Gravity Driven Membrane Filtration. A User guide and video training series.
This guide describes gravity-driven membrane (GDM) filtration, a technology to provide safe and affordable drinking water in rural areas at community scale. It explains how the GDM technology works, how a GDM system can be implemented and maintained, and which elements contribute to a sustainable operation.
SODIS Manual. Guidance on solar water disinfection.
The SODIS manual presents an overview of the SODIS method based on 20 years of research and practice. The first part introduces solar disinfection, provides information about the history of the SODIS method and highlights its benefits. The second part addresses the technical aspects that influence the efficacy of the SODIS method in removing pathogens from water. This information aims at providing a solid understanding of the correct application of SODIS in the field. The third part reviews specific approaches and tools used to promote the SODIS method to target populations.
The Safe Water School Manual contains teaching materials to provide school lessons on drinking water treatment, hygiene and sanitation. It combines school lessons with scientific experiments, games and art activities. The lessons are based on the life-skills approach, and are inspired by the participatory teaching and learning methods PHAST and CHAST. These methods were selected be-cause they have been shown to be helpful in empowering school children to improve water, sanitation and hygiene (WASH) practices at school and at home.
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authors => protected'Gärtner, N.; Germann, L.; Wanyama, K.; Ouma, H.; Meierh ofer, R.' (89 chars)
title => protected'Keeping water from kiosks clean: strategies for reducing recontamination dur ing transport and storage in Eastern Uganda' (119 chars)
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categories => protected'chlorination; drinking water treatment; water kiosks; safe storage; drinking water recontamination; hygiene' (107 chars)
description => protected'Drinking water is frequently recontaminated during transport and storage whe n water is poured into jerrycans. To address this issue, three strategies ai ming at reducing these recontamination risks were implemented at water kiosk s in Eastern Uganda. In all three strategies, water at the kiosks was chlori nated to a free residual chlorine (FRC) concentration of 2 mg/L at the tap of the kiosk. In addition, water was collected in different containers for drinking water transport: a) uncleaned jerrycans, b) cleaned jerrycans, and c) cleaned improved containers with a wide mouth and a spigot. Water quality in the containers was compared to that of a control group collecting unchlo rinated water in uncleaned jerrycans. Water samples were collected at the ta p of the kiosk, from the containers of 135 households after they were filled at the tap, and from the same containers in the households after 24 h of water storage. The samples were analysed for counts of <em>E. coli</em>, tot al coliforms, and FRC. Household interviews and structured observations were conducted to identify confounding variables and to assess the influence of water, sanitation, and hygiene infrastructure and practices on recontaminati on.<br /> All three intervention strategies contributed to significantly low er <em>E. coli</em> recontamination levels after 24 h than in the control group (Median (Mdn) = 9 CFU/100 mL, Interquartile Range (IQR) = 25). Median <em>E. coli</em> counts and mean FRC consumption were higher in
= 2, ΔFRC = 1.6 mg/L) and the lowest in cleaned improved containers (Median = 0 CFU/100 mL, IQR = 0, ΔFRC = 1.2 mg/L). The F RC concentration at the tap of 2 mg/L was too low to protect water from <e m>E. coli</em> recontamination in uncleaned jerrycans over 24 h. Cleaning the jerrycans was inconv...' (2599 chars)
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authors => protected'Dössegger, L.; Tournefier, A.; Germann, L.; Gärtner, N .; Huonder, T.; Etenu, C.; Wanyama, K.; Ouma, H.; Meierh ofer, R.' (165 chars)
title => protected'Assessment of low-cost, non-electrically powered chlorination devices for gr avity-driven membrane water kiosks in eastern Uganda' (128 chars)
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categories => protected'point-of-collection chlorination; water treatment; recontamination; GDM wate r kiosk; low-income country' (103 chars)
description => protected'Recontamination during transport and storage is a common challenge of water supply in low-income settings, especially if water is collected manually. Ch lorination is a strategy to reduce recontamination. We assessed seven low-co st, non-electrically powered chlorination devices in gravity-driven membrane filtration (GDM) kiosks in eastern Uganda: one floater, two in-line dosers, three end-line dosers (tap-attached), and one manual dispenser. The evaluat ion criteria were dosing consistency, user-friendliness, ease of maintenance , local supply chain, and cost. Achieving an adequate chlorine dosage (∼2 mg/L at the tap and ≥ 0.2 mg/L after 24 h of storage in a container) was c hallenging. The T-chlorinator was the most promising option for GDM kiosks: it achieved correct dosage (CD, 1.5-2.5 mg/L) with a probability of 90 per c ent, was easy to use and maintain, economical, and can be made from locally available materials. The other in-line option, the chlorine-dosing bucket (4 0 per cent CD) still needs design improvements. The end-line options AkvoTur (67 per cent CD) and AquatabsFlo® (57 per cent CD) are easy to install and operate at the tap, but can be easily damaged in the GDM set-up. The Ventur i doser (52 per cent CD) did not perform satisfactorily with flow rates > 6 L/min. The chlorine dispenser (52 per cent CD) was robust and user-friend ly, but can only be recommended if users comply with chlorinating the water themselves. Establishing a sustainable supply chain for chlorine products wa s challenging. Where solid chlorine tablets were locally rarely available, t he costs of liquid chlorine options were high (27-162 per cent of the water price).' (1679 chars)
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authors => protected'Daniel, D.; Diener, A.; Pande, S.; Jansen, S.; Marks,&nb sp;S.; Meierhofer, R.; Bhatta, M.; Rietveld, L.' (138 chars)
title => protected'Understanding the effect of socio-economic characteristics and psychosocial factors on household water treatment practices in rural Nepal using Bayesian belief networks' (168 chars)
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description => protected'About 20 Million (73%) people in Nepal still do not have access to safely ma naged drinking water service and 22 million (79%) do not treat their drinkin g water before consumption. Few studies have addressed the combination of so cio-economic characteristics and psychosocial factors that explain such beha viour in a probabilistic manner. In this paper we present a novel approach t o assess the usage of household water treatment (HWT), using data from 451 h ouseholds in mid and far-western rural Nepal. We developed a Bayesian belief network model that integrates socio-economic characteristics and five psych osocial factors. The socio-economic characteristics of households included p resence of young children, having been exposed to HWT promotion in the past, level of education, type of water source used, access to technology and wea lth level. The five psychosocial factors capture households' perceptions of incidence and severity of water-borne infections, attitudes towards the impa ct of poor water quality on health, water treatment norms and the knowledge level for performing HWT. We found that the adoption of technology was influ enced by the psychosocial factors norms, followed by the knowledge level for operating the technology. Education, wealth level, and being exposed to the promotion of HWT were the most influential socio-economic characteristics. Interestingly, households who were connected to a piped water scheme have a higher probability of HWT adoption compared to other types of water sources. The scenario analysis revealed that interventions that only target single s ocio-economic characteristics do not effectively boost the probability of HW T practice. However, interventions addressing several socio-economic charact eristics increase the probability of HWT adoption among the target groups.' (1822 chars)
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authors => protected'Meierhofer, R.; Rubli, P.; Oremo, J.; Odhiambo, A.' (70 chars)
title => protected'Does activated silver reduce recontamination risks in the reservoirs of cera mic water filters?' (94 chars)
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categories => protected'household water treatment; water quality; recontamination; low income countr y; safe storage; silver disinfection; ceramic water filter' (134 chars)
description => protected'Efforts to provide safe water are challenged by recontamination and regrowth of pathogens in treated water during storage. This study evaluated the pote ntial of metallic silver with a chemically etched surface to reduce recontam ination risks during water storage in ceramic water filters. Batch experimen ts were conducted in the laboratory with water storage buckets containing th ree configurations of varying amounts of silver. Field trials in a rural are a in Kenya assessed the effect of the same configurations in the storage buc kets of locally produced ceramic pot filters without colloidal silver coatin g. The tests revealed that the etched silver slightly reduced microbiologica l recontamination risks during water storage despite the low diffusion of si lver ions (<5 µg Ag/L). The effect was strongly influenced by water chem istry parameters. A statistically significant difference in the removal of < em>E. coli</em> (Δ Log Removal Value (LRV) = 0.6) and total coliforms (Δ L RV = 1.7) was found between households using a filter with silver in the wat er reservoir and those using a filter without silver. Multivariate regressio n of water handling factors and hygiene practices on filter performance reve aled that the presence of silver in the reservoir and cleaning the filter el ement with a brush were associated with a better filter performance.' (1360 chars)
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title => protected'Influence of container cleanliness, container disinfection with chlorine, an d container handling on recontamination of water collected from a water kios k in a Kenyan slum' (170 chars)
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categories => protected'chlorination; drinking water quality; drinking water treatment; low-income c ountry; recontamination; safe storage' (113 chars)
