Study Overview
- Title:
- Safe Water – Advances in Purification Options (SWAPNO)
- Study is 3ie funded:
- No
- Study ID:
- RIDIE-STUDY-ID-662be75eebc7f
- Initial Registration Date:
- 04/26/2024
- Last Update Date:
- 12/06/2023
- Study Status:
- Ongoing
- Location(s):
- Bangladesh
- Abstract:
Drinking water quality in Bangladesh has and continues to be a critical public health issue. Tubewell construction, initiated to reduce microbial contamination of water sources, led to widespread arsenic contamination. Recent surveys also cite high prevalence of E. coli contamination, potentially due to poorly constructed wells and unsafe water storage practices. In addition to poor water quality, many adverse health outcomes, such as diarrhea, have also been linked to infrequent handwashing and other hygiene practices, which can be a matter of water quality, access, and behavior change.
Past interventions have largely focused on only one of these factors; however, a holistic, integrated approach is needed to improve health outcomes. We provide a low-cost, user-friendly filtration system to remove arsenic and microbial contamination and clean. In addition to this technology, our training includes key messages around handwashing and hygienic practices, which will be easier to implement with increased household access to clean water.
For the proposed study, we plan to evaluate typical water use practices, including quantity used, transport required, costs, effort, storage, availability, waste production, and water quality regarding microbial and arsenic contamination. This will be done once before and multiple times during the intervention. The study participants will be further involved in the technical adaptation of the system through group discussions and interviews.
Overall, we aim to evaluate the impact of improved water systems on the health and hygiene practices of households through a randomized controlled trial. The proposed systems should eliminate most contaminants found in Bangladesh groundwater and ensure convenient access to clean water for all household members with a focus on children.
- Registration Citation:
- Categories:
- Health, Nutrition, and Population
Water and Sanitation
- Additional Keywords:
- Arsenic, Microbial contamination, Water, Bangladesh
- Secondary ID Number(s):
Principal Investigator(s)
- Name of First PI:
- Amanda S. Wendt
- Affiliation:
- Potsdam Institute for Climate Impact Research
- Name of Second PI:
- Jillian L. Waid
- Affiliation:
- Potsdam Institute for Climate Impact Research
Study Sponsor
- Name:
- German Alliance for Global Health Research (GLOHRA)
- Study Sponsor Location:
- Germany
Research Partner
- Name of Partner Institution:
- Heidelberg Univerisity
- Type of Organization:
- Research institute/University
- Location:
- Germany
Intervention Overview
- Intervention:
The intervention group will receive four group sessions, which will cover the importance of clean water, water filter use and maintenance, as well as messages on handwashing and safe water storage. Intervention households will receive water filters adapted to remove both microbial and arsenic contamination after the first group session. Control households will receive two group sessions including messaging on handwashing and safe water storage. Both groups will receive handwashing stations. A sub-sample of the intervention group will receive an improved handwashing station enabling drainage from the basin outside the household. Group sessions will be additionally supplemented with household visits, where field facilitators will support households 1-on-1 to reinforce messages and problem-solve with the household.
- Theory of Change:
We expect the intervention to improve household drinking water quality and household member health through the following ways:
- Assets received, group sessions, and household visits in intervention groups will:
- directly reduce the contamination in household water
- improve respondent knowledge of water safety
- enable households to access and maintain water filters, thereby providing safe water to household members
- increases in knowledge and access will motivate respondents and household members to consume this water and maintain water filters
- Assets received, group sessions, and household visits in both intervention and control groups will:
- enable more convenient handwashing
- improve respondent knowledge of proper handwashing timing and practice
- provide households with an accessible source of water and soap for convenient handwashing during food preparation or bathroom use
- increases in knowledge and access will motivate respondents and household members to wash hands consistently and properly
- Assets received, group sessions, and household visits in intervention groups will:
- Multiple Treatment Arms Evaluated?
