Journal Article

What Point-of-Use Water Treatment Products Do Consumers Use? Evidence from a Randomized Controlled Trial among the Urban Poor in Bangladesh

Unicomb, Leanne, Najnin, Nusrat, Mahmud, Minhaj, Islam, M. Sirajul, Albert, Jeff, Levine, David I., Luby, Stephen, Luoto, Jill

2011

Overview

There is evidence that household point-of-use (POU) water treatment products can reduce the enormous burden of water-borne illness. Nevertheless, adoption among the global poor is very low, and little evidence exists on why. We gave 600 households in poor communities in Dhaka, Bangladesh randomly-ordered two-month free trials of four water treatment products: dilute liquid chlorine (sodium hypochlorite solution, marketed locally as Water Guard), sodium dichloroisocyanurate tablets (branded as Aquatabs), a combined flocculant-disinfectant powdered mixture (the PUR Purifier of Water), and a silver-coated ceramic siphon filter. Consumers also received education on the dangers of untreated drinking water. We measured which products consumers used with self-reports, observation (for the filter), and chlorine tests (for the other products). We also measured drinking water's contamination with E. coli (compared to 200 control households). Households reported highest usage of the filter, although no product had even 30% usage. E. coli concentrations in stored drinking water were generally lowest when households had Water Guard. Households that self-reported product usage had large reductions in E. coli concentrations with any product as compared to controls. Traditional arguments for the low adoption of POU products focus on affordability, consumers' lack of information about germs and the dangers of unsafe water, and specific products not meshing with a household's preferences. In this study we provided free trials, repeated informational messages explaining the dangers of untreated water, and a variety of product designs. The low usage of all products despite such efforts makes clear that important barriers exist beyond cost, information, and variation among these four product designs. Without a better understanding of the choices and aspirations of the target end-users, household-based water treatment is unlikely to reduce morbidity and mortality substantially in urban Bangladesh and similar populations.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Bangladesh / Ceramic coatings / Ceramic powders / Chlorine / Cities - economics / Clinical trials / Consumer Behavior - economics / Consumer education / Consumers / Contamination / Copyright / Developing countries / Dilution / Disinfectants - administration & dosage / Disinfectants - pharmacology / Disinfection - economics / Disinfection - methods / Disinfection - statistics & numerical data / Drinking water / Drinking Water - microbiology / E coli / Earth Sciences / Environmental health / Escherichia coli / Escherichia coli - isolation & purification / Filtration - statistics & numerical data / Food Contamination - prevention & control / Health education / Households / Humans / Hygiene / Laboratories / LDCs / Low income areas / Low income groups / Medical research / Morbidity / Poverty / Powders (Particulate matter) / Product introduction / Public health / Sanitation / Science Policy / Self Report / Social and Behavioral Sciences / Social Class / Sodium / Sodium dichloroisocyanurate / Sodium hypochlorite / Studies / Tablets / Urban poor / Urban populations / Urban poverty / Water pollution / Water purification / Water Purification - economics / Water Purification - methods / Water Purification - statistics & numerical data / Water quality / Water treatment / Waterborne diseases