Waltaji Terfa Kutane, WHO Ethiopia [email protected]
14-18 October 2013University of North Carolina
Drinking Water Supply Sanitary Survey and Microbiological Water Quality Assessment from Source to Home Storage in Gambella, Ethiopia
Outline
• Introduction
• Study Objective
• Methodology
• Result and Discussion
• Conclusion
• Actions following the study Result at national level
Introduction • The principal risks to human health associated with the consumption
of contaminated & polluted water are microbiological in nature.
• Dated back to Dr.John Snow's discovery of 1854 Broad Street cholera outbreak in England was spread by contaminated water.
• Most common & widespread danger contamination is either directly
or indirectly, by sewage, by other wastes, or by human or animal excrement
• Exacerbated by poor Sanitation & hygiene behavior/practice in the water supply system including household
• Coliform bacteria are present in large number in excrement & sensitive indicator of the presence of faecal contamination.
Introduction Poor latrine facilities and open defecation coupled with hygiene behavior are
responsible for improved water supply contamination
Prüss-Üstün A, Bos R, Gore F, Bartram J. Safer water, better health: costs, benefits and sustainability ofinterventions to protect and promote health. World Health Organization, Geneva, 2008.
Introduction… Ethiopia
• Access to safe water supply was 49% (U=97%, R=39) using 2011 data– Piped 9%– Other improved 40%– Current coverage 54% National WASH Inventory
• Access to improved +shared sanitation facilities was 34% % (U=69%, R=25%)
• Access to any sanitation facilities 55% including un improved latrine facilities
Source:2013 JMP update
Introduction… Ethiopia Safe water supply coverage based on the national standard is:
• Adopted from WHO GV the 2001 Ethiopia Standard:– Drinking-water should not contain any microorganisms known to be pathogenic—capable of
causing disease—or any bacteria indicative of fecal pollution
• Urban: – dwellers that can obtain at least 20 liters/person/day throughout the year from a source within 0.5 km of the
household.• Rural: – dwellers that can obtain at least 15 liters/person/day throughout the year from a source with in 1.5 km of the
household.
• In both cases the water must either be collected from: – an improved source such as protected well, improved & protected spring, sanitary rainfall catchment, etc.; or – can otherwise be treated to acceptable standards
• The national definition is in line with the five basic indicators included in the definition of safe water supply :– Quantity– Quality– Cost/ affordability – Continuity(24hours/day; 7days/week, 30 days/month, 365days/year)– Coverage /accessibility
Study Objective • To identify risk factors responsible from source to household level
for poor microbiological water quality of water supply system targeted for the survey
• To determine the level of contamination & microbiological quality of water supply system and household targeted by the survey
• To verify whether water supply included in this study met the national definition/satandard of safe water supply
• To inform the water supply system, health decision &development partners the importance drinking water quality incremental improvement through risk identifcation & management/ mitigation
Methodology
Household have access to improved source
Observation and interview
WHO standard sanitary survey form for water source & HH
risk identification Indicator bacteria test (Total coliform and E. coli using
Membrane filtration technique
Result and Discussion
• 69.8%, 20%, 19.3%, 6.3%, 4.1% and 2.7% of the survey respondent households use municipal supply, protected wells, protected springs, river & pond respectively.
• Only 30.6% of the surveyed households getting half(10/litter/person/day) of the WHO recommended 20 litters per person per day for developing countries; 53.4% less than 6 litter & 16% they don`t know
• No reliable system at grass root level, which can track timely the issue of maintenance, community has to wait for more than a month from center to get back broken hand pumps.
Result and Discussion Result of Sanitary Risk Assessment for Improved Water Source Type of Source Number Sanitary Risk Score
Low Intermediate
High Very High
Protected well 15 1 2 8(53.3%)
4(26.7%)
Protected Spring
11 2 1 5(45.5%)
3(27.3%)
Piped water supply
4 1 2 1(25%) 0
Total 30 4(13.3%)
5(16.7%)
14(46.7%)
7(23.3%)
Household level Sanitary Risk Assessment Result Number of Household
Sanitary Risk Score Low Intermediate High Very High Remark
365 37(10.1%)
29(7.9%)
194(53.2%)
105(28.8%)
All HH use the above improved sources
Improved vs Safe Drinking Water
Boreholes & tube wells…31% not safe
Protected springs…….37% not safe
Protected dug wells….. 57% not safe
Source http://www.undispatch.comndg.water.target.met.but.what.about.sanitation.and.darrhea
Result and Discussion
Sample source Number of Sample
Cfu/100ml(Total Coliform)<1(A) 1-10(B) 11-50© 50+(D)