- No
Implementing Agency
- Type of Organization:
- NGO (local)/Community Based Organization/Other civil society organization
Program Funder
- Name of Organization:
- German Alliance for Global Health Research (GLOHRA)
- Type of Organization:
- NGO (local)/Community Based Organization/Other civil society organization
Intervention Timing
- Intervention or Program Started at time of Registration?
- Yes
- Start Date:
- 11/21/2022
- End Date:
- 12/06/2023
Evaluation Method Overview
- Primary (or First) Evaluation Method:
- Randomized control trial
- Other (not Listed) Method:
- Additional Evaluation Method (If Any):
- Regression with controls
- Other (not Listed) Method:
Method Details
- Details of Evaluation Approach:
We will use a cluster randomized trial study design over 14 clusters (7 intervention and 7 control) with 337 women respondents. We will conduct a baseline and endline survey in addition to two surveillance rounds including assessments of water quality, handwashing and hygiene knowledge and practices, and water filter use and maintenance.
We will assess impacts on water quality and health using mixed regression for continuous outcomes and melogit regression for binary outcomes adjusting for baseline values when available and for cluster using random effects.
Qualitative methods will also be employed to understand the existing water use systems at baseline, water filter use and issues/recommendations during implementation, and changes to existing water use systems at the end of the intervention.
- Outcomes (Endpoints):
- Drinking water arsenic levels
- Microbial contamination of drinking water
- Reported water filter use
- Knowledge of water filter use and maintenance
- Knowledge of critical handwashing moments
- Reported handwashing
- Reported health symptoms:
- Headache
- Dizziness
- Weakness
- Vomiting
- Abdominal pain
- Numbness in limbs
- Red irritated eyes
- Muscle cramps
- Skin lesions
- Diarrhea (children only)
- Food security
- Water Security
- Unit of Analysis:
- Household
- Hypotheses:
- Water filters reduce arsenic in household drinking water
- Water filters reduce microbial contamination in household drinking water
- Intervention households use water filters to treat their drinking water
- Intervention households adopt proper care and maintenance of water filters
- Individuals in intervention households exhibit fewer symptoms of arsenic exposure
- Women in intervention households have lower levels of arcenic intake
- Unit of Intervention or Assignment:
- Settlement (approximately village)
- Number of Clusters in Sample:
- 14
- Number of Individuals in Sample:
- 380
- Size of Treatment, Control, or Comparison Subsamples:
- 400
Supplementary Files
- Analysis Plan:
- Other Documents:
Outcomes Data
- Description:
- We will conduct household surveys, which will include including assessments of water quality, handwashing and hygiene knowledge and practices, and water filter use and maintenance. The data from these surveys and the following laboratory analysis of water samples will be used to assess outcomes.
- Data Already Collected?
- No
- Data Previously Used?
- Data Access:
- Data Obtained by the Study Researchers?
- Data Approval Process:
- Approval Status:
Treatment Assignment Data
- Participation or Assignment Information:
- Yes
- Description:
- Data Obtained by the Study Researchers?
- Data Previously Used?
- Data Access:
- Data Obtained by the Study Researchers?
- Data Approval Process:
- Approval Status:
Data Analysis
- Data Analysis Status:
Study Materials
- Upload Study Materials:
Registration Category
- Registration Category:
- Prospective, Category 1: Data for measuring impacts have not been collected
Completion Overview
- Intervention Completion Date:
- Data Collection Completion Date:
- Unit of Analysis:
- Clusters in Final Sample:
- Total Observations in Final Sample:
- Size of Treatment, Control, or Comparison Subsamples:
Findings
- Preliminary Report:
- Preliminary Report URL:
- Summary of Findings:
- Paper:
- Paper Summary:
- Paper Citation:
Data Availability
- Data Availability (Primary Data):
- Date of Data Availability:
- Data URL or Contact:
- Access procedure:
Other Materials
- Survey:
- Survey Instrument Links or Contact:
- Program Files:
- Program Files Links or Contact:
- External Link:
- External Link Description:
- Description of Changes:
Study Stopped
- Date:
- Reason: