Consumption of poor quality water can cause diarrhoea and waterborne disease. To determine how to support residents to consume safe water, the Vanuatu Department of Water Resources (DoWR) undertook an analysis. The analysis included reviewing 793 water quality test results, exploring treatment options with WASH sector stakeholders, surveying 689 community members in three provinces, demonstrating products to 510 people in 22 communities, and interviewing key informants. Analysis of water quality results compiled by DoWR between 2000 and mid-2019 found that Escherichia coli was detected in 60% of samples tested and total coliforms were detected in 84% of samples. Overall, 62% of individuals surveyed stated that water is in some way a daily problem. Discussion facilitators reported that most individuals had not seen or heard of water treatment options beyond boiling and most who boiled admitted they do so only occasionally. Of the water treatment options explored in this research, household water filtration systems seemed the most viable approach. However, individuals underestimated the market cost of filters and indicated a willingness to pay that is half the market price. Of the different filtration systems demonstrated, consumers stated a preference for easy-to-use units with large and transparent water storage containers.

Adventist Development & Relief Agency (ADRA) (2015) ‘Vital needs met in Vanuatu’, 25 March [online] <https://adra.org/vital-needs-met-in-vanuatu> [accessed 20 September 2021].

Arnold, B.F. and Colford, J.M. (2007) ‘Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: a systematic review and meta-analysis’, American Journal of Tropical Medicine and Hygiene 76(2): 354–364 <https://doi.org/10.4269/ajtmh.2007.76.354>.

Backer, H. (2019) ‘Water disinfection for international travelers’, in B.A. Connor, H.D. Nothdurft, J.S. Keystone, K. Leder, M. Mendelson. and P.E. Kozarsky (eds), Travel Medicine, 4th edn, pp. 31–41, Amsterdam: Elsevier.

Carter, K., Tovu, V., Langati, J.T., Buttsworth, M., Dingley, L., Calo, A., Harrison, G., Rao, C., Lopez, A.D. and Taylor, R. (2016) ‘Causes of death in Vanuatu’, Population Health Metrics 14(1): 7 <https://doi.org/10.1186/s12963-016-0074-4>.

Centers for Disease Control and Prevention (CDC) (2012) Solar disinfection [online] <https://www.cdc.gov/safewater/solardisinfection.html> [accessed January 2020].

Clasen, T. (2015) ‘Household water treatment and safe storage to prevent diarrheal disease in developing countries’, Current Environmental Health Reports 2(1): 69–74 <https://doi.org10.1007/s40572-014-0033-9>.

Clasen, T.F. and Bastable, A. (2003) ‘Faecal contamination of drinking water during collection and household storage: the need to extend protection to the point of use’, Journal of Water and Health 1(3): 109–15 <https://doi.org/10.2166/wh.2003.0013>.

Dangour, A.D., Watson, L., Cummings, O., Boisson, S., Che, Y., Velleman, Y., Cavill, S., Allen, E. and Uauy, R. (2013) ‘Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children’, Cochrane Database of Systematic Reviews 8: CD009382 <https://doi.org/10.1002/14651858.CD009382.pub2>.

Department of Water Resources (DoWR) (2016) WASH Cluster Poster [online] <https://mol.gov.vu/images/News-Photo/water/DoWR_File/Monitoring_Evaluation/WASH-Posters.pdf> [accessed January 2020].

DoWR (2019a) Drinking water test results [online] <https://app.powerbi.com/view?r=eyJrIjoiMThjMzQ3YmMtYzZlZS00NWE4LTlkZWQtODc3ODY4NzA5NTY0IiwidCI6IjlmMzE1M2U5LTAzM2ItNGE0YS04MTczLWRmN2I0YzIxOTU5MiIsImMiOjh9> [accessed December 2019] currently version housed at: <https://mol.gov.vu/index.php/en/dowr>.

DoWR (2019b) Republic of Vanuatu: Water Supply Act: National Drinking Water Quality Standards [online] <https://mol.gov.vu/images/News-Photo/water/DoWR_File/Monitoring_Evaluation/Official_Gazette_No_26_of_2019_dated_13_June_2019_1.pdf> [accessed January 2020].

