1921
Volume 100, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

In August 2015, an outbreak of cholera was reported in Tanzania. In cholera-affected areas of urban Dar es Salaam and Morogoro, many households obtained drinking water from vendors, who sold water from tanks ranging in volume from 1,000 to 20,000 L. Water supplied by vendors was not adequately chlorinated. The Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children and the U.N. Children’s Fund, Tanzania, collaborated to enroll and train vendors to treat their water with 8.68-g sodium dichloroisocyanurate tablets (Medentech, Ireland). The Centers for Disease Control and Prevention (CDC) provided monitoring and evaluation support. Vendors were provided a 3-month supply of chlorine tablets. A baseline assessment and routine monitoring were conducted by ward environmental health officers. Approximately 3 months after chlorine tablet distribution, an evaluation of the program was conducted. The evaluation included a full enumeration of all vendors, an in-depth survey with half of the vendors enumerated, and focus group discussions. In total, 797 (88.9%) vendors were included in the full enumeration and 392 in the in-depth survey. Free residual chlorine (FRC) was detected in 12.0% of tanks at baseline and 69.6% of tanks during the evaluation; however, only 17.4% of these tanks had FRC ≥ 0.5 mg/L. The results suggest high acceptability and use of the chlorine tablets by water vendors. However, given variation in the water source used and longer storage times, dosing could be increased in future programming. Bulk chlorination using chlorine tablets offers an efficient community-level approach to treating water closer to the point of use.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. Narra R, 2017. Notes from the field: ongoing cholera epidemic—Tanzania, 2015–2016. MMWR Morb Mortal Wkly Rep 66: 177178. [Google Scholar]
  2. MoHCDGEC, 2016. Tanzania Cholera Situation Report February 23, 2016. Dar es Salaam, Tanzania: MoHCDGEC. [Google Scholar]
  3. WHO, 1993. Guidelines for Cholera Control. Geneva, Switzerland: World Health Organization. Available at: http://www.cliniciansoftheworld.org/WHO_Guidelines_Cholera_Control.pdf. Accessed September 1, 2017. [Google Scholar]
  4. WHO, 2016. Guidelines for Drinking-Water Quality, 4th edition. Geneva, Switzerland: World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/44584/1/9789241548151_eng.pdf. Accessed November 5, 2016. [Google Scholar]
  5. Ramesh A, Blanchet K, Ensink JHJ, Roberts B, , 2015. Evidence on the effectiveness of water, sanitation, and hygiene (WASH) interventions on health outcomes in humanitarian crises: a systematic review. PLoS One 10: e0124688. [Google Scholar]
  6. Taylor DL, Kahawita TM, Cairncross S, Ensink JHJ, , 2015. The impact of water, sanitation and hygiene interventions to control cholera: a systematic review. PLoS One 10: e0135676. [Google Scholar]
  7. Branz A, Levine M, Lehmann L, Bastable A, Imran Ali S, Kadir K, Yates T, Bloom D, Lantagne D, , 2017. Chlorination of drinking water in emergencies: a review of knowledge, recommendations for implementation, and research needed. Waterlines 36: 439. [Google Scholar]
  8. Lantagne D, Yates T, , 2018. Household water treatment and cholera control. J Infect Dis 218 (Suppl 3): S147S153. [Google Scholar]
  9. Lantagne DS, Clasen TF, , 2012. Use of household water treatment and safe storage methods in acute emergency response: case study results from Nepal, Indonesia, Kenya, and Haiti. Environ Sci Technol 46: 1135211360. [Google Scholar]
  10. Clasen TF, Alexander KT, Sinclair D, Boisson S, Peletz R, Chang HH, Majorin F, Cairncross S, , 2015. Interventions to improve water quality for preventing diarrhoea. Cochrane Database Syst Rev 10: CD004794. doi: 10.1002/14651858.CD004794.pub3. [Google Scholar]
  11. Cavallaro EC, Harris JR, da Goia MS, dos Santos Barrado JC, da Nobrega AA, de Alvarenga de Junior IC, Silva AP, Sobel J, Mintz E, , 2011. Evaluation of pot-chlorination of wells during a cholera outbreak, Bissau, Guinea-Bissau, 2008. J Water Health 9: 394402. [Google Scholar]
  12. Garandeau R, Trevett A, Bastable A, , 2006. Chlorination of hand-dug wells in Monrovia. Waterlines 24: 1921. [Google Scholar]
