Hygiene Promotion for Household Water Treatment and Safe Storage in Emergencies

7/27/2019 Hygiene Promotion for Household Water Treatment and Safe Storage in Emergencies

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Hygiene promotion for HWTS December 2012

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Introduction

It is now well accepted that despite sourcewater being safe, water can be contaminatedduring transportation and storage and thehygienic handling of water during transport,storage and use is an important aspect ofhygiene promotion in all WASH interventions.

In an emergency, it may not always bepossible to ensure that the source water isclean (within the existing budget or time

constraints) and household treatment ofwater is an important response option. Aswith the introduction of any hardware, this willonly succeed if the users are considered inthe selection, operation and maintenance ofthe treatment option and intensive hygienepromotion will be required to encouragecorrect and consistent use.

The promotional aspects of the followingwater treatment methods that are mostcommonly used in emergencies will be

considered:

1. Boiling2. Chlorination (including tablets or

liquid)3. Flocculation/disinfection sachets

(including PuR and WaterMaker)4. Natural filtration and flocculation

methods (sedimentation, clothfiltration, moringa seeds, alum)

5. Ceramic filtration (including pot- andcandle-style filters)

6. Membrane filtration

An existing technical brief (TB4) providesinformation on the technical household watertreatment and safe storage (HWTS) optionsbut has limited detail on the promotionalaspects that are required. This short briefingpaper is aimed at hygiene promoters andengineers who are working with communitieson HWTS. It may also be useful formanagers to understand how to ensure the

effectiveness of HWTS interventions. Itshould be read in conjunction with TB4.

Safe water collection and storage

Household water treatment will not always berequired if it is possible to provide analternative safe water supply forconsumption, but promotion will always needto consider how water will be transported,stored and used in the household. Even ifhousehold drinking water is treated, it maystill become recontaminated through storagein dirty or uncovered containers or throughcontact with dirty hands and utensils.

Chlorination can help to reducerecontamination if residual chlorine levels arekept at a reasonable level and it is importantto try to understand how long people storedrinking water in the household whenproviding chlorine. All other household watertreatment methods (HHWT) riskrecontamination.

Handwashing

Improved handwashing can help to ensurethat water does not become contaminatedand must form an important aspect of anyhygiene intervention. Currentrecommendations suggest that it is better tosimplify the promotion as much as possibleby focusing on only two key times forhandwashing (before eating and afterdefaecation) and promoting a simplemessage such as wet, lather, rub and rinserather than including too many steps in the

handwashing process1

. An Oxfam briefingpaper is available on handwashing.

1Seehttp://tinyurl.com/7xdl6ltfor more information

Hygiene Promotion for HWTS in emergencies

Figure 1: Contamination of water in household
http://tinyurl.com/7xdl6lthttp://tinyurl.com/7xdl6lthttp://tinyurl.com/7xdl6lthttp://tinyurl.com/7xdl6lt


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Collection and storage containers

Sphere recommends that each householdhas at least two clean water collectingcontainers of 10-20 litres, plus enough cleanwater storage containers to ensure there is

always water in the

household. Thecontainers shouldeither have a lid orbe narrow necked tolimit environmentalcontamination.

If containers are notclean thenconsideration couldbe given todistribution or toregular mass

cleaning of the containers. This is usuallycarried out at water collection points butcould also be done in neighbourhood groups.The steps for cleaning are2:

1. Drain the container2. Scrub the inside of the container using an

abrasive (soft bristles or small stones)and a cleaning agent (solution ofchlorinated water or soap and water).

3. Clean the exterior of the container with acloth and soap or chlorine solution,paying particular attention to the areaaround the neck and lip of the container

4. Rinse container with clean drinking waterto remove cleaning agent residue

In addition to regular cleanings, in camps ordensely populated settings, Oxfamrecommends periodic super chlorination of allreceptacles, an example of which ispresented in the box opposite.

In some cultures large water containers (20litres or more) are rolled along the ground.This poses no risk of contamination if the lipof the container does not touch the groundand avoids the backbreaking work of haulingwater back to the household.

Using / drawing water in the household

It is important to avoid contaminating drinkingwater with hands when using a cup or scoop.Ideally water should be drawn from a tap or

spigot that is kept off the ground. If this is not

2Taken from Technical Briefing Paper Number 4

available then water should be poured fromthe storage container or a separate,

dedicated scoop or cup should be used.Again this must be kept off the ground.

