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1.
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Pruss-Ustun A, Bos R, Gore F, Bartram J, 2008. Safe Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health. Geneva: World Health Organization. Available at: http://www.who.int/water_sanitation_health/publications/safer_water/en/. Accessed January 23, 2012.
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Boschi-Pinto C, Velebit L, Shibuya K, 2008. Estimating child mortality due to diarrhoea in developing countries. Bull World Health Organ 86: 710–717.
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4.
WHO, 2010. Progress on Sanitation and Drinking-Water: 2010 Update. Geneva: World Health Organization. Available at: http://www.who.int/water_sanitation_health/publications/9789241563956/en/index.html. Accessed January 23, 2012.
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Solo TM, 2003. Independent Water Entrepreneurs in Latin America: The Other Private Sector in Water Services. Washington, DC: The World Bank. Available at: http://water.worldbank.org/water/publications/independent-water-entrepreneurs-latin-america-other-private-sector-water-services. Accessed January 23, 2012.
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McGranahan G, Njiru C, Abu M, Smith M, Mitlin D, 2006. How Small Water Enterprises Can Contribute to the Millennium Development Goals: Evidence from Dar es Salaam, Nairobi, Khartoum and Accra—IIED Publications Database. Available at: http://pubs.iied.org/G00503.html. Accessed November 9, 2011.
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Opryszko MC, Huang H, Soderlund K, Schwab KJ, 2009. Data gaps in evidence-based research on small water enterprises in developing countries. J Water Health 07: 609–622.
-
8.
Sansom K, 2006. Government engagement with non-state providers of water and sanitation services. Public Adm Dev 26: 207–217.
-
9.
Solo TM, 1998. Competition in Water and Sanitation: The Role of Small-Scale Entrepreneurs. The World Bank Public Policy for the Private Sector. Washington, DC: The World Bank. Available at: rru.worldbank.org/documents/publicpolicyjournal/165solo.pdf. Accessed January 23, 2012.
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10.
Thompson J, 2000. Waiting at the tap: changes in urban water use in East Africa over three decades. Environ Urban 12: 37–52.
-
11.
Solo TM, 1999. Small-scale entrepreneurs in the urban water and sanitation market. Environ Urban 11: 117–132.
-
12.
Whittington D, Lauria DT, Mu X, 1991. A study of water vending and willingness to pay for water in Onitsha, Nigeria. World Dev 19: 179–198.
-
13.
Komives K, Whittington D, Wu X, 2001. Infrastructure Coverage and the Poor: A Global Perspective. Policy Research Working Paper 2551, World Bank Publications. Available at: http://books.google.com/books?hl=en&lr=&id=OP7AUapEn4UC&oi=fnd&pg=PA1&dq=%22of+all+these+infrastructure+services+rises,+but+at+different+rates.+The+findings%22+&ots=JuFuvzZ9ka&sig=BZ3e4wJqbcBaT0C9Lg4TRbfKn8U. Accessed August 19, 2012.
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Whittington D, Hanemann WM, Sadoff C, Jeuland M, 2008. The challenge of improving water and sanitation services in less developed countries. Foundations Trends Microecon 4: 469–609.
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Ghana Statistical Service and ICF Macro, 2009. Ghana Demographic and Health Survey 2008. Calverton, MD: Ghana Health Service and IFC Macro. Available at: www.measuredhs.dom/pubs/pdf/FR221/FR221.pdf. Accessed January 23, 2012.
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Nsowah-Nuamah N, Mensah G, Aryeetey ME, Wagatsuma Y, Bentil G, 2001. Urinary schistosomiasis in southern Ghana: a logistic regression approach to data from a community-based integrated control program. Am J Trop Med Hyg 65: 484.
-
19.
WHO, 1985. The Control of Schistosomiasis. World Health Organization Technical Report Series 728. Available at: whqlibdoc.who.int/trs/WHO_TRS-728.pdf. Accessed on January 23, 2012.
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Kwakye-Nuako G, Borketey P, Mensah-Attipoe I, Asmah R, Ayeh-Kumi P, 2010. Sachet drinking water in Accra: the potential threats of transmission of enteric pathogenic protozoan organisms. Ghana Med J 41: 62–67.
