Assessment of low-cost, non-electrically powered chlorination devices for gravity-driven membrane water kiosks in eastern Uganda
Lukas Dössegger | Alan Tournefier | Laura Germann | Nicola Gärtner | Timon Huonder | Cosmas Etenu | Kennedy Wanyama | Henry Ouma | Regula Meierhofer
Recontamination during transport and storage is a common challenge of water supply in low-income settings, especially if water is collected manually. Chlorination is a strategy to reduce recontamination. We assessed seven low-cost, non-electrically powered chlorination devices in gravity-driven membrane filtration (GDM) kiosks in eastern Uganda: one floater, two in-line dosers, three end-line dosers (tap-attached), and one manual dispenser. The evaluation criteria were dosing consistency, user-friendliness, ease of maintenance, local supply chain, and cost. Achieving an adequate chlorine dosage (∼2 mg/L at the tap and ≥ 0.2 mg/L after 24 h of storage in a container) was challenging. The T-chlorinator was the most promising option for GDM kiosks: it achieved correct dosage (CD, 1.5–2.5 mg/L) with a probability of 90 per cent, was easy to use and maintain, economical, and can be made from locally available materials. The other in-line option, the chlorine-dosing bucket (40 per cent CD) still needs design improvements. The end-line options AkvoTur (67 per cent CD) and AquatabsFlo® (57 per cent CD) are easy to install and operate at the tap, but can be easily damaged in the GDM set-up. In accordance with producer’s instructions, the Venturi doser (52 per cent CD) did not perform satisfactorily with flow rates < 6 L/min. The chlorine dispenser (52 per cent CD) was robust and user-friendly, but can only be recommended if users comply with chlorinating the water themselves. Establishing a sustainable supply chain for chlorine products was challenging. Where solid chlorine tablets were locally rarely available, the costs of liquid chlorine options were high (27–162 per cent of the water price).Ahuja, A. (2017) ‘Dispensers for safe water: an updated review of the evidence’, Evidence Action [online] <https://www.evidenceaction.org/dispensers-for-safe-water-an-updated-review-of-the-evidence/> [accessed 19 May 2020].
Ali, S.I., Ali, S.S. and Fesselet, J.-F. (2015) ‘Effectiveness of emergency water treatment practices in refugee camps in South Sudan’, Bulletin of the World Health Organization 93: 550–8 <https://doi.org/10.2471/BLT.14.147645>.
Branz, A. (2017) ‘Chlorination of drinking water in emergencies: a review of knowledge to develop recommendations for implementation and research needed’, Waterlines 36(1): 4–39 <http://dx.doi.org/10.3362/1756-3488.2017.002>.
Brown, J. and Clasen, T. (2012) ‘High adherence is necessary to realize health gains from water quality interventions’, PloS one 7(5): e36735 <http://doi.org/10.1371/journal.pone.0036735>.
Centers for Disease Control and Prevention (CDC) (2020) ‘Free chlorine testing’, CDC [online] <https://www.cdc.gov/safewater/chlorine-residual-testing.html> [accessed 25 November 2020].
Clasen, T. and Edmondson, P. (2006) ‘Sodium dichloroisocyanurate (NaDCC) tablets as an alternative to sodium hypochlorite for the routine treatment of drinking water at the household level’, International Journal of Hygiene and Environmental Health 209(2): 173–81 <https://doi.org/10.1016/j.ijheh.2005.11.004>.
Crider, Y., Sultana, S., Unicomb, L., Davis, J., Luby, S.P. and Pickering, A.J. (2018) ‘Can you taste it? Taste detection and acceptability thresholds for chlorine residual in drinking water in Dhaka, Bangladesh’, Science of the Total Environment 613: 840–6 <http://doi.org/10.1016/j.scitotenv.2017.09.135>.
Enger, K.S., Nelson, K.L., Rose, J.B. and Eisenberg, J.N. (2013) ‘The joint effects of efficacy and compliance: a study of household water treatment effectiveness against childhood diarrhea’, Water Research 47(3): 1181–90 <https://doi.org/10.1016/j.watres.2012.11.034>.