Promotional methods for HWTS

Whilst the mass media (e.g. television, radioand leaflets) can be used to promote aspecific household water treatment method, itis important that interpersonal methods suchas training and demonstrations are alsoused, especially in emergency settings wherethe risks to health are high and people needto be enabled to act quickly.If a specific household water treatment is tobe introduced, try it out yourself beforedesigning the promotional materials. Then ifpossible test your materials on a smallnumber of participants to obtain feedbackand adapt them before large-scalepromotion.

Case study 1: Chlorine disinfectioncampaign in Darfur

In June 2004, an outbreak of shigellosis wasconfirmed in Abou Shouk camp in theNorthern Darfur province of Sudan. As watertesting at the source showed no

contamination, it was assumed that post-collection contamination was happening. Thedecision was taken to launch a programme ofmass disinfection of all water containers inorder to break the contamination cycle.

Five percent chlorine solution was used toclean containers. Approximately 100150millilitres were added to every container,along with some small stones. The containerwas shaken vigorously if it was closed orscrubbed with a local straw broom if open.

Diarrhoea figures from the clinics showed afall in cases following the disinfectioncampaign. Although it is difficult to collectstatistically rigorous data, it does appear thatthe campaign had an impact on theprevalence of watery and bloody diarrhoea.Source Walden 2005

Successful uptake of HWTS is less l ikely

i f there are any mo re than 2 steps in th e

instruct ions. Think twice before

int roducing more complex treatmentmethods.

Figure 2: Oxfam bucket with

spigot


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Key messages and information for eachtreatment method are provided in therespective section.

Interperson al Method s

Interpersonal methods allow participants to

ask questions and clarify misconceptionsand, where populations can be accessedsafely, these methods should always beincluded in the response. However,interpersonal methods are resource and timeintensive and scaling up will require theidentification, training and support ofoutreach networks.

Demonstrat ions

Demonstrations can be carried out atdistribution or water points or in small localgatherings. Volunteers can be trained tocarry out the demonstrations within theircommunities. It is a useful strategy to be

prepared to sample the clean water producedin front of the audience so that they areconvinced of its safety especially whenusing packaged products such as PuR orWaterMaker.

Training

Training will need to be kept short and shouldfocus on the practical skills required for watertreatment, making use of bothdemonstrations and the opportunity topractice the skills learned. Volunteernetworks and community leaders can betrained to train others in the use of the watertreatment method. Training of trainers shouldinclude an action plan detailing what willhappen after the training and how manypeople will be reached by future training.Follow up for ToT participants will need to bescheduled so that they can discuss anyproblems they face in training others.

Discussion groups

HWTS can be included in discussions with avariety of groups but should identify andprioritise those responsible for carrying out

the water treatment or care of drinking water.This will usually be women or young girls.Discussion groups can includedemonstrations but should also aim toexplore any barriers to use.A new approach to selecting HWTS methods

known as SDM (structured decision making)

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could also be used in a simplified form. Thisapproach encourages participants to identifythe key criteria for using a specific watertreatment method (or other practice) such asease of use, cost (time), taste, colour, safetyetc. and to compare different water treatmentmethods such as boiling water or usingPuR using these criteria. Symbols can beused for the different criteria selected and avoting system using stones or seeds could beused to score each method. The benefit of

using such a method is that it can generatediscussion and analysis and help to identifythe specific concerns of users. Inemergencies, it could be adapted and usedwhen monitoring the intervention. Othervisual aids using pictures or symbols couldalso be used to generate discussion.

Home visi ts

Networks of volunteers or mobilisers can visithouseholds to provide information on

treatment methods. There may already beoutreach workers attached to the localhospital or health centres and theinvolvement of local health staff to identifyand support such outreach workers will becritical. Follow up home visits are crucial inensuring that the water treatment method isbeing used effectively.

3See http://onlinelibrary.wiley.com/doi/10.1111/j.1539-

6924.2011.01675.x/full

Figure 3: Criteria used to rank different HWTS methods

Fol low up home vis i ts by comm uni ty

mobi l isers are a vital part of prom oting

the optimal use of household watertreatment method s.


