Academic journal article Bulletin of the World Health Organization

Keeping Clean Water Clean in a Malawi Refugee Camp: A Randomized Intervention Trial

Academic journal article Bulletin of the World Health Organization

Keeping Clean Water Clean in a Malawi Refugee Camp: A Randomized Intervention Trial

Article excerpt

Voir page 286 le resume en francais. En la pagina 286 figura un resumen en espanol.


Considerable efforts have been made to compare the benefits of providing increased quantities of water to impoverished populations with providing better quality water. From an engineering perspective, investments to provide more water, such as digging more wells, are often different in nature and expensive compared to measures such as chlorination which improve water quality.

Many studies have documented the process of contamination of drinking-water within the home (1-7), an issue which demonstrates the interwoven nature of the water quality and water quantity. Some of these studies have shown increased contamination over time of water in the home (1-3) and described factors influencing this contamination such as season (4, 5), whether water had been transferred between vessels, proximity of stored water to animals (1), type of water supply (6), and whether the container was open and/or refrigerated (7). While none of these studies documented precisely how this contamination was occurring, several stated that improved hygiene education needed to accompany water provision efforts (2-4, 7). One response to this has been to place taps on water storage vessels. These have been shown to reduce contamination during storage (5, 8) and to reduce the incidence of diarrhoeal disease (9).

During 1993, 65000 Mozambican refugees resided in Nyamithuthu Camp in southern Malawi. The conditions of constrained resources and crowding in the camp were typical or even better than the conditions for most of the 5.8 million refugees in Africa during that year (10). In 1988, a case-control study conducted during a cholera outbreak in a neighbouring camp had found that case families were less likely to possess a water container than control families (OR = 0.02) and that there was an increasing protective effect with an increased number of containers per family (11). During a cholera outbreak investigation in Nyamithuthu Camp in 1991, water collected at wells was shown to be safe but Vibrio cholerae could readily be isolated from water stored in the home (12). In an attempt to limit this household contamination, the United Nations High Commissioner for Refugees (UNHCR), in conjunction with Medecins Sans Frontieres (MSF), France and the Centers for Disease Control and Prevention (CDC), Atlanta, conducted the following study. It was hypothesized that the provision of a water vessel with a constricted opening could reduce household contamination of water and diarrhoeal disease among those consuming that water.


The 20-litre container evaluated in this study, referred to hereafter as an improved bucket (Fig. 1), had a constraining lid to dissuade hand entry or the scooping of water with a cup or small can but the opening was large enough to permit efficient filling with hand pumps. The improved buckets had a spout, and a handle on the bottom of the opposing side in order to facilitate pouting. Finally, a symbol of a hand with a line through it was painted on the lid to discourage hand entry.


Every fourth hut which appeared to be inhabited in the southernmost portions of Nyamithuthu Camp was marked with a red blaze of paint approximately 3 cm by 10 cm. All marked houses were visited by a Malawian field worker who requested to conduct an interview with the household's female head or whomever else may have been available. A questionnaire was then administered which contained 42 questions regarding family demographics, household conditions, and-hygiene habits. Presence of a latrine was visually confirmed by the interviewers, who inspected it to determine whether or not there were visible faeces on the floor of the latrine. Interviews were conducted in the languages of Chichewa often intermixed with Sena, both of which were spoken by all interviewers. …

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