Volume 78, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


In an earlier study in rural Guatemala, 257 households that received flocculant-disinfectant to treat their drinking water had 39% less diarrhea than 257 control households. Three weeks after completion of the study, national marketing of the flocculant-disinfectant was extended into the study communities. Six months later, we assessed frequency of and characteristics associated with purchase and use of the flocculant-disinfectant by revisiting the original study households and administering a questionnaire. Four hundred sixty-two households (90%) completed the follow-up survey; 22 households (5%) purchased the flocculant-disinfectant within the preceding 2 weeks and used it within the last week. Neither being randomized to the intervention group during the efficacy study nor combined spending on laundry soap, toothpaste, and hand soap in the preceding week was associated with active repeat use. Even after efficacy was demonstrated within their community and an aggressive sophisticated marketing approach, few households purchased flocculant-disinfectant for point-of-use water treatment.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization and UNICEF, 2000. Global Water Supply and Sanitation Assessment 2000 Report. Geneva: World Health Organization.
  2. Luksamijarulkul P, Pumsuwan V, Pungchitton S, 1994. Microbiological quality of drinking water and using water of a Chao Phya River community, Bangkok. Southeast Asian J Trop Med Public Health 25 : 633–637.
    [Google Scholar]
  3. Nogueira G, Nakamura CV, Tognim MC, Abreu Filho BA, Dias Filho BP, 2003. Microbiological quality of drinking water of urban and rural communities, Brazil. Rev Saude Publica 37 : 232–236.
    [Google Scholar]
  4. Vollaard AM, Ali S, Smet J, van Asten H, Widjaja S, Visser LG, Surjadi C, van Dissel JT, 2005. A survey of the supply and bacteriologic quality of drinking water and sanitation in Jakarta, Indonesia. Southeast Asian J Trop Med Public Health 36 : 1552–1561.
    [Google Scholar]
  5. Jiwa SF, Mugula JK, Msangi MJ, 1991. Bacteriological quality of potable water sources supplying Morogoro municipality and its outskirts: a case study in Tanzania. Epidemiol Infect 107 : 479–484.
    [Google Scholar]
  6. Ezzati M, Hoorn SV, Rodgers A, Lopez AD, Mathers CD, Murray CJ, 2003. Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet 362 : 271–280.
    [Google Scholar]
  7. World Health Organization, 2005. The World Health Report: 2005: Make Every Mother and Child Count. Geneva: World Health Organization.
  8. Crump JA, Luby SP, Mintz ED, 2004. The global burden of typhoid fever. Bull World Health Organ 82 : 346–353.
    [Google Scholar]
  9. Mintz E, Bartram J, Lochery P, Wegelin M, 2001. Not just a drop in the bucket: expanding access to point-of-use water treatment systems. Am J Public Health 91 : 1565–1570.
    [Google Scholar]
  10. Sobsey MD, 2002. Managing Water in the Home: Accelerated Health Gains From Improved Water Supply. Geneva: World Health Organization.
  11. Clasen T, Schmidt WP, Rabie T, Roberts I, Cairncross S, 2007. Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis. BMJ 334 : 782.
    [Google Scholar]
  12. World Health Organization, 2002. The World Health Report: 2002: Reducing the Risks, Promoting Healthy Life. Geneva: World Health Organization.
  13. Olembo L, Kaona F, Tuba M, Burnham G, 2004. Safe Water Systems: An Evaluation of the Zambia CLORIN Program (Final Report). Washington, DC: US Agency for International Development.
  14. Souter PF, Cruickshank GD, Tankerville MZ, Keswick BH, Ellis BD, Langworthy DE, Metz KA, Appleby MR, Hamilton N, Jones AL, Perry JD, 2003. Evaluation of a new water treatment for point-of-use household applications to remove microorganisms and arsenic from drinking water. J Water Health 1 : 73–84.
    [Google Scholar]
  15. Reller ME, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Olson CA, Baier KG, Keswick BH, Luby SP, 2003. A randomized controlled trial of household-based flocculant-disinfectant drinking water treatment for diarrhea prevention in rural Guatemala. Am J Trop Med Hyg 69 : 411–419.
    [Google Scholar]
  16. Chiller TM, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Keswick BH, Luby SP, 2006. Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water. Bull World Health Organ 84 : 28–35.
    [Google Scholar]
  17. Pan American Health Organization, 2002. Guatemala 2002. Health in the Americas 2002 Edition. Washington, DC: Pan American Health Organization.
  18. Ministerio de Educación Gobierno d el a Republica de Guatemala, 2002. Segundo Censo Nacional de Talla de Escolares de primer grado de Primaria De La republica d e Guatemala. Guatemala City: Ministerio de Educación Gobierno d el a Republica de Guatemala.
  19. Rangel JM, Lopez B, Mejia MA, Mendoza C, Luby S, 2003. A novel technology to improve drinking water quality: a micro-biological evaluation of in-home flocculation and chlorination in rural Guatemala. J Water Health 1 : 15–22.
    [Google Scholar]
  20. Hanson M, Powell K, 2006. Procter & Gamble PuR Purifier of Water (A): Developing the Product and Taking it to Market. Fontainebleau: INSEAD.
  21. Clasen T, Cairncross S, Haller L, Bartram J, Walker D, 2007. Cost-effectiveness of water quality interventions for preventing diarrhoeal disease in developing countries. Journal of Water and Health 5 : 599–608.
    [Google Scholar]
  22. Loomis J, Brown T, Lucero B, Peterson G, 1996. Improving validity experiments of contingent valuation methods: results of efforts to reduce the disparity of hypothetical and actual willingness to pay. Land Econ 72 : 450–461.
    [Google Scholar]
  23. Hanson M, Powell K, 2006. Procter & Gamble PuR Purifier of Water (B): A Second Chance. Fontainebleau: INSEAD.
  24. Hanson M, Powell K, 2006. Procter & Gamble and Population Services International (PSI): Social Marketing for Safe Water.Fontainebleau: INSEAD.
  25. Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer W, Keswick B, Hoekstra RM, 2006. Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial. Trop Med Int Health 11 : 479–489.
    [Google Scholar]
  26. Harris J, 2005. Challenges to the Commercial Viability of Point-of-Use (POU) Water Treatment Systems in Low-Income Settings. Oxford: Oxford University.
  27. Parker AA, Stephenson R, Riley PL, Ombeki S, Komolleh C, Sibley L, Quick R, 2006. Sustained high levels of stored drinking water treatment and retention of hand-washing knowledge in rural Kenyan households following a clinic-based intervention. Epidemiol Infect 134 : 1029–1036.
    [Google Scholar]
  28. Thevos AK, Kaona F, Siajunza MT, Quick R, 2000. Adoption of safe water behaviors in Zambia: comparing educational and motivational approaches. Educ Health 13 : 366–376.
    [Google Scholar]

Data & Media loading...

  • Received : 01 Sep 2007
  • Accepted : 16 Nov 2007
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error