that widespread promotion of HWT is premature given the available evidence. Further acceptability studies and large blinded trials or trials with an objective health outcome are needed before HWT can be recommended to policy makers and implementers.

7 – Int J Epidemiol. 2009 Jul 2.

Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala.

Arnold B, Arana B, Mäusezahl D, Hubbard A, Colford JM Jr.

BACKGROUND: The promotion of household water treatment and handwashing with soap has led to large reductions in child diarrhoea in randomized efficacy trials. Currently, we know little about the health effectiveness of behaviour-based water and hygiene interventions after the conclusion of intervention activities.

METHODS: We present an extension of previously published design (propensity score matching) and analysis (targeted maximum likelihood estimation) methods to evaluate the behavioural and health impacts of a pre-existing but non-randomized intervention (a 3-year, combined household water treatment and handwashing campaign in rural Guatemala). Six months after the intervention, we conducted a cross-sectional cohort study in 30 villages (15 intervention and 15 control) that included 600 households, and 929 children <5 years of age.

RESULTS: The study design created a sample of intervention and control villages that were comparable across more than 30 potentially confounding characteristics. The intervention led to modest gains in confirmed water treatment behaviour [risk difference = 0.05, 95% confidence interval (CI) 0.02-0.09]. We found, however, no difference between the intervention and control villages in self-reported handwashing behaviour, spot-check hygiene conditions, or the prevalence of child diarrhoea, clinical acute lower respiratory infections or child growth.

CONCLUSIONS: To our knowledge this is the first post-intervention follow-up study of a combined household water treatment and handwashing behaviour change intervention, and the first post-intervention follow-up of either intervention type to include child health measurement. The lack of child health impacts is consistent with unsustained behaviour adoption. Our findings highlight the difficulty of implementing behaviour-based household water treatment and handwashing outside of intensive efficacy trials.

Annotated bibliography on handwashing/hygiene

This bibliography contains citations and abstracts to 17 journal articles published from January – July 2009. The bibliography will be updated on a periodic basis and posted to the Environmental Health at USAID website.

Link – http://www.ehproject.org/PDF/ehkm/handwashing-bibliography_july2009.pdf (pdf, 60KB)

World Toilet Day: The Royal Society For Public Health Asks ‘How Healthy Are Our Loos’?

Poor hygiene is threatening public health and The Royal Society for Public Health believes that, on World Toilet Day – Monday November 17, the developed world has no reason to be complacent about its loo routines.

Toilet germs are spreading fast, with almost 50% of adults in the UK failing to dry their hands after using a public toilet, and one in six adults admitting that they don’t wash their hands every time(1). (…)

Read all MedicalNewsToday.com

USA – Handwashing: women lead men in bacteria

WASHINGTON (AP) — Wash your hands, folks, especially you ladies. A new study found that women have a greater variety of bacteria on their hands than men do. And everybody has more types of bacteria than the researchers expected to find.

“One thing that really is astonishing is the variability between individuals, and also between hands on the same individual,” said University of Colorado biochemistry assistant professor Rob Knight, a co-author of the paper.

“The sheer number of bacteria species detected on the hands of the study participants was a big surprise, and so was the greater diversity of bacteria we found on the hands of women,” added lead researcher Noah Fierer, an assistant professor in Colorado’s department of ecology and evolutionary biology.

The researchers aren’t sure why women harbored a greater variety of bacteria than men, but Fierer suggested it may have to so with the acidity of the skin. Knight said men generally have more acidic skin than women.

Other possibilities are differences in sweat and oil gland production between men and women, the frequency of moisturizer or cosmetics applications, skin thickness or hormone production, he said.

Women also may have more bacteria living under the surface of the skin where they are not accessible to washing, Knight added.

Asked if guys should worry about holding hands with girls, Knight said: “I guess it depends on which girl.”

He stressed that “the vast majority of the bacteria we have on our body are either harmless or beneficial … the pathogens are a small minority.”

Read More – Associated Press

Canadians are not practicing what they preach when it comes to hygiene

TORONTO, Oct. 8 /CNW/ – An international survey on hygiene practices has shown that for the third consecutive year, Canada tops the charts when it comes to knowing the importance of infection prevention. Nine out of 10 Canadians (90%)(1) believe “washing hands regularly” is the most effective way to help protect against catching the flu – more than any other country surveyed and well ahead of Germany who ranked second in this area with 66 per cent. That being said, there is a gap between knowing and doing. Canadians know how to protect themselves and stay healthy, but are not following through with action. Only four in ten (37%)(2) Canadians claim their children always wash their hands before eating and a similar amount said that they did so ‘most’ of the time (44%) (…)

Read all CNW Group

UNICEF Nepal support helps maintain sanitation and hygiene at relief camps

(…) UNICEF has mobilized 80 hygiene volunteers and helpers in 27 temporary shelters to spread the message on hygiene. They are using hand-held loud speakers to disseminate messages to each family, since almost no one has access to other media such as radios, televisions or newspapers.

To further secure the environment in the camps, UNICEF has supported construction of 400 temporary latrines, 120 tube wells with hand pumps, 100 garbage pits and over 200 bathing spaces for women and adolescent girls.  (…)

Read all UNICEF Press Release

India: ‘1 in 5 Indians doesn’t wash hands before eating’

KOLKATA: The next time someone offers you something to eat, be wary lest you catch an infection. 

A survey conducted by the Global Hygiene Council, an independent body, and supported by Dettol, a Reckitt Benckiser brand, has revealed the deplorable hygiene standards of Indians.

It found that a startling 18% of people do not wash their hands before eating, and even among those who do, one in 10 wash their hands with only water. Given that 50% of Indians do not wash their hands after coughing or sneezing, there is a high chance of picking up germs from the person sitting next to you. (…)

Read all Daily Analysis and News (DNA India)

Australia: Hand washing in doctors remains poor

7th August 2008, AUK Staff

Hand washing amongst doctors remains poor according to results of an Australian study. This is despite both local and national education to promote the benefits of having clean hands when seeing patients. Doctors have come out worse than other healthcare professionals in their adherence to keeping their extremities free of germs. (…)

Read all AnaesthesiaUK

Sierra Leone – Rampant disease washes in with flood water

With malaria, diarrhea and vomiting, pneumonia, bronchitis and other respiratory infections, worm infestations, scabies, abscesses, sores, and boils all common ailments in the Kroo Bay community of the Sierra Leone capital Freetown local medical official Amadou Kandor says it’s little wonder 35 is an average life expectancy for the slum’s 6,000 inhabitants. Kroo Bay, one of the poorest areas in the centre of Sierra Leone’s beachfront capital Freetown, is a squalid slum so littered with rubbish that the paths are made of compressed plastic, cans and toothpaste tubes, and patches of bare orange earth are a rare sight.

Swarms of mosquitoes breed in pools of slimy green water, pigs and children play together in mounds of refuse. In one of the two rivers that flows past the densely packed tin and wood shelters, a bloated dead dog bobs on the surface just upstream of where people wash their clothes.

More – Environmental Expert

World Bank – Sanitation, Hygiene and Wastewater Resource Guide

Service provision in sanitation and hygiene involves four main components that must be understood and addressed when designing or implementing a new sanitation project:
- institutions required to implement and sustain improved sanitation and hygiene at scale.
- infrastructure itself (the physical hardware of latrines and sewers);
- promotion of behavior change, both for hygiene, and for household investment in infrastructure; and
- finance required to pay for the infrastructure and promotion

This Sanitation, Hygiene and Wastewater Resource Guide describes sanitation problems and solutions through the above framework, and guides the reader to available resources on these topics.