Trial of liquid chlorine dispenser modelsin urban Bangladeshi households

Shaila ArmanResearch Investigator

Water and Sanitation Research GroupCenter for Communicable Diseases

icddr,b

1Water and Health Conference at UNC, Chapel Hill30 October, 2012

Urban Bangladesh: Municipal water most

common source of drinking water

Around 60% sample found contaminated with microorganism

Drinking contaminated water leads to morbidity and mortality among <5 children

2

Background

Point of use water treatment technology:

Households that treat their water less frequently report diarrhea (Clasen et al., 2007)

Chlorine is a low cost home-based water treatment technology that can reduce diarrhea (Arnold and Colford, 2007)

Interventions with liquid chlorine were successful in some settings (Blanton et al. 2006; Parker et al., 2006; Quick et al., 2002; Ram et al., 2007; Stockman et al., 2007; Thevos et al., 2000)

3

4

Objectives

To identify the best chlorine dispenser package (with or without study provided storage vessel) for use in a randomized controlled trial

To provide information for developing culturally compelling intervention, based on feedback from trial participants

5

Study period

October-December 2010

6

Study site Low-income community, Dhaka

No previous water intervention

Study population

40 low-income household compounds

Total 359 households Eligibility

criteria Shared water source

Description of the trialStudy team Implementation team

Assessment team

7Households compound in urban Dhaka

8

Households compound in urban Dhaka

Hardware: 4 types of chlorine dispenser model with the supply of liquid chlorine at no cost

Reason behind testing the different models:

- different amounts of water needed per compound and households

- different types and sizes of water storage vessels used in households

- no common drinking water storage used in the compounds

9

Trial models for liquid chlorine dispenser

Model 1 : Reservoir(one turn of the valve from dispenser to treat 15 liters)

Model 2: Measuring vessel (one turn of the valve to treat 5 liters)

Model 3 : Without measuring vessel (one turn of the valve to treat 5 liters)

Model 4: Without measuring vessel(one turn of the valve to treat 2.5 liters)

Chlorine dispenser models Total households

No of compounds

1. Reservoir (15 liter dosing) 86 10

13

2. Measuring vessel (5 liter dosing)

94 10

3. Without measuring vessel (5 liter dosing)

87 10

4. Without measuring vessel (2.5 liter dosing)

92 10

Total 359 40

Distribution of compounds and hardware

Implementation team

Enroll sample households

Install hardware and demonstrate use

Household visits twice a month:o Deliver messages on health and non-health

benefitso Encourage and address barriers related to

hardware use

14

Assessment team

15

Collect data on 15th, 45th and 60th days

Assess use by checking residual free chlorine in stored drinking water

Qualitative interviews and household observations

16

Self reported use between 15th day and 60th day

Comparison between self-reported use and presence of residual chlorine (0.2-2mg/l)

17

After 15 days of use After 60 days of use

Self- reported use

Chlorine found

Self-reported use

Chlorine found

122/359 54/122 84/244 27/84

18

Perceived benefits of use

Benefits common to all models:

Improved clarity of drinking water

Save time and fuel cost compared to boiling

Keeps children safe from diseases

19

Specific benefits of different models: Reservoiro Measuring and storing treated water was easy

oLess work for compound members as caretakers

treated water for common use

With measuring vessel oMeasuring water was easy

Without measuring vesseloNo unique benefit

20

Perceived barriers to use

Barriers common to all models:Smelt like bleaching powderTemperature of stored treated water 30-minute wait timeBoilers were not interested

Reluctance of males and children to drink chlorinated water

21

Reservoiro Refilling of reservoirs and maintenance

oUnavailability of reservoirs for use

With measuring vessel oUnavailability of measuring vessel at certain times

Without measuring vessel oMeasuring recommended amount water was difficult

Specific barriers to use of different models:

Feedback on strategy and messages

22

Weekly visits of promoters were appreciated

o helped to resolve problems related to hardware use and encourage use

Communication material was encouraging o information on contamination of supply water and

possibility of getting diarrhea were encouraging

Household observation

23

Did not maintain correct amount of water for dosing in arm without measuring vessel

Did not cover or shake vessel after adding chlorine

Measuring vessels not always kept with dispenser to measure recommended amount of water

24

Hardware was not used; kept under a bedstead

Chlorine dispenser with water reservoir model had most self reported use rate

Water chlorination was less feasible in absence of standardized water storage vessel

Strong smell of chlorine and stored water temperature was threat to acceptability of water chlorination

Unavailability of reservoirs with stored treated water and measuring vessel led to decreased use

Conclusions

25

Recommendations for RCT Marked participants own vessel to measure correct amount of

water for dosingo to minimize conflicts between the compound residents regarding the

ownership of the vessel and also reduce responsibility to maintain the common hardware for use

Select caretakers of the hardware and motivate the tenants to drink chlorinated water by them also

Use reported benefits to promote sustainable water treatment behavior change interventions among both boilers and non boilers

26

27

Acknowledgements