Gärtner, N., Germann, L., Wanyama, K., Ouma, H. and Meierhofer, R. (2020) ‘Keeping water from kiosks clean: strategies for reducing recontamination during transport and storage in eastern Uganda’, Water Research X: 100079 <https://doi.org/10.1016/j.wroa.2020.100079>.
Harris, A.R., Davis, J. and Boehm, A.B. (2013) ‘Mechanisms of post-supply contamination of drinking water in Bagamoyo, Tanzania’, Journal of Water and Health 11(3): 543–54 <http://doi.org/10.2166/wh.2013.023>.
Hunter, P.R. (2009) ‘Household water treatment in developing countries: comparing different intervention types using meta-regression’, Environmental Science and Technology 43(23): 8991–7 <https://doi.org/10.1021/es9028217>.
Jagals, P., Jagals, C. and Bokako, T. (2003) ‘The effect of container-biofilm on the microbiological quality of water used from plastic household containers’, Journal of Water and Health 1(3): 101–8 <http://doi.org/10.2166/wh.2003.0012>.
Lantagne, D.S. (2008) ‘Sodium hypochlorite dosage for household and emergency water treatment’, Journal of the American Water Works Association 100(8): 106–19 <https://doi.org/10.1002/j.1551-8833.2008.tb09704.x>.
Levy, K., Anderson, L., Robb, K.A., Cevallos, W., Trueba, G. and Eisenberg, J.N. (2014) ‘Household effectiveness vs. laboratory efficacy of point-of-use chlorination’, Water Research 54: 69–77 <http://doi.org/10.1016/j.watres.2014.01.037>.
Lu, W., Kiéné, L. and Lévi, Y. (1999) ‘Chlorine demand of biofilms in water distribution systems’, Water Research 33(3): 827–35 <http://doi.org/10.1016/S0043-1354(98)00229-2>.
Luff, R. (2001) Instruction Manual for Coagulation and Disinfection Equipment: Covering Upflow Clarifier, Chlorine and Aluminium Sulphate Dosing Options, Oxford, UK: Oxfam.
McLaughlin, L.A., Levy, K., Beck, N.K., Shin, G.-A., Meschke, J.S. and Eisenberg, J.N. (2009) ‘An observational study on the effectiveness of point-of-use chlorination’, Journal of Environmental Health 71(8): 48.
Meierhofer, R., Rubli, P., Dreyer, K., Ouma, H., Wanyama, K. and Peter-Varbanets, M. (2017) ‘Membrane filtration reduces recontamination risk in chlorinated household water containers’, paper presented at the 40th WEDC International Conference, Loughborough, UK [online] <https://hdl.handle.net/2134/31506> [accessed 12 March 2021].
Meierhofer, R., Wietlisbach, B. and Matiko, C. (2019) ‘Influence of container cleanliness, container disinfection with chlorine, and container handling on recontamination of water collected from a water kiosk in a Kenyan slum’, Journal of Water and Health 17(2): 308–17 <https://doi.org/10.2166/wh.2019.282>.
Mellor, J.E., Smith, J.A., Samie, A. and Dillingham, R.A. (2013) ‘Coliform sources and mechanisms for regrowth in household drinking water in Limpopo, South Africa’, Journal of Environmental Engineering 139(9): 1152–61 <http://doi.org/10.1061/(ASCE)EE.1943-7870.0000722>.
MSR (2017) ‘MSR, Stanford and Path test chlorine dosing prototype in Kenya’, Mountain Safety Research [online] <https://www.msrgear.com/blog/msr-stanford-path-chlorine-dosing-kenya/> [accessed 3 March 2020].
Opryszko, M.C., Guo, Y., MacDonald, L., MacDonald, L., Kiihl, S. and Schwab, K.J. (2013) ‘Impact of water-vending kiosks and hygiene education on household drinking water quality in rural Ghana’, The American Journal of Tropical Medicine and Hygiene 88(4): 651–60 <http://doi.org/10.4269/ajtmh.12-0065>.
Orner, K.D., Calvo, A., Zhang, J. and Mihelcic, J.R. (2017) ‘Effectiveness of in-line chlorination in a developing world gravity-flow water supply’, Waterlines 36(2): 167–82 <https://doi.org/10.3362/1756-3488.16-00016>.