description => protected'The study assessed whether using clean containers that had been disinfected with chlorine at a water kiosk in the Kangemi slum in Nairobi reduced recont amination of treated water during drinking transport and storage. At the sam e time, the impacts of container handling and hygiene conditions at the hous ehold level on water quality changes during storage were evaluated. Data wer e collected during interviews with 135 households using either new, clean Ma ji Safi containers (MSCs) that had been disinfected with chlorine or normal uncleaned jerrycans (NJCs). Bacteriological water quality and free chlorine levels in both types of containers were measured after container filling at the kiosk and in the same containers after 24 h storage in households. The u se of MSCs significantly reduced the risk of recontaminating the treated wat er. After water filling at the kiosk, none of the MSCs contained <i>Escheric hia coli</i> bacteria, and 2.8% were contaminated after 24 h storage. In con trast, 6.2% of NJCs were contaminated after filling, and 15.2% after 24 h st orage. Multivariate logistic regression indicated that the use of a clean wa ter container and sufficient chlorine and the frequency of cleaning the cont ainer in the household mitigated recontamination. We suggest further investi gation of water container designs that facilitate cleaning.' (1351 chars)
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authors => protected'Meierhofer, R.; Bänziger, C.; Deppeler, S.; Kunwar, B.& nbsp;M.; Bhatta, M.' (100 chars)
title => protected'From water source to tap of ceramic filters - factors that influence water q uality between collection and consumption in rural households in Nepal' (146 chars)
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description => protected'The study assessed changes in water quality between the water source and the tap of locally produced low cost ceramic water filters used by a community living in hygienically critical conditions in a remote mountainous area in W estern Nepal. Data was collected from 42 rural households during two visits. The effectiveness of filter handling on its performance was assessed throug h microbiological analysis, structured household interviews and structured o bservations. Water quality decreased significantly when source water was fil led into transport containers, while the use of the filters improved drinkin g water quality for about 40% of the households. Highly inadequate filter cl eaning practices involving the use of contaminated raw water, hands (geo mea n = 110 <i>E. coli</i> CFU/100 mL) and cleaning tools (geo mean = 80 <i>E. c oli</i> CFU/100 mL) stained hygienic parts of the filter. The use of boiling water to disinfect the filters was significantly correlated with improved f ilter performance and should be further promoted. However, even disinfected filters achieved a very low average LRV for <i>E. coli</i> of 0.4 in the fie ld and performed worse than during laboratory tests (LRV for <i>E. coli</i> of 1.5-2). Comprehensive training on adequate filter handling, as well as be tter filter products, are required to improve the impact of filter use.' (1363 chars)
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authors => protected'Meierhofer, R.; Rubli, P.; Dreyer, K.; Ouma, H.; Wanyama , K.; Peter-Varbanets, M.' (111 chars)
title => protected'Membrane filtration reduces recontamination risk in chlorinated household wa ter containers' (90 chars)
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description => protected'The study was conducted in the catchment area of two Gravity Driven Membrane Filtration (GDM) water kiosks in Uganda. It assessed if the cleaning and di sinfection of jerrycans with chlorine can reduce risks for regrowth and reco ntamination of treated water during storage in undisturbed containers, as we ll as at the household level. In addition, the impact of water handling, hou sehold hygiene and safe storage determinants on water quality was evaluated. Results indicate that the cleanliness of the water storage container has a critical impact on water quality changes during storage. Safe drinking water at the point of consumption after 24 hours of storage at the household leve l can be achieved with a combination of ultrafiltration and subsequent chlor ination.' (768 chars)
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Keeping water from kiosks clean: strategies for reducing recontamination during transport and storage in Eastern Uganda
Drinking water is frequently recontaminated during transport and storage when water is poured into jerrycans. To address this issue, three strategies aiming at reducing these recontamination risks were implemented at water kiosks in Eastern Uganda. In all three strategies, water at the kiosks was chlorinated to a free residual chlorine (FRC) concentration of 2 mg/L at the tap of the kiosk. In addition, water was collected in different containers for drinking water transport: a) uncleaned jerrycans, b) cleaned jerrycans, and c) cleaned improved containers with a wide mouth and a spigot. Water quality in the containers was compared to that of a control group collecting unchlorinated water in uncleaned jerrycans. Water samples were collected at the tap of the kiosk, from the containers of 135 households after they were filled at the tap, and from the same containers in the households after 24 h of water storage. The samples were analysed for counts of E. coli, total coliforms, and FRC. Household interviews and structured observations were conducted to identify confounding variables and to assess the influence of water, sanitation, and hygiene infrastructure and practices on recontamination. All three intervention strategies contributed to significantly lower E. coli recontamination levels after 24 h than in the control group (Median (Mdn) = 9 CFU/100 mL, Interquartile Range (IQR) = 25). Median E. coli counts and mean FRC consumption were higher in uncleaned jerrycans (Median = 1 CFU/100 mL, IQR = 6, ΔFRC = 1.8 mg/L) than in cleaned jerrycans (Median = 0 CFU/100 mL IQR = 2, ΔFRC = 1.6 mg/L) and the lowest in cleaned improved containers (Median = 0 CFU/100 mL, IQR = 0, ΔFRC = 1.2 mg/L). The FRC concentration at the tap of 2 mg/L was too low to protect water from E. coli recontamination in uncleaned jerrycans over 24 h. Cleaning the jerrycans was inconvenient due to their small openings, therefore, sand was used. The cleaning with sand reduced recontamination with E. coli but did not reduce the count of total coliforms. Improved containers with a larger opening allowed for cleaning with a brush and showed the lowest levels of recontamination for both E. coli and total coliforms. In addition to the intervention strategies, households receiving a higher number of WASH education visits within the previous year had lower recontamination levels of E. coli in stored water (OR = 0.54, p = .003).
Gärtner, N.; Germann, L.; Wanyama, K.; Ouma, H.; Meierhofer, R. (2021) Keeping water from kiosks clean: strategies for reducing recontamination during transport and storage in Eastern Uganda, Water Research X, 10, 100079 (8 pp.), doi:10.1016/j.wroa.2020.100079, Institutional Repository
Assessment of low-cost, non-electrically powered chlorination devices for gravity-driven membrane water kiosks in eastern Uganda
Recontamination during transport and storage is a common challenge of water supply in low-income settings, especially if water is collected manually. Chlorination is a strategy to reduce recontamination. We assessed seven low-cost, non-electrically powered chlorination devices in gravity-driven membrane filtration (GDM) kiosks in eastern Uganda: one floater, two in-line dosers, three end-line dosers (tap-attached), and one manual dispenser. The evaluation criteria were dosing consistency, user-friendliness, ease of maintenance, local supply chain, and cost. Achieving an adequate chlorine dosage (∼2 mg/L at the tap and ≥ 0.2 mg/L after 24 h of storage in a container) was challenging. The T-chlorinator was the most promising option for GDM kiosks: it achieved correct dosage (CD, 1.5-2.5 mg/L) with a probability of 90 per cent, was easy to use and maintain, economical, and can be made from locally available materials. The other in-line option, the chlorine-dosing bucket (40 per cent CD) still needs design improvements. The end-line options AkvoTur (67 per cent CD) and AquatabsFlo® (57 per cent CD) are easy to install and operate at the tap, but can be easily damaged in the GDM set-up. The Venturi doser (52 per cent CD) did not perform satisfactorily with flow rates > 6 L/min. The chlorine dispenser (52 per cent CD) was robust and user-friendly, but can only be recommended if users comply with chlorinating the water themselves. Establishing a sustainable supply chain for chlorine products was challenging. Where solid chlorine tablets were locally rarely available, the costs of liquid chlorine options were high (27-162 per cent of the water price).
Dössegger, L.; Tournefier, A.; Germann, L.; Gärtner, N.; Huonder, T.; Etenu, C.; Wanyama, K.; Ouma, H.; Meierhofer, R. (2021) Assessment of low-cost, non-electrically powered chlorination devices for gravity-driven membrane water kiosks in eastern Uganda, Waterlines, 40(2), 92-106, doi:10.3362/1756-3488.20-00014, Institutional Repository
Understanding the effect of socio-economic characteristics and psychosocial factors on household water treatment practices in rural Nepal using Bayesian belief networks
About 20 Million (73%) people in Nepal still do not have access to safely managed drinking water service and 22 million (79%) do not treat their drinking water before consumption. Few studies have addressed the combination of socio-economic characteristics and psychosocial factors that explain such behaviour in a probabilistic manner. In this paper we present a novel approach to assess the usage of household water treatment (HWT), using data from 451 households in mid and far-western rural Nepal. We developed a Bayesian belief network model that integrates socio-economic characteristics and five psychosocial factors. The socio-economic characteristics of households included presence of young children, having been exposed to HWT promotion in the past, level of education, type of water source used, access to technology and wealth level. The five psychosocial factors capture households' perceptions of incidence and severity of water-borne infections, attitudes towards the impact of poor water quality on health, water treatment norms and the knowledge level for performing HWT. We found that the adoption of technology was influenced by the psychosocial factors norms, followed by the knowledge level for operating the technology. Education, wealth level, and being exposed to the promotion of HWT were the most influential socio-economic characteristics. Interestingly, households who were connected to a piped water scheme have a higher probability of HWT adoption compared to other types of water sources. The scenario analysis revealed that interventions that only target single socio-economic characteristics do not effectively boost the probability of HWT practice. However, interventions addressing several socio-economic characteristics increase the probability of HWT adoption among the target groups.
