4th Annual Meeting of the International Network to Promote Household Water Treatment and Safe Storage

2-5 June 2008, Accra, Ghana

Presented by: Dr.Suresh Nadakatti

Contents

• Performance– Lab testing– Field evaluation

• Health Impact– On field Experience

• Scale up– Key barriers– Initiatives– Way forward

Pureit Microbiological Water Purifier

Designed For Household Use In Developing Countries

Pureit Protecting Lives

PERFORMANCE

• Laboratory

• Field Evaluation

References

• Thomas Clasen, Suresh Nadakatti, Shashikala Menon, “Microbiological Performance of a Water Treatment Unit Designed for Household Use in Developing Countries”, Tropical Medicine & International Health, Vol 11, No 9, 2006

• Thomas Clasen and Shashikala Menon, “Microbiological Performance of Common Water Treatment Devices for Household Use in India” , Int. J. Environmental Health Research, Vol 17, No. 2, 2007

References

The Pureit Innovation - I

The Pureit innovation

• Safety—No harmful viruses, bacteria, parasites —Provides water that is ‘as safe as boiled water’—Removes pesticides

• Anytime, anywhere performance—Works without electricity—Works without running piped water

• Other consumer benefits—Gives clear, odour-free and good tasting water—No hassles of boiling—No maintenance, no service, no plumbing

The Pureit Innovation-II

Pureit : Combination of Breakthrough Technologies

• Breakthrough technologies

–Physically remove cysts

–Sustained release chlorine technology

• Consumables and lifetime

–The germ-kill processor typically gives 1500L of purified water

–The capacity of the compact carbon trap and polisher are rated for same literage

Unambiguous life indicatorUnambiguous life indicator

Tested by leading National and Medical institutions in India and abroad

Pureit Performance : Results

drinking water

ORGANOCHLORINEPESTICIDES

PostPureit(ppb)

Alpha – HCH BDL **Beta – HCH BDLGamma – HCH BDLDelta – HCH BDLHeptachlor BDLAldrin BDLHeptachlor epoxide BDLEndosulfan – I BDLEndosulfan – II BDLEndosulfan sulfate BDLpp - DDT BDL

ORGANOPHOSPHORUSPESTICIDES

PostPureit(ppb)

Malathion BDLMethyl parathion BDLDimethoate BDLO,O,O - Triethyl phosphorothioate BDLThionazin BDLSulfotep BDLPhorate BDLParathion BDLFamphur BDL

Initial level : 1 ppb

* CFTRI, 2004 ** BDL – Below detectable limit (0.05 ppb)

Pureit Performance : Pesticide Removal*

• Apollo Hospital, TN • Sundaram Medical Foundation, TN• Central Food Technologies and Research Institute, Mysore• Institution of Public Health Engineers, Kolkota• Indian Public Health Association, Kolkota• King’s Institute, TN• National Environmental & Engineering Research Institute of India• National Institute of Cholera and Enteric Diseases, Kolkota• SRL, Ranbaxy Clinical Reference Laboratories, Mumbai• London School of Hygiene and Tropical Medicine, U.K. • Scottish Parasitic Laboratory, UK• Unilever Research, Colworth, UK

Pureit Performance : Tested by leading scientific and medical institutions in India & abroad

Pureit Field Evaluation

Studies Carried Out by Institute of Public Health Engineers(IPHE), India

Kolkata Study• A total of 990 water samples were

collected and analyzed in the laboratory.

• Out of these 990 samples, 600 from corporation’s consumer points, 150 from KMC’s hand pumps, 40 from houseowners’ own deep tubewells and 200 from underground or overhead tanks inside houses.

Water quality (Bacterial Contamination) status of Kolkata city water

Samples collected (Nos.) Samples bacteriologically contaminated (Nos & %)

Deep tube well

(owner’s own)

KMC con-

sumer points

KMC hand pump

Overhead/Under-

ground tank inside

houses

Deep tubewell

Consu- mer

points

KMC hand

pumps

Overhead /

Under- ground

tank inside

houses

40 600 150 200 11(27.5%)

382(63.66%)

37(24.66%)

175(87.5%)

Study Methodology• A total of 155 households were randomly visited

across various urban areas around Kolkata to cover various socio-economic strata for collecting information on:

• Socio-economic & health status, drinking water consuming pattern and purification practices using structured questionnaireTesting of water quality from the available water source for microbiological test of Faecal Coliform

Study Methodology

• Subsequently, 33 households were selected out of the 150 households, which were found to be using worst quality of input water as a panel for installation of domestic water kit.

• Out of these 33 households, 4 samples locations were purposively selected as control group which used water from dug wells (2 nos), pond and river to test the efficacy of the device.