Improved Spring 4 0 4(100%) 0 0Improved Well 8 0 2(25%) 6(75%) 0Pipe System 3 0 3(100%) 0Pipe reservoir 1 0 1(100%) 0 0Home storage 14 0 3(21.4%) 10(71.4%) 1(7.2%)Total 30 0 13(43.3%) 16(53.3%) 1(3.3%)
Microbiological Water Quality Test Result
Improved well 4(50%) +Ve for E.coliHousehold level 3 (21.4%) +Ve for E.coli
Similar Study in North Gondar…. E.Coli
Water Line Pipe (n=14) …. 7(50%)Improved Well(n=14)……….4(28.6%)Improved Spring(n=14) …5(37.7%)
Source: Ethiopia, JHD, 2004
Based on WHO Grading system of microbial quality
Grade A…0%Grade B……43.3%Grade C…53.3%Grade D……3.3%
Result and Discussion • WHO/UNICEF JMP RADWQ, 2004-2005 result for Ethiopia Compliance
with national standard & WHO Guide line– Microbiological Quality sample from source
• Piped…………………..87.6%• Protected springs …. 43.3%• Borehole…………………67.9%• Protected well………..54.9• Total……………………….72%
– Microbiological Quality sample from household (n=1000)• Fecal contamination ……………….55%
– Sanitary survey Result • Protected springs 316 inspected found spring box absent or
faulty38.3% and diversion ditch above the spring absent or non-functional 87%
• Piped water distribution system 428 inspected found cracks in the pre-filters 21.1% and mud balls or cracks in any of the filters 15.8%
Result and Discussion
Education level(n=635)
Diarrhoea Typhoid Dysentery
Hepatitis
Cholera Parasite
No % No
% No % No % No % No %
1-3 22 3.5 3 0.5 7 1.1 0 0.0 11 1.7 7 1.14-6 64 10. 1
32.0 9 1.4 5 0.8 20 3.1 23 3.6
7-9 48 7.5 14
2.2 11 1.7 6 0.9 16 2.5 21 3.3
10-12 80 13 20
3.1 19 2.9 9 1.4 27 4.3 26 4.1
>12 29 4.6 11
1.7 9 1.4 6 0.9 14 2.2 15 2.4
Read & write
86 14 7 1.1 10 1.6 2 0.3 31 4.6 34 5.4
Illiterate 139 22.0 19
2.9 13 2.0 9 1.4 32 5.0 78 12.3
Total 468 74.6 87 13.5 78 12.1 37 5.7 151 23.4 204 32.2
Knowledge of respondent about disease prevention by using safe Water supply by educational level , Gambella, Ethiopia
significant difference with educational level on prevention of diarrhoea with safe water compared greater than 12 grade with illiterate (X²= 10.96; P<0.001).
Better understanding /knowledge with respect to diarrhoea, cholera and parasite
Result and Discussion
Education level(n=579)
Cup Dirty container
Uncovered container
Dirty cover
Chicken/ animals
Drawing by hand
No % No % No % No % No % No %
1-3 14 2.4 11 1.8 10 1.7 4 0.7 0 0 10 1.74-6 32 5.5 29 5.0 45 7.7 15 2.6 6 1.0 54 9.37-9 29 5.0 23 3.9 28 4.8 15 2.6 10 1.7 31 5.410-12 48 8.3 47 8.1 50 8.6 26 4.5 11 1.8 44 7.6>12 15 2.6 19 3.3 19 3.3 13 2.2 8 1.4 16 2.7 Read and write
72 12.4 66 11.4 37 6.4 13 2.2 3 0.5 20 3.5
Illiterate 82 14.2 100 17.3 113 19.5
42 7.3 17 2.9 39 6.7
Total 292 50.4 295 50.8 302 52 128 22.1
55 9.3 214 36.9
Knowledge of respondents on water container contamination as means of waterborne disease transmission in the home, Gambella, Ethiopia
More than half of respondent claimed that uncovered container , dirty container & use of the same cup for water drawing & drinking are responsible for disease transmission
Photo, Arto S, WASH COM
Result and Discussion Drinking-Water Handling Practice at Home (n=635)
Result and Discussion Latrine and hand washing facilities availability, utilization and cleanse(n= 635)
Conclusion • The aim of any safe water supply program/project is to reduce the
risk of contamination at least to the lowest level. However, in the study area this objective was not achieved.
• Four major problem areas of public water supply were identified:– Quality with sensitive indicators coliform and E.Coli organisms indication of
contamination– Risk factors for contamination from source to household level – Knowledge gap on disease prevention using safe water and contamination of
water– Quantity acute shortage & none functionality/lack of reliable preventive
operation and maintenance system
• Ad hoc water quality testing and absence of risk assessment/ sanitary survey in the study area
Conclusion • Finally three conclusions can be drawn from this study:
– Though, putting in place water supply infrastructure is apriority in any water supply programme/project, the risk of contamination is all ways there regard less of the complexity of the infrastructure.
– Availability of the water supply infrastructure does not grantee always the five basic indicators included in the definition of safe water supply :
• Quantity• Quality• Cost/ affordability • Continuity(24hours/day; 7days/week, 30 days/month, 365days/year)• Coverage /accessibility
– Once water supply infrastructure is in place hygienically management from source to mouth need systematical well designed and planned interventions at home to achieve the objective of Framework for safe drinking-water
Recommendation
Addressing Water Quality strategically
As part of O&M
As integral part of the
water supply system
Management
Risk identifcation, prioritization
& prevention/mi
tigation
Actions following the study ResultCapacity building training and field level
water quality testing equipment Mitigation of risks based on the priority
National Drinking Water Quality Monitoring
Surveillance Strategy developed with detail
financial resource requirement and activities
Recent development WSP piloting and
framework development