  13. Guevart E, Van Hecke C, Noeske J, Solle J, Bita Fouda A, Manga B, , 2008. Diffuseur artisanal de chlore pour desinfecter les puits lors de l'epidemie de cholera de Douala. Med Trop 68: 507513. [Google Scholar]
  14. UNDP, 2011. Services and Supply Chains: The Role of the Domestic Private Sector in Water Service Delivery in Tanzania. New York, NY: United Nations Development Programme. Available at: http://www.undp.org/content/undp/en/home/librarypage/poverty-reduction/inclusive_development/services_and_supplychainstheroleofthedomesticprivatesectorinwate/. Accessed December 6, 2016. [Google Scholar]
  15. Wang A, 2016. Notes from the field: chlorination strategies for drinking water during a cholera epidemic—Tanzania, 2016. MMWR Morb Mortal Wkly Rep 65: 11501151. [Google Scholar]
  16. Brunette W, Sundt M, Dell N, Chaudhri R, Breit N, Borriello G, , 2013. Open Data Kit 2.0: Expanding and Refining Information Services for Developing Regions. 2013 HotMobile Workshop: 14th International Workshop on Mobile Computing Systems and Applications, Jekyll Island, GA. Available at: http://www.hotmobile.org/2013/papers/full/2.pdf. Accessed September 5, 2017. [Google Scholar]
  17. Kleiber C, Zeileis A, , 2008. Applied Econometrics with R. New York, NY: Springer-Verlag. ISBN 978-0-387-77316-2. Available at: https://CRAN.R-project.org/package=AER Accessed September 1, 2017. [Google Scholar]
  18. R Core Team, 2017. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing. Available at: https://www.R-project.org/. Accessed September 2, 2017. [Google Scholar]
  19. Fiebelkorn AP, Person B, Quick RE, Vindigni SM, Jhung M, Bowen A, Riley PL, , 2012. Systematic review of behavior change research on point-of-use water treatment interventions in countries categorized as low- to medium-development on the human development index. Soc Sci Med 75: 622633. [Google Scholar]
  20. Clasen TF, , 2009. Scaling up Household Water Treatment Among Low-Income Populations. Geneva, Switzerland: World Health Organization. Available at: http://www.wpro.who.int/vietnam/publications/scaling_up_hwts_in_low_income_community.pdf. Accessed November 5, 2017. [Google Scholar]
  21. Nouri A, Shahmoradi B, Dehestani-Athar S, Maleki A, , 2015. Effect of temperature on pH, turbidity, and residual free chlorine in Sanandaj water distribution network, Iran. J Adv Environ Health Res 3: 188195. [Google Scholar]
  22. Medentech, 2017. Aquatabs Flo. Available at: http://www.aquatabs.com/home/product-range/aquatabs-flo/. Accessed February 2, 2017.
  23. Elala D, Labhasetwar P, Tyrrel S, , 2011. Deterioration in water quality from supply chain to household and appropriate storage in the context of intermittent water supplies. Water Sci Technol Water Supply 11: 400408. [Google Scholar]
  24. Kumpel E, Nelson KL, , 2013. Comparing microbial water quality in an intermittent and continuous piped water supply. Water Res 47: 51765188. [Google Scholar]
  25. 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]
  26. Crump JA, Otieno PO, Slutsker L, Keswick BH, Rosen DH, Hoekstra M, Vulule J, Luby S, , 2005. Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: cluster randomised controlled trial. BMJ 331: 478. [Google Scholar]
  27. Luby SP, Agboatwalla M, Hoekstra RM, Rahbar MH, Billhimer W, Keswick BH, , 2004. Delayed effectiveness of home-based interventions in reducing childhood diarrhea, Karachi, Pakistan. Am J Trop Med Hy 71: 420427. [Google Scholar]
  28. Fewtrell L, Kaufmann R, Kay D, Enanoria W, , 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4252. [Google Scholar]
  29. Makutsa P, Nzaku K, Ogutu P, Barasa P, Ombeki S, Mwaki A, Quick R, , 2001. Challenges in implementing a point-of-use water quality intervention in rural Kenya. Am J Public Health 91: 15711573. [Google Scholar]
  30. Francis M, Nagarajan G, Sarkar R, Mohan VR, Kang G, Balraj V, , 2015. Perception of drinking water safety and factors influencing acceptance and sustainability of a water quality intervention in rural southern India. BMC Public Health 15: 731. [Google Scholar]
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  • Received : 06 Sep 2018
  • Accepted : 26 Feb 2019
  • Published online : 05 Jun 2019

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