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21.
Obiri-Danso K, Okore-Hanson A, Jones K, 2003. The microbiological quality of drinking water sold on the streets in Kumasi, Ghana. Lett Appl Microbiol 37: 334–339.
-
22.
Nana Asamoah D, Amorin R, 2011. Assessment of the quality of bottled/sachet water in the Tarkwa-Nsuaem Municipality (TM) of Ghana. Res J Appl Sci Eng Technol 3: 377–385.
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WaterHealth International, 2011. WaterHealth International. Available at: http://www.waterhealth.com/. Accessed January 23, 2012.
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24.
Alcorn TE, Opryszko MC, Schwab KJ, 2011. Formative ethnographic research to improve evaluation of a novel water system in Ghana. Am J Trop Med Hyg 84: 801–805.
-
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WHO, 2011. Guidelines for Drinking-Water Quality, 4th Ed. Geneva: World Health Organization.
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26.
Liang K, Zeger S, 1986. Longitudinal data analysis using generalized linear models. Biometrika 73: 13–22.
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Zeger SL, Liang KY, 1986. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42: 121–130.
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28.
Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N, Bruckner T, Satariano WA, 2010. To GEE or not to GEE. Epidemiology 21: 467–474.
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Vyas S, Kumaranayake L, 2006. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21: 459–468.
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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: 106–117.
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Trevett AF, Carter RC, Tyrrel SF, 2004. Water quality deterioration: a study of household drinking water quality in rural Honduras. Int J Environ Health Res 14: 273–283.
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UNICEF/WES, USAID, WorldBank/WSP, WSSCC, 2004. The Hygiene Improvement Framework: A Comprehensive Approach for Preventing Childhood Diarrhea. Washington, DC: Environmental Health Project, USAID. Available at: www.ehproject.org/PDF/Joint_Publications/JP008-HIF.pdf. Accessed January 23, 2012.
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| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 726 | 589 | 105 |
| Full Text Views | 490 | 9 | 0 |
| PDF Downloads | 213 | 10 | 0 |
Impact of Water-Vending Kiosks and Hygiene Education on Household Drinking Water Quality in Rural Ghana
Melissa C. Opryszko
Melissa C. Opryszko
Departments of Environmental Health Sciences and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Geography and Environmental Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland
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Yayi Guo
Yayi Guo
Departments of Environmental Health Sciences and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Geography and Environmental Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland
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Luke MacDonald
Luke MacDonald
Departments of Environmental Health Sciences and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Geography and Environmental Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland
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Laura MacDonald
Laura MacDonald
Departments of Environmental Health Sciences and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Geography and Environmental Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland
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Samara Kiihl
Samara Kiihl
Departments of Environmental Health Sciences and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Geography and Environmental Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland
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Kellogg J. Schwab
Kellogg J. Schwab
Departments of Environmental Health Sciences and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Geography and Environmental Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland
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Innovative solutions are essential to improving global access to potable water for nearly 1 billion people. This study presents an independent investigation of one alternative by examining for-profit water-vending kiosks, WaterHealth Centers (WHCs), in rural Ghana to determine their association with household drinking water quality. WHCs' design includes surface water treatment using filtration and ultraviolet light disinfection along with community-based hygiene education. Analyses of water samples for Escherichia coli and household surveys from 49 households across five villages collected one time per year for 3 years indicate that households using WHCs had improved water quality compared with households using untreated surface water (adjusted incidence rate ratio = 0.07, 95% confidence interval = 0.02, 0.21). However, only 38% of households used WHCs by the third year, and 60% of those households had E. coli in their water. Recontamination during water transport and storage is an obstacle to maintaining WHC-vended water quality.
Author Notes
Financial support: This study was supported by the Hopkins Sommer Scholars Program of the Johns Hopkins Bloomberg School of Public Health, the Osprey Foundation of Maryland, the Johns Hopkins University Global Water Program, and the Johns Hopkins University Center for Water and Health.