DoWR (2020a) Collection of water boiling promotional materials [online] <https://mol.gov.vu/index.php/en/monitoring-evaluation-unit-water#tab1> [accessed January 2020].

DoWR (2020b) Vanuatu Draft WASH Cluster Standard Operating Procedures (unpublished).

ENGIE (2019) English survey form translation [online] <https://drive.google.com/file/d/1gOWgfeO-UxhSvSbZOKHLt5Fmnm56yPzg/view> [accessed December 2019].

Harding, A.K. and Anadu, E.C. (2000) ‘Consumer response to public notification’, Journal of the American Water Works Association 92(8): 32–41 <https://doi.org/10.1002/j.1551-8833.2000.tb08989.x>.

Hunter, P.R. (2009) ‘Household water treatment in developing countries: comparing different intervention types using meta-regression’, Environmental Science & Technology 43(23): 8991–7 <https://doi.org/10.1021/es9028217>.

Joseph, G., Haque, S., Moqueet, N. and Hoo, Y.R. (2019) Children Need Clean Water to Grow [online], Policy Research Working Paper 9054, World Bank, Washington, DC <https://openknowledge.worldbank.org/bitstream/handle/10986/32663/WPS9054.pdf?sequence=4&isAllowed=y> [accessed 20 September 2021].

Lauer, J.M., Duggan, C.P., Ausman, L.M., Griffiths, J.K., Webb, P., Bashaasha, B., Agaba, E., Turyashemerwa, F.M. and Ghosh, S. (2018) ‘Unsafe drinking water is associated with environmental enteric dysfunction and poor growth outcomes in young children in rural southwestern Uganda’, The American Journal of Tropical Medicine and Hygiene 99(6): 1606–1612 <https://doi.org/10.4269/ajtmh.18-0143>.

Levy, K., Smith, S.M. and Carlton, E.J. (2019) ‘Climate change impacts on waterborne diseases: moving toward designing interventions’, Current Environmental Health Reports 5(2): 272–82 <https://doi.org/10.1007/s40572-018-0199-7>.

Mitra, P., Pal, D.K. and Das, M. (2018) ‘Does quality of drinking water matter in kidney stone disease: a study in West Bengal, India’, Investigative and Clinical Urology 59(3): 158–65 <https://doi.org/10.4111/icu.2018.59.3.158>.

MoH (Vanuatu Ministry of Health) (2011) Health Islands Environmental Hygiene Chapter [online] <https://healthyislandsvanuatu.files.wordpress.com/2011/08/hi-package_ph.pdf> [accessed January 2020].

National Academy of Sciences (1977) Drinking Water and Health, National Academy of Sciences, Washington, DC.

Nieuwenhuijsen, M.J., Martinez, D., Grellier, J., Bennett, J., Best, N., Iszatt, N., Vrijheid, M. and Toledano, M.B. (2009) ‘Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses’, Environmental Health Perspectives 117(10): 1486–93 <https://doi.org/10.1289/ehp.0900677>.

Philipsborn, R., Ahmed, S.M., Brosi, B.J. and Levy, K. (2016) ‘Climatic drivers of diarrheagenic Escherichia coli incidence: a systematic review and meta-analysis’, The Journal of Infectious Diseases 214(1): 6–15 <https://doi.org/10.1093/infdis/jiw081>.

Radio New Zealand (RNZ) (2019) ‘Petition opposing Rarotongan water chlorination presented’, RNZ, 11 December [online] <https://www.rnz.co.nz/international/pacific-news/405254/petition-opposing-rarotongan-water-chlorination-presented> [accessed January 2020].

Rand, E.C. and Sammy, E. (2018) Vanuatu WASH Sector Analysis [online], Ministry of Lands & Natural Resources <https://drive.google.com/file/d/1FPVdHzrmFe-Es2v5QHbLV5AC5UAFB9c0/view> [accessed January 2020].

Republic of Vanuatu (2016) Vanuatu 2030: The People’s Plan, Government of Vanuatu, Port Vila.

