Volume 82, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



For populations without reliable access to safe drinking water, household water treatment (HWT) provides a means of improving water quality and preventing disease. We extracted data on reported HWT practices from 67 national surveys and reports on the scope of HWT. An estimated 33.0% of the households (1.1 billion people) in these countries report treating their drinking water at home. The practice is widespread in the Western Pacific (66.8%) and Southeast Asia (45.4%) regions, and it is less common in the Eastern Mediterranean (13.6%) and Africa (18.2%). Boiling is the most dominant method with 21.0% of the study households (598 million people) using the method. Despite being at higher risk of waterborne disease because of lower coverage of improved water sources, African and rural households are less likely to practice HWT or use microbiologically adequate methods. Validation of the household surveys and further analysis of these data could help optimize HWT practices.


Article metrics loading...

Loading full text...

Full text loading...



  1. WHO, 2005. World Health Report 2005: Make Every Mother and Child Count. Geneva: World Health Organization.
  2. Guerrant DI, Moore SR, Lima AA, Patrick PD, Schorling JB, Guerrant RL, , 1999. Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil. Am J Trop Med Hyg 61: 707713.
  3. Baqui AH, Black RE, Sack RB, Chowdhury HR, Yunus M, Siddique AK, , 1993. Malnutrition, cell-mediated immune deficiency, and diarrhea: a community-based longitudinal study in rural Bangladeshi children. Am J Epidemiol 137: 355365.[Crossref]
  4. Schneider RE, Shiffman J, , 1978. The potential effect of water on gastrointestinal infections prevalent in developing countries. Am J Clin Nutr 31: 20892099.
  5. WHO/UNICEF, 2008. Progress on Drinking Water and Sanitation: Special Focus on Sanitation. Geneva: World Health Organization.
  6. WHO/UNICEF, 2008. Rapid Drinking Water Quality Assessment. Geneva: World Health Organization.
  7. Aliev S, Shodmonov P, Babakhanova N, Schmoll O, , 2006. Rapid Assessment of Drinking-water Quality in the Republic of Tajikistan. Country Report. Ministry of Health of the Republic of Tajikistan. Geneva: WHO/UNICEF.
  8. Semenza J, Roberts L, Henderson A, Bogan J, Rubin C, , 1998. Water distribution system and diarrhoeal disease transmission: a case study in Uzbekistan. Am J Trop Med Hyg 59: 941946.
  9. Sobsey MD, , 2002. Managing Water in the Home: Accelerated Health Gains from Improved Water Supply. Geneva: World Health Organization.
  10. Bukenya JO, , 2006. Household perceptions of the quality of drinking water in Uganda. Proceedings of the Southern Agricultural Economics Association Annual Meeting, Orlando, Florida, February 5–8, 2006.
  11. Wright J, Gundry S, Conroy J, , 2003. 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]
  12. Clasen T, Schmidt W-P,, Rabie T, Roberts I, Cairncross S, , 2007. Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis. BMJ 334: 782792.[Crossref]
  13. Fewtrell L, Kaufmann R, Kay D, Enanoria W, Haller L, Colford J, , 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4252.[Crossref]
  14. Clasen T, Haller L, Walker D, Bartram J, Cairncross S, , 2007. Cost-effectiveness analysis of water quality interventions for preventing diarrhoeal disease in developing countries. J Water Health 5: 599608.[Crossref]
  15. Hutton G, Haller L, , 2004. Evaluation of the Costs and Benefits of Water and Sanitation Improvements at the Global Level. Geneva: World Health Organization.
  16. WHO, 2007. Combating Waterborne Disease at the Household Level. Geneva: World Health Organization.
  17. WHO, 2008. Guidelines for Drinking Water Quality, 3rd Ed, Second Addendum. Geneva: World Health Organization.
  18. WHO/UNICEF, 2006. Core Questions on Drinking Water and Sanitation for Household Surveys. Geneva: World Health Organization.
  19. DHS, 2009. Demographic and Health Surveys. Calverton, MD: MEASURE ICF Macro.
  20. MIC3S, 2009. Multiple Indicator Cluster Surveys. Monitoring the Situation of Children and Women. New York: UNICEF.
  21. LSMS, 2003. Living Standards Measurement Study. Washington, DC: The World Bank.
  22. Gadgil JA, Shown LJ, , 1995. To Drink Without Risk: the Use of Ultraviolet Light to Disinfect Drinking Water in Developing Countries. Berkeley, CA: Centre for Building Science.
  23. The Rockefeller Foundation, 1917. Annual Report. New York: The Rockefeller Foundation, 156.
  24. Yang C, Sangthong R, Chongsuvivatwong V, McNeil E, Lu L, , 2009. Effect of village income and household income on sanitation facilities, hygiene behaviours and child undernutrition during rapid economic growth in a rural cross-border area, Yunnan, China. J Epidemiol Community Health 63: 403407.[Crossref]
  25. Gonzalez LU, Zuniga DC, , 1983. Costumbres sobre saneamiento básico en población suburbana. Estudio de Viña del Mar, Chile. Bol Oficina Sanit Panam 94: 482494.
