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Crider YS, Tsuchiya M, Mukundwa M, Ray I, Pickering AJ. Adoption of Point-of-Use Chlorination for Household Drinking Water Treatment: A Systematic Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:16001. [PMID: 36715546 PMCID: PMC9885856 DOI: 10.1289/ehp10839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Centralized 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. OBJECTIVES Our 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. METHODS We 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. RESULTS We 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 0.2 mg / 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. DISCUSSION Although 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.
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Affiliation(s)
- Yoshika S. Crider
- Energy and Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
- Division of Epidemiology and Biostatistics, UC Berkeley, Berkeley, California, USA
- King Center on Global Development, Stanford University, Stanford, California, USA
| | - Miki Tsuchiya
- Master of Development Practice Program, UC Berkeley, Berkeley, California, USA
| | - Magnifique Mukundwa
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, UC Berkeley, Berkeley, California, USA
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Venis RA, Taylor V, Sumayani P, Laizer M, Anderson T, Basu OD. Towards a participatory framework for improving water & health outcomes: A case study with Maasai women in rural Tanzania. Soc Sci Med 2022; 301:114966. [PMID: 35429839 DOI: 10.1016/j.socscimed.2022.114966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 02/07/2023]
Abstract
Rural communities in sub-Saharan Africa (SSA) are disproportionately burdened by a pervasive lack of access to safe drinking water. Widespread programmatic failure in the water, sanitation, and hygiene (WaSH) sector has resulted in particularly slow progress in alleviating these challenges in the region. Drawing from decolonial and participatory methodological scholarship, this research demonstrates how geographically and demographically specific, locally controlled, and long-term educational programming can improve health and wellness outcomes when associated with a technological intervention. Specifically, consultations between January 2015 and August 2018 were followed by an iterative and community-driven program development process between January and July 2019. Fifty Maasai women were subsequently recruited to participate and were provided with a point-of-use water treatment technology in August 2019. These women engaged in a series of three 14-week WaSH education programs over an 18-month evaluation period. Results showed that 38% of participants reported regular diarrhea at baseline, decreasing to 8%, 0%, and 3% immediately after each of the three WaSH education programs were provided at 3, 12, and 18 months. Interim measurements taken between WaSH programs showed 35% of participants (at 6 months) and 5% of participants (at 15 months) reporting regular diarrhea. A trend of improvement was thus observed over the study period, though the increase in reported diarrhea at 6 months demonstrates the need for long-term commitment on the part of WASH practitioners when engaging with end users to achieve sustained change. Further, this research highlights the importance of participatory program development and pedagogical approaches in WaSH interventions, where local control of study objective determination and implementation, combined with consistent and long-term engagement, can facilitate sustained technology use and associated reductions in diarrhea.
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Affiliation(s)
- Robbie A Venis
- Department of Civil and Environmental Engineering, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
| | - Virginia Taylor
- Sprott School of Business, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada; Tanzania Education and Micro Business Opportunity (TEMBO) Trust, P.O. Box 95, Longido, Longido District, Arusha Region, Tanzania
| | - Paulina Sumayani
- Tanzania Education and Micro Business Opportunity (TEMBO) Trust, P.O. Box 95, Longido, Longido District, Arusha Region, Tanzania
| | - Marie Laizer
- Tanzania Education and Micro Business Opportunity (TEMBO) Trust, P.O. Box 95, Longido, Longido District, Arusha Region, Tanzania
| | - Troy Anderson
- Sprott School of Business, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Onita D Basu
- Department of Civil and Environmental Engineering, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
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Chirgwin H, Cairncross S, Zehra D, Sharma Waddington H. Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1194. [PMID: 36951806 PMCID: PMC8988822 DOI: 10.1002/cl2.1194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Background Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vulnerable populations, especially for women and girls. The hardest hit regions are sub-Saharan Africa and South Asia. Sustainable Development Goal (SDG) 6 calls for the end of open defecation, and universal access to safely managed water and sanitation facilities, and basic hand hygiene, by 2030. WASH access and use also underpin progress in other areas such as SDG1 poverty targets, SDG3 health and SDG4 education targets. Meeting the SDG equity agenda to "leave none behind" will require WASH providers prioritise the hardest to reach including those living remotely and people who are disadvantaged. Objectives Decision makers need access to high-quality evidence on what works in WASH promotion in different contexts, and for different groups of people, to reach the most disadvantaged populations and thereby achieve universal targets. The WASH evidence map is envisioned as a tool for commissioners and researchers to identify existing studies to fill synthesis gaps, as well as helping to prioritise new studies where there are gaps in knowledge. It also supports policymakers and practitioners to navigate the evidence base, including presenting critically appraised findings from existing systematic reviews. Methods This evidence map presents impact evaluations and systematic reviews from the WASH sector, organised according to the types of intervention mechanisms, WASH technologies promoted, and outcomes measured. It is based on a framework of intervention mechanisms (e.g., behaviour change triggering or microloans) and outcomes along the causal pathway, specifically behavioural outcomes (e.g., handwashing and food hygiene practices), ill-health outcomes (e.g., diarrhoeal morbidity and mortality), nutrition and socioeconomic outcomes (e.g., school absenteeism and household income). The map also provides filters to examine the evidence for a particular WASH technology (e.g., latrines), place of use (e.g., home, school or health facility), location (e.g., global region, country, rural and urban) and group (e.g., people living with disability). Systematic searches for published and unpublished literature and trial registries were conducted of studies in low- and middle-income countries (LMICs). Searches were conducted in March 2018, and searches for completed trials were done in May 2020. Coding of information for the map was done by two authors working independently. Impact evaluations were critically appraised according to methods of conduct and reporting. Systematic reviews were critically appraised using a new approach to assess theory-based, mixed-methods evidence synthesis. Results There has been an enormous growth in impact evaluations and systematic reviews of WASH interventions since the International Year of Sanitation, 2008. There are now at least 367 completed or ongoing rigorous impact evaluations in LMICs, nearly three-quarters of which have been conducted since 2008, plus 43 systematic reviews. Studies have been done in 83 LMICs, with a high concentration in Bangladesh, India, and Kenya. WASH sector programming has increasingly shifted in focus from what technology to supply (e.g., a handwashing station or child's potty), to the best way in which to do so to promote demand. Research also covers a broader set of intervention mechanisms. For example, there has been increased interest in behaviour change communication using psychosocial "triggering", such as social marketing and community-led total sanitation. These studies report primarily on behavioural outcomes. With the advent of large-scale funding, in particular by the Bill & Melinda Gates Foundation, there has been a substantial increase in the number of studies on sanitation technologies, particularly latrines. Sustaining behaviour is fundamental for sustaining health and other quality of life improvements. However, few studies have been done of intervention mechanisms for, or measuring outcomes on sustained adoption of latrines to stop open defaecation. There has also been some increase in the number of studies looking at outcomes and interventions that disproportionately affect women and girls, who quite literally carry most of the burden of poor water and sanitation access. However, most studies do not report sex disaggregated outcomes, let alone integrate gender analysis into their framework. Other vulnerable populations are even less addressed; no studies eligible for inclusion in the map were done of interventions targeting, or reporting on outcomes for, people living with disabilities. We were only able to find a single controlled evaluation of WASH interventions in a health care facility, in spite of the importance of WASH in health facilities in global policy debates. The quality of impact evaluations has improved, such as the use of controlled designs as standard, attention to addressing reporting biases, and adequate cluster sample size. However, there remain important concerns about quality of reporting. The quality and usefulness of systematic reviews for policy is also improving, which draw clearer distinctions between intervention mechanisms and synthesise the evidence on outcomes along the causal pathway. Adopting mixed-methods approaches also provides information for programmes on barriers and enablers affecting implementation. Conclusion Ensuring everyone has access to appropriate water, sanitation, and hygiene facilities is one of the most fundamental of challenges for poverty elimination. Researchers and funders need to consider carefully where there is the need for new primary evidence, and new syntheses of that evidence. This study suggests the following priority areas:Impact evaluations incorporating understudied outcomes, such as sustainability and slippage, of WASH provision in understudied places of use, such as health care facilities, and of interventions targeting, or presenting disaggregated data for, vulnerable populations, particularly over the life-course and for people living with a disability;Improved reporting in impact evaluations, including presentation of participant flow diagrams; andSynthesis studies and updates in areas with sufficient existing and planned impact evaluations, such as for diarrhoea mortality, ARIs, WASH in schools and decentralisation. These studies will preferably be conducted as mixed-methods systematic reviews that are able to answer questions about programme targeting, implementation, effectiveness and cost-effectiveness, and compare alternative intervention mechanisms to achieve and sustain outcomes in particular contexts, preferably using network meta-analysis.
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Affiliation(s)
- Hannah Chirgwin
- International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
| | | | | | - Hugh Sharma Waddington
- London School of Hygiene and Tropical Medicine and International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
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Sempewo JI, Kisaakye P, Mushomi J, Tumutungire MD, Ekyalimpa R. Assessing willingness to pay for water during the COVID-19 crisis in Ugandan households. SOCIAL SCIENCES & HUMANITIES OPEN 2021; 4:100230. [PMID: 34805972 PMCID: PMC8592029 DOI: 10.1016/j.ssaho.2021.100230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
With the emergence of COVID-19, improving hygiene through handwashing with water and detergent is a priority. This behavioural practice requires that households have access to reliable improved water. One measure that can provide an invaluable source of information to measure access to improved water supply is willingness to pay (WTP). However, little is known about WTP for water during a pandemic such as COVID-19. Data from a cross-sectional survey was used to assess potential household determinants of WTP for water during March-June 2020 in 1639 Ugandan households. The focus is on the period March-June 2020 when the government of Uganda implemented a countrywide total lockdown in a bid to curb the spread of the deadly virus. Results indicate that most households were not willing to pay for water during March-June 2020. Sex of the household head, region of residence, water source, number of times hands are washed and whether a household buys or pays for water were significant explanatory household determinants for WTP for water. The results provide a rich understanding of the household factors that determine WTP for water during a pandemic. This evidence is important in guiding government and water utilities in developing sustainable regulations and policy interventions particularly during emergencies. The findings suggest that increasing or maintaining water revenues will be a challenge in emergencies if no attention is placed to addressing the disparity in socio-economic attributes associated with households’ WTP.