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Motivational interviewing techniques can beused to encourage uptake in householdswhere resistance is high. This entails usingspecific person centred counsellingtechniques. Open-ended questions,affirmations and summarising techniques are

used to encourage the person to considertheir own internal motives for change and thefacilitatornudges them towards engaging inchange talk and action4.

Mass media

Mass media can reach large numbers ofpeople quickly and can therefore be veryuseful in an emergency. However the use ofthe mass media will need to be combinedwith more interactive methods to be effective.Where possible interaction that gives people

a chance to ask questions should beencouraged.

Television and radio

Whilst television and radio can reach largenumbers of people, it must be rememberedthat the specific target audience may nothave access to such media. For example thehousehold may own a radio but only the malehead of household listens to it or the radioslot may be broadcast at a time when the

participant groups are busy doing otherthings. Ensure that any broadcasts areorganised in co-ordination with thegovernment and other agencies working inthe area. The government may be entitled tofree airtime from the broadcasting company.

Leaflets

It is important to consider the literacy level ofthe target audience and the language(s) usedin the leaflet. Existing leaflets may be

available from previous social marketingcampaigns on HWTS. The provision of aleaflet is not a substitute for demonstrationsof use.

Rememb er to:

1. Consult and collaborate with WASHexperts and government bodies.

2. Ensure that discussion withcommunities has taken place todetermine acceptability and the mostuser friendly instructions e.g. type of

container to be used, type of chlorine

4Seehttp://mi.fhi.net/for more information

(e.g. household bleach, pre-packagedsolutions etc.), potential problems withacceptability

3. Provide clear steps and illustrationswhere possible (see example leaflets)

4. Carry out a rapid pretesting of theleaflet

5. Monitor subsequent household use

It is also useful to translate back into theoriginal language (using a second translator)in order to identify misunderstandings.

Poster s and leaflets

Posters can be useful reminders of how to dosomething or when to do it. The instructionson how to use a household treatment method

should be distributed with the product inleaflet or poster form, with the suggestionthat these are put on the wall near to wherethe treatment is being carried out. They couldalso be stuck on the sides of water

containers.Preparing posters or instruction leaflets fromscratch can take some time but existing

instructions for some products may alreadyexist and will just need adapting.

Mobile Phones

In recent years more interest has beenshown in using mobile phones for hygienepromotion. Instructions for water treatmentmethods can be sent on the phone andpeople can even have their questionsanswered. This method shows great promiseespecially for remote populations or whereinsecurity prevents access.

Social marketing in an emergency

Other ideas for promotion

o Labels with instructions for treatingwater or maintaining the filter can bestuck on storage containers

o Calendars or small posters withinformation about keeping water cleanto hang near to where water is stored

o Comics or games that focus onkeeping drinking water clean for usewith children or in schools
http://mi.fhi.net/http://mi.fhi.net/http://mi.fhi.net/http://mi.fhi.net/


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Social marketing is an approach that usesmarketing principles to promote somethingthat has a social value such as clean water ormosquito nets. There are numerousexamples of social marketing in relation tohousehold water treatment but it will be

difficult to do the necessary formativeresearch during an acute emergency.However, existing materials could be quicklyadapted and the available customer researchmay shed light on beliefs and values evenfollowing the disruption of an emergency. Theprinciples of social marketing also remainvalid in an emergency and audiencesegmentation and trying to understand themotivations of the different target audiencesare useful techniques that can still beapplied.

Motivational Messages

Recent interest and research on motivationhas shown that the promise of better healthmay not be the main motivating factor formany people and alternative motivationalfactors should be identified where possible.For example social norms (what is expectedin a certain situation or what other people do)can be a powerful motivation for change.Disgust or the need to nurture ones familycan also be strong motivations. This means

that messages should not just stress thehealth benefits but could also appeal to thesealternative motivations. For example amotivational message might be: Dont get leftouteveryone is using the new candle filteror Good mothers know what is best for theirchildren they use XX water treatment.

Distribution of household water NFIs

If distributing sachets (e.g. PuR andWaterMaker), it is usual to distribute one

sachet per day for a family of five persons

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so long as they are encouraged to prioritisethe water for drinking rather than otherhousehold uses. Most projects also distributebuckets, stirring rods and cloths for initialstraining where needed.