Daniel, D.; Diener, A.; Pande, S.; Jansen, S.; Marks, S.; Meierhofer, R.; Bhatta, M.; Rietveld, L. (2019) Understanding the effect of socio-economic characteristics and psychosocial factors on household water treatment practices in rural Nepal using Bayesian belief networks, International Journal of Hygiene and Environmental Health, 222(5), 847-855, doi:10.1016/j.ijheh.2019.04.005, Institutional Repository
Does activated silver reduce recontamination risks in the reservoirs of ceramic water filters?
Efforts to provide safe water are challenged by recontamination and regrowth of pathogens in treated water during storage. This study evaluated the potential of metallic silver with a chemically etched surface to reduce recontamination risks during water storage in ceramic water filters. Batch experiments were conducted in the laboratory with water storage buckets containing three configurations of varying amounts of silver. Field trials in a rural area in Kenya assessed the effect of the same configurations in the storage buckets of locally produced ceramic pot filters without colloidal silver coating. The tests revealed that the etched silver slightly reduced microbiological recontamination risks during water storage despite the low diffusion of silver ions (<5 µg Ag/L). The effect was strongly influenced by water chemistry parameters. A statistically significant difference in the removal of E. coli (Δ Log Removal Value (LRV) = 0.6) and total coliforms (Δ LRV = 1.7) was found between households using a filter with silver in the water reservoir and those using a filter without silver. Multivariate regression of water handling factors and hygiene practices on filter performance revealed that the presence of silver in the reservoir and cleaning the filter element with a brush were associated with a better filter performance.
Meierhofer, R.; Rubli, P.; Oremo, J.; Odhiambo, A. (2019) Does activated silver reduce recontamination risks in the reservoirs of ceramic water filters?, Water, 11(5), 1108 (11 pp.), doi:10.3390/w11051108, Institutional Repository
Influence of container cleanliness, container disinfection with chlorine, and container handling on recontamination of water collected from a water kiosk in a Kenyan slum
The study assessed whether using clean containers that had been disinfected with chlorine at a water kiosk in the Kangemi slum in Nairobi reduced recontamination of treated water during drinking transport and storage. At the same time, the impacts of container handling and hygiene conditions at the household level on water quality changes during storage were evaluated. Data were collected during interviews with 135 households using either new, clean Maji Safi containers (MSCs) that had been disinfected with chlorine or normal uncleaned jerrycans (NJCs). Bacteriological water quality and free chlorine levels in both types of containers were measured after container filling at the kiosk and in the same containers after 24 h storage in households. The use of MSCs significantly reduced the risk of recontaminating the treated water. After water filling at the kiosk, none of the MSCs contained Escherichia coli bacteria, and 2.8% were contaminated after 24 h storage. In contrast, 6.2% of NJCs were contaminated after filling, and 15.2% after 24 h storage. Multivariate logistic regression indicated that the use of a clean water container and sufficient chlorine and the frequency of cleaning the container in the household mitigated recontamination. We suggest further investigation of water container designs that facilitate cleaning.
Meierhofer, R.; Wietlisbach, B.; Matiko, C. (2019) Influence of container cleanliness, container disinfection with chlorine, and container handling on recontamination of water collected from a water kiosk in a Kenyan slum, Journal of Water and Health, 17(2), 308-317, doi:10.2166/wh.2019.282, Institutional Repository
From water source to tap of ceramic filters - factors that influence water quality between collection and consumption in rural households in Nepal
The study assessed changes in water quality between the water source and the tap of locally produced low cost ceramic water filters used by a community living in hygienically critical conditions in a remote mountainous area in Western Nepal. Data was collected from 42 rural households during two visits. The effectiveness of filter handling on its performance was assessed through microbiological analysis, structured household interviews and structured observations. Water quality decreased significantly when source water was filled into transport containers, while the use of the filters improved drinking water quality for about 40% of the households. Highly inadequate filter cleaning practices involving the use of contaminated raw water, hands (geo mean = 110 E. coli CFU/100 mL) and cleaning tools (geo mean = 80 E. coli CFU/100 mL) stained hygienic parts of the filter. The use of boiling water to disinfect the filters was significantly correlated with improved filter performance and should be further promoted. However, even disinfected filters achieved a very low average LRV for E. coli of 0.4 in the field and performed worse than during laboratory tests (LRV for E. coli of 1.5-2). Comprehensive training on adequate filter handling, as well as better filter products, are required to improve the impact of filter use.
Meierhofer, R.; Bänziger, C.; Deppeler, S.; Kunwar, B. M.; Bhatta, M. (2018) From water source to tap of ceramic filters - factors that influence water quality between collection and consumption in rural households in Nepal, International Journal of Environmental Research and Public Health, 15(11), 2439 (14 pp.), doi:10.3390/ijerph15112439, Institutional Repository
Membrane filtration reduces recontamination risk in chlorinated household water containers
The study was conducted in the catchment area of two Gravity Driven Membrane Filtration (GDM) water kiosks in Uganda. It assessed if the cleaning and disinfection of jerrycans with chlorine can reduce risks for regrowth and recontamination of treated water during storage in undisturbed containers, as well as at the household level. In addition, the impact of water handling, household hygiene and safe storage determinants on water quality was evaluated. Results indicate that the cleanliness of the water storage container has a critical impact on water quality changes during storage. Safe drinking water at the point of consumption after 24 hours of storage at the household level can be achieved with a combination of ultrafiltration and subsequent chlorination.
