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. 2012;7(5):e36735.
doi: 10.1371/journal.pone.0036735. Epub 2012 May 7.

High adherence is necessary to realize health gains from water quality interventions

Joe Brown  1 , Thomas Clasen
Affiliations

High adherence is necessary to realize health gains from water quality interventions

Joe Brown et al. PLoS One. 2012.

Abstract

Background: Safe drinking water is critical for health. Household water treatment (HWT) has been recommended for improving access to potable water where existing sources are unsafe. Reports of low adherence to HWT may limit the usefulness of this approach, however.

Methods and findings: We constructed a quantitative microbial risk model to predict gains in health attributable to water quality interventions based on a range of assumptions about pre-treatment water quality; treatment effectiveness in reducing bacteria, viruses, and protozoan parasites; adherence to treatment interventions; volume of water consumed per person per day; and other variables. According to mean estimates, greater than 500 DALYs may be averted per 100,000 person-years with increased access to safe water, assuming moderately poor pre-treatment water quality that is a source of risk and high treatment adherence (>90% of water consumed is treated). A decline in adherence from 100% to 90% reduces predicted health gains by up to 96%, with sharpest declines when pre-treatment water quality is of higher risk.

Conclusions: Results suggest that high adherence is essential in order to realize potential health gains from HWT.

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Conflict of interest statement

Competing Interests: This study was supported in part by a grant to the London School of Hygiene & Tropical Medicine by Unilever, Ltd., which produces and sells point-of-use water treatment products including the Pureit® water filter. Unilever had no role in the design of the study, analysis of the data, or preparation and submission of the manuscript for publication. As an employee of LSHTM and otherwise, TC and JB provide research and consulting services to UN organizations, government agencies, NGOs and private companies that promote water, sanitation and hygiene interventions including point-of-use water treatment products. These include, without limitation, the World Health Organization, UNICEF, the United States Agency for International Development, the Department for International Development, Medentech, Unilever and Vestergaard-Frandsen. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. DALYs averted per 100,000 population, per year, based on assumptions about technology effectiveness (2 log10 reduction in each pathogen class), adherence, and background water quality assumptions from Table 2 .
See this image and copyright information in PMC

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