Authors' addresses: Melissa C. Opryszko, Yayi Guo, Luke MacDonald, and Kellogg J. Schwab, Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mails: mopryszk@jhsph.edu, yguo@jhsph.edu, lmacdona@jhsph.edu, and kschwab@jhsph.edu. Laura MacDonald, Department of Geography and Environmental Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, E-mail: laura.macdonald@jhu.edu. Samara Kiihl, Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mail: sfkiihl@jhsph.edu.
ProCite
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-
1.
United Nations, 2009. The Millennium Development Goals Report. United Nations Department of Economic and Social Affairs, New York. Available at: www.un.org/millenniumgoals/pdf/MDG_Report_209_ENG.pdf. Accessed January 23, 2012.
-
2.
Pruss-Ustun A, Bos R, Gore F, Bartram J, 2008. Safe Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health. Geneva: World Health Organization. Available at: http://www.who.int/water_sanitation_health/publications/safer_water/en/. Accessed January 23, 2012.
-
3.
Boschi-Pinto C, Velebit L, Shibuya K, 2008. Estimating child mortality due to diarrhoea in developing countries. Bull World Health Organ 86: 710–717.
-
4.
WHO, 2010. Progress on Sanitation and Drinking-Water: 2010 Update. Geneva: World Health Organization. Available at: http://www.who.int/water_sanitation_health/publications/9789241563956/en/index.html. Accessed January 23, 2012.
-
5.
Solo TM, 2003. Independent Water Entrepreneurs in Latin America: The Other Private Sector in Water Services. Washington, DC: The World Bank. Available at: http://water.worldbank.org/water/publications/independent-water-entrepreneurs-latin-america-other-private-sector-water-services. Accessed January 23, 2012.
-
6.
McGranahan G, Njiru C, Abu M, Smith M, Mitlin D, 2006. How Small Water Enterprises Can Contribute to the Millennium Development Goals: Evidence from Dar es Salaam, Nairobi, Khartoum and Accra—IIED Publications Database. Available at: http://pubs.iied.org/G00503.html. Accessed November 9, 2011.
-
7.
Opryszko MC, Huang H, Soderlund K, Schwab KJ, 2009. Data gaps in evidence-based research on small water enterprises in developing countries. J Water Health 07: 609–622.
-
8.
Sansom K, 2006. Government engagement with non-state providers of water and sanitation services. Public Adm Dev 26: 207–217.
-
9.
Solo TM, 1998. Competition in Water and Sanitation: The Role of Small-Scale Entrepreneurs. The World Bank Public Policy for the Private Sector. Washington, DC: The World Bank. Available at: rru.worldbank.org/documents/publicpolicyjournal/165solo.pdf. Accessed January 23, 2012.
-
10.
Thompson J, 2000. Waiting at the tap: changes in urban water use in East Africa over three decades. Environ Urban 12: 37–52.
-
11.
Solo TM, 1999. Small-scale entrepreneurs in the urban water and sanitation market. Environ Urban 11: 117–132.
-
12.
Whittington D, Lauria DT, Mu X, 1991. A study of water vending and willingness to pay for water in Onitsha, Nigeria. World Dev 19: 179–198.
-
13.
Komives K, Whittington D, Wu X, 2001. Infrastructure Coverage and the Poor: A Global Perspective. Policy Research Working Paper 2551, World Bank Publications. Available at: http://books.google.com/books?hl=en&lr=&id=OP7AUapEn4UC&oi=fnd&pg=PA1&dq=%22of+all+these+infrastructure+services+rises,+but+at+different+rates.+The+findings%22+&ots=JuFuvzZ9ka&sig=BZ3e4wJqbcBaT0C9Lg4TRbfKn8U. Accessed August 19, 2012.
-
14.
Whittington D, Hanemann WM, Sadoff C, Jeuland M, 2008. The challenge of improving water and sanitation services in less developed countries. Foundations Trends Microecon 4: 469–609.
-
15.
Government of Ghana, 2009. Ghana Water and Sanitation Sector Performance Report 2009. Accra, Ghana: Ministry of Water Resources, Works and Housing. Available at: wsmp.org/downloads/4d8ca15ec1a12.pdf. Accessed January 23, 2012.