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title => protected'Changes in water treatment, hygiene practices, household floors, and child h ealth in times of Covid-19: a longitudinal cross-sectional survey in Surkhet District, Nepal' (168 chars)
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categories => protected'drinking water treatment; scheme-level passive chlorination; hand washing; h ygiene; child health; Covid-19; Nepal' (113 chars)
description => protected'<em>Introduction: </em>Consistent and effective practice of water treatment, sanitation, and hygiene (WASH) behaviour is an indispensable requisite for realizing health improvements among children living in low-income areas with challenging hygienic conditions. Sustainably achieving such a behaviour cha nge is challenging but more likely to be realized during epidemics, when hea lth threats are high and the dissemination of information on preventative me asures is intense. Our study conducted cross-sectional surveys in Surkhet Di strict Nepal, before and during the Covid-19 pandemic to assess the impact o f water safety interventions and hygiene training implemented before and dur ing the pandemic on WASH conditions and practices and to assess the associat ion of these changes with child health.<br /><em>Methods: </em>Information o n WASH infrastructure, WASH behaviour, nutrition, and child health, includin g on parasitic infections, was obtained before and during the Covid-19 pande mic in spring 2018 and spring 2021, from 589 children aged between 6 months and 10 years and their caregivers. Data was collected through quantitative, structured face-to-face interviews, observations, health examinations of chi ldren including anthropometric measurements, analysis of children's stool, a nd water quality analysis. The association of changes in WASH factors with c hanges in child health was analysed using multivariate generalized estimatin g equations for repeated measures.<br /><em>Results: </em>Water safety manag ement was significantly improved by the introduction of chlorination to pipe d water supply systems, which served 40% of households. In addition, the per centage of households using a ceramic water filter increased from 12.2% to 3 4.8%. Large and significant changes were observed in handwashing behaviour ( frequency, use of soap and washing at critical times) and infrastructure: 35 % of households constructed a new handwashing station. Kitchen and household hygiene also improved. ...' (4350 chars)
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doi => protected'10.1016/j.ijheh.2023.114138' (27 chars)
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authors => protected'Shrestha, A.; Kunwar, B. M.; Meierhofer, R.' (63 chars)
title => protected'Water, sanitation, hygiene practices, health and nutritional status among ch ildren before and during the COVID-19 pandemic: longitudinal evidence from r emote areas of Dailekh and Achham districts in Nepal' (204 chars)
journal => protected'BMC Public Health' (17 chars)
year => protected2022 (integer)
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issue => protected'' (0 chars)
startpage => protected'2035 (27 pp.)' (13 chars)
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categories => protected'COVID-19; water; sanitation; hygiene; child health; nutritional status; prob lems due to COVID-19; Achham and Dailekh districts Nepal' (132 chars)
description => protected'<em>Background </em>The COVID-19 pandemic drew hygiene to the center of dise ase prevention. The provision of adequate water, sanitation, and hygiene (WA SH) services is crucial to protect public health during a pandemic. Yet, acc ess to levels of water supply that support adequate hygiene measures are def icient in many areas in Nepal. We examined WASH practices and their impact o n child health and nutritional status in two districts before and during the COVID-19 pandemic.<br /><em>Methods</em> A longitudinal and mixed method st udy was conducted in March-May 2018 and November–December 2021. In total, 715 children aged 0-10 years were surveyed at baseline. Of these, 490 childr en were assessed at endline. Data collection methods included observations, a questionnaire, stool analysis, anthropometric measurements, water quality analysis, and an assessment of clinical signs of nutritional deficiencies. W e conducted 10 in-depth interviews to understand major problems related to C OVID-19.<br /><em>Results</em> Most respondents (94.2%) had heard about COVI D-19; however, they did not wear face masks or comply with any social distan cing protocols. Almost 94.2% of the households self-reported handwashing wit h soap 5-10 times per day at endline, especially after defecation, compared to 19.6% at baseline. Water quality was better at endline than at baseline w ith median 12 to 29 CFU <em>Escherichia coli</em>/100 mL (interquartile rang e at baseline [IQR] = 4-101) at the point of collection and 34 to 51.5 C FU <em>Escherichia coli</em>/100 mL (IQR = 8–194) at the point of cons umption. Fever (41.1-16.8%; <em>p</em> = 0.01), respiratory illness (14. 3-4.3%; <em>p</em> = 0.002), diarrhea (19.6–9.5%; <em>p</em> = 0.0 1), and <em>Giardia lamblia</em> infections (34.2-6.5%, <em>p =</em> 0.0 1) decreased at endline. In contrast, nutritional deficiencies such as bitot ’s spots (26.7-40.2%; <em>p</em> = 0.01), pale conjunctiva (47.0-63.3% ; <em>p</em> = 0.01)...' (2599 chars)
serialnumber => protected'' (0 chars)
doi => protected'10.1186/s12889-022-14346-8' (26 chars)
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authors => protected'Shrestha, A.; Six, J.; Dahal, D.; Marks, S.; Meierhofer, R.' (84 chars)
title => protected'Association of nutrition, water, sanitation and hygiene practices with child ren's nutritional status, intestinal parasitic infections and diarrhoea in r ural Nepal: a cross-sectional study' (187 chars)
journal => protected'BMC Public Health' (17 chars)
year => protected2020 (integer)
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startpage => protected'1241 (21 pp.)' (13 chars)
otherpage => protected'' (0 chars)
categories => protected'child health; drinking water quality; sanitation and hygiene; diarrhoea; int estinal parasitic infections; Nepal; undernutrition' (127 chars)
description => protected'<em>Background:</em> Providing universal access to safe water, sanitation an d hygiene (WASH) in remote Nepal remains challenging. We investigated WASH c onditions and their association with children's nutritional status, intestin al parasitic infections and diarrhoea.<br /><em>Methods:</em> Data was colle cted through a cross-sectional survey of 1427 households, including question naires, observations, stool analysis, anthropometry, water quality measureme nts, and assessment of clinical signs of nutritional deficiencies.<br /><em> Results:</em> We found 55.5% of children were undernourished, 63.9% had clin ical signs of nutritional deficiencies, 51.1% had intestinal parasitic infec tions and 52.2% had diarrhoea. Multivariate mixed logistic regression analys is revealed a statistically significant negative association between undernu trition and socio-economic level, with adjusted odds ratios (AOR) of 0.70 (9 5%-CI = 0.43-1.11) and 0.43 (95%-CI = 0.25-0.75) for high and interm ediate levels compared to the lowest level. Undernutrition was negatively as sociated with regular deworming of children (AOR = 0.44, 95% CI = 0. 20-0.94), food supplements (AOR = 0.57, 95% CI = 0.38-0.84), househo ld's own food production (AOR = 0.67, 95% CI = 0.46-0.97) and person al hygiene (AOR = 0.83, 95% CI = 0.51-1.35). Nutritional deficiency was negatively associated with handwashing after cleaning a baby’s bottom (AOR = 0.60, 95% CI = 0.40-0.92) and cleanliness of caregiver's hand s (AOR = 0.61, 95% CI = 0.41-0.89) and positively associated with ke eping animals inside the house overnight (AOR = 1.71, 95% CI = 1.17-
th intermittent water supply (AOR = 2.72, 95% CI = 1.18-6.31) and th e presence of a mud floor (AOR = 2.29, 95% CI = 1.20-4.37) and negat ively associated with cl...' (2598 chars)
serialnumber => protected'' (0 chars)
doi => protected'10.1186/s12889-020-09302-3' (26 chars)
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Changes in water treatment, hygiene practices, household floors, and child health in times of Covid-19: a longitudinal cross-sectional survey in Surkhet District, Nepal
Introduction: Consistent and effective practice of water treatment, sanitation, and hygiene (WASH) behaviour is an indispensable requisite for realizing health improvements among children living in low-income areas with challenging hygienic conditions. Sustainably achieving such a behaviour change is challenging but more likely to be realized during epidemics, when health threats are high and the dissemination of information on preventative measures is intense. Our study conducted cross-sectional surveys in Surkhet District Nepal, before and during the Covid-19 pandemic to assess the impact of water safety interventions and hygiene training implemented before and during the pandemic on WASH conditions and practices and to assess the association of these changes with child health. Methods: Information on WASH infrastructure, WASH behaviour, nutrition, and child health, including on parasitic infections, was obtained before and during the Covid-19 pandemic in spring 2018 and spring 2021, from 589 children aged between 6 months and 10 years and their caregivers. Data was collected through quantitative, structured face-to-face interviews, observations, health examinations of children including anthropometric measurements, analysis of children's stool, and water quality analysis. The association of changes in WASH factors with changes in child health was analysed using multivariate generalized estimating equations for repeated measures. Results: Water safety management was significantly improved by the introduction of chlorination to piped water supply systems, which served 40% of households. In addition, the percentage of households using a ceramic water filter increased from 12.2% to 34.8%. Large and significant changes were observed in handwashing behaviour (frequency, use of soap and washing at critical times) and infrastructure: 35% of households constructed a new handwashing station. Kitchen and household hygiene also improved. An additional 22% of households improved the cleanliness of the toilet. The number of houses with a cemented floor increased by 20%. WASH changes were significantly associated with improved child health: the chlorination of piped water supply reduced odds ratios for diarrhoea (OR = 0.36, 95% CI = 0.15–0.88, p = 0.025), respiratory difficulties (OR = 0.39, 95% CI = 0.16-0.92, p = 0.033), fever (OR = 0.42, 95% CI = 0.26-0.71, p = 0.001) and cough (OR = 0.58, 95% CI = 0.36-0.93, p = 0.024), and. The frequency of handwashing with soap was associated with significantly reduced odds ratios for infections with Giardia lamblia (OR = 0.68, 95% CI = 0.50-0.91, p = 0.011), stunting and wasting (OR = 0.75, 95% CI = 0.66–0.92, p = 0.003) and fever (OR = 0.85, 95% CI = 0.75–0.96, p = 0.008),. The presence of a handwashing station at baseline was associated with significantly reduced odds ratios for respiratory difficulties (OR = 0.45, 95% CI = 0.26-0.78, p = 0.004). The construction of a handwashing station between baseline and endline was significantly associated with reduced odds ratios for pale conjunctiva (OR = 0.32, 95% CI = 0.17–0.60, p < 0.001), which is a clinical sign of iron deficiency and anaemia, respiratory difficulties (OR = 0.39, 95% CI = 0.17-0.89, p = 0.026) and cough (OR = 0.44, 95% CI = 0.26-0.76, p = 0.003). Using a clean container for the transport of drinking water was significantly associated with reduced odds ratios for infections with Giardia lamblia (OR = 0.39, 95% CI = 0.16-0.93, p = 0.033) and diarrhoea (OR = 0.48, 95% CI = 0.24-0.96, p = 0.038). Similarly, a cemented floor in the household was significantly associated with reduced odd ratios for diarrhoea (OR = 0.38, 95% CI = 0.16-0.87, p = 0.022) and infections with Giardia lamblia (OR = 0.44, 95% CI = 0.19-1.02, p = 0.056). Conclusion: WASH training and the promotion of preventative measures during the Covid-19 pandemic supported improved water safety management and hygiene behaviour, which resulted in a reduction in infectious diseases among children in the study area.
