Long-term Impact of Integration of Household Water Treatment and Hygiene Promotion with Antenatal Services on Maternal Water Treatment and Hygiene Practices in Malawi

Anagha Loharikar Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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Elizabeth Russo Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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Anandi Sheth Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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Manoj Menon Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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Amose Kudzala Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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Blessius Tauzie Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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Humphreys D. Masuku Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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Tracy Ayers Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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Robert M. Hoekstra Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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Robert Quick Epidemic Intelligence Service, and Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations Children's Fund–Malawi, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi

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A clinic-based program to integrate antenatal services with distribution of hygiene kits including safe water storage containers, water treatment solution (brand name WaterGuard), soap, and hygiene education, was implemented in Malawi in 2007 and evaluated in 2010. We surveyed 389 participants at baseline in 2007, and found and surveyed 232 (60%) participants to assess water treatment, test stored drinking water for residual chlorine (an objective measure of treatment), and observe handwashing technique at follow-up in 2010. Program participants were more likely to know correct water treatment procedures (67% versus 36%; P < 0.0001), treat drinking water with WaterGuard (24% versus 2%; P < 0.0001), purchase and use WaterGuard (21% versus 1%; P < 0.001), and demonstrate correct handwashing technique (50% versus 21%; P < 0.001) at the three-year follow-up survey than at baseline. This antenatal-clinic-based program may have contributed to sustained water treatment and proper handwashing technique among program participants.

Author Notes

* Address correspondence to Anagha Loharikar, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A38, Atlanta, GA 30333. E-mails: anagha.loharikar@gmail.com or igd2@cdc.gov

Financial support: This study was supported by PATH.

Authors' addresses: Anagha Loharikar, Elizabeth Russo, Anandi Sheth, Manoj Menon, and Robert Quick, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: anagha.loharikar@gmail.com or igd2@cdc.gov, elizabeth.russo@gmail.com, anandisheth@gmail.com, mmenon@cdc.gov, and rxq1@cdc.gov. Amose Kudzala and Blessius Tauzie, United Nations Children's Fund–Malawi, Lilongwe, Malawi, E-mails: akudzala@unicef.org and btauzie@unicef.org. Humphreys D. Masuku, Ministry of Health, Lilongwe, Malawi, E-mail: dzanjom@yahoo.co.uk. Tracy Ayers and Robert M. Hoekstra, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: tayers@cdc.gov and mhoekstra@cdc.gov.

  • 1.

    Parashar UD, Bresee JS, Glass RI, 2003. The global burden of diarrhoeal disease in children. Bull World Health Organ 81: 236.

  • 2.

    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.

    • Search Google Scholar
    • Export Citation
  • 3.

    Curtis V, Cairncross S, 2003. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 3: 275281.

    • Search Google Scholar
    • Export Citation
  • 4.

    Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM Jr, 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4252.

    • Search Google Scholar
    • Export Citation
  • 5.

    Stockman LJ, Fischer TK, Deming M, Ngwira B, Bowie C, Cunliffe N, Bresee J, Quick RE, 2007. Point-of-use water treatment and use among mothers in Malawi. Emerg Infect Dis 13: 10771080.

    • Search Google Scholar
    • Export Citation
  • 6.

    Sheth AN, Russo ET, Menon M, Wannemuehler K, Weinger M, Kudzala AC, Tauzie B, Masuku HD, Msowoya TE, Quick R, 2010. Impact of the integration of water treatment and handwashing incentives with antenatal services on hygiene practices of pregnant women in Malawi. Am J Trop Med Hyg 83: 13151321.

    • Search Google Scholar
    • Export Citation
  • 7.

    Phelan S, 2010. Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol 202: 1353 e1e8.

  • 8.

    Russo ET, Sheth A, Menon M, Wannemuehler K, Weinger M, Kudzala AC, Tauzie B, Masuku HD, Msowoya TE, Quick R, 2012. Water treatment and handwashing behaviors among non-pregnant friends and relatives of participants in an antenatal hygiene promotion program in Malawi. Am J Trop Med Hyg 86: 860865.

    • Search Google Scholar
    • Export Citation
  • 9.

    Wood S, Foster J, Kols A, 2012. Understanding why women adopt and sustain home water treatment: insights from the Malawi antenatal care program. Soc Sci Med 75: 634642.

    • Search Google Scholar
    • Export Citation
  • 10.

    Quick R, 2003. Changing community behaviour: experience from three African countries. Int J Environ Health Res 13 (Suppl 1): S115S121.

    • Search Google Scholar
    • Export Citation
  • 11.

    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: 10291036.

    • Search Google Scholar
    • Export Citation
  • 12.

    Luby SP, Mendoza C, Keswick BH, Chiller TM, Hoekstra RM, 2008. Difficulties in bringing point-of-use water treatment to scale in rural Guatemala. Am J Trop Med Hyg 78: 382387.

    • Search Google Scholar
    • Export Citation
  • 13.

    Brown J, Proum S, Sobsey MD, 2009. Sustained use of a household-scale water filtration device in rural Cambodia. J Water Health 7: 404412.

  • 14.

    Tuttle J, Ries AA, Chimba RM, Perera CU, Bean NH, Griffin PM, 1995. Antimicrobial-resistant epidemic Shigella dysenteriae type 1 in Zambia: modes of transmission. J Infect Dis 171: 371375.

    • Search Google Scholar
    • Export Citation
  • 15.

    Swerdlow DL, Malenga G, Begkoyian G, Nyangulu D, Toole M, Waldman RJ, Puhr DN, Tauxe RV, 1997. Epidemic cholera among refugees in Malawi, Africa: treatment and transmission. Epidemiol Infect 118: 207214.

    • Search Google Scholar
    • Export Citation
  • 16.

    Swerdlow DL, Mintz ED, Rodriguez M, Tejada E, Ocampo C, Espejo L, Greene KD, Saldana W, Seminario L, Tauxe RV, 1992. Waterborne transmission of epidemic cholera in Trujillo, Peru: lessons for a continent at risk. Lancet 340: 2833.

    • Search Google Scholar
    • Export Citation
  • 17.

    Roberts L, Chartier Y, Chartier O, Malenga G, Toole M, Rodka H, 2001. Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial. Bull World Health Organ 79: 280287.

    • Search Google Scholar
    • Export Citation
  • 18.

    Wilson JM, Chandler GN, 1993. Sustained improvements in hygiene behaviour amongst village women in Lombok, Indonesia. Trans R Soc Trop Med Hyg 87: 615616.

    • Search Google Scholar
    • Export Citation
  • 19.

    Cairncross S, Shordt K, Zacharia S, Govindan BK, 2005. What causes sustainable changes in hygiene behaviour? A cross-sectional study from Kerala, India. Soc Sci Med 61: 22122220.

    • Search Google Scholar
    • Export Citation
  • 20.

    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.

    • Search Google Scholar
    • Export Citation
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