RESUMO
Low-cost household technologies for water treatment are crucial to improving drinking water quality and preventing health, social and economic impacts, mostly in middle- and low-income regions. This work assessed the removal efficiency of physical-chemical and bacteriological parameters from river water by a multi-barrier household water treatment system for 113 consecutive days. This system combines a pre-treatment step through a non-woven synthetic blanket, filtration by an intermittent household slow sand filter (HSSF) and a Mesita Azul® ultraviolet disinfection device. In general, the water quality was improved by the evaluated system. Turbidity was removed by an average of 73% (ranging from 33 to 94%), total coliforms (TC) of 3.88 log10 (ranging from 2.22 to 5.16 log10) and E. coli of 2.49 log10 (ranging from 1.81 to 3.30 log10). Filtration improvement was mostly correlated to HSSF biofilm development and influent water quality. Characterisation of HSSF schmutzdecke demonstrated a predominance of organic content, and a higher presence of carbohydrates than proteins on the sand and the blanket. Ultraviolet disinfection with Mesita Azul® inactivated most of the remaining bacteria after filtration and no regrowth was observed after 15 days of disinfection. In conclusion, the multi-barrier household water treatment system was efficient in treating river water, reducing risks of microbial contamination to achieve safe drinking water.
Assuntos
Água Potável , Purificação da Água , Desinfecção , Escherichia coli , Filtração , Dióxido de SilícioRESUMO
Low adoption and compliance levels for household water treatment and safe storage (HWTS) technologies have made it challenging for these systems to achieve measurable health benefits in the developing world. User compliance remains an inconsistently defined and poorly understood feature of HWTS programs. In this article, we develop a comprehensive approach to understanding HWTS compliance. First, our Safe Drinking Water Compliance Framework disaggregates and measures the components of compliance from initial adoption of the HWTS to exclusive consumption of treated water. We apply this framework to an ultraviolet (UV)-based safe water system in a cluster-randomized controlled trial in rural Mexico. Second, we evaluate a no-frills (or "Basic") variant of the program as well as an improved (or "Enhanced") variant, to test if subtle changes in the user interface of HWTS programs could improve compliance. Finally, we perform a full-cost analysis of both variants to assess their cost effectiveness (CE) in achieving compliance. We define "compliance" strictly as the habit of consuming safe water. We find that compliance was significantly higher in the groups where the UV program variants were rolled out than in the control groups. The Enhanced variant performed better immediately postintervention than the Basic, but compliance (and thus CE) degraded with time such that no effective difference remained between the two versions of the program.
Assuntos
Desinfecção/métodos , Água Potável/análise , Conhecimentos, Atitudes e Prática em Saúde , Purificação da Água/métodos , Análise Custo-Benefício , Desinfecção/economia , Desinfecção/instrumentação , Características da Família , Humanos , México , População Rural , Raios Ultravioleta , Microbiologia da Água , Purificação da Água/economia , Purificação da Água/instrumentação , Abastecimento de Água/economia , Abastecimento de Água/métodosRESUMO
Inconsistent use of household water treatment and safe storage (HWTS) systems reduces their potential health benefits. Ultraviolet (UV) disinfection is more convenient than some existing HWTS systems, but it does not provide post-treatment residual disinfectant, which could leave drinking water vulnerable to recontamination. In this paper, using as-treated analyses, we report on the field efficacy of a UV disinfection system at improving household drinking water quality in rural Mexico. We further assess the risk of post-treatment contamination from the UV system, and develop a process-based model to better understand household risk factors for recontamination. This study was part of a larger cluster-randomized stepped wedge trial, and the results complement previously published population-level results of the intervention on diarrheal prevalence and water quality. Based on the presence of Escherichia coli (proportion of households with ≥ 1 E. coli/100 mL), we estimated a risk difference of -28.0% (95% confidence interval (CI): -33.9%, -22.1%) when comparing intervention to control households; -38.6% (CI: -48.9%, -28.2%) when comparing post- and pre-intervention results; and -37.1% (CI: -45.2%, -28.9%) when comparing UV disinfected water to alternatives within the household. We found substantial increases in post-treatment E. coli contamination when comparing samples from the UV system effluent (5.0%) to samples taken from the storage container (21.1%) and drinking glasses (26.0%). We found that improved household infrastructure, additional extractions from the storage container, additional time from when the storage container was filled, and increased experience of the UV system operator were associated with reductions in post-treatment contamination. Our results suggest that the UV system is efficacious at improving household water quality when used as intended. Promoting safe storage habits is essential for an effective UV system dissemination. The drinking glass appears to represent a small but significant source of recontamination that is likely to impact all HWTS systems.
Assuntos
Desinfecção/instrumentação , Água Potável/microbiologia , Escherichia coli/isolamento & purificação , Raios Ultravioleta , Purificação da Água/instrumentação , Purificação da Água/métodos , Desinfecção/métodos , Características da Família , Humanos , México , Medição de Risco , População Rural , Microbiologia da ÁguaRESUMO
In collaboration with a local non-profit organization, this study evaluated the expansion of a program that promoted and installed Mesita Azul, an ultraviolet-disinfection system designed to treat household drinking water in rural Mexico. We conducted a 15-month, cluster-randomized stepped wedge trial by randomizing the order in which 24 communities (444 households) received the intervention. We measured primary outcomes (water contamination and diarrhea) during seven household visits. The intervention increased the percentage of households with access to treated and safely stored drinking water (23-62%), and reduced the percentage of households with Escherichia coli contaminated drinking water (risk difference (RD): -19% [95% CI: -27%, -14%]). No significant reduction in diarrhea was observed (RD: -0.1% [95% CI: -1.1%, 0.9%]). We conclude that household water quality improvements measured in this study justify future promotion of the Mesita Azul, and that future studies to measure its health impact would be valuable if conducted in populations with higher diarrhea prevalence.