Data gaps in evidence-based research on small water enterprises in developing countries

Melissa C. Opryszko, Haiou Huang, Kurt Soderlund and Kellogg J. Schwab (2009). Data gaps in evidence-based research on small water enterprises in developing countries. Journal of water and health ; vol. 7, no. 4 ; p. 609–622. doi:10.2166/wh.2009.213

Abstract

Small water enterprises (SWEs) are water delivery operations that predominantly provide water at the community level. SWEs operate beyond the reach of piped water systems, selling water to households throughout the world. Their ubiquity in the developing world and access to vulnerable populations suggests that these small-scale water vendors may prove valuable in improving potable water availability. This paper assesses the current literature on SWEs to evaluate previous studies and determine gaps in the evidence base. Piped systems and point-of-use products were not included in this assessment. Results indicate that SWEs are active in urban, peri-urban and rural areas of Africa, Asia and Latin America. Benefits of SWEs include: no upfront connection fees; demand-driven and flexible to local conditions; and service to large populations without high costs of utility infrastructure. Disadvantages of SWEs include: higher charges for water per unit of volume compared with infrastructure-based utilities; lack of regulation; operation often outside legal structures; no water quality monitoring; increased potential for conflict with local utilities; and potential for extortion by local officials. No rigorous, evidence-based, peer-reviewed scientific studies that control for confounders examining the effectiveness of SWEs in providing potable water were identified.

Shower heads can make you ill

New research suggests that many shower heads are teeming with Mycobacterium avium, a bacteria that can cause lung disease. A third of the 50 shower heads checked contained a film coating of “significant levels” of the bacteria inside concluded  a scientists report from The University of Colorado . “If you are getting a face full of water when you first turn your shower on, that means you are probably getting a particularly high load of Mycobacterium avium, which may not be too healthy,” said lead researcher Norman Pace. (But how many people are facing the shower head when they turn on the water?) Anyway, from the BBC News:
Water spurting from shower heads can distribute bacteria-filled droplets that suspend themselves in the air and can easily be inhaled into the deepest parts of the lungs, say the scientists from the University of Colorado at Boulder…

While it is rarely a problem for most healthy people, those with weakened immune systems, like the elderly, pregnant women or those who are fighting off other diseases, can be susceptible to infection…

Since plastic shower heads appear to “load up” with more bacteria-rich biofilms, metal shower heads may be a good alternative, said Professor Pace.
Source:BoingBoing, http://www.boingboing.net/2009/09/15/many-shower-heads-fi.html, by David Pescovitz, September 15, 2009.
Related news: http://news.bbc.co.uk/2/hi/health/8254206.stm

Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia

Semba, R.D. … [et al.] (2009). Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia. International journal of hygiene and environmental health ; vol. 212, no. 4 : p. 387-97. DOI: 10.1016/j.ijheh.2008.09.001

Author abstract: In developing countries, poor families in urban slums often do not receive municipal services including water. The objectives of our study were to characterize families who purchased drinking water and to examine the relation between purchasing drinking water and child morbidity and mortality in urban slums of Indonesia, using data collected between 1999 and 2003. Of 143,126 families, 46.8% purchased inexpensive drinking water from street vendors, 47.4% did not purchase water, i.e., had running or spring/well water within household, and 5.8% purchased more expensive water in the previous 7 days. Families that purchased inexpensive drinking water had less educated parents, a more crowded household, a father who smoked, and lower socioeconomic level compared with the other families. Among children of families that purchased inexpensive drinking water, did not purchase drinking water, or purchased more expensive water, the prevalence was, respectively, for diarrhea in last 7 days (11.2%, 8.1%, 7.7%), underweight (28.9%, 24.1%, 24.1%), stunting (35.6%, 30.5%, 30.5%), wasting (12.0%, 10.5%, 10.9%), family history of infant mortality (8.0%, 5.6%, 5.1%), and of under-five child mortality (10.4%, 7.1%, 6.4%) (all P<0.0001). Use of inexpensive drinking water was associated with under-five child mortality (Odds Ratio [O.R.] 1.32, 95% Confidence Interval [C.I.] 1.20-1.45, P<0.0001) and diarrhea (O.R. 1.43, 95% C.I. 1.29-1.60, P<0.0001) in multivariate logistic regression models, adjusting for potential confounders. Purchase of inexpensive drinking water was common and associated with greater child malnutrition, diarrhea, and infant and under-five child mortality in the family. Greater efforts must be made to ensure access to safe drinking water, a basic human right and target of the Millennium Development Goals, in urban slums.