Peter-Varbanets, M., Dreyer, K., McFadden, N., Ouma, H., Wanyama, K., Etenu, C. and Meierhofer, R. (2017) ‘Evaluating novel gravity-driven membrane (GDM) water kiosks in schools’, paper presented at the 40th WEDC International Conference, Loughborough, UK [online] <https://hdl.handle.net/2134/31530> [accessed 12 March 2021].
Pickering, A.J., Crider, Y., Sultana, S., Swarthout, J., Goddard, F.G., Islam, S.A., Sen, S., Ayyagari, R. and Luby, S.P. (2019) ‘Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial’, The Lancet Global Health 7(9): e1247–56 <https://doi.org/10.1016/S2214-109X(19)30315-8>.
Reed, B., Scott, R., Skinner, B. and Jackson, T. (2011) G004: Domestic Water Containers: An Engineer’s Guide, Loughborough, UK: WEDC, Loughborough University.
Roberts, L., Chartier, Y., Chartier, O., Malenga, G., Toole, M. and Rodka, H. (2001) ‘Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial’, Bulletin of the World Health Organization 79: 280–7.
Skinner, B. (2001) Chlorinating Small Water Supplies, Loughborough, UK: Water, Engineering and Development Centre, Loughborough University.
Steele, A., Clarke, B. and Watkins, O. (2008) ‘Impact of jerry can disinfection in a camp environment: experiences in an IDP camp in northern Uganda’, Journal of Water and Health 6(4): 559–64 <http://doi.org/10.2166/wh.2008.072>.
Safe Water and AIDS Project (SWAP) (2017) Annual Report 2017, SWAP, Kisumu, Kenya.
Wilhelm, N., Kaufmann, A., Blanton, E. and Lantagne, D. (2018) ‘Sodium hypochlorite dosage for household and emergency water treatment: updated recommendations’, Journal of Water and Health 16(1): 112–25 <https://doi.org/10.2166/wh.2017.012>.
World Health Organization (WHO) (2017) Guidelines for Drinking-Water Quality: Fourth Edition Incorporating the First Addendum, Geneva, Switzerland: WHO.
Wright, J., Gundry, S. and Conroy, R. (2004) ‘Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use’, Tropical Medicine & International Health 9(1): 106–17 <http://doi.org/10.1046/j.1365-3156.2003.01160.x>.
Yates, T.M., Armitage, E., Lehmann, L.V., Branz, A.J. and Lantagne, D.S. (2015) ‘Effectiveness of chlorine dispensers in emergencies: case study results from Haiti, Sierra Leone, Democratic Republic of Congo, and Senegal’, Environmental Science & Technology 49(8): 5115–22 <https://doi.org/10.1021/acs.est.5b00309>.
Yee, L.F., Abdullah, M.P., Ata, S. and Ishak, B. (2006) ‘Dissolved organic matter and its impact on the chlorine demand of treated water’, Malaysian Journal of Analytical Sciences 10(2): 243–50.
Ahuja, A. (2017) ‘Dispensers for safe water: an updated review of the evidence’, Evidence Action [online] <https://www.evidenceaction.org/dispensers-for-safe-water-an-updated-review-of-the-evidence/> [accessed 19 May 2020].
Ali, S.I., Ali, S.S. and Fesselet, J.-F. (2015) ‘Effectiveness of emergency water treatment practices in refugee camps in South Sudan’, Bulletin of the World Health Organization 93: 550–8 <https://doi.org/10.2471/BLT.14.147645>.
Branz, A. (2017) ‘Chlorination of drinking water in emergencies: a review of knowledge to develop recommendations for implementation and research needed’, Waterlines 36(1): 4–39 <http://dx.doi.org/10.3362/1756-3488.2017.002>.
Brown, J. and Clasen, T. (2012) ‘High adherence is necessary to realize health gains from water quality interventions’, PloS one 7(5): e36735 <http://doi.org/10.1371/journal.pone.0036735>.
Centers for Disease Control and Prevention (CDC) (2020) ‘Free chlorine testing’, CDC [online] <https://www.cdc.gov/safewater/chlorine-residual-testing.html> [accessed 25 November 2020].
