Volume 95, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Use of drinking water sold in plastic bags (sachet water) is growing rapidly in west Africa. The impact on water consumption and child health remains unclear, and a debate on the taxation and regulation of sachet water is ongoing. This study assessed the feasibility of providing subsidized sachet water to low-income urban households in Accra and measured the resultant changes in water consumption. A total of 86 children, 6–36 months of age in neighborhoods lacking indoor piped water, were randomized to three study arms. The control group received education about diarrhea. The second arm received vouchers for 15 L/week/child of free water sachets (value: $0.63/week) plus education. The third arm received vouchers for the same water sachet volume at half price plus education. Water consumption was measured at baseline and followed for 4 months thereafter. At baseline, 66 of 81 children (82%) drank only sachet water. When given one voucher/child/week, households redeemed an average 0.94 vouchers/week/child in the free-sachet-voucher arm and 0.82 vouchers/week/child in the half-price arm. No change in water consumption was observed in the half-price arm, although the study was not powered to detect such differences. In the free-sachet-voucher arm, estimated sachet water consumption increased by 0.27 L/child/day ( = 0.03). The increase in sachet water consumption by children in the free-sachet-voucher arm shows that provision of fully subsidized water sachets might improve the quality of drinking water consumed by children. Further research is needed to quantify this and any related child health impacts.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Stoler J, Weeks JR, Fink G, , 2012. Sachet drinking water in Ghana's Accra-Tema metropolitan area: past, present, and future. J Water Sanit Hyg Dev 2: 223240.[Crossref]
  2. Fisher MB, Williams AR, Jalloh MF, Saquee G, Bain RES, Bartram JK, , 2015. Microbiological and chemical quality of packaged sachet water and household stored drinking water in Freetown, Sierra Leone. PLoS One 10: e0131772.[Crossref]
  3. Stoler J, Fink G, Weeks JR, Otoo RA, Ampofo JA, Hill AG, , 2012. When urban taps run dry: sachet water consumption and health effects in low income neighborhoods of Accra, Ghana. Health Place 18: 250262.[Crossref]
  4. Stoler J, Weeks JR, Otoo RA, , 2013. Drinking water in transition: a multilevel cross-sectional analysis of sachet water consumption in Accra. PLoS One 8: e67257.[Crossref]
  5. Satterthwaite M, , 2012. JMP Working Group on Equity and Non-Discrimination Final Report. Geneva, Switzerland: WHO/UNICEF Joint Monitoring Programme, 32.
  6. Stoler J, Tutu RA, Ahmed H, Frimpong LA, Bello M, , 2014. Sachet water quality and brand reputation in two low-income urban communities in Greater Accra, Ghana. Am J Trop Med Hyg 90: 272278.[Crossref]
  7. Ghana Standards Authority, 2009. Water Quality—Specification for Drinking-Water. Accra, Ghana: Ghana Standards Authority.
  8. Johnston R, Amoako-Mensah S, , 2014. Water Quality Module of the Ghana Living Standards Survey VI: Monitoring Household Drinking Water Quality through a Household Survey. Water and Health—Where Science Meets Policy. Chapel Hill, NC: University of North Carolina.
  9. Dada AC, , 2011. Packaged water: optimizing local processes for sustainable water delivery in developing nations. Global Health 7: 24.[Crossref]
  10. Wright J, Gundry S, Conroy R, , 2004. Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use. Trop Med Int Health 9: 106117.[Crossref]
  11. WHO International Programme on Chemical Safety, 1994. Assessing Human Health Risks of Chemicals: Derivation of Guidance Values for Health-Based Exposure Limits. Geneva, Switzerland: World Health Organization.
  12. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, 2005. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press.
  13. Ministry of Health, 2010. Standard Treatment Guidelines. Accra, Ghana: Ghana National Drugs Programme, Ministry of Health.
  14. Boisson S, Stevenson M, Shapiro L, Kumar V, Singh LP, Ward D, Clasen T, , 2013. Effect of household-based drinking water chlorination on diarrhoea among children under five in Orissa, India: a double-blind randomised placebo-controlled trial. PLoS Med 10: e1001497.[Crossref]
  15. R Core Team, 2013. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.
  16. StataCorp, 2013. Stata Statistical Software. College Station, TX: StataCorp LP.
  17. Brown J, Clasen T, , 2012. High adherence is necessary to realize health gains from water quality interventions. PLoS One 7: e36735.[Crossref]
  18. Hunter PR, Zmirou-Navier D, Hartemann P, , 2009. Estimating the impact on health of poor reliability of drinking water interventions in developing countries. Sci Total Environ 407: 26212624.[Crossref]
  19. Enger KS, Nelson KL, Clasen T, Rose JB, Eisenberg JNS, , 2012. Linking quantitative microbial risk assessment and epidemiological data: informing safe drinking water trials in developing countries. Environ Sci Technol 46: 51605167.[Crossref]
  20. Babatunde M, Biala M, , 2010. Externality effects of sachet water consumption and the choice of policy instruments in Nigeria: evidence from Kwara State. J Econ 1: 113131.
  21. Boisson S, Kiyombo M, Sthreshley L, Tumba S, Makambo J, Clasen T, , 2010. Field assessment of a novel household-based water filtration device: a randomised, placebo-controlled trial in the Democratic Republic of Congo. PLoS One 5: e12613.[Crossref]
  22. Hunter PR, , 2009. Household water treatment in developing countries: comparing different intervention types using meta-regression. Environ Sci Technol 43: 89918997.[Crossref]
  23. Freeman MC, Trinies V, Boisson S, Mak G, Clasen T, , 2012. Promoting household water treatment through women's self help groups in Rural India: assessing impact on drinking water quality and equity. PLoS One 7: e44068.[Crossref]
  24. Brown J, Sobsey MD, , 2012. Boiling as household water treatment in Cambodia: a longitudinal study of boiling practice and microbiological effectiveness. Am J Trop Med Hyg 87: 394398.[Crossref]
  25. Bain R, Cronk R, Wright J, Yang H, Slaymaker T, Bartram J, , 2014. Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 11: e1001644.[Crossref]

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  • Received : 25 Nov 2015
  • Accepted : 20 Mar 2016

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