Sodha, S.V., Menon, M., Trivedi, K., Ati, A., Figueroa, M.E., Ainslie, R., Wannemuehler, K. and Quick, R. (2011) ‘Microbiologic effectiveness of boiling and safe water storage in South Sulawesi, Indonesia’, Journal of Water and Health 9(3): 577–85 <https://doi.org/10.2166/wh.2011.255>.

String, G., Singleton, R., Mirindi, P. N., Polo, F. and Lantagne, D. (2017) ‘Operational research on water safety plans: implementations in India, DRC, Fiji, and Vanuatu (Version 1)’, in R.J. Shaw (ed.), Local Action with International Cooperation to Improve and Sustain Water, Sanitation and Hygiene (WASH) Services: Proceedings of the 40th WEDC International Conference, Loughborough, UK, 24–28 July 2017, WEDC, Loughborough University <https://hdl.handle.net/2134/31548> [accessed 20 September 2021].

String, G.M., Singleton, R.I., Mirindi, P.M. and Lantagne, D.S. (2020) ‘Operational research on rural, community-managed Water Safety Plans: case study results from implementations in India, DRC, Fiji, and Vanuatu’, Water Research 170: 115288 <https://doi.org/10.1016/j.watres.2019.115288>.

UNICEF/WHO (2017) A Snapshot of Household Sanitation, Drinking Water and Hygiene in the East Asia and Pacific [online] <https://www.unicef.org/eap/reports/snapshot-household-sanitation-drinking-water-and-hygiene> [accessed 29 September 2021].

VNSO (2014) Vanuatu Demographic and Health Survey 2013, Government of Vanuatu, Port Vila.

VNSO (2017) Vanuatu 2016 Post-TC Pam Mini-Census Report, Government of Vanuatu, Port Vila.

World Bank (2020) Data <https://data.worldbank.org/country/vanuatu> [accessed January 2019].

World Health Organization (WHO) (2017) Guidelines for Drinking-Water Quality, 4th edition, incorporating the 1st addendum [online] <https://www.who.int/publications/i/item/9789241549950> [accessed September 2021].

WHO (2018) ‘Household air pollution and health’ [online] <https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health> [accessed January 2019].

WHO (2019) Results of Round II of the WHO Household Water Treatment Evaluation Scheme [online] <https://www.who.int/publications-detail-redirect/9789241516037> [accessed 20 September 2021].

WHO/UNICEF (2019) Estimates on the Use of Water, Sanitation and Hygiene in Vanuatu, WHO, Geneva.

Willis, S., Goldfarb, D.S., Thomas, K. and Bultitude, M. (2019) ‘Water to prevent kidney stones: tap vs bottled; soft vs hard – does it matter?’ BJU International 124(6): 905–906 <https://doi.org/10.1111/bju.14871>.

Willocks, L.J., Sufi, F., Wall, R., Seng, C. and Swan, A.V. (2000) ‘Compliance with advice to boil drinking water during an outbreak of cryptosporidiosis. Outbreak Investigation Team’, Communicable Disease and Public Health 3(2): 137–8 <https://www.ncbi.nlm.nih.gov/pubmed/10902259>.

Wong, V., Cowling, B.J. and Aiello, A.E. (2014) ‘Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis’, Epidemiology and Infection 142(5): 922–32 <https://doi.org/10.1017/S095026881400003X>.

Workman, C.L. (2019) ‘Perceptions of drinking water cleanliness and health-seeking behaviours: a qualitative assessment of household water safety in Lesotho, Africa’, Global Public Health 14(9): 1347–59 <https://doi.org/10.1080/17441692.2019.1566483>.

Adventist Development & Relief Agency (ADRA) (2015) ‘Vital needs met in Vanuatu’, 25 March [online] <https://adra.org/vital-needs-met-in-vanuatu> [accessed 20 September 2021].

Arnold, B.F. and Colford, J.M. (2007) ‘Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: a systematic review and meta-analysis’, American Journal of Tropical Medicine and Hygiene 76(2): 354–364 <https://doi.org/10.4269/ajtmh.2007.76.354>.