Clasen, T. and Edmondson, P. (2006) ‘Sodium dichloroisocyanurate (NaDCC) tablets as an alternative to sodium hypochlorite for the routine treatment of drinking water at the household level’, International Journal of Hygiene and Environmental Health 209(2): 173–81 <https://doi.org/10.1016/j.ijheh.2005.11.004>.
Crider, Y., Sultana, S., Unicomb, L., Davis, J., Luby, S.P. and Pickering, A.J. (2018) ‘Can you taste it? Taste detection and acceptability thresholds for chlorine residual in drinking water in Dhaka, Bangladesh’, Science of the Total Environment 613: 840–6 <http://doi.org/10.1016/j.scitotenv.2017.09.135>.
Enger, K.S., Nelson, K.L., Rose, J.B. and Eisenberg, J.N. (2013) ‘The joint effects of efficacy and compliance: a study of household water treatment effectiveness against childhood diarrhea’, Water Research 47(3): 1181–90 <https://doi.org/10.1016/j.watres.2012.11.034>.
Gärtner, N., Germann, L., Wanyama, K., Ouma, H. and Meierhofer, R. (2020) ‘Keeping water from kiosks clean: strategies for reducing recontamination during transport and storage in eastern Uganda’, Water Research X: 100079 <https://doi.org/10.1016/j.wroa.2020.100079>.
Harris, A.R., Davis, J. and Boehm, A.B. (2013) ‘Mechanisms of post-supply contamination of drinking water in Bagamoyo, Tanzania’, Journal of Water and Health 11(3): 543–54 <http://doi.org/10.2166/wh.2013.023>.
Hunter, P.R. (2009) ‘Household water treatment in developing countries: comparing different intervention types using meta-regression’, Environmental Science and Technology 43(23): 8991–7 <https://doi.org/10.1021/es9028217>.
Jagals, P., Jagals, C. and Bokako, T. (2003) ‘The effect of container-biofilm on the microbiological quality of water used from plastic household containers’, Journal of Water and Health 1(3): 101–8 <http://doi.org/10.2166/wh.2003.0012>.
Lantagne, D.S. (2008) ‘Sodium hypochlorite dosage for household and emergency water treatment’, Journal of the American Water Works Association 100(8): 106–19 <https://doi.org/10.1002/j.1551-8833.2008.tb09704.x>.
Levy, K., Anderson, L., Robb, K.A., Cevallos, W., Trueba, G. and Eisenberg, J.N. (2014) ‘Household effectiveness vs. laboratory efficacy of point-of-use chlorination’, Water Research 54: 69–77 <http://doi.org/10.1016/j.watres.2014.01.037>.
Lu, W., Kiéné, L. and Lévi, Y. (1999) ‘Chlorine demand of biofilms in water distribution systems’, Water Research 33(3): 827–35 <http://doi.org/10.1016/S0043-1354(98)00229-2>.
Luff, R. (2001) Instruction Manual for Coagulation and Disinfection Equipment: Covering Upflow Clarifier, Chlorine and Aluminium Sulphate Dosing Options, Oxford, UK: Oxfam.
McLaughlin, L.A., Levy, K., Beck, N.K., Shin, G.-A., Meschke, J.S. and Eisenberg, J.N. (2009) ‘An observational study on the effectiveness of point-of-use chlorination’, Journal of Environmental Health 71(8): 48.
Meierhofer, R., Rubli, P., Dreyer, K., Ouma, H., Wanyama, K. and Peter-Varbanets, M. (2017) ‘Membrane filtration reduces recontamination risk in chlorinated household water containers’, paper presented at the 40th WEDC International Conference, Loughborough, UK [online] <https://hdl.handle.net/2134/31506> [accessed 12 March 2021].
Meierhofer, R., Wietlisbach, B. and Matiko, C. (2019) ‘Influence of container cleanliness, container disinfection with chlorine, and container handling on recontamination of water collected from a water kiosk in a Kenyan slum’, Journal of Water and Health 17(2): 308–17 <https://doi.org/10.2166/wh.2019.282>.
