Academic journal article Journal of Health Population and Nutrition

Targeting Appropriate Interventions to Minimize Deterioration of Drinking-Water Quality in Developing Countries

Academic journal article Journal of Health Population and Nutrition

Targeting Appropriate Interventions to Minimize Deterioration of Drinking-Water Quality in Developing Countries

Article excerpt


Conservative estimates indicate that around 1.5 billion people worldwide use an engineered water supply, such as a public standpipe or community well which requires collection and storage of water in the home (1). Although the quality of water supplied by such systems may be up to the standard of the World Health Organization (WHO) guideline at the point of supply (2), it has been well-documented that deterioration between collection and consumption is a widespread though not a universal problem (3). In other words, drinking-water that is of acceptable quality at the point of supply becomes microbiologically contaminated during the distinct processes of collection, transportation, and household storage. In this paper, the terms-'recontaminated' or 'recontamination'-will be used for refering to such deterioration of drinking-water.

The severity of the health risk from consuming recontaminated drinking-water will vary among communities, households, and individuals. This is because water-handling practices, other related factors, and decisively the health and immunity status of the individual together determine the health risk. It would be useful if the 'most-at-risk' communities or households could be identified to design appropriate interventions. For this purpose, a rapid appraisal tool is needed which could be used by extension workers in community water-supply programmes. The information provided by such a tool should form the basis of an intervention strategy that is tailored to the community context.

Recontaminated drinking-water undermines the positive health impacts of providing improved water supply. There is, therefore, a need to employ appropriate intervention measures that will prevent or minimize deterioration of water quality. These may include physical interventions, such as specially-designed water-storage containers, and educational campaigns that promote good hygiene behaviour. A carefully-planned and implemented intervention strategy may well be successful in maintaining safe drinking-water up to the point of consumption. Nevertheless, it is important to be realistic about what can be achieved in terms of reducing diarrhoeal disease in communities that face a multitude of poverty-related problems.

This paper proposes a semi-quantified 'disease risk index' (DRI) that is designed to identify communities or households that are 'most at risk' from consuming recontaminated drinking-water. The DRI is a rapid appraisal tool whose primary purpose is to collect information for use in the planning of an intervention strategy. The paper also reviews several intervention measures which are intended to minimize deterioration of water quality and considers how they can be most effectively used. A literature review of physical and educational interventions was undertaken using established databases, including the Web of Science® and ScienceDirect. This was supplemented with information sourced from Internet searches of websites of international agencies involved in treatment of household water and promotion of hygiene. Finally, key issues with regard to developing an intervention strategy are discussed in the context of community water-supply programmes. This section considers the rationale for tailored interventions and examines the value of the DRI in designing interventions more successfully.


In a previous paper, we presented a conceptual framework that describes how several interrelated factors affect the potential pathogen load in drinking- water stored in households (4). Figure 1 illustrates the conceptual framework, and Table 1 briefly defines the primary factors-'handling', 'hygiene', 'environment', and secondary factors-'pathogen', 'anthropology' and 'socioeconomics'. Where stored drinking-water contains sufficient numbers of a pathogen to constitute an infective dose, the final barrier preventing disease is the status of the health and immunity of the individual. …

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