Making the Case for Household Hygiene and Safe Water: Where's the Evidence?

Over 1 billion people lack access to improved water sources. Countless hundreds of millions more drink water from “improved”, but unsafe water sources. Water from improved and safe sources can also become contaminated when it is collected, transported to, or stored in homes. Water treatment at the household level is a final barrier that can improve drinking water quality and reduce waterborne disease risks. Handwashing with soap also reduces the risk of diarrheal, respiratory, and skin diseases. Recent field evaluations and meta-analyses of these two simple, low-cost interventions have yielded more precise and more powerful estimates of their effects. Different methods for point-of-use water treatment, including chlorination, filtration, flocculation/chlorination, and solar disinfection will be described and the evidence base for each will be reviewed. Published studies and work in progress on point-of-use water treatment and on handwashing from Africa, Asia, and Latin America will be presented, along with summaries of recent meta-analyses (Arnold and Colford, 2007; Clasen et al., 2006; Curtis and Cairncross, 2003). The weight of evidence clearly demonstrates significant health benefits from the use of these two interventions. Promotion of the key behavior change elements and of the hardware for each intervention, through the private sector, social marketing programs, schools, and clinics, and the current challenges of “going to scale” will be discussed. It will be argued that these interventions are critical components of global efforts to attain the Millennium Development Goals. A case will be made for including point-of-use water treatment and handwashing promotion as essential elements in child survival programs worldwide.