Even if only water collection containers are tobe distributed, it is a good idea to use theopportunity to inform people about theiroptimal use. Street theatre, songs, puppetsand other entertainment can be used at

distribution points whilst people are waiting

5Lantagne, D and Clasen T (2009) PoUWT in

emergencies page 43

but make sure that the method used is asinteractive as possible by asking theaudience questions to cross check what theyhave learned. See the Oxfam briefing paperon NFIs for more information.

Communication strategy and plan

As with any hygiene promotion intervention, itis important to identify a strategy forintervention and to draw up a communicationplan that details the objectives, indicators,target audiences, means of communicationand how the intervention will be monitored.

Monitoring and follow up

Regular follow up and monitoring is crucial tothe success of HWTS interventions. Involvingthe community in monitoring can mean that

this aspect of the intervention also helpscommunities, as well as Oxfam, to learn howto do things better.

When distributing products with detailedinstructions such as Aquatabs, PuR andWaterMaker, it is common for theinstructions to be misinterpreted and frequentand dynamic monitoring will be required.

If chlorine products are being distributed,monitoring residual chlorine levels at thehousehold is a useful way to monitoreffectiveness. Community members and/ormobilisers can be taught how to use andinterpret pool testers and they should besupplied with monitoring forms to record theinformation. Monitoring should be undertakenat least weekly. For example, ten randomhouseholds per mobiliser could be identifiedfor water testing. However, ad hoc testingduring home visits can also be a useful wayto help motivate change.

Communities can also be involved indemonstrations when using equipment suchas the delagua kit.

Feedback is required on the following keyareas:

1. The distribution was it fair and welldone? How could it be done betternext time?

2. The product is it being usedcorrectly? How is the taste? Is it easy

to use? What are the barriers to use?3. Communication methods have

people attended a demonstration and


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had the opportunity to ask questions?Do people understand thewritten/broadcast information? Dostaff members communicaterespectfully?

Feedback can be sought through individualobservations and discussions during homevisits or from focus group discussions. Thelatter is especially useful when seekinginformation about barriers to change andwhat improvements are needed in projectdesign.

Household water treatment methods

Boiling

In many places boiling water may not be apractical option as it can be an expensiveand environmentally damaging practice. Inaddition it is time consuming and can takethose responsible (often women) away fromother productive work.However, in areas of the world with a goodfuel supply, boiling can be cost effectivecompared to alternative HWTS options andmay be well accepted by communities.

Oxfam recommends that boiling should only

be promoted in areas where it is widelyaccepted or where other HWTS options arelimited.

Key messages

1. Water should be heated until itreaches a rolling boil (WHO) Someorganizations, such as the CDC,recommend a continuous boil of oneminute, in order to ensure that usersdo not stop heating the water beforethe boiling point is reached.

2. Boiled water should be stored inthe container in which it wasboiled, preferably a closedcontainer with a lid.

3. Care must be taken to avoid scaldsand burns keep children awayfrom fires and boiling water

Chlorination

For domestic use, chlorine remains thesimplest and most effective chemical

disinfectant for treatment of water. It is easilyavailable in a number of forms and iseffective in killing all types of bacterial and

viral water-borne pathogens except helminthsand protozoa such as giardia. In addition, theresidual chlorine usually protects treatedwater from recontamination for at least 24hours6. However, depending on the level ofcontamination or recontamination due to

using dirty, open or poor quality containers,the residual chlorine will eventually get usedup and the water will be at risk of furthercontamination again.

There are 3 forms of chlorine which arewidely used in emergencies:

1. Mother solution (1% sodiumhypochlorite solution made fromcalcium hypochlorite or bleach)

2. Dilute sodium hypochlorite especiallypackaged for water treatment in

bottles (e.g. WaterGuard or SrEau)3. Tablets of sodium

dichloroisocyanurate (e.g.

6Lantagne, D. (April 2006) Harmonization of USGmessages, boiling and chlorination standards workgroup framing document, CDC internal document

Case study 2: Cholera outbreak inNorthern Uganda

Oxfam worked to train community healthvolunteers (CHVs) to add Aquatabs to jerrycans at each hand pump in the camp. Later,due to a shortage of Aquatabs, the CHVs

were trained to safely make mother solutionand administer doses of chlorine solution toeach jerry can. Although the campaign waslargely successful, the challenges included:

Compliance issues with masschlorination, as people objected tothe unfavourable taste;

The common perception that eatingAquatabs would protect people fromcholera

A lack of storage space in the houseout of the reach of children

The difficulty in treating quantities ofless than 20 litres with Aquatabs.

The last challenge was addressed by havingonly the CHVs add the Aquatabs or mothersolution to the water to ensure the correctdose and prevent ingestion. When theprogramme transferred to using mothersolution, CHVs were able to adjust the dose forthe container size.

Source: Technical briefing paper 4


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Aquatabs)Ideally, chlorine on its own should only beused where the water is relatively clear andtransparent and very turbid water (dissolvedand undissolved solids in the water that makeit look cloudy), is not suitable for treatment

(see TB4). A contact time of at least 30minutes is required for the chorine to be fullyeffective. According to WHO, minimum targetconcentrations for chlorine at point of deliveryare 0.2mg/litre in normal circumstances and0.5mg/litre in high-risk situations.Aquatabs are supplied in strips of tentablets of varying strengths according to theamount of water to be treated. Theinstructions usually tell users to add onetablet (2 mg/L) to clear water (or two tablets -4-6mg/L - to turbid water) in a standard-sized

container, and wait 30 minutes beforedrinking.Given the variability of tablet strength it ispreferable to distribute the same strengthtablets in one locality only so that people donot get confused.All chlorination products will require theestablishment of a supply chain to providesufficient supplies for ongoing use.

Key Messages

Care is needed to ensure the right amountof liquid or tablets for the size of thecollection container and to wait the rightamount of time (30 minutes) before drinking.

1. Use the product as directed e.g.Waterguard solution is packaged in a bottlewith directions instructing users to add onefull bottle cap of the solution to clear water (ortwo caps to turbid water) in a standard-sizedstorage container, agitate, and wait 30minutes before drinking.

2. All products must be kept out ofreach of children

3. Products must be diluted beforeconsumption

Bucket chlorination

This is a useful method to use (see casestudy 2) in the acute phase of an emergency.Bucket chlorination can take place at waterpoints or at home and either chlorine tabletsor a mother solution of chlorine can be used.Community mobilisers can be involved in

carrying out the chlorination and in providinginformation and monitoring.

Flocculation and disinfection

A particular challenge for many household-based water treatment technologies is high

turbidity. Solids in the water will use up thefree chlorine (and reduce the protection fromthe chlorine residual) or other chemicaldisinfectants and cause the prematureclogging of filters.

While turbidity can often be managed by pre-treatment or even simple sedimentation(such as the three pot method; see page 8),flocculation/coagulation using commonsubstances such as alum or crushedmoringa seeds can be an effective and

relatively low-cost option, where people arefamiliar with these methods. Such forms ofassisted sedimentation have been shown toreduce the levels of certain microbialpathogens, especially protozoa that mayotherwise present a challenge to chemicaldisinfectants. However, disinfection is stillrequired in most cases for complete microbialprotection (see TB4 for more information).Some manufacturers have combinedflocculation and time-released disinfectioninto a single product that is sold in sachetsfor household use (e.g. PuR andWaterMaker). PuR has been shown toremove the majority of bacteria, viruses andprotozoa and also removes the majority ofheavy metals such as arsenic and somepesticides. PuR is packaged in 4g sachetsand each sachet will treat 10 litres of water.WaterMaker comes in two preparations: 5gto clean 20 litres of water and 2.5g to make10 litres of clean water.

Key Messages1. Use the product as directed: e.g.To treat water with PuR:

o Open the sachet,o Add the contents to an open

bucket containing 10 litres ofwater,

o Stir for 5 minuteso Let the solids settle to the bottom

of the bucketo Strain the water through a cotton

cloth into a second containero Wait 20 minutes for the

hypochlorite to inactivate themicroorganisms


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o Bury the residue in a pit ordispose of it safely in the latrine asit can be harmful to children andwildlife.

2. All products must be kept out of

reach of children

Optional message:

Straining dirty water through a cloth beforetreatment can make the product moreeffective.