Contact: Prof. Richard Semba, Department of Ophthalmology, Johns Hopkins University School of Medicine, USA, e-mail: rdsemba [at] jhmi.edu

Hygiene: Is fecal contamination of drinking water after collection associated with household water handling and hygiene practices?

Water-borne illness, primarily caused by fecal contamination of drinking water, is a major health burden in the state of Andhra Pradesh, India. Currently drinking water is treated at the reservoir level and supplied on alternate days, necessitating storage in households for up to 48 hrs. [Researchers from the University of Iowa (USA) and the Institute of Health Systems  (India)] hypothesized that fecal contamination occurs principally during storage due to poor water handling. In this study [they] tested for coliform bacteria in water samples collected at distribution points as household storage containers were filled, and then tested containers in the same households 24-36 hours after collection. [The researchers] also conducted an observational survey to make an assessment of water handling and hygiene. Ninety-two percent (47/51) of samples tested at supply points were adequately chlorinated and bacterial contamination was found in two samples with no residual chlorine. Samples collected from household storage containers showed an increase in contamination in 18/50 houses (36%). Households with contaminated stored samples did not show significant differences in demographics, water handling, hygiene practices, or sanitation. Nevertheless, the dramatic increase in contamination after collection indicates that until an uninterrupted water supply is possible, the point at which the biggest health impact can be made is at the household level.

Full reference:

Eshcol, J. … [et al] (2009). Is fecal contamination of drinking water after collection associated with household water handling and hygiene practices? : a study of urban slum households in Hyderabad, India. Journal of water and health ; vol. 07,  no. 1 ;  p. 145-154. doi:10.2166/wh.2009.094

Contact: Jayasheel Eshcol, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, USA, jayasheel-eshcol [at] uiowa.edu

Microfinance: improving access to water supply and sanitation in urban India

Preliminary results of research [1] in India suggest that microlending may be an effective means of helping households in communities with existing trunk infrastructure to access improved water supply and sanitation services in their homes. The study represents “the first known investigation into the potential for microcredit to unleash latent demand for water supply and sanitation improvements among low-income households in developing countries”.

Through in-depth interviews with more than 800 households in the city of Hyderabad in India, researchers conclude that, even if provided with market (not concessional) rates of financing, a substantial proportion of poor households would invest in water and sewer network connections.

[1] Davis, J. … [et al.] (2008). Improving access to water supply and sanitation in urban India: microfinance for water and sanitation infrastructure development. Water science and technology ; vol. 58, no. 4 ; p. 887-891. doi:10.2166/wst.2008.437
Read full article here

Contact: Jenna Davis, Stanford University, USA, jennadavis@stanford.edu

Congo cholera campaign ’should start at lakesides’

Research in the Democratic Republic of Congo (DRC) has shown that lakeside communities are often the source of cholera outbreaks.

DRC health department officials plan to alter how they combat cholera following the research, which said that current efforts “failed to achieve long-term control”.

[...]

Most previous DRC cholera control efforts have targeted city residents, the researchers say. They recommend refocusing prevention and control efforts on lakeside communities. These are smaller populations, making such programmes more affordable.

And cities might be best protected by first targeting limited resources – including safe water – within these smaller communities that are likely to form the initial outbreak.

“We want to make sure that, by 2012, access to safe water is assured by providing potable water to communities through pipes, rather than using water from lakes,” says lead author, physician and epidemiologist Didier Bompangue from the DRC Health Ministry.

Link to full article in May edition of Emerging Infectious Diseases here

Read more: Aimable Twahirwa and Christina Scott, SciDev.Net, 9 May 2008