Meierhofer, R.; Kunwar, B. M.; Shrestha, A. (2023) Changes in water treatment, hygiene practices, household floors, and child health in times of Covid-19: a longitudinal cross-sectional survey in Surkhet District, Nepal, International Journal of Hygiene and Environmental Health, 249, 114138 (14 pp.), doi:10.1016/j.ijheh.2023.114138, Institutional Repository
Water, sanitation, hygiene practices, health and nutritional status among children before and during the COVID-19 pandemic: longitudinal evidence from remote areas of Dailekh and Achham districts in Nepal
Background The COVID-19 pandemic drew hygiene to the center of disease prevention. The provision of adequate water, sanitation, and hygiene (WASH) services is crucial to protect public health during a pandemic. Yet, access to levels of water supply that support adequate hygiene measures are deficient in many areas in Nepal. We examined WASH practices and their impact on child health and nutritional status in two districts before and during the COVID-19 pandemic. Methods A longitudinal and mixed method study was conducted in March-May 2018 and November–December 2021. In total, 715 children aged 0-10 years were surveyed at baseline. Of these, 490 children were assessed at endline. Data collection methods included observations, a questionnaire, stool analysis, anthropometric measurements, water quality analysis, and an assessment of clinical signs of nutritional deficiencies. We conducted 10 in-depth interviews to understand major problems related to COVID-19. Results Most respondents (94.2%) had heard about COVID-19; however, they did not wear face masks or comply with any social distancing protocols. Almost 94.2% of the households self-reported handwashing with soap 5-10 times per day at endline, especially after defecation, compared to 19.6% at baseline. Water quality was better at endline than at baseline with median 12 to 29 CFU Escherichia coli/100 mL (interquartile range at baseline [IQR] = 4-101) at the point of collection and 34 to 51.5 CFU Escherichia coli/100 mL (IQR = 8–194) at the point of consumption. Fever (41.1-16.8%; p = 0.01), respiratory illness (14.3-4.3%; p = 0.002), diarrhea (19.6–9.5%; p = 0.01), and Giardia lamblia infections (34.2-6.5%, p = 0.01) decreased at endline. In contrast, nutritional deficiencies such as bitot’s spots (26.7-40.2%; p = 0.01), pale conjunctiva (47.0-63.3%; p = 0.01), and dermatitis (64.8-81.4%; p = 0.01) increased at endline. The inadequacy of the harvest and the lack of household income to meet households' nutritional needs increased drastically (35.0-94.2%; p = 0.01). Conclusion We found that improved water quality and handwashing practices were associated with a decrease in infectious diseases. However, food security also decreased resulting in a high prevalence of nutritional deficiencies. Our findings underline that disaster preparedness should consider access to adequate WASH, nutrition, and health supplies.
Shrestha, A.; Kunwar, B. M.; Meierhofer, R. (2022) Water, sanitation, hygiene practices, health and nutritional status among children before and during the COVID-19 pandemic: longitudinal evidence from remote areas of Dailekh and Achham districts in Nepal, BMC Public Health, 22, 2035 (27 pp.), doi:10.1186/s12889-022-14346-8, Institutional Repository
Association of nutrition, water, sanitation and hygiene practices with children's nutritional status, intestinal parasitic infections and diarrhoea in rural Nepal: a cross-sectional study
Background: Providing universal access to safe water, sanitation and hygiene (WASH) in remote Nepal remains challenging. We investigated WASH conditions and their association with children's nutritional status, intestinal parasitic infections and diarrhoea. Methods: Data was collected through a cross-sectional survey of 1427 households, including questionnaires, observations, stool analysis, anthropometry, water quality measurements, and assessment of clinical signs of nutritional deficiencies. Results: We found 55.5% of children were undernourished, 63.9% had clinical signs of nutritional deficiencies, 51.1% had intestinal parasitic infections and 52.2% had diarrhoea. Multivariate mixed logistic regression analysis revealed a statistically significant negative association between undernutrition and socio-economic level, with adjusted odds ratios (AOR) of 0.70 (95%-CI = 0.43-1.11) and 0.43 (95%-CI = 0.25-0.75) for high and intermediate levels compared to the lowest level. Undernutrition was negatively associated with regular deworming of children (AOR = 0.44, 95% CI = 0.20-0.94), food supplements (AOR = 0.57, 95% CI = 0.38-0.84), household's own food production (AOR = 0.67, 95% CI = 0.46-0.97) and personal hygiene (AOR = 0.83, 95% CI = 0.51-1.35). Nutritional deficiency was negatively associated with handwashing after cleaning a baby’s bottom (AOR = 0.60, 95% CI = 0.40-0.92) and cleanliness of caregiver's hands (AOR = 0.61, 95% CI = 0.41-0.89) and positively associated with keeping animals inside the house overnight (AOR = 1.71, 95% CI = 1.17-2.51) and the presence of total coliforms in the drinking water source (AOR = 10.44, 95% CI = 1.61-67.4). Diarrhoea was positively associated with intermittent water supply (AOR = 2.72, 95% CI = 1.18-6.31) and the presence of a mud floor (AOR = 2.29, 95% CI = 1.20-4.37) and negatively associated with cleanliness of the toilet (AOR = 0.68, 95% CI = 0.47-0.98), and the cleanliness of children’s hands (AOR = 0.62, 95% CI = 0.40-0.96). Conclusions: Our study found, more than half of the survey children were in a critical health condition. Results suggest that child health improvements are dependent on multiple public health improvements, including providing better nutrition, promoting adequate hygiene behaviour, such as handwashing, keeping the latrines clean, keeping the household environment free from animal faeces and assuring a reliable supply of safe water.
Shrestha, A.; Six, J.; Dahal, D.; Marks, S.; Meierhofer, R. (2020) Association of nutrition, water, sanitation and hygiene practices with children's nutritional status, intestinal parasitic infections and diarrhoea in rural Nepal: a cross-sectional study, BMC Public Health, 20(1), 1241 (21 pp.), doi:10.1186/s12889-020-09302-3, Institutional Repository
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authors => protected'Meierhofer, R.; Tomberge, V. M. J.; Inauen, J.; Shr estha, A.' (90 chars)
title => protected'Water carrying in hills of Nepal-associations with women’s musculoskeletal disorders, uterine prolapse, and spontaneous abortions' (131 chars)
journal => protected'PLoS One' (8 chars)
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startpage => protected'e0269926 (23 pp.)' (17 chars)
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description => protected'More than a third of women in Nepal have to carry water from source to home to satisfy their families’ daily needs. A cross-sectional study was carrie d out in a hilly area in Nepal to assess water-carrying practices and their association with women’s health. Quantitative interviews were conducted wi th 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water car rying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive phy sical stress due to water carrying during the dry season. Women suffered fro m a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk categ ory of water carrying was significantly associated with uterine prolapse (OR = 1.44, 95%CI = 1.12-1.85, <em>p</em> = 0.031) and pain in the hips (OR = 1 .69, 95%CI = 1.27-2.26, <em>p</em><0.001). Receiving help with water carr ying during pregnancy and during the first three months after delivery was a ssociated with reduced odds ratios for uterine prolapse (OR = 0.10, 95% CI = 0.01-0.87, <em>p</em> = 0.037), and strong back pain (OR = 0.32, 95% CI = 0 .12-0.87, <em>p</em> = 0.026). Improvements to water supply infrastructure a nd the promotion of social support for carrying water during pregnancy and a fter delivery are recommended to reduce water-carrying-related health risks.' (1672 chars)
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doi => protected'10.1371/journal.pone.0269926' (28 chars)
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authors => protected'Tomberge, V. M. J.; Shrestha, A.; Meierhofer, R.; I nauen, J.' (90 chars)
title => protected'Understanding safe water-carrying practices during pregnancy and postpartum: a mixed-methods study in Nepal' (107 chars)
journal => protected'Applied Psychology: Health and Well-Being' (41 chars)
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categories => protected'access to water; convergent mixed-methods design; health action process appr oach; low-income population; psychosocial determinants of health; women's he alth' (156 chars)
