Workplan and fieldwork:

The first part of the study was a policy review, which examined existing rural water-related policies and collects effectiveness measures and cost data for the three study countries. The review – undertaken by the Universities of Bristol and Cape Town – assessed the extent to which current policy took account of water contamination between source and point-of-use.

This initial policy review has been followed by a set of field surveys in three different sub-Saharan African countries: Kenya, Zimbabwe and South Africa. A sample of 120 rural households was selected from the study areas in each of these countries. The field surveys were carried out between late 2002 and early 2003 in Zimbabwe and South Africa, with two rounds of sampling and survey, timetabled to capture seasonal change. In Kenya, one round of survey has already taken place and a second survey round is currently underway.

The field survey measured the change in the microbiological quality of drinking water 'along the chain' from source to final point-of-use in the home. For this, the Colilert system was used to assess the numbers of E. Coli and total coliforms in water samples from water storage vessels, water sources, transport vessels, drinking cups and hands of household members. Early results suggest that even where the source water was free of contamination, the water stored in the home had deteriorated in quality. In addition, the field survey also gathered data about diarrhoea among young children in participating households using a smiley diary. Anthropometric measurements of height, weight and arm circumference were taken for young children and their adult carers in order to ascertain possible health implications of water contamination. The survey also gathered data about water treatment, storage, and use practices in these households, as well as sanitation and hygiene behaviour. The socio-economic and demographic characteristics of the participating households were also identified through a questionnaires survey.

Given the widespread problem of water contamination, a field trial is currently being carried out in Zimbabwe and South Africa of ceramic filters. This field trial is scheduled to finish by March 2004 in South Africa and April/May 2004 in Zimbabwe.

This information will be used to quantify the changing levels of contamination from the source to final point-of-use in the household, and to look at the relationship between quality of water in the home and diarrhoea amongst children. The final goal of this fieldwork is to look at the costs of different options for improving drinking water (whether source improvements, hygiene education, or better treatment in the home) and their effectiveness in combating diarrhoea from an economic perspective. This analysis will complement work in health economics currently being undertaken by WHO.