Dataset Information

Assessing the Impact of a Risk-Based Intervention on Piped Water Quality in Rural Communities: The Case of Mid-Western Nepal.

ABSTRACT: Ensuring universal access to safe drinking water is a global challenge, especially in rural areas. This research aimed to assess the effectiveness of a risk-based strategy to improve drinking water safety for five gravity-fed piped schemes in rural communities of the Mid-Western Region of Nepal. The strategy was based on establishing community-led monitoring of the microbial water quality and the sanitary status of the schemes. The interventions examined included field-robust laboratories, centralized data management, targeted infrastructure improvements, household hygiene and filter promotion, and community training. The results indicate a statistically significant improvement in the microbial water quality eight months after intervention implementation, with the share of taps and household stored water containers meeting the international guidelines increasing from 7% to 50% and from 17% to 53%, respectively. At the study endline, all taps had a concentration of <10 CFU Escherichia coli/100 mL. These water quality improvements were driven by scheme-level chlorination, improved hygiene behavior, and the universal uptake of household water treatment. Sanitary inspection tools did not predict microbial water quality and, alone, are not sufficient for decision making. Implementation of this risk-based water safety strategy in remote rural communities can support efforts towards achieving universal water safety.

SUBMITTER: Tosi Robinson D

PROVIDER: S-EPMC6121632 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Assessing the Impact of a Risk-Based Intervention on Piped Water Quality in Rural Communities: The Case of Mid-Western Nepal.

Tosi Robinson Dorian D Schertenleib Ariane A Kunwar Bal Mukunda BM Shrestha Rubika R Bhatta Madan M Marks Sara J SJ

International journal of environmental research and public health 20180731 8

Ensuring universal access to safe drinking water is a global challenge, especially in rural areas. This research aimed to assess the effectiveness of a risk-based strategy to improve drinking water safety for five gravity-fed piped schemes in rural communities of the Mid-Western Region of Nepal. The strategy was based on establishing community-led monitoring of the microbial water quality and the sanitary status of the schemes. The interventions examined included field-robust laboratories, centr ...[more]

PMID: 30065180

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Project description:BACKGROUND: Waterborne disease is a major risk for small water supplies in rural settings. This study was done to assess the impact of an educational intervention designed to improve water quality and estimate the contribution of water to the incidence of diarrhoeal disease in poor rural communities in Puerto Rico a two-part study was undertaken. METHODS: An educational intervention was delivered to communities relying on community water supplies. This intervention consisted of student operators and administrators supervising and assisting community members who voluntarily "operate" these systems. These voluntary operators had no previous training and were principally concerned with seeing that some water was delivered. The quality of that water was not something they either understood or addressed. The impact of this intervention was measured through water sampling for standard bacteriological indicators and a frank pathogen. In addition, face-to-face epidemiological studies designed to determine the base-line occurrence of diarrhoeal disease in the communities were conducted. Some 15 months after the intervention a further epidemiological study was conducted in both the intervention communities and in control communities that had not received any intervention. RESULTS: Diarrhoeal illness rates over a four week period prior to the intervention were 3.5%. Salmonella was isolated from all of 5 distributed samples prior to intervention and from only 2 of 12 samples after the intervention. In the 15 months follow-up study, illness rates were lower in the intervention compared to control communities (2.5% vs 3.6%%) (RR = 0.70, 95%CI 0.43, 1.15), though this was not statistically significant. However, in the final Poisson regression model living in an intervention system (RR = 0.318; 95%CI 0.137 - 0.739) and owning a dog (RR = 0.597, 95%CI 0.145 - 0.962) was negatively associated with illness. Whilst size of system (RR = 1.006, 95%CI 1.001 - 1.010) and reporting problems with sewage system (RR = 2.973, 95%CI 1.539 - 5.744) were positively associated with illness. CONCLUSIONS: Educational interventions directed both at identified individuals and the community in general in small communities with poor water quality is a way of giving communities the skills and knowledge to manage their own drinking water quality. This may also have important and sustainable health benefits, though further research preferably using a randomised control trial design is needed.

Project description:Adequate menstrual hygiene management (MHM) requires access to water and sanitation and can be challenging for many women and girls living in resource-poor settings. Inadequate MHM has been associated with urogenital infections. The aim of this study is to assess the impact of a combined household-level piped water and sanitation intervention on MHM practices and urogenital infection symptoms (UGS) among women living in rural communities of Odisha (India). This study was nested within a pair-matched cohort study designed to assess impact of the Gram Vikas MANTRA program, which provided household-level piped water, bathing areas and latrine to all households in intervention villages, on diarrheal disease (primary outcome). The program did not specifically promote menstrual hygiene practices. Forty-five intervention villages were randomly selected from a list of those where implementation was previously completed at least five years before and matched to 45 control villages. Data for the main study was collected in four rounds from June 2015 to October 2016. For the MHM sub study, household surveys were administered in round four to randomly selected women aged 18 or older among study households from the 90 villages, to assess self-reported MHM practicesand urogenital infections symptoms. MHM practices were deemed adequate if they met some of the criteria developed on the basis of international monitoring that the GV program could modify (adequate frequency of absorbent change, washing the body with soap and privacy for managing menstruation). Multilevel mixed-effects logistic regression with a random effect distribution at the level of the pair and village was used to estimate the effect of the intervention on adequate MHM practices (primary outcome) and reported UGS (secondary outcome). A total of 1045 women (517 from intervention and 528 from control) were included in the study. Women who lived in the villages receiving the intervention, were more likely to report adequate MHM practices than those in control villages (Adjusted OR (AOR) 3.54, 95% Confidence Interval (CI): 1.86-6.78). 14.51% and 15.53% of women living in the control and intervention villages reported having at least one UGS. There was no evidence of an intervention effect on reported UGS (AOR = 0.97, 95%CI: 0.64-1.46). While household latrines or bathing areas with access to piped water improve the environment that enable MHM practices related to privacy, the provision of such facilities alone had only a moderate impact in adequate MHM and did not have an effect on self-reported UGS. More targeted inventions that include behavior change strategies and that address other barriers may be necessary to improve MHM practices.

Dataset Information

Assessing the Impact of a Risk-Based Intervention on Piped Water Quality in Rural Communities: The Case of Mid-Western Nepal.

Publications

Assessing the Impact of a Risk-Based Intervention on Piped Water Quality in Rural Communities: The Case of Mid-Western Nepal.

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