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Affiliation(s)
- Jotham Ivan Sempewo
- College of Engineering, Design Art and Technology, Department of Civil and Environmental Engineering, Makerere University, Uganda
| | - Peter Kisaakye
- School of Statistics and Planning, Makerere University, Uganda
| | - John Mushomi
- College of Business and Management Sciences, Department of Population Studies, Makerere University, Uganda
| | - Martin Dahlin Tumutungire
- College of Engineering, Design Art and Technology, Department of Civil and Environmental Engineering, Makerere University, Uganda
| | - Ronald Ekyalimpa
- College of Engineering, Design Art and Technology, Department of Construction Economics and Management, Makerere University, Uganda
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Smith DW, Sultana S, Crider YS, Islam SA, Swarthout JM, Goddard FGB, Rabbani A, Luby SP, Pickering AJ, Davis J. Effective Demand for In-Line Chlorination Bundled with Rental Housing in Dhaka, Bangladesh. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:12471-12482. [PMID: 34498866 DOI: 10.1021/acs.est.1c01308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Delivering safe water in cities of lower- and middle-income countries remains elusive even where there is a piped supply. Passive, in-line chlorination upstream of the point of water collection reduces child diarrhea without the behavior change required for point-of-use water treatment products or manual chlorine dispensers. We conducted a price experiment to measure effective demand (willingness and ability to pay) for an in-line chlorination service using tablet chlorinators among 196 landlords of rental housing properties in Dhaka, Bangladesh. We offered a 12-month subscription using Becker-DeGroot-Marschak auctions with real money payments. The service consistently delivered chlorinated water and satisfied tenants. Landlords' effective demand for in-line chlorination was similar to or greater than that for point-of-use treatment products and manual chlorine dispensers previously documented among Dhaka households. Over the service period, landlords renting to low-income households had lower effective demand than those renting to middle-income households despite similar initial rates of payment across both groups. Making in-line chlorination financially viable for the lowest-income consumers would likely require service cost reductions, subsidies, or both. Our findings suggest that even revealed preference experiments may overestimate the effective demand needed to sustain water supply improvements, especially in low-income populations, if they only measure demand once.
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Affiliation(s)
- Daniel W Smith
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Sonia Sultana
- Environmental Interventions Unit, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Yoshika S Crider
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Syed Anjerul Islam
- Environmental Interventions Unit, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Jenna M Swarthout
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Frederick G B Goddard
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Atonu Rabbani
- Department of Economics, University of Dhaka, Dhaka 1000, Bangladesh
- BRAC James P. Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka 1212, Bangladesh
| | - Stephen P Luby
- Stanford Woods Institute for the Environment, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Amy J Pickering
- Department of Civil & Environmental Engineering, Davis Hall, University of California, Berkeley, Berkeley, California 94720, United States
| | - Jennifer Davis
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
- Stanford Woods Institute for the Environment, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
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Meyer DD, Hill C, McCain K, Smith JA, Bessong PO, Rogawski McQuade ET, Wright NC. Embedding Usage Sensors in Point-of-Use Water Treatment Devices: Sensor Design and Application in Limpopo, South Africa. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:8955-8964. [PMID: 34133882 PMCID: PMC9207768 DOI: 10.1021/acs.est.0c08683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Health benefits from point-of-use (POU) water treatment devices come only with consistent use. Embedded sensors can measure the consistency of POU-device use and can provide insights about improving it. We demonstrate both potentials with data from SmartSpouts: accelerometer-based sensors embedded in spigot handles that record the duration and timing of use. In the laboratory, most sensor readings correlated well (>0.98) with manually timed water withdrawals. In the field, SmartSpouts measured >60,000 water withdrawals across 232 households in Limpopo, South Africa. Sensors proved critical to understanding consistent use; surveys overestimated it by 53 percentage points. Sensor data showed when households use POU devices (evening peaks and delayed weekend routines) and user preferences (safe storage over filters). We demonstrate analytically and with data that (i) consistent use (e.g., 7 continuous days) is extremely sensitive to single-day use prevalence and (ii) use prevalence affects the performance of contact-time-based POU devices, exemplified with silver tablets. Deployed SmartSpouts had limitations, including memory overflows and confounding device relocation with water withdrawal. Nevertheless, SmartSpouts provided useful and objective data on the prevalence of single-day and consistent use. Considerably less expensive than alternatives, SmartSpouts enable an order of magnitude increase in how many POU-device sensors can be deployed.
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Affiliation(s)
- David D Meyer
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Courtney Hill
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - Kelly McCain
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - James A Smith
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - Pascal O Bessong
- University of Virginia, Charlottesville, Virginia 22904, United States
- University of Venda, Thohoyandou 0950, Limpopo, South Africa
| | | | - Natasha C Wright
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
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Willingness to Pay for Improved Operations and Maintenance Services of Gravity-Fed Water Schemes in Idjwi Island (Democratic Republic of the Congo). WATER 2021. [DOI: 10.3390/w13081050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Developing understanding of the economic value that communities ascribe to improved operations and maintenance (O&M) services has emerged as a key factor in achieving financial sustainability for rural water systems. The present study elicits household willingness to pay (WTP) for improved O&M services in eight gravity-fed water schemes in Idjwi Island (Democratic Republic of the Congo, DRC). A contingent valuation survey was implemented through an open-ended format questionnaire to 1105 heads of household and a log-linear regression model was employed to assess the factors influencing higher values. Findings show an average willingness to pay of 327 Congolese Francs (CDF) per month and 36 CDF per bucket. Results also indicate a significant WTP differential among studied schemes. The analysis of the conditioning factors reveals that the level of excludability, the participation in management meetings and the time employed in fetching water from an improved source are contingent with their WTP. The findings of this study are important for development agents trying to establish acceptable, affordable and practicable tariffs that help finance reliable rural water systems in Idjwi.
