Household Water Treatment Methods in Developing Countries
Water is essential to human survival; yet most people in developing countries do not have access to clean water. Household water treatment methods (HWT) have been implemented in most developing countries, to overcome this problem. HWT methods have proven to be effective; and the consistency of its use is key to receive all of their benefits. Still, old methods are more widely used options within the countries studied;, with boiling being found as the most preferred method. Some of the prevalent problems in acquiring and using other HWT methods, at least for rural areas, is the lack of money or poor infrastructure for their installation. Researchers, have attributed both to the reason of why certain HWT methods are not being fully adopted in certain regions of the world. Nevertheless, household’s preferences show an indicator of what might be adopted and regularly used by any household. This literature review will discuss the preference on HWT adoption in 5 developing countries: India, Peru, Zambia, Kenya and Mexico.
Clean water is essential to a sustainable development (WHO/UNICEF, 2005). It is critical for socio-economic development, food production, a healthy ecosystem and for human survival itself (WHO and UNICEF, 2012). Household water treatment happens at the point of water collection or use, rather than at a large, centralized location (Lantagne et al., 2017). It can effectively reduce exposure to unsafe drinking water at home in developing countries, increase decent sanitation and hygiene, and they have also been provend to reduce poverty (Rietveld et al., 2018). Many studies have confirmed that having access to clean water can drive economic growth, keep kids in school and increase opportunities for women and girls (Reygadas et al., 2018; Lantagne et al., 2017). Currently there are a variety of HWT methods thatwhich have been implemented in developing countries, and some of them have been proven to be preferred among the others. As shown by researchers, there are factors that influence preference for and adoption of any HWT methods (Albert and Luoto, 2010). These factors will be analyzed to explain why it is important to be aware of them before implementing new methods in developing countries.
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A community’s specific circumstances make it difficult to choose a specific HWT method to be preferred. The most appropriate option for a community depends on many factors, such as: “existing water, sanitation conditions, water quality, cultural acceptability, implementation feasibility, availability of technology, and other local conditions” (WHO/UNICEF, 2012). Taking into consideration all of the factors previously mentioned, studies made in five countries were analyzed. In order to reduce bias, all samples were taken in both rural and urban areas.
A study by Burt et al, performed in 2017 specifically investigated the use of HWT in this region, and used a sample of 556 households. The areas represented two low-income districts with low-quality water sources. Burt et al., (2017) compared preferences for boiling to other methods commercially used and available. Households were asked about their source of water, how they perceived their water quality, how it was collected and used. The study chose Muslim and Christian regions, to cover a range of cultures and geographies of the country. It considered different factors that influenced preference for a HWT adoption: low cost, commercially available, portable and efficacious (Burt et al., 2017). Traditional methods, such us, boiling and ceramic post filters were compared to newer methods as PUR filtration, tablets and siphons.
A new method on water treatment discussed by Reygadas et al., (2017), known as Ultraviolet (UV) Disinfection was tested. Unlike chemical approaches to water disinfection, “UV light provides rapid, effective inactivation of microorganisms through a physical process. When bacteria and viruses are exposed to the germicidal wavelengths of UV light, they are rendered incapable of reproducing and infecting” (Lantagne et al., 2017). Reygadas et al., (2017) studied 24 rural communities, consisting of 34 households. At the beginning of the study, the communities did not have functioning piped water systems, most people relied on untreated water from local springs and shallow wells for drinking water (Reygadas et al.,2018). Similar to Burt et al., (2017) traditional methods were compared to newer methods, in this case UV Disinfection.
Huaylino et al., (2017) studied a sample of 78 homes, and determined the type of HWT method used, as well as households self-report on how effective the method used was. Consistency of reported HWT practices was high in both urban (100%) and rural (93.3%) settings, as was availability of treated water (based on self-report) in all sampling points (Huaylinos et al., 2017). In addition, Huaylinos et al., (2017) reconsider how HWT methods should be promoted, implemented and monitored to ensure its effectiveness in day-to-day conditions. Similar to the design and purpose of this study, Lantagne et al, (2010) concluded that the proper use of HWT methods is critical to achieving the full health impact of this intervention.