Backer, H. (2019) ‘Water disinfection for international travelers’, in B.A. Connor, H.D. Nothdurft, J.S. Keystone, K. Leder, M. Mendelson. and P.E. Kozarsky (eds), Travel Medicine, 4th edn, pp. 31–41, Amsterdam: Elsevier.

Carter, K., Tovu, V., Langati, J.T., Buttsworth, M., Dingley, L., Calo, A., Harrison, G., Rao, C., Lopez, A.D. and Taylor, R. (2016) ‘Causes of death in Vanuatu’, Population Health Metrics 14(1): 7 <https://doi.org/10.1186/s12963-016-0074-4>.

Centers for Disease Control and Prevention (CDC) (2012) Solar disinfection [online] <https://www.cdc.gov/safewater/solardisinfection.html> [accessed January 2020].

Clasen, T. (2015) ‘Household water treatment and safe storage to prevent diarrheal disease in developing countries’, Current Environmental Health Reports 2(1): 69–74 <https://doi.org10.1007/s40572-014-0033-9>.

Clasen, T.F. and Bastable, A. (2003) ‘Faecal contamination of drinking water during collection and household storage: the need to extend protection to the point of use’, Journal of Water and Health 1(3): 109–15 <https://doi.org/10.2166/wh.2003.0013>.

Dangour, A.D., Watson, L., Cummings, O., Boisson, S., Che, Y., Velleman, Y., Cavill, S., Allen, E. and Uauy, R. (2013) ‘Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children’, Cochrane Database of Systematic Reviews 8: CD009382 <https://doi.org/10.1002/14651858.CD009382.pub2>.

Department of Water Resources (DoWR) (2016) WASH Cluster Poster [online] <https://mol.gov.vu/images/News-Photo/water/DoWR_File/Monitoring_Evaluation/WASH-Posters.pdf> [accessed January 2020].

DoWR (2019a) Drinking water test results [online] <https://app.powerbi.com/view?r=eyJrIjoiMThjMzQ3YmMtYzZlZS00NWE4LTlkZWQtODc3ODY4NzA5NTY0IiwidCI6IjlmMzE1M2U5LTAzM2ItNGE0YS04MTczLWRmN2I0YzIxOTU5MiIsImMiOjh9> [accessed December 2019] currently version housed at: <https://mol.gov.vu/index.php/en/dowr>.

DoWR (2019b) Republic of Vanuatu: Water Supply Act: National Drinking Water Quality Standards [online] <https://mol.gov.vu/images/News-Photo/water/DoWR_File/Monitoring_Evaluation/Official_Gazette_No_26_of_2019_dated_13_June_2019_1.pdf> [accessed January 2020].

DoWR (2020a) Collection of water boiling promotional materials [online] <https://mol.gov.vu/index.php/en/monitoring-evaluation-unit-water#tab1> [accessed January 2020].

DoWR (2020b) Vanuatu Draft WASH Cluster Standard Operating Procedures (unpublished).

ENGIE (2019) English survey form translation [online] <https://drive.google.com/file/d/1gOWgfeO-UxhSvSbZOKHLt5Fmnm56yPzg/view> [accessed December 2019].

Harding, A.K. and Anadu, E.C. (2000) ‘Consumer response to public notification’, Journal of the American Water Works Association 92(8): 32–41 <https://doi.org/10.1002/j.1551-8833.2000.tb08989.x>.

Hunter, P.R. (2009) ‘Household water treatment in developing countries: comparing different intervention types using meta-regression’, Environmental Science & Technology 43(23): 8991–7 <https://doi.org/10.1021/es9028217>.

Joseph, G., Haque, S., Moqueet, N. and Hoo, Y.R. (2019) Children Need Clean Water to Grow [online], Policy Research Working Paper 9054, World Bank, Washington, DC <https://openknowledge.worldbank.org/bitstream/handle/10986/32663/WPS9054.pdf?sequence=4&isAllowed=y> [accessed 20 September 2021].