Study Methodology

The panel households were visited daily for 3 weeks to ensure usage of the water kit and collection of data to assess its technical efficacy, quantity and quality of water consumed for drinkingThe water quality was monitored twice a week for testing water quality of input and output water of domestic water kit on the following parameters

Parameter Monitored• o Microbiological tests:

§ Coliform organisms§ Faecal Coliform

• o Chemical tests:§ Turbidity§ pH value

Total dissolved solids (tested the input water only once per household)

Type of residential units surveyed

Dwelling AreaDwelling Area

Municipality

Total% of

Distri- bution

Dum Dum

North Dum Dum

South Dum Dum

Bidhan

Nagar

Count Count Count Count Count

>2400 Sq.Ft. 1 2 3 1.94%

1200-2400 Sq.Ft 3 13 4 3 23 14.84%

600-1200 Sq.Ft 14 20 17 51 32.90%

150-600 Sq.Ft 24 16 22 62 40.00%

<150 Sq.Ft 9 7 16 10.32%

Total50 50 50 5 155 100.00%

Socio-Economic Status

Sl. No. Income pattern (range) (Rs.)Percentage of

Population in Study area (%)

1. <1000 1

2. 1000 – 2000 1

3. 2001- 5000 28

4. 5001 – 10,000 40

5. 10,001 – 25000 9

6. 25001 – 50000 18

7. > 50000 3

Dwelling Areas

Sl. No. Dwelling Area (sq. Ft)Percentage of

Population in Study area (%)

1. <150 10

2. 150 – 600 40

3. 601 – 1200 33

4. 1201 – 2400 15

5. > 2400 2

Sanitation Facilities

Sl. No. Sanitation facilities availablePercentage of

Population in Study area (%)

1. Common both & common toilet 15

2. Private bath but common toilet 4

3. Private bath & Private toilet 81

Source of Drinking Water

Sl. No. Source of Drinking WaterPercentage of

Population in Study area (%)

1. Public tap outside residence 22

2. Water vendor 1

3. Own hand pump 3

4. Municipal house connection 67

5. Own bore well 1

6. Shared Municipal house connection 1

7. Public hand pump 5

Purification Practice before Drinking

Sl. No. Purification practice before drinkingPercentage of

Population in Study area (%)

1. Purify 46

2. Do not purify 54

Method of Purification

Sl.No. Method of PurificationPercentage of

Population in Study area (%)

1. Cloth filter 12

2. Boiling 33

3. Candle filter 36

4. On-tap device 2

5. UV- device 1

6. Zeoline 12

7. Halogen tab 2

8. Alum 1

9. Camphor 1

Frequency of Water Purification

Sl. No. Frequency of water purificationPercentage of

Population in Study area (%)

1. Once a day 55

2. More than once a day 28

3. As and when required 17

Drinking Water Container Cleaning Habit

Sl. No. Drinking Water container cleaning habit

Percentage of Population in Study

area (%)

1. Daily 35

2. Not daily 65

Drinking Water Storage

Sl. No. Drinking Water storagePercentage of

Population in Study area (%)

1. Separate Vessel 81

2. No Separate Vessel 19

Drinking Water Usage HabitDrinking Water Usage Habit

Sl. No. Drinking Water usage habitPercentage of

Population in Study area (%)

1. Tumbler / Glass / Utensils dipped onStorage container

15

2. Use separate utensil to take out water from storage container

85

Sense of Drinking Water Storage

Sl. No. Sense of Drinking Water StoragePercentage of

Population in Study area (%)

1. Storage container keep covered 65

2. Storage container do not keep covered

35

Turbidity

Turbidity (NTU)Range

Number of Raw water samples (% of total samples)

Number of Treated water samples(% of total samples)

<1 93(46.96)

187(94.44)

1-<5 91(45.96)

11(5.56)

5-<10 12(6.07)

0

>10 2(1.01)

0

TOTAL 198 198

Total Coliform

Total Coliform Count /100 ml (CFU) Range

Number of Raw water samples (% of total

samples)

Number of Treated water samples (% of

total samples)0

(Absent)9

(4.54)198

(100)

1 - 10 11(5.56)

0

11 - 50 59(29.80)

0

51 - 100 47(23.74)

0

> 100 72(36.36)

0

TOTAL 198 198

Faecal coliform

Faecal Coliform Count / 100 ml (CFU) Range

Number of Raw water samples(% of total

samples)

Number of Treated water samples(% of total

samples)

0(Absent)

37(18.69)

198(100)

1 - 10 37(18.69)

0

11 - 50 98(49.50)

0

51 - 100 19(9.59)

0

> 100 7(3.53)

0

TOTAL 198 198

CONCLUSIONAs the urban and rural communities of the country are still deprived of having safe water for drinking for most of the time, a cost-effective and user-friendly domestic water treatment is in urgent need. The study on Puriet Water Purifier conducted by IPHE was extensive in nature and quite conclusive. The results conclusively indicate that the Puriet Water Purifier is capable of producing microbially safe and physically and aesthetically acceptable water even from highly contaminated surface water sources like river, ponds etc. Moreover, the low cost of purification by Pureit could convert some of the non-users of any water purification systems in houses if adequate awareness regarding water quality is generated. However, effective post sell services must be ensured to have better responses for the purifier.

Health Intervention Studies

Limited contribution of improved water supplies in reducing

disease burden

Increasingly evident that in-home treatment and safe storage can result in greater public health

benefits

A systematic meta-analysis of 57 studies

measuring bacteria counts for source water

and stored water at home:

Significant decline post-collection

bacteriological quality

-Wright et al, 2003

Meta Analysis – Fewtrell et al 2005

InterventionNo. of

studiesRisk

ReductionSource Treatment Only 3 11%

Household Treatment Only 12 35%Excluding Poorly designed

studies 8 39%Rural location 6 39%

Urban/ periurban 4 26%

In-home treatments: Improved disease reduction potential

Meta Review on household treatment – Clasen et al, 2006

• 30 trials covering >53000 participants

• All Interventions to improve microbiol. quality of drinking water - effective in preventing diarrhea in population of all ages and in children <5 years

• Household interventions more effective in preventing diarrhea than interventions at the water source– Numbers varied

• Shown to be significantly higher than source intervention

– ~40% or more as compared to Esrey’s 16%

• Effectiveness positively influenced by compliance

• Effectiveness was not conditioned on the presence of improved water supplies or sanitation in the study setting

Pureit Protecting Lives

On field experience

Based on comprehensive reviews– WHO conclusion

• “Conclusive evidence that simple acceptable, low cost interventions at household and community level are capable of dramatically improving the microbial quality and the attendant risks of diarrheal disease and death”

(Sobsey 2002)

Health intervention study Pureit … assured protection

• Study by National Institute of Epidemiology (NIE), Govt. of India

• A year long health intervention (Pureit) study in the slums of Chennai

Study showed 50% reduction in diarrhoeal diseases amongst young children, in homes installed with Pureit (v/s control)

NIE study Video

Conclusions

• Intervention group– Significant (~49%) reduction in prevalence

of diarrhea – Children with at least one diarrhea ~21%

reduced– Gravity/ length of diarrhea also reduced

Limitations• Block randomization – possibility of some

children drinking water in ‘intervention’ households

• Courtesy bias with the intervention group– Overstate the effect of intervention

• Results cannot be generalized to all age groups– Study focused on under-5 children

• Results obtained under study conditions and need for larger scale studies in more pragmatic settings

Example of a Successful P/P Partnership

NIE UnileverPublic Health

ExpertiseMicrobiology &

Hygiene – Water sampling

Hardware and its servicing

Municipal Corpn. Chennai

Sundaram Med. Found.

Pureit Protecting Lives

Scale up

Challenge

• Identify means to scale up to reach low income sections of society

• Key barriers– Awareness

– Availability

– Affordability

Scale Up Initiatives

• School Programs

• Micro-finance model

UNICEF School Program Rapidly bringing safe water to low income schools

• Partnership with UNICEF to install Pureit in low income schools … a rapid intervention that provides children from low income homes access to safe drinking water

• Educate children on the importance of hygiene and safe water for health

• Working with the school & local community to manage & sustain on-going maintenance & costs

Pureit installed in 100 government schools and 100 anganwaris.

15,000 children from low income homes protected with safe drinking water

Video 1

Video 2

Micro-finance Model

Barrier Action Role Party

Awareness Safe water education of SHG Members

Education NGO

Availability Making Pureit available for Purchase and installation at SHG members’ premises

Distribution / servicing

HUL

Affordability Making available to SHG member

a. loan for purchasing Pureit b. facility to repay loan through

Installment

Funding MFI

Extending the health benefit to the poor

• Building social partnerships with NGOs to extend the benefit of safe drinking water to low income & rural homes

• Work with local communities … create awareness on importance of safe water & provide access to safe drinking water

What is needed

• More Partners

• Distribution

• Funding

Hindustan Unilever’s Pureit

• Back Up

• NIE Study Back up slides

Month-wise Distribution of Diarrhoeal Episodes

Distribution of Diarrhoeal Episodes by Children

Distribution of Diarrhoeal Days by Episodes

233

462

0

50

100

150

200

250

300

350

400

450

500

1

No.

of E

piso

des

PureitControl

Total Number of Diarrhoeal Episodes