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Towards safe drinking water and clean cooking for all. LANCET GLOBAL HEALTH 2021; 9:e361-e365. [DOI: 10.1016/s2214-109x(20)30476-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/09/2020] [Accepted: 10/23/2020] [Indexed: 12/17/2022]
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Sempewo JI, Kisaakye P, Mushomi J, Tumutungire MD, Ekyalimpa R. Assessing willingness to pay for water during the COVID-19 crisis in Ugandan households. SOCIAL SCIENCES & HUMANITIES OPEN 2021. [PMID: 34805972 DOI: 10.2166/ws.2021.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
With the emergence of COVID-19, improving hygiene through handwashing with water and detergent is a priority. This behavioural practice requires that households have access to reliable improved water. One measure that can provide an invaluable source of information to measure access to improved water supply is willingness to pay (WTP). However, little is known about WTP for water during a pandemic such as COVID-19. Data from a cross-sectional survey was used to assess potential household determinants of WTP for water during March-June 2020 in 1639 Ugandan households. The focus is on the period March-June 2020 when the government of Uganda implemented a countrywide total lockdown in a bid to curb the spread of the deadly virus. Results indicate that most households were not willing to pay for water during March-June 2020. Sex of the household head, region of residence, water source, number of times hands are washed and whether a household buys or pays for water were significant explanatory household determinants for WTP for water. The results provide a rich understanding of the household factors that determine WTP for water during a pandemic. This evidence is important in guiding government and water utilities in developing sustainable regulations and policy interventions particularly during emergencies. The findings suggest that increasing or maintaining water revenues will be a challenge in emergencies if no attention is placed to addressing the disparity in socio-economic attributes associated with households' WTP.
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Affiliation(s)
- Jotham Ivan Sempewo
- College of Engineering, Design Art and Technology, Department of Civil and Environmental Engineering, Makerere University, Uganda
| | - Peter Kisaakye
- School of Statistics and Planning, Makerere University, Uganda
| | - John Mushomi
- College of Business and Management Sciences, Department of Population Studies, Makerere University, Uganda
| | - Martin Dahlin Tumutungire
- College of Engineering, Design Art and Technology, Department of Civil and Environmental Engineering, Makerere University, Uganda
| | - Ronald Ekyalimpa
- College of Engineering, Design Art and Technology, Department of Construction Economics and Management, Makerere University, Uganda
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Morse T, Luwe K, Lungu K, Chiwaula L, Mulwafu W, Buck L, Harlow R, Fagan GH, McGuigan K. A Transdisciplinary Methodology for Introducing Solar Water Disinfection to Rural Communities in Malawi-Formative Research Findings. INTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT 2020; 16:871-884. [PMID: 32048797 PMCID: PMC7687190 DOI: 10.1002/ieam.4249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/14/2019] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
Despite the increasing volume of evidence demonstrating the efficacy of solar water disinfection (SODIS) as a household water treatment technology, there still appear to be significant barriers to uptake in developing countries. The potential of SODIS is often treated with skepticism in terms of effective treatment, volume, and safety, and is dismissed in preference for more accepted technologies such as ceramic filters and dose chlorination. As part of WATERSPOUTT (EU H2020 688928), our study used a transdisciplinary methodology to cocreate an innovative SODIS system in rural Malawi. The formative work focused on the design of 1) an appropriate and acceptable system and 2) a context-specific intervention delivery program using a behavior-centered design. Initial research identified specific water needs and challenges, which were discussed along with a cocreation process with potential end users, through a series of shared dialogue workshops (SDWs). Specifications from end users outlined a desire for higher volume systems (20 L) that were "familiar" and could be manufactured locally. Development of the "SODIS bucket" was then undertaken by design experts and local manufacturers, with input from end users and subject to controlled testing to ensure efficacy and safety. Concurrent data were collated using questionnaires (n = 777 households), water point mapping (n = 121), water quality testing (n = 46), and behavior change modeling (n = 100 households). These identified specific contextual issues (hydrogeology, water access, gender roles, social capital, and socioeconomic status), and behavioral determinants (normative, ability, and self-regulation factors) that informed the development and delivery mechanism for the implementation toolkit. Integr Environ Assess Manag 2020;16:871-884. © 2020 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).