A 6-month case study was conducted in Peru, a country in which 82.8% of households’ report treating their water at home (Lanata et al., 2017). The analysis had a sample of 229 households, and water samples were made to assess que quality of water being consumed. Lanata et al., (2017) reported that consumption of untreated water in the home among adults and children was common, which was later corroborated during home observations. Similar to the studies made by Reygadas et al., (2017) and Huaylinos et al., (2017) the drinking water of self-reported users was significantly better than the source water in the urban setting and negligible but significantly better in the rural setting.
Rosa et. al, (2016), made a study with a sample size of 480 households (203 rural and 276 urban). Similar to the studies made in Peru, India and Mexico ( Reygadas et al., 2017; Huaylinos et al., 2017; Lanata et al., 2017) the availability of self-reported treated water was low at the beginning of the study, with only 23.3% and 4.2% of urban and rural households, respectively. All of the households being surveyed had at least one child; in order to avoid bias of single households. The households were surveyed three times in a period of 4 weeks, to keep track of consistency and perception of HWT methods in the area (Rosa et al., 2016).
The study performed by Burt et al, (2017) reported a high usage of the assigned HWT methods. It showed that ceramic pot filters and boiling are the cheapest options, at least for the participants who were not willing to pay the price of the other methods (Burt et al., 2017). Another study, similarly showed that ceramic pot filters are indeed one of the cheapest ways to treat water (Lantagne et al., 2017). The user preference (Figure1) indicated that boiling (with an efficient stove) and the pot filter (with a storage container) were the most preferred HWT options, even before costs were factored in (Burt et al., 2017). The pot filter was preferred across districts and across source water quality, as has been observed in the study made in South Asia (Freeman et al., 2012) but preferences for boiling were on par with the pot filter (Burt et al., 2012). The chlorine additives, siphon filter and PUR were generally given low rankings. The study made by Burt et al., (2017) also indicated that even when boiling was not as easy to use as tablets, siphons and purifiers, the water tasted better and it was a more effective method. At least 26 % households, who denied the survey, had roughly the same rankings for boiling as the households that did take the survey, implying that they did not decline to take the survey simply because they preferred the one system that did not require any purchase (Burt et al., 2017). This once again shows the preference is more inclined to whether people can afford the product, without taking into consideration other factors (Rietveld et al., 2018).
The targeted population still showed preference for boiling and in-home chlorination, as well as garrafon-bottled water. “Garrafon” is a term to describe big buckets of cleaned water sold by a certified vendor. Less than 20% of the population chose to switch their traditional method (boiling and chlorination) to try U.V radiation (Reygadas et al., 2017). The study made by Reygadas et al., (2017) determined that preference was based on the communities and their economy. In addition, enhanced communities (medium to high income), preferred to purchase garrafon-bottles, because they were able to do so. On the other hand, basic communities (low income) preferred boiling and chlorination as a baseline drinking practice. These reports seem to support the idea that people’s preference is based mostly on the price of the product (Rietveld et al., 2018).
As observed in table 1, boiling was the preferred HWT method, with a self-report usage of 53.4% in rural areas and 64.4% in urban areas. Supporting Reygadas et al. (2017), rural areas had a higher percentage of use of HWT methods than urban areas because of their income and ability to afford a different method. Still, filtration appeared to be more effective health wise than boiling (Huaylinos et al., 2017). According to Huaylinos et al., (2017) among the urban and rural boilers, households were not aware of the direct costs of boiling, as they had never calculated how much fuel would be used for this task specifically, as opposed to cooking. However, in both settings, all households reported that the money spent was worthwhile as otherwise this would be spent on medical fees (Huaylinos et al., 2017).
Table 2 displays the report of different HWT methods used. As shown boiling was the highest percentage with 97.1% in rural areas and 92.6% in Urban areas. All but one urban respondent and half of rural participants reported boiling their water on a daily basis. Householders in both settings reported treating their water throughout the year; and showed preference for boiling because it was affordable and available at all times (Lanata et al., 2017). In comparison to the study by Reygadas et al., (2017), there was no difference in preference based on the communities’ income, they both prefered boiling even when they could afford other HWT methods. Even when the self-reported HWT-use was higher than 80% in both rural and urban areas; Lanata et al. (2017) reported that the consumption of untreated water at home among adults and children was highly common during home observations. Therefore, the main concern for this study was not in people’s preference but on the accuracy of self-report (Lanata et al., 2017).