description => protected'Daily carrying of heavy loads of domestic water, especially during pregnancy and postpartum, bears a threat to maternal health in low-income countries. Using an extended health action process approach (HAPA), we examined women's reasons for and psychosocial determinants of safe water-carrying during pre gnancy and postpartum. In a mixed-methods study, trained local interviewers conducted 1001 quantitative interviews with women of reproductive age (<em>n </em> = 921 analyzed) and 21 qualitative interviews with women of reproduct ive age, in-laws, and spouses in rural Nepal. We analyzed the quantitative d ata with generalized estimating equations to model the HAPA-based psychosoci al determinants of avoiding water-carrying during pregnancy and postpartum. Subjective perspectives were investigated with thematic analysis. Outcome ex pectancies (<em>B</em> = 0.24), self-efficacy (<em>B </em>= 0.20), and injun ctive norms (<em>B </em>= 0.23) were significantly associated with the inten tion to avoid water-carrying. Self-efficacy (<em>B</em> = 0.36) and instrume ntal support (<em>B </em>= 0.05) are related to behavior (all <em>p</em> < ; 0.05). Women explained water-carrying during pregnancy by a lack of family support, a shift of health decision-making power to in-laws, and low behavi oral control. Overall, the necessity of water, family decision-making struct ures, and low support make it difficult for women to discontinue water-carry ing. Additionally to infrastructural improvements, behavioral interventions may increase women's self-efficacy for safe water-carrying (e.g. reducing we ight) and social support.' (1621 chars)
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authors => protected'Tomberge, V. M. J.; Bischof, J. S.; Meierhofer,&nbs p;R.; Shrestha, A.; Inauen, J.' (116 chars)
title => protected'The physical burden of water carrying and women's psychosocial well-being: e vidence from rural nepal' (100 chars)
journal => protected'International Journal of Environmental Research and Public Health' (65 chars)
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startpage => protected'7908 (11 pp.)' (13 chars)
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categories => protected'gender inequalities in health; water access; psychosocial well-being; unpaid work; low-income population' (104 chars)
description => protected'Many women in low-income countries carry heavy loads of drinking water for t heir families in difficult terrain. This can adversely affect their health a nd well-being. The present study is the first to investigate the physical bu rden of water carrying and women's psychosocial well-being, and how this rel ationship is moderated by environmental and health conditions. Trained local interviewers conducted interviews with 1001 women across five rural communi ties in Nepal. In addition, objective measurement was used to assess the wei ght carried and distance from the water source. The physical burden of water carrying was calculated from weight, distance, and frequency of trips. Its association with psychosocial well-being was modeled using generalized estim ating equations. Two additional models included the terrain and uterine prol apse as moderators. The physical burden of water carrying is directly relate d to higher emotional distress and reduced daily functioning. This correlati on was exacerbated for women carrying in hilly versus flat terrain, and for those who had uterine prolapse. Our results underline the importance of adeq uate water access for women's psychosocial well-being, especially for vulner able populations such as women with impaired health (e.g., uterine prolapse) or those living in hilly terrain. The results further highlight the interco nnectedness of the Sustainable Development Goal (SDG) 6: water access, SDG 3 : health and well-being, and SDG 5: gender equality.' (1496 chars)
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Water carrying in hills of Nepal-associations with women’s musculoskeletal disorders, uterine prolapse, and spontaneous abortions
More than a third of women in Nepal have to carry water from source to home to satisfy their families’ daily needs. A cross-sectional study was carried out in a hilly area in Nepal to assess water-carrying practices and their association with women’s health. Quantitative interviews were conducted with 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water carrying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive physical stress due to water carrying during the dry season. Women suffered from a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk category of water carrying was significantly associated with uterine prolapse (OR = 1.44, 95%CI = 1.12-1.85, p = 0.031) and pain in the hips (OR = 1.69, 95%CI = 1.27-2.26, p<0.001). Receiving help with water carrying during pregnancy and during the first three months after delivery was associated with reduced odds ratios for uterine prolapse (OR = 0.10, 95% CI = 0.01-0.87, p = 0.037), and strong back pain (OR = 0.32, 95% CI = 0.12-0.87, p = 0.026). Improvements to water supply infrastructure and the promotion of social support for carrying water during pregnancy and after delivery are recommended to reduce water-carrying-related health risks.
Meierhofer, R.; Tomberge, V. M. J.; Inauen, J.; Shrestha, A. (2022) Water carrying in hills of Nepal-associations with women’s musculoskeletal disorders, uterine prolapse, and spontaneous abortions, PLoS One, 17(6), e0269926 (23 pp.), doi:10.1371/journal.pone.0269926, Institutional Repository
Understanding safe water-carrying practices during pregnancy and postpartum: a mixed-methods study in Nepal
Daily carrying of heavy loads of domestic water, especially during pregnancy and postpartum, bears a threat to maternal health in low-income countries. Using an extended health action process approach (HAPA), we examined women's reasons for and psychosocial determinants of safe water-carrying during pregnancy and postpartum. In a mixed-methods study, trained local interviewers conducted 1001 quantitative interviews with women of reproductive age (n = 921 analyzed) and 21 qualitative interviews with women of reproductive age, in-laws, and spouses in rural Nepal. We analyzed the quantitative data with generalized estimating equations to model the HAPA-based psychosocial determinants of avoiding water-carrying during pregnancy and postpartum. Subjective perspectives were investigated with thematic analysis. Outcome expectancies (B = 0.24), self-efficacy (B = 0.20), and injunctive norms (B = 0.23) were significantly associated with the intention to avoid water-carrying. Self-efficacy (B = 0.36) and instrumental support (B = 0.05) are related to behavior (all p < 0.05). Women explained water-carrying during pregnancy by a lack of family support, a shift of health decision-making power to in-laws, and low behavioral control. Overall, the necessity of water, family decision-making structures, and low support make it difficult for women to discontinue water-carrying. Additionally to infrastructural improvements, behavioral interventions may increase women's self-efficacy for safe water-carrying (e.g. reducing weight) and social support.
Tomberge, V. M. J.; Shrestha, A.; Meierhofer, R.; Inauen, J. (2022) Understanding safe water-carrying practices during pregnancy and postpartum: a mixed-methods study in Nepal, Applied Psychology: Health and Well-Being, 14(2), 691-711, doi:10.1111/aphw.12325, Institutional Repository
The physical burden of water carrying and women's psychosocial well-being: evidence from rural nepal
Many women in low-income countries carry heavy loads of drinking water for their families in difficult terrain. This can adversely affect their health and well-being. The present study is the first to investigate the physical burden of water carrying and women's psychosocial well-being, and how this relationship is moderated by environmental and health conditions. Trained local interviewers conducted interviews with 1001 women across five rural communities in Nepal. In addition, objective measurement was used to assess the weight carried and distance from the water source. The physical burden of water carrying was calculated from weight, distance, and frequency of trips. Its association with psychosocial well-being was modeled using generalized estimating equations. Two additional models included the terrain and uterine prolapse as moderators. The physical burden of water carrying is directly related to higher emotional distress and reduced daily functioning. This correlation was exacerbated for women carrying in hilly versus flat terrain, and for those who had uterine prolapse. Our results underline the importance of adequate water access for women's psychosocial well-being, especially for vulnerable populations such as women with impaired health (e.g., uterine prolapse) or those living in hilly terrain. The results further highlight the interconnectedness of the Sustainable Development Goal (SDG) 6: water access, SDG 3: health and well-being, and SDG 5: gender equality.
