Adapting a safe water storage container to improve household stored water quality in rural Burkina Faso: a cluster randomized trial

Abstract

Safe water storage protects household drinking water from microbial contamination, maintaining water quality and preventing diarrhea and other water-borne diseases. However, achieving high adoption and sustained use of safe storage is challenging. Systematic adaptation can address these challenges by improving contextual fit while retaining core functionality to protect water quality. We applied Plan-Do-Study-Act (PDSA) cycles to systematically adapt a safe water storage container (SWSC) intervention for implementation in rural Burkina Faso. This study describes the adaptation process and the impacts of the SWSC on Escherichia coli contamination in household stored water in a cluster-randomized trial with 49 intervention villages (274 households) and 50 no-intervention control villages (290 households). SWSC adoption among intervention households was high (88.9%). The intervention achieved approximately a 0.4 log reduction in E. coli contamination. Intervention impact was likely moderated by differential changes in improved source use across intervention and control households. Safe storage improves water quality when used consistently. PDSA frameworks can guide the adaptation of safe storage interventions to optimize adoption and sustained use in new contexts while preserving core functions that protect water quality.

Identifying predictors of E. coli in rural household water in sub-Saharan Africa using elimination regression

“…Trials of safe storage interventions in West Africa have struggled to achieve high, sustained uptake, and improper storage was commonly observed (e.g., using a communal cup to scoop water instead of dispensing it via the tap). 48,49 The potential for water contamination after collection varies between settings. Contamination potential is exceptionally high in locations where water is collected offpremises, transported, and stored, as each step offers a new potential entry point for contamination.…”

Adaptation of Water, Sanitation, and Hygiene Interventions: A Model and Scoping Review of Key Concepts and Tools

“…Our systematic literature search yielded no examples that referenced core functions, nor analogous concepts under a different name. We found two examples of WaSH adaptation taking a systematic approach to assessing potential outcomes, but this was done through empirical data collection on key pre-selected outcomes using continuous quality improvement framework (21,86). Overall, the scope of potential outcomes considered by all WaSH studies was limited, typically only direct health impacts expected of the intervention (e.g., diarrheal disease prevalence) or intermediate outcomes such as functionality and use of WaSH infrastructure.…”

“…Most published literature of WaSH intervention adaptation reports adaptation in the early stages of programming, typically in intervention design stage before any implementation has been done, or in the pilot stage before implementation at-scale [see, e.g., (18)(19)(20)(21)]. These studies report adaptations designed and implemented with strong support from academics.…”