Table 3 shows that Chlorination was the most preferred method in both urban and rural areas, with a self-report usage of 87.9% and 97% respectively. In comparison to other studies (Reygadas et al., 2017, Huaylinos et al., 2017, Lanata et al., 2017), the use of boiling as a HWT method was less than 11% combining both settings. In addition, Rosa et al., (2017) determined that less than 45 % of the heads of households in both settings had completed secondary or higher education, and couldn’t afford other commercial methods besides at home chlorination. Similar to the study made by Rietveld et al., (2018) those who completed a higher education were able to adopt non-traditional HWT methods besides chlorination and/or boiling (Rosa et al., 2017).
This literature review was written to raise awareness on how understanding people’s preferences on certain HWT methods can increase its adoption among developing countries. Preferences were an important indicator of what might be adopted and regularly used (Albert et al., 2010); other factors such as effectiveness and affordability were evaluated as well (Lanata et al., 2014; Freeman et al., 2012). Developing countries tend to prefer simple and old fashioned methods primarily because of their price (Reygadas et al., 2018; Burt et al., 2017; Albert et al., 2017). Boiling is the most widely used option within the countries studied, as it is in other parts of the world (Rosa et al., 2010). Even when gathering fuelwood and heating water for boiling required time and labor, factors such as saved time or other advantages of the retail HWTS products were not enough to induce other households to adopt other methods because of their apparent increased price (Burt et al., 2017). Findings suggest that boiling, the only HWT method currently practiced at a global scale, is still being preferred by many communities to several highly-marketed retail products (Rosa et al., 2017). Furthermore, the studies found that this preference was not only true for boiling, but other old-fashioned methods such as chlorination and ceramic-pot filters as well.
- Some studies had small samples of less than 100 households ((Reygadas et al.,2018; Huaylinos et al., 2017) in comparison to samples larger than 400 households (Burt et al., 2017; Rosa et al., 2016). Because more data is always better in order to provide a more accurate analysis, a bigger sample is recommended to achieve more accurate results. In most case scenarios people refused to take the surveys, because they couldn’t afford trying a new method (Burt et al., 2017). Therefore, finding a way to provide these methods for free for people to try them, in order to have a bigger sample size, could have changed some of the data.
- It is hard to study all the challenges that make some HWT methods available through developing countries. Therefore, it is hard to compare data directly across countries. As mentioned by WHO and UNICEF (2012) and showed in this literature review, the adoption of any HWT method for a community depends on many factors. For that reason, studies comparing similar countries which share similar cultures, challenges, and perhaps even geography and how these factors influence HWT methods used could help in more accurately identifying what methods are more likely to be adopted in those specific countries or regions.
- It is recommended that further research be made on whether cultural background plays a major role and its directly correlated to the adoption of HWT methods (Rosa et al., 2017; Lantagne et al., 2017) or not. For example, observations showed that households in Central and South America and South Asia (Reygadas et al., 2017; Huaylinos et al., 2017) tend to prefer boiling, while households in Africa preferred Chlorination (Rosa et al., 2017).
- Some studies showed how education had a direct correlation with adoption of HWT methods (Rietveld et al., 2018; Rosa et al., 2017). Still, not only determining whether education is correlated to adoption of HWT methods, but also helping people understand other methods (besides the traditional ones) could help increase this methods likelihood of adoption. For example, LifeStraw, a membrane filtration HWT method, invented and launched in 2006 was not part of any of the studies presented today; even though it is simple, cost-effective and commercially available (Salwa et al., 2009). A study done in Gezira Sudan consisting of 734 people showed that LifeStraw was used for a short period of time before people went back to using traditional methods (Salwa et al., 2009). Salwa et al., (2009) determined that further research was going to be needed on the LifeStraw, in order to increase knowledge about all its benefits. Research has still not been done on this matter and it has been more than 10 years.
- A major concern was not only in the preference of HWT methods use, but also in the quality of water being consumed (Rosa et al., 2010; Reygadas et al., 2017; Freeman et al., 2012; Lanata et al., 2017). The majority of studies were based on self- report (Reygadas et al., 2017; Lanata et al. 2017; Lantagne et al., 2017) and people’s perception of their quality of water being consumed. Therefore, actual biological research should be made across these countries to evaluate the bacteria in the water along with possible solutions to help the problem.
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