Tomberge, V. M. J.; Bischof, J. S.; Meierhofer, R.; Shrestha, A.; Inauen, J. (2021) The physical burden of water carrying and women's psychosocial well-being: evidence from rural nepal, International Journal of Environmental Research and Public Health, 18(15), 7908 (11 pp.), doi:10.3390/ijerph18157908, Institutional Repository
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authors => protected'Dössegger, L.; Tournefier, A.; Germann, L.; Gärtner, N .; Huonder, T.; Etenu, C.; Wanyama, K.; Ouma, H.; Meierh ofer, R.' (165 chars)
title => protected'Assessment of low-cost, non-electrically powered chlorination devices for gr avity-driven membrane water kiosks in eastern Uganda' (128 chars)
journal => protected'Waterlines' (10 chars)
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categories => protected'point-of-collection chlorination; water treatment; recontamination; GDM wate r kiosk; low-income country' (103 chars)
description => protected'Recontamination during transport and storage is a common challenge of water supply in low-income settings, especially if water is collected manually. Ch lorination is a strategy to reduce recontamination. We assessed seven low-co st, non-electrically powered chlorination devices in gravity-driven membrane filtration (GDM) kiosks in eastern Uganda: one floater, two in-line dosers, three end-line dosers (tap-attached), and one manual dispenser. The evaluat ion criteria were dosing consistency, user-friendliness, ease of maintenance , local supply chain, and cost. Achieving an adequate chlorine dosage (∼2 mg/L at the tap and ≥ 0.2 mg/L after 24 h of storage in a container) was c hallenging. The T-chlorinator was the most promising option for GDM kiosks: it achieved correct dosage (CD, 1.5-2.5 mg/L) with a probability of 90 per c ent, was easy to use and maintain, economical, and can be made from locally available materials. The other in-line option, the chlorine-dosing bucket (4 0 per cent CD) still needs design improvements. The end-line options AkvoTur (67 per cent CD) and AquatabsFlo® (57 per cent CD) are easy to install and operate at the tap, but can be easily damaged in the GDM set-up. The Ventur i doser (52 per cent CD) did not perform satisfactorily with flow rates > 6 L/min. The chlorine dispenser (52 per cent CD) was robust and user-friend ly, but can only be recommended if users comply with chlorinating the water themselves. Establishing a sustainable supply chain for chlorine products wa s challenging. Where solid chlorine tablets were locally rarely available, t he costs of liquid chlorine options were high (27-162 per cent of the water price).' (1679 chars)
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authors => protected'Peter, M.; Meierhofer, R.' (35 chars)
title => protected'GDM-Wasserkioske. Sauberes Trinkwasser für die ländliche Bevölkerung Ugan das' (79 chars)
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description => protected'In ländlichen Gegenden Ugandas werden die an der Eawag entwickelten Ultrafi ltrationsanlagen eingesetzt, um die Versorgung mit sauberem Trinkwasser sich erzustellen. Die Anlagen an den Ufern des Lake Victoria können mit sehr ger ingem Aufwand und ohne externe Ressourcen betrieben werden. Wasserqualitäts untersuchungen haben gezeigt, dass die Anlagen zuverlässig sauberes Wasser liefern. Mit dem Verkauf des Wassers wird ein Einkommen generiert, das den t äglichen Betrieb und Unterhalt der Anlagen sichert.' (508 chars)
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authors => protected'Meierhofer, R.; Rubli, P.; Dreyer, K.; Ouma, H.; Wanyama , K.; Peter-Varbanets, M.' (111 chars)
title => protected'Membrane filtration reduces recontamination risk in chlorinated household wa ter containers' (90 chars)
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description => protected'The study was conducted in the catchment area of two Gravity Driven Membrane Filtration (GDM) water kiosks in Uganda. It assessed if the cleaning and di sinfection of jerrycans with chlorine can reduce risks for regrowth and reco ntamination of treated water during storage in undisturbed containers, as we ll as at the household level. In addition, the impact of water handling, hou sehold hygiene and safe storage determinants on water quality was evaluated. Results indicate that the cleanliness of the water storage container has a critical impact on water quality changes during storage. Safe drinking water at the point of consumption after 24 hours of storage at the household leve l can be achieved with a combination of ultrafiltration and subsequent chlor ination.' (768 chars)
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authors => protected'Peter-Varbanets, M.; Dreyer, K.; McFadden, N.; Ouma, H.; Wanyama, K.; Etenu, C.; Meierhofer, R.' (130 chars)
title => protected'Evaluating novel gravity-driven membrane (GDM) water kiosks in schools' (70 chars)
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description => protected'This paper presents results of the field evaluation of three gravity driven membrane (GDM) water kiosks purifying Victoria lake water in schools in Ugan da. The study evaluated the technical performance of the systems and the fea sibility of the operation and maintenance concepts over two years of operati on, as well as the financial viability of the business model and management concept and overall system sustainability. The results show that GDM water k iosks are a simple technology capable of treating turbid surface water and c an autonomously supply good quality water to schools and communities. They r equire little maintenance, are simple to operate and maintain, and with trai ned local O&M team support, they offer sustainability of operation in remote low-income areas. The business and management model evaluation has not yet been completed and is ongoing.' (866 chars)
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authors => protected'Peter-Varbanets, M.; Johnston, R.; Meierhofer, R.; Kage,  ;F.; Pronk, W.' (95 chars)
title => protected'Gravity-driven membrane disinfection for household drinking water treatment' (75 chars)
journal => protected'In: Shaw, R. (Eds.), The future of water, sanitation and hygiene in low -income countries - innovation, adaptation and engagement in a changing worl d. Proceedings of the 35th WEDC international conference, Loughborough Unive rsity, Loughborough, UK, 6-' (255 chars)
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categories => protected'household water treatment; ultrafiltration; membrane disinfection' (65 chars)
description => protected'Ultrafiltration (UF) has been proven to be very effective in the treatment o f water for the removal of particles, colloids and microorganisms. However, household application of UF is limited due to membrane fouling which results in complex and maintenance-intensive UF systems. In gravity-driven membrane disinfection (GDMD) technology, a stable membrane flux of 4-10 L.h<sup>-1</ sup>m<sup>-2</sup> is observed during ultrafiltration without any backflushi ng, chemical cleaning or an external energy supply for over 24 months, while operated at relatively low pressures (40-65 cm of water column). This novel approach to operate UF systems at stable flux conditions can be considered an important breakthrough in membrane technology, as it allows development o f a robust, maintenance-free, low-cost and user-friendly household water tre atment system, which has a great potential for implementation.' (898 chars)
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Assessment of low-cost, non-electrically powered chlorination devices for gravity-driven membrane water kiosks in eastern Uganda
Recontamination during transport and storage is a common challenge of water supply in low-income settings, especially if water is collected manually. Chlorination is a strategy to reduce recontamination. We assessed seven low-cost, non-electrically powered chlorination devices in gravity-driven membrane filtration (GDM) kiosks in eastern Uganda: one floater, two in-line dosers, three end-line dosers (tap-attached), and one manual dispenser. The evaluation criteria were dosing consistency, user-friendliness, ease of maintenance, local supply chain, and cost. Achieving an adequate chlorine dosage (∼2 mg/L at the tap and ≥ 0.2 mg/L after 24 h of storage in a container) was challenging. The T-chlorinator was the most promising option for GDM kiosks: it achieved correct dosage (CD, 1.5-2.5 mg/L) with a probability of 90 per cent, was easy to use and maintain, economical, and can be made from locally available materials. The other in-line option, the chlorine-dosing bucket (40 per cent CD) still needs design improvements. The end-line options AkvoTur (67 per cent CD) and AquatabsFlo® (57 per cent CD) are easy to install and operate at the tap, but can be easily damaged in the GDM set-up. The Venturi doser (52 per cent CD) did not perform satisfactorily with flow rates > 6 L/min. The chlorine dispenser (52 per cent CD) was robust and user-friendly, but can only be recommended if users comply with chlorinating the water themselves. Establishing a sustainable supply chain for chlorine products was challenging. Where solid chlorine tablets were locally rarely available, the costs of liquid chlorine options were high (27-162 per cent of the water price).
Dössegger, L.; Tournefier, A.; Germann, L.; Gärtner, N.; Huonder, T.; Etenu, C.; Wanyama, K.; Ouma, H.; Meierhofer, R. (2021) Assessment of low-cost, non-electrically powered chlorination devices for gravity-driven membrane water kiosks in eastern Uganda, Waterlines, 40(2), 92-106, doi:10.3362/1756-3488.20-00014, Institutional Repository
GDM-Wasserkioske. Sauberes Trinkwasser für die ländliche Bevölkerung Ugandas
In ländlichen Gegenden Ugandas werden die an der Eawag entwickelten Ultrafiltrationsanlagen eingesetzt, um die Versorgung mit sauberem Trinkwasser sicherzustellen. Die Anlagen an den Ufern des Lake Victoria können mit sehr geringem Aufwand und ohne externe Ressourcen betrieben werden. Wasserqualitätsuntersuchungen haben gezeigt, dass die Anlagen zuverlässig sauberes Wasser liefern. Mit dem Verkauf des Wassers wird ein Einkommen generiert, das den täglichen Betrieb und Unterhalt der Anlagen sichert.
Peter, M.; Meierhofer, R. (2018) GDM-Wasserkioske. Sauberes Trinkwasser für die ländliche Bevölkerung Ugandas, Aqua & Gas, 98(5), 36-39, Institutional Repository
Membrane filtration reduces recontamination risk in chlorinated household water containers
The study was conducted in the catchment area of two Gravity Driven Membrane Filtration (GDM) water kiosks in Uganda. It assessed if the cleaning and disinfection of jerrycans with chlorine can reduce risks for regrowth and recontamination of treated water during storage in undisturbed containers, as well as at the household level. In addition, the impact of water handling, household hygiene and safe storage determinants on water quality was evaluated. Results indicate that the cleanliness of the water storage container has a critical impact on water quality changes during storage. Safe drinking water at the point of consumption after 24 hours of storage at the household level can be achieved with a combination of ultrafiltration and subsequent chlorination.
Evaluating novel gravity-driven membrane (GDM) water kiosks in schools
This paper presents results of the field evaluation of three gravity driven membrane (GDM) water kiosks purifying Victoria lake water in schools in Uganda. The study evaluated the technical performance of the systems and the feasibility of the operation and maintenance concepts over two years of operation, as well as the financial viability of the business model and management concept and overall system sustainability. The results show that GDM water kiosks are a simple technology capable of treating turbid surface water and can autonomously supply good quality water to schools and communities. They require little maintenance, are simple to operate and maintain, and with trained local O&M team support, they offer sustainability of operation in remote low-income areas. The business and management model evaluation has not yet been completed and is ongoing.