-
16.
Ghana Statistical Service and ICF Macro, 2009. Ghana Demographic and Health Survey 2008. Calverton, MD: Ghana Health Service and IFC Macro. Available at: www.measuredhs.dom/pubs/pdf/FR221/FR221.pdf. Accessed January 23, 2012.
-
17.
WHO, 2010. Ghana: Fact Sheet of Health Statistics. Geneva: World Health Organization. Available at: http://www.afro.who.int/en/ghana/who-country-office-ghana.html. Accessed January 23, 2012.
-
18.
Nsowah-Nuamah N, Mensah G, Aryeetey ME, Wagatsuma Y, Bentil G, 2001. Urinary schistosomiasis in southern Ghana: a logistic regression approach to data from a community-based integrated control program. Am J Trop Med Hyg 65: 484.
-
19.
WHO, 1985. The Control of Schistosomiasis. World Health Organization Technical Report Series 728. Available at: whqlibdoc.who.int/trs/WHO_TRS-728.pdf. Accessed on January 23, 2012.
-
20.
Kwakye-Nuako G, Borketey P, Mensah-Attipoe I, Asmah R, Ayeh-Kumi P, 2010. Sachet drinking water in Accra: the potential threats of transmission of enteric pathogenic protozoan organisms. Ghana Med J 41: 62–67.
-
21.
Obiri-Danso K, Okore-Hanson A, Jones K, 2003. The microbiological quality of drinking water sold on the streets in Kumasi, Ghana. Lett Appl Microbiol 37: 334–339.
-
22.
Nana Asamoah D, Amorin R, 2011. Assessment of the quality of bottled/sachet water in the Tarkwa-Nsuaem Municipality (TM) of Ghana. Res J Appl Sci Eng Technol 3: 377–385.
-
23.
WaterHealth International, 2011. WaterHealth International. Available at: http://www.waterhealth.com/. Accessed January 23, 2012.
-
24.
Alcorn TE, Opryszko MC, Schwab KJ, 2011. Formative ethnographic research to improve evaluation of a novel water system in Ghana. Am J Trop Med Hyg 84: 801–805.
-
25.
WHO, 2011. Guidelines for Drinking-Water Quality, 4th Ed. Geneva: World Health Organization.
-
26.
Liang K, Zeger S, 1986. Longitudinal data analysis using generalized linear models. Biometrika 73: 13–22.
-
27.
Zeger SL, Liang KY, 1986. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42: 121–130.
-
28.
Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N, Bruckner T, Satariano WA, 2010. To GEE or not to GEE. Epidemiology 21: 467–474.
-
29.
Vyas S, Kumaranayake L, 2006. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21: 459–468.
-
30.
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: 106–117.
-
31.
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: 280–287.
-
32.
Trevett AF, Carter RC, Tyrrel SF, 2004. Water quality deterioration: a study of household drinking water quality in rural Honduras. Int J Environ Health Res 14: 273–283.
-
33.
UNICEF/WES, USAID, WorldBank/WSP, WSSCC, 2004. The Hygiene Improvement Framework: A Comprehensive Approach for Preventing Childhood Diarrhea. Washington, DC: Environmental Health Project, USAID. Available at: www.ehproject.org/PDF/Joint_Publications/JP008-HIF.pdf. Accessed January 23, 2012.
-
34.
Esrey SA, Feachem RG, Hughes JM, 1985. Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities. Bull World Health Organ 63: 757–772.
-
35.
US Environmental Protection Agency, 1998. Toxicological Review of Naphthalene (CAS No. 91-20-3) in Support of Summary Information on the Integrated Risk Information System (IRIS). Cincinnati, OH: National Center for Environmental Assessment. Available at: www.epa.gov/iris/toxreviews/0436tr.pdf. Accessed January 23, 2012.
-
36.
Blum D, Feachem R, 1983. Measuring the impact of water supply and sanitation investments on diarrheal diseases: problems of methodology. Int J Epidemiol 12: 357–365.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 726 | 589 | 105 |
| Full Text Views | 490 | 9 | 0 |
| PDF Downloads | 213 | 10 | 0 |