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Affiliation(s)
- Tracy Morse
- Department of Civil and Environmental EngineeringUniversity of StrathclydeGlasgowUnited Kingdom
- Centre for Water, Sanitation, Hygiene and Appropriate Technology Development, University of Malawi (Polytechnic)BlantyreMalawi
| | - Kondwani Luwe
- Centre for Water, Sanitation, Hygiene and Appropriate Technology Development, University of Malawi (Polytechnic)BlantyreMalawi
| | - Kingsley Lungu
- Centre for Water, Sanitation, Hygiene and Appropriate Technology Development, University of Malawi (Polytechnic)BlantyreMalawi
- Department of Environmental HealthUniversity of Malawi (Polytechnic)BlantyreMalawi
| | - Levison Chiwaula
- Faculty of Social Sciences and Humanities, University of Malawi (Chancellor College)ZombaMalawi
| | - Wapulumuka Mulwafu
- Faculty of Social Sciences and Humanities, University of Malawi (Chancellor College)ZombaMalawi
| | - Lyndon Buck
- Department of Product DesignBuckinghamshire New UniversityLondonUnited Kingdom
| | - Richard Harlow
- Department of Product DesignBuckinghamshire New UniversityLondonUnited Kingdom
| | - G Honor Fagan
- Department of Sociology and Social Science Institute (MUSSI)Maynooth UniversityMaynoothIreland
| | - Kevin McGuigan
- Department of Physiology and Medical PhysicsRoyal College of SurgeonsIrelandDublinIreland
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Heitzinger K, Hawes SE, Rocha CA, Alvarez C, Evans CA. Assessment of the Feasibility and Acceptability of Using Water Pasteurization Indicators to Increase Access to Safe Drinking Water in the Peruvian Amazon. Am J Trop Med Hyg 2020; 103:455-464. [PMID: 32372750 PMCID: PMC7356428 DOI: 10.4269/ajtmh.18-0963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Approximately two billion people lack access to microbiologically safe drinking water globally. Boiling is the most popular household water treatment method and significantly reduces diarrheal disease, but is often practiced inconsistently or ineffectively. The use of low-cost technologies to improve boiling is one approach with potential for increasing access to safe drinking water. We conducted household trials to evaluate the feasibility and acceptability of water pasteurization indicators (WAPIs) in the Peruvian Amazon in 2015. A total of 28 randomly selected households were enrolled from a rural and a peri-urban community. All households trialed two WAPI designs, each for a 2-week period. Ninety-six percent of participants demonstrated the correct use of the WAPIs at the end of each trial, and 88% expressed satisfaction with both WAPI models. Ease of use, short treatment time, knowledge of the association between WAPI use and improved health, and the taste of treated water were among the key factors that influenced acceptability. Ease of use was the key factor that influenced design preference. Participants in both communities preferred a WAPI with a plastic box that floated on the water's surface compared with a WAPI with a wire that was dipped into the pot of drinking water while it was heating (77% versus 15%, P < 0.001); we selected the box design for a subsequent randomized trial of this intervention. The high feasibility and acceptability of the WAPIs in this study suggest that these interventions have potential to increase access to safe water in resource-limited settings.
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Affiliation(s)
- Kristen Heitzinger
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation for Health and Development, Department of Infectious Disease, Imperial College London, London, United Kingdom
- Address correspondence to Kristen Heitzinger, Asociación Benéfica Prisma, 251 Carlos Gonzales, Lima 15073 Peru. E-mail:
| | - Stephen E. Hawes
- Department of Epidemiology, University of Washington, Seattle, Washington
| | | | - Carlos Alvarez
- Regional Center for Disease Prevention and Control, Loreto Regional Ministry of Health, Iquitos, Peru
| | - Carlton A. Evans
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation for Health and Development, Department of Infectious Disease, Imperial College London, London, United Kingdom
- IFHAD: Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
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12
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Murray AL, Napotnik JA, Rayner JS, Mendoza A, Mitro B, Norville J, Faith SH, Eleveld A, Jellison KL, Lantagne DS. Evaluation of consistent use, barriers to use, and microbiological effectiveness of three prototype household water treatment technologies in Haiti, Kenya, and Nicaragua. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 718:134685. [PMID: 31839311 DOI: 10.1016/j.scitotenv.2019.134685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
Household water treatment (HWT) can improve drinking water quality and reduce diarrheal disease. New HWT technologies are typically evaluated under ideal conditions; however, health gains depend on consistent, effective household use, which is less often evaluated. We conducted four evaluations of three prototype HWT technologies: two filters and one electrochlorinator. Evaluations consisted of a baseline survey, HWT distribution to households (ranging from 60 to 82), and four visits (ranging from 1 week-14 months after distribution). Each visit included a survey, observation of treated water presence (confirmed use), and microbiological analysis of treated and untreated samples for E. coli. Consistent use was defined as the proportion of total visits with confirmed use. Overall, confirmed use declined 2.54% per month on average, and 2-72% of households demonstrated 100% consistent use. Consistent use was positively associated with baseline HWT knowledge and practice and belief that drinking water was unsafe, and negatively associated with technological problems. Reported barriers to use were behavioral, such as forgetting or when outside the home, and technological failures. Technologies demonstrated 68-96% E. coli reductions, with 18-70% of treated samples having detectable E. coli. Results highlight the importance of household use evaluations within prototype HWT technology design cycles, the need for standard evaluation metrics, and difficulties in achieving both consistent use and microbiological effectiveness with HWT technologies.
