Household Water Quality Testing and Information: Identifying Impacts on Health Outcomes and Sanitation- and Hygiene-Related Risk-Mitigating Behaviors

Abstract

Background: In 2014, a group of 512 households in multipurpose water systems and also relying on unimproved water, sanitation, and hygiene practices in the Greater Accra region of Ghana were randomly selected to participate in water quality self-testing and also receipt of information in the form of handouts on how to improve water quality. Objectives and Research Design: Using a cluster-randomized controlled design, we study the health, sanitation, and hygiene behavior impacts of the household water quality testing and information experiment. Subjects: The study has three arms: (1) adult household members, (2) schoolgoing children, and (3) control group. Measures: The study measures the effects on handwashing with soap, cleanliness of households, and prevalence of diarrhea and self-reported fever. We also address impacts on child health and nutrition outcomes, particularly diarrhea and anthropometric outcomes. Results: We show that there is high household willingness to participate in this intervention on water quality self-testing. About 7 months after households took part in the intervention, the study finds little impacts on health outcomes and on sanitation- and hygiene-related risk-mitigating behaviors, regardless of the intervention group, either schoolchildren or adult household members. Impacts (direction and extent) are rather homogeneous for most of the outcomes across treatment groups. Conclusions: The study discusses the implications of the findings and also offers several explanations for the lack of transmission of impacts from the household water quality testing and information intervention on health outcomes and on sanitation and hygiene behaviors.

Demand for environmental quality: averting behaviors impacts and valuation in Southern Ghana

“…The link between the experiment and the outcome measures depends on several assumptions, including household participating in the training workshop on water quality testing experiment, household being able to perform water quality testing, household understanding and applying the knowledge on water quality information in managing WASH environment, the test kits being able to differentiate between the microbial quality of different water sources, household switching to improved WASH practices, among others. However, the failure of these assumptions would lead to the inability of the experiment to improve the outcome measures (see also Okyere et al, , 2019Okyere, 2018 for details on research design). This article focuses on outcome measures on averting behaviors and WASH investments that are achievable within the shortest possible time.…”

“…A full description of the experimental design is found elsewhere (Okyere et al, , 2019Okyere, 2018). In summary, the study randomizes the intervention at the school level, with the treatment provided directly to a sample of 128 schoolchildren in four public basic schools, to 128 parents/ guardians in four public basic schools, and no intervention (comparison group) of 256 households in the remaining eight public schools in Ga South municipality and Shai-Osudoku district in the Greater Accra region of Ghana.…”

“…The second phase of the intervention was completed in March 2015 where the information component based on two handouts was repeated for the treatment groups. The treatment households participated in each round of the interventions using the same procedures for both groups and were also told to discuss the intervention with their respective households (see Okyere et al, , 2019Okyere, 2018). Appendix Figure A2 presents the timeline for the data collection and introduction of the experiment.…”

“…One example is the Aquagenx Compartment Bag Test (CBT) or hydrogen sulfide (H 2 S) which is used to test for the level or presence of E. coli in a given water sample. Water quality self-testing, as the name indicates in this study context, involves households testing their own stored water using CBT and relying on the information in managing drinking and general purpose water (see also Okyere et al, , 2019Okyere, 2018).…”

“…One half of the treatment was assigned to schoolchildren while the other one half was assigned to adult household members in order to determine of the effects of intra-household decision-making on information. The comparison group neither participated in the water quality self-testing nor received information on how to improve household water quality (see also Okyere et al, , 2019Okyere, 2018).…”