Lauer, J.M., Duggan, C.P., Ausman, L.M., Griffiths, J.K., Webb, P., Bashaasha, B., Agaba, E., Turyashemerwa, F.M. and Ghosh, S. (2018) ‘Unsafe drinking water is associated with environmental enteric dysfunction and poor growth outcomes in young children in rural southwestern Uganda’, The American Journal of Tropical Medicine and Hygiene 99(6): 1606–1612 <https://doi.org/10.4269/ajtmh.18-0143>.

Levy, K., Smith, S.M. and Carlton, E.J. (2019) ‘Climate change impacts on waterborne diseases: moving toward designing interventions’, Current Environmental Health Reports 5(2): 272–82 <https://doi.org/10.1007/s40572-018-0199-7>.

Mitra, P., Pal, D.K. and Das, M. (2018) ‘Does quality of drinking water matter in kidney stone disease: a study in West Bengal, India’, Investigative and Clinical Urology 59(3): 158–65 <https://doi.org/10.4111/icu.2018.59.3.158>.

MoH (Vanuatu Ministry of Health) (2011) Health Islands Environmental Hygiene Chapter [online] <https://healthyislandsvanuatu.files.wordpress.com/2011/08/hi-package_ph.pdf> [accessed January 2020].

National Academy of Sciences (1977) Drinking Water and Health, National Academy of Sciences, Washington, DC.

Nieuwenhuijsen, M.J., Martinez, D., Grellier, J., Bennett, J., Best, N., Iszatt, N., Vrijheid, M. and Toledano, M.B. (2009) ‘Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses’, Environmental Health Perspectives 117(10): 1486–93 <https://doi.org/10.1289/ehp.0900677>.

Philipsborn, R., Ahmed, S.M., Brosi, B.J. and Levy, K. (2016) ‘Climatic drivers of diarrheagenic Escherichia coli incidence: a systematic review and meta-analysis’, The Journal of Infectious Diseases 214(1): 6–15 <https://doi.org/10.1093/infdis/jiw081>.

Radio New Zealand (RNZ) (2019) ‘Petition opposing Rarotongan water chlorination presented’, RNZ, 11 December [online] <https://www.rnz.co.nz/international/pacific-news/405254/petition-opposing-rarotongan-water-chlorination-presented> [accessed January 2020].

Rand, E.C. and Sammy, E. (2018) Vanuatu WASH Sector Analysis [online], Ministry of Lands & Natural Resources <https://drive.google.com/file/d/1FPVdHzrmFe-Es2v5QHbLV5AC5UAFB9c0/view> [accessed January 2020].

Republic of Vanuatu (2016) Vanuatu 2030: The People’s Plan, Government of Vanuatu, Port Vila.

Sodha, S.V., Menon, M., Trivedi, K., Ati, A., Figueroa, M.E., Ainslie, R., Wannemuehler, K. and Quick, R. (2011) ‘Microbiologic effectiveness of boiling and safe water storage in South Sulawesi, Indonesia’, Journal of Water and Health 9(3): 577–85 <https://doi.org/10.2166/wh.2011.255>.

String, G., Singleton, R., Mirindi, P. N., Polo, F. and Lantagne, D. (2017) ‘Operational research on water safety plans: implementations in India, DRC, Fiji, and Vanuatu (Version 1)’, in R.J. Shaw (ed.), Local Action with International Cooperation to Improve and Sustain Water, Sanitation and Hygiene (WASH) Services: Proceedings of the 40th WEDC International Conference, Loughborough, UK, 24–28 July 2017, WEDC, Loughborough University <https://hdl.handle.net/2134/31548> [accessed 20 September 2021].

String, G.M., Singleton, R.I., Mirindi, P.M. and Lantagne, D.S. (2020) ‘Operational research on rural, community-managed Water Safety Plans: case study results from implementations in India, DRC, Fiji, and Vanuatu’, Water Research 170: 115288 <https://doi.org/10.1016/j.watres.2019.115288>.

UNICEF/WHO (2017) A Snapshot of Household Sanitation, Drinking Water and Hygiene in the East Asia and Pacific [online] <https://www.unicef.org/eap/reports/snapshot-household-sanitation-drinking-water-and-hygiene> [accessed 29 September 2021].

VNSO (2014) Vanuatu Demographic and Health Survey 2013, Government of Vanuatu, Port Vila.