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Affiliation(s)
- Anna L Murray
- Tufts University Department of Civil and Environmental Engineering, 200 College Avenue Medford, MA, 02155, USA.
| | - Julie A Napotnik
- Lehigh University Department of Civil and Environmental Engineering, 13 East Packer Avenue Bethlehem, PA, 18015, USA
| | - Justine S Rayner
- Tufts University Department of Civil and Environmental Engineering, 200 College Avenue Medford, MA, 02155, USA
| | - Antonia Mendoza
- Fundación Tierra, Avenida del Parque, San Juan del Sur, Nicaragua
| | - Brittany Mitro
- Tufts University Department of Civil and Environmental Engineering, 200 College Avenue Medford, MA, 02155, USA
| | - Joshua Norville
- Tufts University School of Medicine, Department of Public Health and Community Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
| | - Sitnah H Faith
- Safe Water and AIDS Project, P.O. Box 3323, Kisumu, Kenya
| | - Alie Eleveld
- Safe Water and AIDS Project, P.O. Box 3323, Kisumu, Kenya
| | - Kristen L Jellison
- Lehigh University Department of Civil and Environmental Engineering, 13 East Packer Avenue Bethlehem, PA, 18015, USA
| | - Daniele S Lantagne
- Tufts University Department of Civil and Environmental Engineering, 200 College Avenue Medford, MA, 02155, USA
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13
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Tsai FJ, Wu M, Lin CP. Does a Free-Trial Approach Increase Purchase and Use of a Household Water Treatment and Safe Storage Product in Rural Haiti? Am J Trop Med Hyg 2020; 102:518-525. [PMID: 31971158 DOI: 10.4269/ajtmh.19-0606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A cluster, randomized control trial was conducted to assess the effects of social marketing approach on purchase rates and water treatment behavior of Klorfasil, a chlorine-based household water treatment product among seven villages in Thomassique, Haiti, from May to December 2016. Villages were randomized to the free-trial (257 households) or cost-sharing (240 households) group. Households in the free-trial group were allowed 30 days of free Klorfasil use before purchase decision. Households who purchased Klorfasil were then followed up for 30, 60, and 180 days. At the last follow-up, respondents were asked if they would like to repurchase Klorfasil. Questionnaire survey and water quality assessment by residual-free chlorine were conducted in each survey. Chi-square test, t-test, and logistic regression were applied. The first purchase rate of the cost-sharing group was significantly higher than that of the free-trial group (79.2% versus 67.3%). By contrast, the repurchase rate of the free-trial group was higher (82.9% versus 66.3%). However, the overall repurchase rate was 71.6% and the proportion of long-term users was significantly higher in the cost-sharing group (56% versus 47%). Water treatment rates in the cost-sharing group were significantly higher than those in the free-trial group in the first and final surveys (odds ratio [OR] = 0.15, OR = 0.32). Households with high and medium economic status both had significantly higher purchase rates than low economic status households (OR = 4.40, OR = 1.94). Households with higher educated respondents had significantly better water treatment practices (OR = 2.15). The free-trial approach did not increase the first purchase rate but increased the repurchase rate later. The cost-sharing approach significantly encouraged long-term usage.
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Affiliation(s)
- Feng-Jen Tsai
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei City, Taiwan.,Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei City, Taiwan
| | - Michael Wu
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chia-Ping Lin
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei City, Taiwan
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14
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Loubière S, Taylor O, Tinland A, Vargas-Moniz M, O'Shaughnessy B, Bokszczanin A, Kallmen H, Bernad R, Wolf J, Santinello M, Loundou A, Ornelas J, Auquier P. Europeans' willingness to pay for ending homelessness: A contingent valuation study. Soc Sci Med 2020; 247:112802. [PMID: 32045825 DOI: 10.1016/j.socscimed.2020.112802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
The purpose of this study is to assess the utility value European citizens put on an innovative social program aimed at reducing homelessness. The Housing First (HF) model involves access to regular, scattered, independent and integrated housing in the community with the support of a multidisciplinary team. Currently, HF is not implemented by most European countries or funded by healthcare or social plans, but randomised controlled trials have stressed significant results for improved housing stability, recovery and healthcare services use. The broader implementation of HF across Europe would benefit from a better understanding of citizens' preferences and "willingness to pay" (WTP) for medico-social interventions like HF. We conducted a representative telephone survey between March and December 2017 in eight European countries (France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden). Respondent's WTP for HF (N = 5631) was assessed through a contingent valuation method with a bidding algorithm. 42.3% of respondents were willing to pay more taxes to reduce homelessness through the HF model, and significant differences were found between countries (p < 0.001); 30.4% of respondents who did not value the HF model were protest zeros (either contested the payment vehicle-taxes- or the survey instrument). Respondents were willing to pay €28.2 (±11) through annual taxation for the HF model. Respondents with higher educational attainment, who paid national taxes, reported positive attitudes about homelessness, or reported practices to reduce homelessness (donations, volunteering) were more likely to value the HF model, with some countries' differences also related to factors at the environmental level. These findings inform key stakeholders that European citizens are aware of the issue of homelessness in their countries and that scaling up the HF model across Europe is both feasible and likely to have public support.
