Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112564

Daniel P. Abbott, MPH¹, Matthew C. Freeman², Richard Rheingans, MA, PhD², and Robert Quick, MD, MPH³. (1) Mickey Leland International Hunger Fellow, Congressional Hunger Center, 229.5 Pennslyvania Avenue, SE, Washington, DC 20003, 202-547-7022, dabbott@hungercenter.org, (2) Center for Global Safe Water, Global Environmental Health, Emory University, Grace Crum Rollins Building, 1518 Clifton Rd, Atlanta, GA 30322, (3) Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention, 1600 North Clifton Road, MS-38, Atlanta, GA 30333

Background: The Safe Water System (SWS) is a simple, effective, and inexpensive water quality intervention involving treatment with 1% sodium-hypochlorite solution, safe water storage, and behavior change techniques. Field trials on 3 continents have shown that use of the SWS decreases diarrheal rates >40%. In Western Kenya, CARE has implemented the SWS in communities since 2000 and now partners with PSI and community based organizations (CBO) to make the intervention available via three implementation strategies: 1. (CARE /PSI) Commercial distribution and social marketing with support from CARE training and community structures 2. (PSI) Commercial distribution and social marketing 3. (CARE/CBO) CBOs trained to implement in communities This study compares the implementation approaches and assesses their impacts on adoption.

Methods: We conducted a cross-sectional survey in a random sample of 529 households in 5 communities in Nyanza Province, Kenya to evaluate adoption of WaterGuard, the local SWS brand. Stored water was tested for residual chlorine to assess use of WaterGuard. Key-informant interviews with project staff members were conducted to characterize implementation approaches. Bivariate and multivariate analyses were carried out to assess the association between implementation characteristics and knowledge and adoption of the SWS. Results were compared to a 2003 evaluation to assess effectiveness of the strategies over time.

Results: Analysis (N=529 HH) revealed fairly high rates of adoption, with detectable stored-water residual chlorine levels between 7% and 21%. The community served by the CBO maintained a high SWS adoption rate of 17% (18% in 2003), as measured by the presence of residual chlorine in stored water. Radio advertisements in the local language were the source of product knowledge for 49% of population. Commercial distribution was effective in urban areas (16% and 28% had ever used WaterGuard) but was less successful in rural areas (1% and 6% had ever used WaterGuard).

Conclusions: Comparison of implementation approaches provides evidence for successful strategies. Radio advertisements and CBO partnerships are successful methods of creating awareness. Commercial distribution is promising, but faces challenges in rural areas where shops are often unable to stock WaterGuard. Distribution and promotion through existing CBOs is a reliable and promising strategy to increase adoption and sustainability of household based interventions.

Learning Objectives:

• Describe implementation methods used for SWS
• Identify aspects of successful implementation methods
• Discuss methods of reducing barriers and increasing adoption of the intervention

Keywords: Water, International Health

Related Web page: www.sph.emory.edu/CGSW/

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation