Trial of liquid chlorine dispenser models
in 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
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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)
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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
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Study period
October-December
2010
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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
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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
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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
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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 benefits
o Encourage and address barriers related to hardware use
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Assessment team
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Collect data on 15th, 45th and 60th days
Assess use by checking residual free chlorine in stored drinking water
Qualitative interviews and household observations
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Self reported use between 15th day and 60th day
Comparison between self-reported use and presence of residual chlorine (0.2-2mg/l)
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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
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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
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Specific benefits of different models:
Reservoir
o 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 vessel
oNo unique benefit
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Perceived barriers to use
Barriers common to all models:
Smelt like bleaching powder
Temperature of stored treated water
30-minute wait time
Boilers were not interested
Reluctance of males and children to drink chlorinated water
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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
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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
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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
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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
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Recommendations for RCT
Marked participants own vessel to measure correct amount of water for dosing
o 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
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Acknowledgements