Water Quality and Health Impacts in Rural Water Schemes Matthew W. Hurst¹ , Mamaru A. Moges² ¹ School of Civil and Environmental Engineering, Cornell University ² School of Civil and Water Resources Engineering, Bahir Dar University
Introduction • CMP is a system that is well established as a sustainable way to implement and maintain rural community water points • However, the direct health impacts have not been studied extensively. • Research questions include: – Does construction of the scheme and providing scheme water changes the health status of the computer? – If so, how does this change community health status? – Is there a link between functionality, sustainability, and health?
Functionality, sustainability, and health • Health: self-reported incidence in the past year of diarrheal disease and other waterborne diseases • Sustainability: long term functionality • Functionality: accessibility and coverage – Accessibility: number of hours in a day water is available for the community – Coverage: % of community population that lives within 1.5 km of the water source
Study Area-Sostu Tirba • Study area was the most seriously affected in 2008 by AWD outbreak (Acute Water Diarrheal) • The Woreda Health Office and Water Resource Development Office reports 100% sanitation coverage and 100% water coverage • We want to investigate if these claims are true given the outbreak of AWD • There are enough CMP and non-CMP water points in the kebele of Sostu Tirba for comparison
Objectives • Development of methodology for indexing sustainability of rural water supply schemes • Study how hygiene and WASH infrastructure are related to household health (measured as self-reported waterborne disease incidence) • WASH mapping for these communities
Materials and Methods
Surveys and Interviews • Survey has 150 questions divided into 8 sections (based on WHO/UNICEF, 2004) – (1) general information – (2) socio-economic conditions – (3) water supply – (4) transport, handling and storage of water – (5) hand washing behavior – (6) latrine use – (7) other sanitation and hygiene behaviors – (8) health
Number of 2 z p ( 1 p ) N Gott/Scheme households Sample size n 2 2 e ( N 1 ) p ( 1 p ) z Amicha 35 26 Betena 52 34 Where: Chimna 43 30 Degegno 45 31 N is the total number of Gimar 50 34 households in Tirba, Jagita 42 30 p is the expected proportion Jalta 16 14 of people who are expected Jomera 58 37 to have waterborne disease Jomeram 3 3 KesMen 45 31 (since this unknown, a 50% KidaneM 54 35 value was chosen as this Kiflusta 39 28 yields maximum sample size), KiIaj2 49 33 e is the confidence interval KilajI 48 33 ( ± 10%) and z is a standard Lacosta 36 27 Manaja 44 31 variate from a normal Mesekela 54 35 distribution (at the 95% Shumasta 52 34 confidence level , z = 1.96). Sigure M 48 33 TachJ1 46 32 TachJ2 44 31 Walkiti 63 39 Yemala1 49 33 Yemala2 32 25 Total Number Surveys 719
Interview with WASHCos and Pump Attendants WASHCos: Pump Attendant: • Quality and presence of • Training documentation • Roles and responsibilities • Financial management by regarding operation and WASHCo including fee maintanence collection structure • Functionality of the • Management of the system scheme (i.e., availability of spare parts, etc.) • Areas for improvement • Water quality and water safe planning: procedures and records
Water Quality • Assess microbiological and physical-chemical quality through turbidity and bacteriological tests • Water is taken from the source and household level • For the household water quality was assessed for transport, transfer, and drinking vessels
3. Materials and Method: Methods
Sustainability Index Total of 20 indicator variables used in developing the index PCA (Principal Component Analysis) of three components – Functionality – governance and operation and maintenance – and community opinion
Component Factors Scoring Factor Component 1-Governance and Operation and Maintenance Public Hearings Held 0.87 Public Audit Held 0.91 Bank Account Present 0.94 Tariff Collection System 0.87 Attendant at Scheme 0.73 Committee 0.86 Implementation Fee Collected 0.71 Spare Parts Available 0.89 Component 2-Community Opinion of Water Scheme and WASHCo Household Feels Consulted in the Decision-making Processes 0.84 Household Feels Price is Fair 0.91 Household Feels System is Well-managed Financially 0.87 Household is Confident that System Attendants can Fix Problems as they Arise 0.61 Household is Confident that the Overall Training the WASHCo and System Attendants Received is Adequate 0.59 Household feels that they can Afford all the Water that they want 0.28 Household Members Attended Planning and Public Meetings 0.15 Component 3-Functionality of Scheme Average Hours per Day Water is Supplied 0.91 Household Ranking of Water Quality during the Dry Season 0.91 Household Ranking of Water Quality during the Wet Season 0.96 Training for Operation and Maintenance was Available when System was Implemented 0.43 Amount of Birr (re-scaled) Collected Each Year 0.47