Natural filtration methods

In order to effectively chlorinate turbid water,it is useful to either let the water settle or filterit through a cloth. Settling and decanting thewater (often known as the three pot method)

is an effective way to reduce turbidity and toreduce the demand for chlorine but requiresat least 2 containers.

Aluminium sulphate and moringa seeds aretwo naturally occurring flocculants. In manycountries alum can be bought as a block ofwhite stone that is stirred in turbid water. Thiscauses the solids to clump together and then

they will then settle out, allowing the cleanerwater to be decanted. However using too

much alum can affect the taste of the waterand make it unpalatable.

Ceramic Filtration

Locally manufactured ceramic filters havetraditionally been used throughout the world

to treat household water and there arenumerous examples of filters beingdistributed in emergencies. Both pot andcandle filters have been used. However,recent evaluations7 have suggested that theyshould not be distributed in acuteemergencies where people are living inemergency shelters.

Ceramic filters can provide safe water forusers for up to 2 years without the need forreplacement candles but should not be used

if a simpler method is available andacceptable. Consideration should also begiven to the availability of replacementcandles and taps. Significant training andfollow up will be needed if people are notfamiliar with the filters. Turbid water mayneed to be filtered through a clean cloth first.Because of the lack of residual protection, itis important that users be trained to properlycare for and maintain the ceramic filter and

7Palmer (2005)

Figure 5: Cloth filtration in Kenya, source:CDC, R. Quick

Tips for maintenance of candle filters

1. Clean the candles when the flow rate startsto slow down

2. Use a separate cloth to clean the top andbottom containers

3. Take care that you do not scrub the candlestoo vigourously

4. When cleaning put the wing nut and washer(that provides a tight seal for the candle) in asafe place

5. Replace the candles when they becomeworn or break

Figure 4: Instructions for use of PUR

Figure 6: An alum chunk Source: CDC, D.Lantagne


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receptacle.

Candle Filters

The Stefani candle filter is available from theOxfam equipment catalogue as:

1. A complete set with a bucket, 2

candles, a tap, and a pictorial leaflet(Code FHF/1)

2. A set for when a local container isavailable, including three candles anda tap (Code FHFCT/1).

Key Messages

1. To use:o If water very dirty, filter first

through a clean piece of fine clotho Fill the top receptacle or the

ceramic filter itself with watero Wait at least one hour (you should

have approximately one litre ofclean water available to drink)

o Turn the tap on the lowercontainer to access the cleanwater

2. Remember to clean your filter andcandles regularly with separatecloths

Clean the candles by gentlyscrubbing with asoft brush and rinsing with water. You will

also need to clean out the top receptacle.Cleaning is required when the candles clogup and the water flow slows down.

A common problem is that people often cleanthe candle and then clean the bottomcontainer with the same cloth. The outside ofthe candle is likely to be contaminated andthis will then contaminate the clean water inthe bottom container. The candles will also

need to be replaced periodically but shouldlast for at least a year.

Pot filters

Pot filters work in a similar way to candlefilters but the top receptacle itself is ceramicand acts as the filter. It is important that anyfilters used have passed microbiologicaltesting and quality control checks.

Membrane filtration

Oxfam has been trialing a number of newproducts that use membrane filtration invarious emergency situations. These workthrough reverse osmosis where themembrane allows water molecules to passthrough but not larger molecules such as

bacteria and viruses.The advantages of membrane filtration arethat it eliminates viruses as well as bacteria.They are usually quite easy to use as theyemploy a single stage system that produceswater immediately rather than having to wait.However, the membrane filter will needwashing and can get clogged up quite easily.The Lifestraw is one such product but to dateit has not proved a viable option as users donot like it and it spreads contamination on themouthpiece. Work is underway to develop an

effective household level membrane filter.

Figure 7: Cleaning of ceramiccandles source: IFRC

Figure 8: Instructions for use of pot filter


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The briefing paper will be updated as moreinformation becomes available on this watertreatment method.