Peter-Varbanets, M.; Dreyer, K.; McFadden, N.; Ouma, H.; Wanyama, K.; Etenu, C.; Meierhofer, R. (2017) Evaluating novel gravity-driven membrane (GDM) water kiosks in schools, In: WEDC conference 40, 2735 (7 pp.), Institutional Repository
Gravity-driven membrane disinfection for household drinking water treatment
Ultrafiltration (UF) has been proven to be very effective in the treatment of water for the removal of particles, colloids and microorganisms. However, household application of UF is limited due to membrane fouling which results in complex and maintenance-intensive UF systems. In gravity-driven membrane disinfection (GDMD) technology, a stable membrane flux of 4-10 L.h-1m-2 is observed during ultrafiltration without any backflushing, chemical cleaning or an external energy supply for over 24 months, while operated at relatively low pressures (40-65 cm of water column). This novel approach to operate UF systems at stable flux conditions can be considered an important breakthrough in membrane technology, as it allows development of a robust, maintenance-free, low-cost and user-friendly household water treatment system, which has a great potential for implementation.
Peter-Varbanets, M.; Johnston, R.; Meierhofer, R.; Kage, F.; Pronk, W. (2011) Gravity-driven membrane disinfection for household drinking water treatment, In: Shaw, R. (Eds.), The future of water, sanitation and hygiene in low-income countries - innovation, adaptation and engagement in a changing world. Proceedings of the 35th WEDC international conference, Loughborough University, Loughborough, UK, 6-, 1086 (8 pp.), Institutional Repository
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authors => protected'Meierhofer, R.; Flückiger, A. C.; Gebauer, H.' (66 chars)
title => protected'Do sales models influence the purchase and use of ceramic filters in rural a reas of Kenya and Bolivia?' (102 chars)
journal => protected'Journal of Water Supply: Research and Technology. Aqua' (54 chars)
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startpage => protected'87' (2 chars)
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categories => protected'base of the pyramid (BOP); ceramic water filters; developing countries; hous ehold water treatment; sales approach; social marketing' (131 chars)
description => protected'Demand for safe water, as well as access to adequate and affordable products for drinking water treatment, is key for household water treatment (HWT) in low-income countries. Critical barriers, particularly in rural areas, are t he lack of adequate marketing and sales models and the challenge of setting up distribution channels that reach low-income customers, leading to the una vailability of HWT products. Trials with four different social marketing and sales models, involving local Q1 entrepreneurs, staff of an NGO, community health workers and members of community-based organizations, were conducted in Kenya and Bolivia to test which marketing and sales strategies, as well a s which behavioural determinants, influence product purchase and water treat ment practices in different local contexts. Selling filters through the wate r utility, a community-based enterprise, was a promising retail model in Ken ya and in Bolivia. Most successful were sales done by a women’s group in B olivia. We found that community education activities, independent of the sta keholder carrying out the activity, are an important element to create deman d for water treatment products. Other factors influencing product purchase a nd practice are very context specific and include: the turbidity of water, r isk perception, socio-economic status, social norms and emotional attributes .' (1369 chars)
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authors => protected'Bogler, A.; Meierhofer, R.' (36 chars)
title => protected'The challenge of producing and marketing colloidal silver water filters in N epal' (80 chars)
journal => protected'Water' (5 chars)
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startpage => protected'3599' (4 chars)
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categories => protected'household water treatment; ceramic filters; safe drinking water; developing countries; marketing water treatment products; qualitative comparative analy sis' (155 chars)
description => protected'Background: Obtaining safe drinking water can be a challenge in Nepal. By tr aining potters and setting up production sites for Colloidal Silver Filters, several non-governmental organizations have tried to provide local people w ith a low-cost option for household water treatment. Out of 19 trained entre preneurs, only four are currently producing filters. The goal of this evalua tion was to find out what conditions lead to the successful continuation of the production and the reasons for failure. Methods: The evaluation of the p otters was based on a Qualitative Comparative Analysis and the conditions lo oked at were: "Production", "Collaboration", "Market" and "Potter". Results: Analysis showed that production problems and insufficient demand led to the termination of ceramic filter production and that both trouble-free product ion and high demand are necessary for a sustainable business.' (897 chars)
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authors => protected'Meierhofer, R.; Flückiger, C.; Gebauer, H.' (58 chars)
title => protected'Evaluating of distribution models for household water treatment products in Kenya' (81 chars)
journal => protected'In: WEDC conference 37' (22 chars)
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startpage => protected'1851 (6 pp.)' (12 chars)
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description => protected'Marketing trials for ceramic filters and other HWTS products were carried ou t in Kenya over 16 months. Community education trainings and sales models we re set up at four different sites with local entrepreneurs, Community Health Workers of the Public Health system, Community-based Organizations and staf f of NGOs. Selling filters through the water utility, a community-based ente rprise, was the most successful retail model, followed by sales done by Comm unity Health Workers. Evidence showed that community-based organizations nee d to be equipped with adequate management and marketing skills to successful ly sell products.<br/> Community education through household visits (indepen dent of the stakeholder carrying out the activity) was an effective marketin g strategy. Emotional attributes, social norms, if people think it is import ant to treat the water and education level had the highest influence on the frequency of household water treatment in households.' (965 chars)
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Do sales models influence the purchase and use of ceramic filters in rural areas of Kenya and Bolivia?
Demand for safe water, as well as access to adequate and affordable products for drinking water treatment, is key for household water treatment (HWT) in low-income countries. Critical barriers, particularly in rural areas, are the lack of adequate marketing and sales models and the challenge of setting up distribution channels that reach low-income customers, leading to the unavailability of HWT products. Trials with four different social marketing and sales models, involving local Q1 entrepreneurs, staff of an NGO, community health workers and members of community-based organizations, were conducted in Kenya and Bolivia to test which marketing and sales strategies, as well as which behavioural determinants, influence product purchase and water treatment practices in different local contexts. Selling filters through the water utility, a community-based enterprise, was a promising retail model in Kenya and in Bolivia. Most successful were sales done by a women’s group in Bolivia. We found that community education activities, independent of the stakeholder carrying out the activity, are an important element to create demand for water treatment products. Other factors influencing product purchase and practice are very context specific and include: the turbidity of water, risk perception, socio-economic status, social norms and emotional attributes.
Meierhofer, R.; Flückiger, A. C.; Gebauer, H. (2016) Do sales models influence the purchase and use of ceramic filters in rural areas of Kenya and Bolivia?, Journal of Water Supply: Research and Technology. Aqua, 65(1), 87-102, doi:10.2166/aqua.2015.069, Institutional Repository
The challenge of producing and marketing colloidal silver water filters in Nepal
Background: Obtaining safe drinking water can be a challenge in Nepal. By training potters and setting up production sites for Colloidal Silver Filters, several non-governmental organizations have tried to provide local people with a low-cost option for household water treatment. Out of 19 trained entrepreneurs, only four are currently producing filters. The goal of this evaluation was to find out what conditions lead to the successful continuation of the production and the reasons for failure. Methods: The evaluation of the potters was based on a Qualitative Comparative Analysis and the conditions looked at were: "Production", "Collaboration", "Market" and "Potter". Results: Analysis showed that production problems and insufficient demand led to the termination of ceramic filter production and that both trouble-free production and high demand are necessary for a sustainable business.
Bogler, A.; Meierhofer, R. (2015) The challenge of producing and marketing colloidal silver water filters in Nepal, Water, 7(7), 3599-3612, doi:10.3390/w7073599, Institutional Repository
Evaluating of distribution models for household water treatment products in Kenya
Marketing trials for ceramic filters and other HWTS products were carried out in Kenya over 16 months. Community education trainings and sales models were set up at four different sites with local entrepreneurs, Community Health Workers of the Public Health system, Community-based Organizations and staff of NGOs. Selling filters through the water utility, a community-based enterprise, was the most successful retail model, followed by sales done by Community Health Workers. Evidence showed that community-based organizations need to be equipped with adequate management and marketing skills to successfully sell products. Community education through household visits (independent of the stakeholder carrying out the activity) was an effective marketing strategy. Emotional attributes, social norms, if people think it is important to treat the water and education level had the highest influence on the frequency of household water treatment in households.
Meierhofer, R.; Flückiger, C.; Gebauer, H. (2014) Evaluating of distribution models for household water treatment products in Kenya, In: WEDC conference 37, 1851 (6 pp.), Institutional Repository
Comment on "Point of Use Household Drinking Water Filtration: A Practical, Effective Solution for Providing Sustained Access to Safe Drinking Water in the Developing World. Environ. Sci. Technol. 43 (3), pp. 968-969. Lantagne D., Meierhofer R., Allgood R., McGuigan K.G., Quick R. (2009).
