Assessing the Impact of a Risk-Based Intervention on Piped Water Quality in Rural Communities: The Case of Mid-Western Nepal

Abstract

Ensuring universal access to safe drinking water is a global challenge, especially in rural areas. This research aimed to assess the effectiveness of a risk-based strategy to improve drinking water safety for five gravity-fed piped schemes in rural communities of the Mid-Western Region of Nepal. The strategy was based on establishing community-led monitoring of the microbial water quality and the sanitary status of the schemes. The interventions examined included field-robust laboratories, centralized data management, targeted infrastructure improvements, household hygiene and filter promotion, and community training. The results indicate a statistically significant improvement in the microbial water quality eight months after intervention implementation, with the share of taps and household stored water containers meeting the international guidelines increasing from 7% to 50% and from 17% to 53%, respectively. At the study endline, all taps had a concentration of <10 CFU Escherichia coli/100 mL. These water quality improvements were driven by scheme-level chlorination, improved hygiene behavior, and the universal uptake of household water treatment. Sanitary inspection tools did not predict microbial water quality and, alone, are not sufficient for decision making. Implementation of this risk-based water safety strategy in remote rural communities can support efforts towards achieving universal water safety.

Assessing Drinking Water Quality at the Point of Collection and within Household Storage Containers in the Hilly Rural Areas of Mid and Far-Western Nepal

“…This study also highlighted the fact that sanitary inspection results at the household level did not reliably predict microbial quality of stored water, as has been raised by other studies [21,34]. Instead, only one variable is significantly correlated with storage water quality (last paragraph in Section 3.2).…”

“…These findings raise questions about the adequacy and completeness of common sanitary inspection checklists at the household for predicting actual health risks. These finding are corroborated by Robinson et al [21], who argued that sanitary inspection forms in rural Nepal, while useful for general risk assessment and risk management of spring-fed piped water schemes, cannot replace regular water quality testing for monitoring purposes.…”

“…E. coli concentration data were exponentially distributed, so these variables were log 10 transformed, with all zero values being replaced by 0.5 prior to transformation. This approach is commonly used in environmental microbiology studies when analysing and reportings both mean and standard deviation; see for example [4,20,21]. However, since the transformed data did not meet the assumptions of parametric testing methods, i.e., assumptions of normality or linearity, we used non-parametric testing equivalents for the water quality-related analyses; see for example another study that used non-parametric tests for log transformed data [22].…”

A Bayesian Belief Network model to link sanitary inspection data to drinking water quality in a medium resource setting in rural Indonesia

“…Snoad et al 13 utilized logistic regression to predict the fecal contamination by SI and their AUC values were low (range 0.41–0.64). Other authors also used multiple statistical analyses and found that SI variables could not explain well the water quality 10 , 14 , 16 , which imply that our models (with AUC values of 0.69 and 0.84) were slightly better in predicting the water quality at POU, using SI data.…”

Appraisal of Public Pipe-borne Water Quality in Jimeta/Yola Adamawa State (Nigeria): From the Treatment-plants to End-user Points

“…The pipe-water supply according to the study was characterized by an irregular flow that runs weekly or twice a week and in some cases, thrice a month [5]. The irregular or intermittent piped water supply was reported to serve as a causative medium through which contaminates entered the water channels, thus increasing the risk to public health [7,19,20].…”