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HHWT options, key messages and issueses Potential promotional issues Key

y low protection against parasitic cystssinfection effectiveness in turbid watersated with organic and some inorganicdsuser taste and odour objectionsy of ensuring quality control of solutionstanding about the effects of chlorinationcts

over the potential long term carcinogenicchlorine by-products

o Can be in solution or tablet formo Need to stress the importance of contact timeo Important to monitor HH residual chlorine levelso Many people cannot tolerate the taste or smell in high doses need to work with engineers and population to adjust dosageo Some people may be aware of possible long-term carcinogenic effects but in emergencies the benefits of short-term chlorine

use far outweigh the potential side effects. Recent research8

has shown that trihalomethanes (THM) levels in point of usewater treatment methods do not exceed the WHO guideline values.

o Given the variability of tablet strength it is preferable to distribute only same strength tablets in one locality so that people donot get confused

1. UWatergcap of tcontain

2. All3. Dil4. MVigoro

Water

teps are necessary to use the product,uires a demonstration to teach new users for users to have, employ, and maintain

ets, a cloth, and a stirring deviceer relative cost per litre of water treatedd to other household water treatment

sistance to colour/tastes difficult to dispose of in flood-affected

o Needs careful follow up to ensure people are using it correctlyo There may be objections to the taste so will need to be trialled before use even where product is familiar

1. Uoooooooo

2. AllOptio3. Str

ectiveness against virusesesidual protection can lead toination if treated water is stored unsafely

y in quality control of locally produced filtersakage over time, and need for spare partsd receptacles need to be regularlyespecially when using turbid source watersw rate of 1-3 litres per houro be appropriate in first phase emergencydue to need for user education, follow-uply chain establishment

o Users will need help in setting up producto Expensive item that people may feel they would rather sell

1. Too

o

2. R

8Lantagne, D et al (2010) Am. J. Trop. Med. Hyg, 00(0), 2010, pp. 000000 doi:10.4269/ajtmh.2010.09-0431


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o transporteed space in their homes to accommodate

acceptable in terms of the time requiredof fuelesidual protection against recontaminationremove suspended or dissolveddspidemiologically confirmed health impactfor burn injuries and increased risk ofry infections from indoor stoves or firesy high cost of carbon based fuel sourcecurrent deforestation risk) and thety cost of collecting fueluser taste objections (boiled water tastes

use the carbon dioxide has been removed)for incomplete water treatment if users dowater to full boiling temperature

o Only to be used where government promotes this method and people find it acceptableo Aeration (by vigorous shaking) can improve the tasteo The addition of a pinch of salt to each litre of water can also improve the tasteo Could be promoted for most vulnerable such as children under five years and elderly.

1. W2. B

prco

3. Caan

equent backwashingividual designs can transmit infection

o Information not yet available o In


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References

1. Arvai, J. and Post, K (2012) Risk Management in a Developing Country Context: ImprovingDecisions About Point-of-Use Water Treatment Among the Rural Poor in Africa Risk Analysis,Vol. 32, No. 1, 2012

2. IFRC (2008) Household water treatment and safe storage in emergencies; a field manual forRed Cross and Red Crescent personnel and volunteers

3. Lantagne, D. (April 2006) Harmonization of USG boiling and chlorination standards workgroup framing document CDC internal document4. Lantagne, D. Blount, Cardinali, C. and Quick, R. (2007) Disinfection by-product formation and

mitigation strategies in point-of-use chlorination of turbid and non-turbid waters in WesternKenya, Journal of Water and Health 2007 IWA publishing

5. Lantagne, D and Stavely, L. (2008) Oxfam Houshold Water Treatment Technical Brief. OxfamInternational, Oxford, UK.

6. Lantagne, D and Clasen T (2009). Point of Use Water Treatment in Emergency Response.London School of Hygiene and Tropical Medicine. London, UK.

7. Lantagne, D et al (2010) Am. J. Trop. Med. Hyg, 00(0), 2010, pp. 000000 doi:10.4269/ajtmh.2010.09-0431

8. Palmer, J. (2005). Community acceptability of household ceramic water filters distributed

during Oxfam's response to the tsunami in Sri Lanka. London, UK, London School of Hygieneand Tropical Medicine. MSc.

9. Thevos A, Quick R and Yanduli V. Motivational Interviewing enhances the adoption of waterdisinfection practices in Zambia. Health Promotion International 2000; 15(3): 207-214.

Hygiene Promotion for Household Water Treatment and Safe Storage in Emergencies

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