Access to Household Water Quality Information Leads to Safer Water: A Cluster Randomized Controlled Trial in india

Abstract

Household-specific feedback on the microbiological safety of drinking water may result in changes to water management practices that reduce exposure risks. We conducted a randomized, controlled trial in India to determine if information on household drinking water quality could change behavior and improve microbiological quality as indicated by Escherichia coli counts. We randomly assigned 589 participating households to one of three arms: (1) a messaging-only arm receiving messaging on safe water management ( n = 237); (2) a standard testing arm receiving the same messaging plus laboratory E. coli testing results specific to that household's drinking water ( n = 173); and (3) a test kit arm receiving messaging plus low-cost E. coli tests that could be used at the household's discretion ( n = 179). Self-reported water treatment increased significantly in both the standard testing arm and the test kit arm between baseline and follow-up one month later. Mean log E. coli counts per 100 mL in household stored drinking water increased in the messaging-only arm from 1.42 to 1.87, while decreasing in the standard testing arm (1.38 to 0.89, 65% relative reduction) and the test kit arm (1.08 to 0.65, 76% relative reduction). Findings indicate that household-specific water quality information can improve both behaviors and drinking water quality.

Development and field testing of low‐cost, quantal microbial assays with volunteer reporting as scalable means of drinking water safety estimation

“…Because tests are performed by users on water they actually drink and yield a tangible colour‐change signal, such tests have the potential to convey drinking water risk information to users more convincingly than outsiders giving the same information verbally (Trent et al . ).…”

“…Work continues on developing more user‐friendly reporting platforms (Trent et al . ). Second, participant feedback from community follow‐up meetings strongly suggested that self‐testing and the resultant water quality information had a direct and immediate impact on consumers’ perception of water supplies.…”

“…Without at‐scale monitoring of water quality, poor infrastructure performance may go undetected and waterborne disease risk can be elevated (Trent et al . ).…”

“…Nevertheless, the positive effects of better access to water safety information have already been demonstrated at pilot scale in India (Trent et al . ) using a similar field‐deployable test intended for household use by nonexpert volunteers.…”

“…Unsafe water may also look, taste and smell acceptable to consumers (Orgill et al 2013). Providing a framework that supplies water safety information in a tangible way at the community level can assist with reducing risk, because this information can drive changes to household water management practices, implementing point-of-use treatment technologies, or adjustments in operation or maintenance of supplies (Trent et al 2018). Our experience in volunteer testing campaigns suggests that demand exists for water quality information in the participating rural communities.…”