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Reducing the user burden in WASH interventions for low-income countries

Reducing the user burden in WASH interventions for low-income countries

Publication Year:
Humphrey, Jean H.
Resource Type:
Journal Article
A trial in urban Bangladesh tested an automatic water chlorination device, Aquatabs Flo, to reduce child diarrhoea. While effective, challenges arose: compatibility with only specific water systems, global lack of piped water access, varying intervention effects between neighborhoods, and 18% of sites rejecting the chlorinated water due to taste and smell concerns. The solution may not be universally applicable.
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Resource Information


Faecal-pathogen-free living environments, food, and drinking water are irrefutably fundamental to human health. Nonetheless, several controlled experiments have failed to prove that WASH interventions, designed to reduce faecal exposure, improve health outcomes. These disappointing findings do not challenge the biological plausibility that water, sanitation, and hygiene (WASH) services are essential to health, but do suggest that low-cost WASH interventions—those often available to rural dwellers in low-income countries—might not reduce the extremely high concentrations of contamination characteristic of impoverished living conditions to the very low concentrations of contamination required for health.

Resource Type

Journal Article

Publication Year



Humphrey, Jean H.



Relevant Country


Specific Contaminants

Bacteria, Escherichia coli

Specific Solutions

Aquatabs Flo

University Affiliation

Johns Hopkins Bloomberg School of Public Health

Business Connect Takeaways

The article discusses the results of a study that evaluated the effectiveness of in-line drinking water chlorination in reducing child diarrhoea in urban Bangladesh. The study was a double-blind, cluster-randomised controlled trial that included baseline data collection, randomisation and intervention delivery, and up to 14 months of follow-up data collection. The results of the study showed that in-line drinking water chlorination was effective in reducing child diarrhoea in urban Bangladesh.
The study found that the intervention reduced the incidence of diarrhoea by 22% and the prevalence of faecal contamination by 68%. In-line chlorination was also found to be more cost-effective than other household water treatment interventions. The potential implications of this technology for improving public health in low-income settings beyond Bangladesh are significant.
The article highlights the importance of improving access to safe drinking water in low-income settings to reduce the burden of diarrhoeal disease. The authors note that diarrhoeal disease is a leading cause of morbidity and mortality in low-income settings, particularly among children under five years of age. In-line drinking water chlorination is a low-cost, low-maintenance technology that can disinfect drinking water without electricity, and has the potential to improve access to safe drinking water and reduce the burden of diarrhoeal disease in many low-income settings around the world.

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