Microbiological Effectiveness and Cost of Disinfecting Water by Boiling in Semi-urban India

Thomas Clasen Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health Research, St Michael’s Hospital, University of Toronto, Toronto, Canada; and Hindustan Unilever Research Centre, Unilever Research India, Bangalore, India

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Catherine McLaughlin Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health Research, St Michael’s Hospital, University of Toronto, Toronto, Canada; and Hindustan Unilever Research Centre, Unilever Research India, Bangalore, India

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Neeru Nayaar Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health Research, St Michael’s Hospital, University of Toronto, Toronto, Canada; and Hindustan Unilever Research Centre, Unilever Research India, Bangalore, India

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Sophie Boisson Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health Research, St Michael’s Hospital, University of Toronto, Toronto, Canada; and Hindustan Unilever Research Centre, Unilever Research India, Bangalore, India

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Romesh Gupta Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health Research, St Michael’s Hospital, University of Toronto, Toronto, Canada; and Hindustan Unilever Research Centre, Unilever Research India, Bangalore, India

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Dolly Desai Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health Research, St Michael’s Hospital, University of Toronto, Toronto, Canada; and Hindustan Unilever Research Centre, Unilever Research India, Bangalore, India

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Nimish Shah Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Global Health Research, St Michael’s Hospital, University of Toronto, Toronto, Canada; and Hindustan Unilever Research Centre, Unilever Research India, Bangalore, India

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Despite shortcomings, boiling is the most common means of treating water at home and the benchmark against which emerging point-of-use water treatment approaches are measured. In a 5-month study, we assessed the microbiological effectiveness and cost of the practice among 218 self-reported boilers relying on unprotected water supplies. Boiling was associated with a 99% reduction in geometric mean fecal coliforms (FCs; P < 0.001). Despite high levels of fecal contamination in source water, 59.6% of stored drinking water samples from self-reported boilers met the World Health Organization standard for safe drinking water (0 FC/100mL), and 5.7% were between 1 and 10 FC/100 mL. Nevertheless, 40.4% of stored drinking water samples were positive for FCs, with 25.1% exceeding 100 FC/100 mL. The estimated monthly fuel cost for boiling was INR 43.8 (US$0.88) for households using liquid petroleum gas and INR 34.7 (US$0.69) for households using wood.

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