VNSO (2017) Vanuatu 2016 Post-TC Pam Mini-Census Report, Government of Vanuatu, Port Vila.

World Bank (2020) Data <https://data.worldbank.org/country/vanuatu> [accessed January 2019].

World Health Organization (WHO) (2017) Guidelines for Drinking-Water Quality, 4th edition, incorporating the 1st addendum [online] <https://www.who.int/publications/i/item/9789241549950> [accessed September 2021].

WHO (2018) ‘Household air pollution and health’ [online] <https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health> [accessed January 2019].

WHO (2019) Results of Round II of the WHO Household Water Treatment Evaluation Scheme [online] <https://www.who.int/publications-detail-redirect/9789241516037> [accessed 20 September 2021].

WHO/UNICEF (2019) Estimates on the Use of Water, Sanitation and Hygiene in Vanuatu, WHO, Geneva.

Willis, S., Goldfarb, D.S., Thomas, K. and Bultitude, M. (2019) ‘Water to prevent kidney stones: tap vs bottled; soft vs hard – does it matter?’ BJU International 124(6): 905–906 <https://doi.org/10.1111/bju.14871>.

Willocks, L.J., Sufi, F., Wall, R., Seng, C. and Swan, A.V. (2000) ‘Compliance with advice to boil drinking water during an outbreak of cryptosporidiosis. Outbreak Investigation Team’, Communicable Disease and Public Health 3(2): 137–8 <https://www.ncbi.nlm.nih.gov/pubmed/10902259>.

Wong, V., Cowling, B.J. and Aiello, A.E. (2014) ‘Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis’, Epidemiology and Infection 142(5): 922–32 <https://doi.org/10.1017/S095026881400003X>.

Workman, C.L. (2019) ‘Perceptions of drinking water cleanliness and health-seeking behaviours: a qualitative assessment of household water safety in Lesotho, Africa’, Global Public Health 14(9): 1347–59 <https://doi.org/10.1080/17441692.2019.1566483>.

Adventist Development & Relief Agency (ADRA) (2015) ‘Vital needs met in Vanuatu’, 25 March [online] <https://adra.org/vital-needs-met-in-vanuatu> [accessed 20 September 2021].

Arnold, B.F. and Colford, J.M. (2007) ‘Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: a systematic review and meta-analysis’, American Journal of Tropical Medicine and Hygiene 76(2): 354–364 <https://doi.org/10.4269/ajtmh.2007.76.354>.

Backer, H. (2019) ‘Water disinfection for international travelers’, in B.A. Connor, H.D. Nothdurft, J.S. Keystone, K. Leder, M. Mendelson. and P.E. Kozarsky (eds), Travel Medicine, 4th edn, pp. 31–41, Amsterdam: Elsevier.

Carter, K., Tovu, V., Langati, J.T., Buttsworth, M., Dingley, L., Calo, A., Harrison, G., Rao, C., Lopez, A.D. and Taylor, R. (2016) ‘Causes of death in Vanuatu’, Population Health Metrics 14(1): 7 <https://doi.org/10.1186/s12963-016-0074-4>.

Centers for Disease Control and Prevention (CDC) (2012) Solar disinfection [online] <https://www.cdc.gov/safewater/solardisinfection.html> [accessed January 2020].

Clasen, T. (2015) ‘Household water treatment and safe storage to prevent diarrheal disease in developing countries’, Current Environmental Health Reports 2(1): 69–74 <https://doi.org10.1007/s40572-014-0033-9>.

Clasen, T.F. and Bastable, A. (2003) ‘Faecal contamination of drinking water during collection and household storage: the need to extend protection to the point of use’, Journal of Water and Health 1(3): 109–15 <https://doi.org/10.2166/wh.2003.0013>.

Dangour, A.D., Watson, L., Cummings, O., Boisson, S., Che, Y., Velleman, Y., Cavill, S., Allen, E. and Uauy, R. (2013) ‘Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children’, Cochrane Database of Systematic Reviews 8: CD009382 <https://doi.org/10.1002/14651858.CD009382.pub2>.