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Affiliation(s)
- Sandrine Loubière
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 13385, Marseille, France; Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, 13385, Marseille, France.
| | - Owen Taylor
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 13385, Marseille, France.
| | - Aurelie Tinland
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 13385, Marseille, France; MARSS Outreach Team, Assistance Publique - Hôpitaux de Marseille, 13001, Marseille, France.
| | - Maria Vargas-Moniz
- APPsyCI (Applied Psychology Research Center: Capabilities and Inclusion), ISPA-Instituto Universitário, 1149-041, Lisbon, Portugal.
| | | | - Anna Bokszczanin
- Institute of Psychology, Opole University, Pl. Staszica 1, 45-052, Opole, Poland.
| | - Hakan Kallmen
- STAD, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Norra Stati Onsgatan 69, 113 64, Stockholm, Sweden.
| | | | - Judith Wolf
- Radboud University Medical Center, Radboud Institute for Health Sciences, Impuls - Netherlands Center for Social Care Research, Geert Grooteplein 27, 6525, EZ Nijmegen, the Netherlands.
| | - Massimo Santinello
- Department of Developmental and Social Psychology, University of Padova, Via Venezia, 8 - 35131, Padova, Italy.
| | - Anderson Loundou
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 13385, Marseille, France; Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, 13385, Marseille, France.
| | - Jose Ornelas
- APPsyCI (Applied Psychology Research Center: Capabilities and Inclusion), ISPA-Instituto Universitário, 1149-041, Lisbon, Portugal.
| | - Pascal Auquier
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 13385, Marseille, France; Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, 13385, Marseille, France.
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15
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Brown J, Hayashi MAL, Eisenberg JNS. The Critical Role of Compliance in Delivering Health Gains from Environmental Health Interventions. Am J Trop Med Hyg 2020; 100:777-779. [PMID: 30675842 DOI: 10.4269/ajtmh.18-0624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Gains in reducing childhood disease burden rely heavily on effective means of preventing environmental exposures. For many environmental health interventions, such as point-of-use water treatment, sanitation, or cookstoves, exposures are strongly influenced by user behaviors and the degree to which participants adhere to the prescribed preventive measures. In this commentary, we articulate the need for increased attention on user behaviors-critically, the careful measurement and inclusion of compliance-to strengthen exposure assessment and health impact trials in environmental health intervention research. We focus here on water, sanitation, and hygiene interventions to illustrate the problem with the understanding that this issue extends to other environmental health interventions.
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Affiliation(s)
- Joe Brown
- Georgia Institute of Technology, Atlanta, Georgia
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16
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Tidwell JB, Terris-Prestholt F, Quaife M, Aunger R. Understanding demand for higher quality sanitation in peri-urban Lusaka, Zambia through stated and revealed preference analysis. Soc Sci Med 2019; 232:139-147. [PMID: 31085398 DOI: 10.1016/j.socscimed.2019.04.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 11/18/2022]
Abstract
Poor peri-urban sanitation is a significant public health problem, likely to become more important as the world rapidly urbanizes. However, little is known about the role of consumer demand in increasing peri-urban sanitation quality, especially for tenants using shared sanitation as only their rental choices can be observed in the market. We analyzed data on existing housing markets collected between 9 Jun and 6 Jul 2017 using the Hedonic Pricing Method (HPM) to capture the percentage of rent attributable to sanitation quality (n = 933). We also conducted discrete choice experiments (DCEs) to obtain willingness to pay (WTP) estimates for specific sanitation components (n = 1087), and explored the implications by estimating the proportion of plots for which improved sanitation quality would generate a higher return on investment for landlords than building a place for an additional tenant to live. The HPM attributed 18% of rental prices to sanitation (∼US$8.10 per month), but parameters for several components were poorly specified due to collinearity and low overall prevalence of some products. DCEs revealed that tenants were willing to pay $2.20 more rent per month for flushing toilets on plots with running water and $3.39 more per month for solid toilet doors, though they were willing to pay little for simple hole covers and had negative WTP for adding locks to doors (-$1.04). Solid doors and flushing toilets had higher rent increase to cost ratios than other ways landlords commonly invested in their plots, especially as the number of tenant households on a plot increased. DCEs yielded estimates generally consistent with and better specified than HPM and may be useful to estimate demand in other settings. Interventions leveraging landlords' profit motives could lead to significant improvements in peri-urban sanitation quality, reduced diarrheal disease transmission, and increased well-being without subsidies or infrastructure investments by government or NGOs.