  26. Gilman RH, Marquis GS, Ventura G, Campos M, Spira W, Diaz F, , 1993. Water cost and availability: key determinants of family hygiene in a Peruvian shantytown. Am J Public Health 83: 15541558.[Crossref]
  27. Clasen TF, Thao DH, Boisson S, Shipin O, , 2008. Microbiological effectiveness and cost of boiling to disinfect drinking water in rural Vietnam. Environ Sci Technol 42: 42554260.[Crossref]
  28. Clasen T, McLaughlin C, Nayaar N, Boisson S, Gupta R, Desai D, Shah N, , 2008. Microbiological effectiveness and cost of disinfecting water by boiling in semi-urban India. Am J Trop Med Hyg 79: 407413.
  29. Oswald WE, Lescano AG, Bern C, Calderon MM, Cabrera L, Gilman RH, , 2007. Fecal contamination of drinking water within peri-urban households, Lima, Peru. Am J Trop Med Hyg 77: 699704.
  30. Gupta SK, Suantio A, Gray A, Widyastuti E, Jain N, Rolos R, Hoekstra RM, Quick R, , 2007. Factors associated with E. coli contamination of household drinking water among tsunami and earthquake survivors, Indonesia. Am J Trop Med Hyg 76: 11581162.
  31. Luby SP, Syed AH, Atiullah N, Faizan MK, Fisher-Hoch S, , 1999. Limited effectiveness of home drinking water purification efforts in Karachi, Pakistan. Int J Infect Dis 4: 37.[Crossref]
  32. Rosa G, Miller L, Clasen T, , 2010. Microbiological effectiveness of disinfecting water by boiling in rural Guatemala. Am J Trop Med Hyg (in press).
  33. Kols A, , 2009. Supply and Demand for Household Water Treatment Products in Andhra Pradesh, Karnataka, and Maharashtra, India. PATH. A Catalyst for Global Health.Seattle, WA.
  34. USAID, 2006. Bringing Consumers to the Table: Perceptions and Practice of Household Water Treatment Methods in Nepal. Hygiene Improvement Project. Washington, DC: USAID.
  35. Blakely T, Hales S, Kieft C, Wilson N, Woodward A, , 2005. The global distribution of risk factors by poverty level. Bull World Health Organ 83: 118126.
  36. Boerma JT, Sommerfelt AE, , 1993. Demographic and Health Surveys (DHS): contributions and limitations. World Health Stat Q 46: 222226.
  37. Stone L, Campbell G, , 1984. The use and misuse of surveys in international development: an experiment from Nepal. Hum Organ 43: 2737.[Crossref]
  38. Ruel MT, Arimond M, , 2002. Spot-check observational method for assessing hygiene practices: review of experience and implications for programmes. J Health Popul Nutr 20: 6576.
  39. Stanton BF, Clemens JD, Aziz KMA, Rahman M, , 1987. Twenty-four-hour recall, knowledge-attitude-practice questionnaires, and direct observations of sanitary practices: a comparative study. Bull World Health Organ 65: 217222.
  40. Manun’Ebo M, Cousens S, Haggerty P, Kalengaie M, Ashworth A, Kirkwood B, , 1997. Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaire. Trop Med Int Health 2: 10151021.[Crossref]
  41. Arnold B, Arana B, Mausezahl D, Hubbard A, Colford JM, Jr, 2009. Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala. Int J Epidemiol 38: 16511661.[Crossref]
  42. Moser S, Heri S, Mosler H-J, , 2005. Determinants of the Diffusion of SODIS. A Qualitative Field Study in Bolivia. Summary Report. Dubendorf: Swiss Federal Institute of Aquatic Science and Technology (Eawag).
  43. Webb AL, Stein AD, Ramakrishnan U, Hertzberg VS, Urizar M, Martorell R, , 2006. A simple index to measure hygiene behaviours. Int J Epidemiol 35: 14691477.[Crossref]
  44. Quick RE, Kimura A, Thevos A, Tembo M, Shamputa I, Hutwagner L, , 2002. Diarrhoea prevention through household-level water disinfection and safe storage in Zambia. Am J Trop Med Hyg 66: 584589.
  45. Reller ME, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Olson CA, Baier KG, , 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: 411419.
  46. Luby S, Agboatwalla MRS, Sobel JA, , 2001. Low-cost intervention for cleaner drinking water in Karachi, Pakistan. Int J Infect Dis 5: 144150.[Crossref]
  47. Quick RE, Vencel LV, Mintz ED, Soleto L, Aparicio J, Gironaz M, Hutwagner L, Greene K, Bopp C, Maloney K, Chavez D, Sobsey MD, Tauxe R, , 1999. Diarrhoea prevention in Bolivia through point-of-use water treatment and safe storage: a promising new strategy. Epidemiol Infect 122: 8390.[Crossref]
  48. McLaughlin LA, Levy K, Becks NK, Shin G, Meschke JS, Eisenberg JN, , 2009. An observational study on the effectiveness of point-of-use chlorination. J Environ Health 71: 4853.
  49. Rochelle CR, Arding AK, , 2005. Drinking water quality and solar disinfection: effectiveness in peri-urban households in Nepal. J Water Health 3: 239248.[Crossref]
  50. Rose A, Roy S, Abraham V, Holmgren G, George K, Balraj V, Abraham S, Muliyil J, Joseph A, Kang G, , 2006. Solar disinfection of water for diarrhoeal prevention in southern India. Arch Dis Child 91: 139141.[Crossref]
  51. McLennan JD, , 2000. To boil or not: drinking water for children in a periurban barrio. Soc Sci Med 51: 12111220.[Crossref]
  52. WHO, 2002. World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva: World Health Organization.

Data & Media loading...

  • Received : 06 Jul 2009
  • Accepted : 26 Oct 2009

Most Cited This Month

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