Department of Water Resources (DoWR) (2016) WASH Cluster Poster [online] <https://mol.gov.vu/images/News-Photo/water/DoWR_File/Monitoring_Evaluation/WASH-Posters.pdf> [accessed January 2020].

DoWR (2019a) Drinking water test results [online] <https://app.powerbi.com/view?r=eyJrIjoiMThjMzQ3YmMtYzZlZS00NWE4LTlkZWQtODc3ODY4NzA5NTY0IiwidCI6IjlmMzE1M2U5LTAzM2ItNGE0YS04MTczLWRmN2I0YzIxOTU5MiIsImMiOjh9> [accessed December 2019] currently version housed at: <https://mol.gov.vu/index.php/en/dowr>.

DoWR (2019b) Republic of Vanuatu: Water Supply Act: National Drinking Water Quality Standards [online] <https://mol.gov.vu/images/News-Photo/water/DoWR_File/Monitoring_Evaluation/Official_Gazette_No_26_of_2019_dated_13_June_2019_1.pdf> [accessed January 2020].

DoWR (2020a) Collection of water boiling promotional materials [online] <https://mol.gov.vu/index.php/en/monitoring-evaluation-unit-water#tab1> [accessed January 2020].

DoWR (2020b) Vanuatu Draft WASH Cluster Standard Operating Procedures (unpublished).

ENGIE (2019) English survey form translation [online] <https://drive.google.com/file/d/1gOWgfeO-UxhSvSbZOKHLt5Fmnm56yPzg/view> [accessed December 2019].

Harding, A.K. and Anadu, E.C. (2000) ‘Consumer response to public notification’, Journal of the American Water Works Association 92(8): 32–41 <https://doi.org/10.1002/j.1551-8833.2000.tb08989.x>.

Hunter, P.R. (2009) ‘Household water treatment in developing countries: comparing different intervention types using meta-regression’, Environmental Science & Technology 43(23): 8991–7 <https://doi.org/10.1021/es9028217>.

Joseph, G., Haque, S., Moqueet, N. and Hoo, Y.R. (2019) Children Need Clean Water to Grow [online], Policy Research Working Paper 9054, World Bank, Washington, DC <https://openknowledge.worldbank.org/bitstream/handle/10986/32663/WPS9054.pdf?sequence=4&isAllowed=y> [accessed 20 September 2021].

Lauer, J.M., Duggan, C.P., Ausman, L.M., Griffiths, J.K., Webb, P., Bashaasha, B., Agaba, E., Turyashemerwa, F.M. and Ghosh, S. (2018) ‘Unsafe drinking water is associated with environmental enteric dysfunction and poor growth outcomes in young children in rural southwestern Uganda’, The American Journal of Tropical Medicine and Hygiene 99(6): 1606–1612 <https://doi.org/10.4269/ajtmh.18-0143>.

Levy, K., Smith, S.M. and Carlton, E.J. (2019) ‘Climate change impacts on waterborne diseases: moving toward designing interventions’, Current Environmental Health Reports 5(2): 272–82 <https://doi.org/10.1007/s40572-018-0199-7>.

Mitra, P., Pal, D.K. and Das, M. (2018) ‘Does quality of drinking water matter in kidney stone disease: a study in West Bengal, India’, Investigative and Clinical Urology 59(3): 158–65 <https://doi.org/10.4111/icu.2018.59.3.158>.

MoH (Vanuatu Ministry of Health) (2011) Health Islands Environmental Hygiene Chapter [online] <https://healthyislandsvanuatu.files.wordpress.com/2011/08/hi-package_ph.pdf> [accessed January 2020].

National Academy of Sciences (1977) Drinking Water and Health, National Academy of Sciences, Washington, DC.

Nieuwenhuijsen, M.J., Martinez, D., Grellier, J., Bennett, J., Best, N., Iszatt, N., Vrijheid, M. and Toledano, M.B. (2009) ‘Chlorination disinfection by-products in drinking water and congenital anomalies: review and meta-analyses’, Environmental Health Perspectives 117(10): 1486–93 <https://doi.org/10.1289/ehp.0900677>.

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