Dataset Information

Household effectiveness vs. laboratory efficacy of point-of-use chlorination.

ABSTRACT: Treatment of water at the household level offers a promising approach to combat the global burden of diarrheal diseases. In particular, chlorination of drinking water has been a widely promoted strategy due to persistence of residual chlorine after initial treatment. However, the degree to which chlorination can reduce microbial levels in a controlled setting (efficacy) or in a household setting (effectiveness) can vary as a function of chlorine characteristics, source water characteristics, and household conditions. To gain more understanding of these factors, we carried out an observational study within households in rural communities of northern coastal Ecuador. We found that the efficacy of chlorine treatment under controlled conditions was significantly better than its household effectiveness when evaluated both by ability to meet microbiological safety standards and by log reductions. Water treated with chlorine achieved levels of microbial contamination considered safe for human consumption after 24 h of storage in the household only 39-51% of the time, depending on chlorine treatment regimen. Chlorine treatment would not be considered protective against diarrheal disease according to WHO log reduction standards. Factors that explain the observed compromised effectiveness include: source water turbidity, source water baseline contamination levels, and in-home contamination. Water in 38% of the households that had low turbidity source water (<10 NTU) met the safe water standard as compared with only 17% of the households that had high turbidity source water (>10 NTU). A 10 MPN/100 mL increase in baseline Escherichia coli levels was associated with a 2.2% increase in failure to meet the E. coli standard. Higher mean microbial contamination levels were seen in 54% of household samples in comparison to their matched controls, which is likely the result of in-home contamination during storage. Container characteristics (size of the container mouth) did not influence chlorine effectiveness. We found no significant differences between chlorine treatment regimens in ability to meet the safe water standards or in overall log reductions, although chlorine dosage did modify the effect of source conditions. These results underscore the importance of measuring both source water and household conditions to determine appropriate chlorine levels, as well as to evaluate the appropriateness of chlorine treatment and other point-of-use water quality improvement interventions.

SUBMITTER: Levy K

PROVIDER: S-EPMC3975601 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Household effectiveness vs. laboratory efficacy of point-of-use chlorination.

Levy Karen K Anderson Larissa L Robb Katharine A KA Cevallos William W Trueba Gabriel G Eisenberg Joseph N S JN

Water research 20140131

Treatment of water at the household level offers a promising approach to combat the global burden of diarrheal diseases. In particular, chlorination of drinking water has been a widely promoted strategy due to persistence of residual chlorine after initial treatment. However, the degree to which chlorination can reduce microbial levels in a controlled setting (efficacy) or in a household setting (effectiveness) can vary as a function of chlorine characteristics, source water characteristics, and ...[more]

PMID: 24561887

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Project description:BackgroundCentralized chlorination of urban piped water supplies has historically contributed to major reductions in waterborne illness. In locations without effective centralized water treatment, point-of-use (POU) chlorination for households is widely promoted to improve drinking water quality and health. Realizing these health benefits requires correct, consistent, and sustained product use, but real-world evaluations have often observed low levels of use. To our knowledge, no prior reviews exist on adoption of chlorine POU products.ObjectivesOur objectives were to identify which indicators of adoption are most often used in chlorine POU studies, summarize levels of adoption observed, understand how adoption changes over time, and determine how adoption is affected by frequency of contact between participants and study staff.MethodsWe conducted a systematic review of household POU chlorination interventions or programs from 1990 through 2021 that reported a quantitative measure of adoption, were conducted in low- and middle-income countries, included data collection at households, and reported the intervention start date.ResultsWe identified 36 studies of household drinking water chlorination products that met prespecified eligibility criteria and extracted data from 46 chlorine intervention groups with a variety of chlorine POU products and locations. There was no consensus definition of adoption of household water treatment; the most common indicator was the proportion of household stored water samples with free chlorine residual >0.1 or 0.2mg/L. Among studies that reported either free or total chlorine-confirmed adoption of chlorine POU products, use was highly variable (across all chlorine intervention groups at the last time point measured in each study; range: 1.5%-100%; sample size-weighted median=47%; unweighted median=58%). The median follow-up duration among intervention groups was 3 months. On average, adoption declined over time and was positively associated with frequency of contact between respondents and study staff.DiscussionAlthough prior research has shown that POU chlorine products improve health when correctly and consistently used, a reliance on individual adoption for effective treatment is unlikely to lead to the widespread public health benefits historically associated with pressurized, centralized treatment of piped water supplies. https://doi.org/10.1289/EHP10839.

Project description:Rural households in developing countries rely on communal water supplies and household water frequently becomes contaminated following its collection, transportation and during its storage. Using culture-dependent and -independent techniques, we examined the changes in microbial water quality between communal tap water and household water storage in a rural area of Cameroon, Africa. The culturable fecal indicator bacteria (FIB) were used to assess the potential health risks associated with different household water storage conditions (e.g., type of container and open vs. closed container) and interventions (e.g., water storage days, cleaned on the last day of use, and hygiene practices). Only the amount of days the water was stored significantly differed (p-value < 0.05), which showed that potential health risks increased when water was stored for more than 3 days. The higher abundance of molecular FIB in biofilm than household water suggested that omnipresent biofilm in household water could potential health risk. The high-throughput sequencing revealed that the most abundant phylum was Proteobacteria, followed by Actinobacteria and Bacteroidetes in both the water and the biofilm samples. Bacterial genera seen in biofilm bacteria, such as Pseudomonas, Acinetobacter and Comamonas. Acinetobacter, Chryseobacterium, Stenotrophomonas and Corynebacterium, were relatively more abundant in the biofilm than in the water. Potential bacterial pathogens including Acinetobacter baumannii, Citrobacter freundii, Stenotrophomonas maltophilia and Haemophilus influenza, were detected in household water and biofilm. The microbial quality might be affected by water-storage time and households repeatedly using the same water storage containers without proper sanitization, triggering microbial regrowth and biofilm formation on water containers. Higher bacterial diversity and potentially pathogenic bacteria found in the biofilm samples of a household water supply are unhealthy for the house's inhabitants. It is important to develop interventions aimed at preventing the formation of these dangerous biofilms in a communal water supply.

Dataset Information

Household effectiveness vs. laboratory efficacy of point-of-use chlorination.

Publications

Household effectiveness vs. laboratory efficacy of point-of-use chlorination.

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