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Where
has the Safe Water System been used?
 Bolivia
Project
Partners - CDC
-
Child and Community
Health Project/PROSIN
-
USAID
- PSI
- Andean
Rural Health Care
- Rotary
Club of Estes Park, Colorado
- PAHO
- Millipore
Foundation
- Project
Concern International
- Centro
Nacional de Enfermedades Tropicos
- Ministry
of Public Health
- Peace
Corps
- Instituto
Bibosi
- Local
municipalities
- Pro
Habitat
- Universidad
Mayor de San Andres
- Ministerio
de Urbanismo y Vivienda
Target
Populations/Location - First
field trial: periurban population in El Alto, Bolivia
- Second
field trial: street vendors in La Paz, Bolivia
- Third
field trial: periurban population in Montero, Bolivia
- Social
marketing trial: urban and rural populations in Santiesteban, Ichilo, and Sara
Provinces in northern Santa Cruz Department
- Expansion:
7 departments (states) of Bolivia
Project
Design - Three
successive field trials to test impact of the SWS on water quality, diarrhea,
and street-vended beverages
- Trial
of social marketing
- Large-scale
implementation project
Intervention
Elements - Sodium
hypochlorite solution produced locally using appropriate technology. The brand
name is CLARO.
- Locally
produced, 20-liter plastic containers with spigots
- Community
education
- Social
marketing
Project
Start Date - Field
trial one: December 1992
- Field
trial two: June 1993
- Field
trial three: September 1994
- Social
marketing (CLARO) trial: November 1996
- Social
marketing expansion project: March 1997
Results
of Project Evaluations - In
the El Alto field trial, narrow-mouth, plastic water storage vessels and 5% calcium
hypochlorite solution for home disinfection of stored water were provided to a
Bolivian Aymara Indian community at risk for cholera. Each of 42 families in the
study obtained water from a household well; fecal coliform bacteria were found
in water from 40/42 (95%) wells (geometric mean 84.7 colonies/100 ml) and 34/42
(81%) usual water storage vessels (geometric mean 57.6 colonies/100 ml). One group
of families received the special vessels and chlorine (group A), a second received
only the special vessels (group B), and a third served as a control
group
(group C). Water samples collected every 3 weeks from group A special vessels
had lower geometric mean fecal coliform colony counts (p <.0001) and lower
geometric mean Escherichia coli colony counts (p <.0001) than water
from group B or C vessels. Adequate levels of free chlorine persisted in these
vessels for at least 5 hours. The special vessels and chlorine solution were well
accepted and continued to be used for at least 6 months. Use of the vessel and
chlorine solution produced drinking water from nonpotable sources that met WHO
standards for microbiologic quality.
- In
the Montero field trial, 127 households in two periurban communities were randomized
into intervention and control groups, surveyed, and the intervention was distributed.
Monthly water quality testing and weekly diarrhea surveillance were conducted.
Over a 5-month period, intervention households had 44% fewer diarrhea episodes
than control households (p=0.002). Infants <1 year old (p=0.05) and children
5-14 years old (p=0.01) in intervention households had significantly less diarrhoea
than control children. Campylobacter was less commonly isolated from intervention
than controls (p=0.02). Stored water in intervention participants households was
less contaminated with E. coli than stored water in control households
(p<0.0001). Intervention households exhibited less E. coli contamination
of stored water and less diarrhea than control households.
- An
evaluation of the social marketing trial compared an intervention group of households
using CLARO water vessels and disinfectant solution with a control group of households
using traditional water treatment and storage methods. Three months after the
launch of the CLARO social marketing campaign, in the intervention communities
50% of households reported using the CLARO water vessel, 34 per cent said that
they were using CLARO disinfectant, but only 19% had detectable levels of chlorine
in their stored water.
Within
intervention communities, households that reported using the CLARO vessel or CLARO
disinfectant had significantly lower fecal coliform counts than households
that reported not using these products (p<0.05). During the 9-week prelaunch
period, children <15 years old in intervention families had 0.22 episodes of
diarrhea per person, and in control families had 0.28 episodes per person. During
the 12-week post-launch period, children in intervention families had 0.12 episodes
person, a reduction of 54.5 per cent, and children in control families had 0.28
episodes per person. The slope of the curve describing the weekly incidence of
diarrhea in families in intervention communities showed a rate of decrease of
disease that was significantly greater than in control families (p<0.05).
Remarks - This
project has scaled back because of funding and management problems.
- CLARO
water vessels and disinfectant have been used by PAHO and various NGOs to respond
to a series of local, regional, and national emergencies, including flooding associated
with El Nino, earthquakes, landslides, and cholera epidemics.
For
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