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Affiliation(s)
- James B Tidwell
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
| | - Fern Terris-Prestholt
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
| | - Matthew Quaife
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
| | - Robert Aunger
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
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17
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Reygadas F, Gruber JS, Dreizler L, Nelson KL, Ray I. Measuring User Compliance and Cost Effectiveness of Safe Drinking Water Programs: A Cluster-Randomized Study of Household Ultraviolet Disinfection in Rural Mexico. Am J Trop Med Hyg 2018; 98:824-834. [PMID: 29363448 PMCID: PMC5930887 DOI: 10.4269/ajtmh.17-0440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/27/2017] [Indexed: 11/07/2022] Open
Abstract
Low adoption and compliance levels for household water treatment and safe storage (HWTS) technologies have made it challenging for these systems to achieve measurable health benefits in the developing world. User compliance remains an inconsistently defined and poorly understood feature of HWTS programs. In this article, we develop a comprehensive approach to understanding HWTS compliance. First, our Safe Drinking Water Compliance Framework disaggregates and measures the components of compliance from initial adoption of the HWTS to exclusive consumption of treated water. We apply this framework to an ultraviolet (UV)-based safe water system in a cluster-randomized controlled trial in rural Mexico. Second, we evaluate a no-frills (or "Basic") variant of the program as well as an improved (or "Enhanced") variant, to test if subtle changes in the user interface of HWTS programs could improve compliance. Finally, we perform a full-cost analysis of both variants to assess their cost effectiveness (CE) in achieving compliance. We define "compliance" strictly as the habit of consuming safe water. We find that compliance was significantly higher in the groups where the UV program variants were rolled out than in the control groups. The Enhanced variant performed better immediately postintervention than the Basic, but compliance (and thus CE) degraded with time such that no effective difference remained between the two versions of the program.
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Affiliation(s)
| | - Joshua S. Gruber
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Lindsay Dreizler
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kara L. Nelson
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley, Berkeley, California
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18
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Guerrini A, Vigolo V, Romano G, Testa F. Levers supporting tariff growth for water services: evidence from a contingent valuation analysis. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2018; 207:23-31. [PMID: 29154005 DOI: 10.1016/j.jenvman.2017.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/15/2017] [Accepted: 11/03/2017] [Indexed: 06/07/2023]
Abstract
The backwardness of the water utilities sector necessitates urgent investment in infrastructure to improve water quality and efficiency in water supply networks. A policy of tariff growth represents the main source to sustain such investments. Therefore, customer engagement in the form of willingness to pay (WTP) is highly desirable by water utilities to obtain social legitimization and support. This study examines the determinants of consumers' WTP for improvement programs for three drinking water issues: quality of water sources, renewal of water mains, and building of new wastewater treatment plants. The study is based on a survey conducted among a sample of 587 customers of a water utility located in the province of Verona in the north of Italy. The contingence valuation method is used to measure WTP. Specifically, an ordinal logistic regression model yields the following significant determinants of WTP: quality of water and services provided, preference for privatization of the water utility, sustainable consumption of water, and some socio-demographic variables. The findings provide interesting insights into the drivers of WTP as well as managerial recommendations for water utilities. In particular, the findings show that water utilities need to improve service and water quality to increase customers' acceptance of tariff growth. In addition, utilities should invest in customer education and communication activities focusing on specific age groups (e.g., older customers) to enhance their WTP. Finally, communication strategies should reinforce the possible role of liberalization and privatization in supporting infrastructure investments.
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Affiliation(s)
- Andrea Guerrini
- Department of Business Administration, University of Verona, Via Cantarane 24, Italy.
| | - Vania Vigolo
- Department of Business Administration, University of Verona, Via Cantarane 24, Italy.
| | - Giulia Romano
- Department of Economics and Management, University of Pisa, Via C. Ridolfi 10, Pisa, Italy.
| | - Federico Testa
- Department of Business Administration, University of Verona, Via Cantarane 24, Italy.
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19
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Delaire C, Das A, Amrose S, Gadgil A, Roy J, Ray I. Determinants of the use of alternatives to arsenic-contaminated shallow groundwater: an exploratory study in rural West Bengal, India. JOURNAL OF WATER AND HEALTH 2017; 15:799-812. [PMID: 29040082 DOI: 10.2166/wh.2017.321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Shallow groundwater containing toxic concentrations of arsenic is the primary source of drinking water for millions of households in rural West Bengal, India. Often, this water also contains unpleasant levels of iron and non-negligible fecal contamination. Alternatives to shallow groundwater are increasingly available, including government-built deep tubewells, water purchased from independent providers, municipal piped water, and household filters. We conducted a survey of 501 households in Murshidabad district in 2014 to explore what influenced the use of available alternatives. Socioeconomic status and the perceived likelihood of gastrointestinal (GI) illness (which was associated with dissatisfaction with iron in groundwater) were the primary determinants of the use of alternatives. Arsenic knowledge was limited. The choice amongst alternatives was influenced by economic, social, and aesthetic factors, but not by health risk perceptions. The use of purchased water was rarely exclusive and was strongly associated with socioeconomic status, suggesting that this form of market-based water provision does not ensure universal access. Demand for purchased water appeared to decrease significantly shortly after free piped water became available at public taps. Our results suggest that arsenic mitigation interventions that also address co-occurring water problems (iron, GI illness) could be more effective than a focus on arsenic alone.
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Affiliation(s)
- Caroline Delaire
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA 94720, USA E-mail:
| | - Abhijit Das
- Department of Economics, Vijoygarh Jyotish Ray College, Kolkata 700032, India
| | - Susan Amrose
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA 94720, USA E-mail:
| | - Ashok Gadgil
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA 94720, USA E-mail: ; Energy Technologies Area, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Joyashree Roy
- Department of Economics and Global Change Programme, Jadavpur University, Kolkata 700032, India
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley, CA 94720, USA
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