Results and Discussion
CMP and Non-CMP Sustainability Index
Why are CMP schemes more sustainable? Some, but not all CMP system have better administration in documenting the collection process for tariffs and in carrying out fee collection. • This high level of governance and operation and maintenance rating is reflected in the requirements of communities that apply for schemes: they must have a functioning WASHCo that is trained specifically in implementation and daily operating procedures. • Higher community participation is the result of the community having greater confidence in the ability of the system attendant to operate and maintain CMP schemes and in the WASHCo to manage the scheme. • High community opinion is also related to the community’s willingness to pay for the water service and the likelihood that WASHCo will collect future fees. The functionality was also higher and may be in large part due to the higher numbers of system attendants at CMP points compared to non-CMP points.
Sustainability and Diarrheal Disease Sustainability Diarrheal Disease
Significant factors impacting Sustainability index overlayed diarrheal disease with diarrheal disease incidence
Variables having major impact Factor Coefficient (β) Standard Error P-value Adjusted Odds Ratio Open Defecation 0.94 1.10 0.39 2.56 Open Defecation 1.45 0.86 0.09 4.25 Practiced Before Health Campaign Hand Washing 0.68 0.69 0.33 1.97 Station Located by Latrine ‘Proper’ Defecation 1.05 0.77 0.17 2.85 Practice on Farm Animals Have 1.28 0.74 0.08 3.59 Separate Dwelling from Human Beings Irrigation Practiced -1.30 0.54 0.02 0.27 Proper Disposal of -0.31 0.57 0.59 0.74 Solid Waste Constant -0.77 3.23 1.00 0.46 Analysis of variance for model: adjusted R 2 = 0.18, degrees of freedoms in regression = 7,
Currently, does water quality at the source matter? Source water quality did not show up as a significant variable in the multivariate Regression model as impacting human health WHY? Very little association between diarrheal illness incidence and sustainability or functionality of water source. However, there are two concerns with justifying that improved water source necessarily equates with significantly improved health: (1) source water cannot be safe unless well protected and ultimately disinfected by some means, and (2) disease incidence is related to a plethora of other WASH variables such as utilization of a latrine, hand 18 households overall, n = 61 samples washing, etc.
Transfer vessel contamination • There is also an average increase of 35% between transfer vessels and drinking vessel. • Such results suggest that the drinking vessel provides a surface for water contamination resulting from poor household handling practices. The most likely practice that causes contamination is that the household often wipes the glass out by hands. • Another household practice is leaving standing water in the glass. • The quality of water for washing dishes is often recycled and below the quality of the source water, however, there is not a significant amount of water left in the glass to probably significantly increase contamination,
Conclusions • CMP are far more sustainable compared to non-CMP systems. Due to: (1) governance and operation and maintenance and (2) community opinion. • Sustainability of water points is not correlated with final source water contamination at the household level Even though these schemes give much greater and higher quality of water access to women, there is no evidence that the final contamination in the household is affected by initial source water quality. In addition to this finding, even protected sources have high contamination at the household level. • These two findings together suggest that leaving a residual of chlorine in source water would provide a protective barrier to some of the poor hygienic storage and handling practices of water in the households • Even protected sources can still have high contamination at the household level resulting from poor hygienic handling and storage practices at the household level.
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