Trial of liquid chlorine dispenser models
in urban Bangladeshi households
Shaila Arman
Research Investigator
Water and Sanitation Research Group
Center for Communicable Diseases
icddr,b
Water and Health Conference at UNC, Chapel Hill
1
30 October, 2012
Background
Urban Bangladesh:
 Municipal water most
common source of drinking
water
 Around 60% sample found
contaminated with
microorganism
 Drinking contaminated
water leads to morbidity
and mortality among <5
children
2
Point of use water treatment technology:
 Households that treat their water less frequently
report diarrhea (Clasen et al., 2007)
 Chlorine is a low cost home-based water treatment
technology that can reduce diarrhea (Arnold and Colford,
2007)
 Interventions with liquid chlorine were successful in
some settings (Blanton et al. 2006; Parker et al., 2006; Quick et al.,
2002; Ram et al., 2007; Stockman et al., 2007; Thevos et al., 2000)
3
 In some settings interventions with chlorine were not
consistently used due to:
- peoples satisfaction with quality of currently
available drinking water, even if contaminated
- practices related to storing and purifying
drinking water
- available technologies, where promoted, were
not culturally acceptable and feasible
4
Objectives
 To identify the best chlorine dispenser package (with
or without study provided storage vessel) for use in a
randomized controlled trial
 To provide information for developing culturally
compelling intervention, based on feedback from trial
participants
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Description of the trial
Study team


Implementation team
Assessment team
Study
period
Study site

October-December
2010
 Low-income community,
Dhaka
 No previous water
intervention
 40 low-income
Study
household compounds
population
 Total 359 households
Eligibility
criteria
 Shared water source
6
Households compound in urban Dhaka
7
Households compound in urban Dhaka
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 Hardware: 4 types of chlorine dispenser model with
the supply of liquid chlorine at no cost
 Reason behind testing the different models:
- different amounts of water needed per compound
and households
- different types and sizes of water storage vessels
used in households
- no common drinking water storage used in the
compounds
9
Trial models for liquid chlorine dispenser
Model 1 : Reservoir
(one turn of the valve from dispenser to treat 15 liters)
Model 2: Measuring vessel
(one turn of the valve to treat 5 liters)
Model 3 : Without measuring vessel
(one turn of the valve to treat 5 liters)
Model 4: Without measuring vessel
(one turn of the valve to treat 2.5 liters)
Distribution of compounds and hardware
Chlorine dispenser models
Total
No of
households compounds
1. Reservoir (15 liter dosing)
86
10
2. Measuring vessel
(5 liter dosing)
3. Without measuring vessel
(5 liter dosing)
94
10
87
10
4. Without measuring vessel
(2.5 liter dosing)
92
10
359
40
Total
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Implementation team
 Enroll sample households
 Install hardware and demonstrate use
 Household visits twice a month:
o Deliver messages on health and non-health
benefits
o Encourage and address barriers related to
hardware use
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Assessment team
 Collect data on 15th, 45th and 60th days
 Assess use by checking residual free chlorine
in stored drinking water
 Qualitative interviews and household
observations
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Self reported use between 15th day and 60th day
15th day
60th day
70%
45%
37%
42%
32%
31%
Reservoir model—
Measuring vessel Without measuring
one turn for 15 liters model– one turn for vessel model– one
5 liters
turn for 5 liters
25% 27%
Without measuring
vessel model– one
turn for 2.5 liters
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Comparison between self-reported use and
presence of residual chlorine (0.2-2mg/l)
After 15 days of use
Selfreported use
122/359
After 60 days of use
Chlorine
Selffound reported use
54/122
84/244
Chlorine
found
27/84
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Perceived benefits of use
Benefits common to all models:
 Improved clarity of drinking water
 Save time and fuel cost compared to boiling
 Keeps children safe from diseases
18
Specific benefits of different models:
 Reservoir
o Measuring and storing treated water was easy
o Less work for compound members as
caretakers treated water for common use
 With measuring vessel
o Measuring water was easy
 Without measuring vessel
o No unique benefit
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Perceived barriers to use
Barriers common to all models:
 Smelt like bleaching powder
 Temperature of stored treated water
 30-minute wait time
 Boilers were not interested
 Reluctance of males and children to drink
chlorinated water
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Specific barriers to use of different models:
 Reservoir
o Refilling of reservoirs and maintenance
o Unavailability of reservoirs for use
 With measuring vessel
o Unavailability of measuring vessel at certain
times
 Without measuring vessel
o Measuring recommended amount water was
difficult
21
Feedback on strategy and messages
 Weekly visits of promoters were appreciated
o helped to resolve problems related to hardware
use and encourage use
 Communication material was encouraging
o information on contamination of supply water and
possibility of getting diarrhea were encouraging
22
Household observation
 Did not maintain correct amount of water for
dosing in arm without measuring vessel
 Did not cover or shake vessel after adding chlorine
 Measuring vessels not always kept with dispenser
to measure recommended amount of water
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Hardware was not used; kept under a bedstead
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Conclusions
 Chlorine dispenser with water reservoir model had
most self reported use rate
 Water chlorination was less feasible in absence of
standardized water storage vessel
 Strong smell of chlorine and stored water
temperature was threat to acceptability of water
chlorination
 Unavailability of reservoirs with stored treated water
and measuring vessel led to decreased use
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Recommendations for RCT
 Marked participants own vessel to measure correct
amount of water for dosing
o
to minimize conflicts between the compound residents
regarding the ownership of the vessel and also reduce
responsibility to maintain the common hardware for use
 Select caretakers of the hardware and motivate the
tenants to drink chlorinated water by them also
 Use reported benefits to promote sustainable water
treatment behavior change interventions among
both boilers and non boilers
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Acknowledgements
Community members
Stephen P. Luby (icddr,b)
Leanne Unicomb (icddr,b)
Fazlul Kader Chowdhury (icddr,b)
Md. Al Mamun (icddr,b)
Smriti Roy (icddr,b)
Subas Chandra Biswas (icddr,b)
Rouha Anamika Sarker (icddr,b)
Meghan Scott(icddr,b)
Elli Leontsini (John Hopkins Bloomberg School of Public Health)
Peter Winch (John Hopkins Bloomberg School of Public Health)
Bill and Melinda Gates Foundation
For correspondence: [email protected]
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