Mellor, J.E., Smith, J.A., Samie, A. and Dillingham, R.A. (2013) ‘Coliform sources and mechanisms for regrowth in household drinking water in Limpopo, South Africa’, Journal of Environmental Engineering 139(9): 1152–61 <http://doi.org/10.1061/(ASCE)EE.1943-7870.0000722>.
MSR (2017) ‘MSR, Stanford and Path test chlorine dosing prototype in Kenya’, Mountain Safety Research [online] <https://www.msrgear.com/blog/msr-stanford-path-chlorine-dosing-kenya/> [accessed 3 March 2020].
Opryszko, M.C., Guo, Y., MacDonald, L., MacDonald, L., Kiihl, S. and Schwab, K.J. (2013) ‘Impact of water-vending kiosks and hygiene education on household drinking water quality in rural Ghana’, The American Journal of Tropical Medicine and Hygiene 88(4): 651–60 <http://doi.org/10.4269/ajtmh.12-0065>.
Orner, K.D., Calvo, A., Zhang, J. and Mihelcic, J.R. (2017) ‘Effectiveness of in-line chlorination in a developing world gravity-flow water supply’, Waterlines 36(2): 167–82 <https://doi.org/10.3362/1756-3488.16-00016>.
Peter-Varbanets, M., Dreyer, K., McFadden, N., Ouma, H., Wanyama, K., Etenu, C. and Meierhofer, R. (2017) ‘Evaluating novel gravity-driven membrane (GDM) water kiosks in schools’, paper presented at the 40th WEDC International Conference, Loughborough, UK [online] <https://hdl.handle.net/2134/31530> [accessed 12 March 2021].
Pickering, A.J., Crider, Y., Sultana, S., Swarthout, J., Goddard, F.G., Islam, S.A., Sen, S., Ayyagari, R. and Luby, S.P. (2019) ‘Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial’, The Lancet Global Health 7(9): e1247–56 <https://doi.org/10.1016/S2214-109X(19)30315-8>.
Reed, B., Scott, R., Skinner, B. and Jackson, T. (2011) G004: Domestic Water Containers: An Engineer’s Guide, Loughborough, UK: WEDC, Loughborough University.
Roberts, L., Chartier, Y., Chartier, O., Malenga, G., Toole, M. and Rodka, H. (2001) ‘Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial’, Bulletin of the World Health Organization 79: 280–7.
Skinner, B. (2001) Chlorinating Small Water Supplies, Loughborough, UK: Water, Engineering and Development Centre, Loughborough University.
Steele, A., Clarke, B. and Watkins, O. (2008) ‘Impact of jerry can disinfection in a camp environment: experiences in an IDP camp in northern Uganda’, Journal of Water and Health 6(4): 559–64 <http://doi.org/10.2166/wh.2008.072>.
Safe Water and AIDS Project (SWAP) (2017) Annual Report 2017, SWAP, Kisumu, Kenya.
Wilhelm, N., Kaufmann, A., Blanton, E. and Lantagne, D. (2018) ‘Sodium hypochlorite dosage for household and emergency water treatment: updated recommendations’, Journal of Water and Health 16(1): 112–25 <https://doi.org/10.2166/wh.2017.012>.
World Health Organization (WHO) (2017) Guidelines for Drinking-Water Quality: Fourth Edition Incorporating the First Addendum, Geneva, Switzerland: WHO.
Wright, J., Gundry, S. and Conroy, R. (2004) ‘Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use’, Tropical Medicine & International Health 9(1): 106–17 <http://doi.org/10.1046/j.1365-3156.2003.01160.x>.
Yates, T.M., Armitage, E., Lehmann, L.V., Branz, A.J. and Lantagne, D.S. (2015) ‘Effectiveness of chlorine dispensers in emergencies: case study results from Haiti, Sierra Leone, Democratic Republic of Congo, and Senegal’, Environmental Science & Technology 49(8): 5115–22 <https://doi.org/10.1021/acs.est.5b00309>.
Yee, L.F., Abdullah, M.P., Ata, S. and Ishak, B. (2006) ‘Dissolved organic matter and its impact on the chlorine demand of treated water’, Malaysian Journal of Analytical Sciences 10(2): 243–50.
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