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Cycle 6 (2017 Deadline)
Effectiveness of point-of-use water treatment technologies to prevent child stunting in South Africa
PI: Pascal Bessong, pascal.bessong@gmail.com, University of Venda
U.S. Partner: James Smith, University of Virginia
Project Dates: March 2018 - August 2021
Project Overview
In low-resource settings, lack of safe water and adequate sanitation has long-term detrimental consequences for child health and development. Continuous exposure to unclean water can lead to poor linear growth among children. Stunting early in life is an important marker of long-term morbidity and has been associated with cognitive impairment, poor school performance, low adult economic productivity, and increased risk of chronic disease later in life. In a recent study, the prevalence of stunting increased from 12% in the first month of life to 37% at 2 years of age in the Dzimauli community of Limpopo, South Africa. Interventions that improve access to safe water and sanitation have the potential to make a significant impact on child stunting but have not been well-studied towards this aim. The municipal water supply for the Dzimauli community is not consistent, and community-level water treatment systems are not available. Less than 20% of households reported treating their drinking water in 2009, which suggests that there is a clear need for an acceptable drinking water solution.
U.S. partner James Smith and his team have helped develop two point-of-use water treatment technologies with demonstrated technical efficacy, sustainability, and social acceptance in several low-resource communities: the silver-impregnated ceramic water filter and the silver-impregnated ceramic disk, called a MadiDrop. This PEER project, led in South Africa by Dr. Pascal Bessong, tested the effectiveness of these technologies on improvement in child health outcomes, specifically reducing pathogen exposure and preventing stunting among children in Limpopo.
Final Summary of Project Activities
The PEER researchers identified and enrolled 400 eligible households from villages in the Dzimauli community. Each household’s caregiver was given a container to collect a stool sample from their youngest child, and households were randomized to receive one of three interventions or no intervention. All subjects were advised regarding water health, sanitation, and hygiene practices to follow in the home, and the researchers conducted a baseline questionnaire on demographics, socioeconomic status, water sources, and sanitation and hygiene practices.
Intervention households were visited every month for two years to ensure that the intervention technologies provided were in working condition and being used properly. At three-month intervals, the monthly home visits were extended for further data and sample collection, and all households were visited, including those who received no intervention. At these visits, researchers took height and weight measurements on all children under 15 in the household and collected a stool sample from the youngest child. The PEER team also collected treated water samples from the safe-storage water container at a random subset of 50 households receiving the filter or ceramic disk, and they replaced the ceramic disks every six months.
Stool and water samples were tested for the presence of pathogens, as well as biomarkers for levels of gut function. The researchers found that silver-impregnated clay water filters did significantly remove germs from household water, but this did not correlate with a reduction in stunting in young children. The team also observed how seasonal changes in drinking water availability and the type of drinking water sources affected enteric infections in young children, and they concluded that home-based filters alone were not enough to provide health benefits to young children. They recommended a multi-pronged approach to reduce the load of intestinal pathogens in young children, including the provision of sanitation facilities in the communities and at school.
The PEER team hosted two workshops for high school students and teachers on the consequences of enteropathogenic infections on health growth and cognitive development in children. The researchers published their results in three peer-reviewed papers and received an additional two grants, for a total of $90,000, during the project period.
Publications
David D. Meyer, Courtney Hill, Kelly McCain, James A. Smith, Pascal O. Bessong, Elizabeth T. Rogawski McQuade, and Natasha C. Wright. 2021. Embedding usage sensors in point-of-use water treatment devices: sensor design and application in Limpopo, South Africa. Environmental Science and Technology 2021 55, 13, 8955–8964. https://doi.org/10.1021/acs.est.0c08683
Kathy H. Nguyen, Darwin J. Operario, Mzwakhe E. Nyathi, Courtney L. Hill, James A. Smith, Richard L. Guerrant, Amidou Samie, Rebecca A. Dillingham, Pascal O. Bessong, and Elizabeth T. Rogawski McQuade. 2021. Seasonality of drinking water sources and the impact of drinking water source on enteric infections among children in Limpopo, South Africa. International Journal of Hygiene and Environmental Health 231:113640. https://doi.org/10.1016/j.ijheh.2020.113640
Courtney L. Hill, Kelly McCain, Mzwakhe E. Nyathi, Joshua N. Edokpayi, David M. Kahler, Darwin J. Operario, David D.J. Taylor, Natasha C. Wright, James A. Smith, Richard L. Guerrant, Amidou Samie, Rebecca A. Dillingham, Pascal O. Bessong, and Elizabeth T. Rogawski McQuade. 2020. Impact of low-cost point-of-use water treatment technologies on enteric infections and growth among children in Limpopo, South Africa. American Journal of Tropical Medicine and Hygiene 103(4):1405-1415. https://doi.org/10.4269/ajtmh.20-0228
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