Water quality and hygiene behavior in Burkina Faso: The impact of locally produced sodium hypochlorite solution in schools

Introduction.Sodium hypochlorite is a crucial element in the water treatment process. We aimed to verify if schools that lack adequate access to water and don't provide hygiene education courses would improve water quality after an intervention program. Methods.Twenty schools from the rural area of Burkina Faso were equipped with electro-chlorinator devices that produce sodium hypochlorite and received training to make water drinkable. Data related to behavioral change was collected. In addition, microbiological analysis of fecal coliforms, total coliforms, and fecal streptococci was performed in the drinking water from water stations or water storage containers. These indicators were measured before and two years after the program in six schools that participated, paired with three control schools from the same region. Results.Before the intervention, no schools practiced treating their water. After intervention, schools did it daily. WASH courses and water treatment training were also observed in intervention schools. Only the samples belonging to the control schools contained microorganisms in the drinking water after the intervention, particularly fecal coliforms and total coliforms. Fecal streptococci were not detected in any of the samples analyzed. Before the intervention, 50% of water samples from the intervention group and 66% from the control group were contaminated with fecal coliforms. Conclusion.Schools became independent of external disinfectant production after receiving electro-chlorinator devices and proper training to comply with WASH measures. Our findings might be useful to public health practitioners trying to implement sustainable programs.

Impact of Water, Sanitation and Hygiene Interventions on Growth, Non-diarrheal Morbidity and Mortality in Children Residing in Low- and Middle-income Countries: A Systematic Review

Objective: To evaluate the impact of water, sanitation and hygiene (WASH) interventions in children (age <18 y) on growth, non-diarrhealmorbidity and mortality in children.Design: Systematic review of randomized controlled trials, non-randomized controlled trials and controlled before-after studies.Setting: Low- and middle-income countries.Participants: 41 trials with WASH intervention, incorporating data on 113055 children.Intervention: Hygiene promotion and education (15 trials), water intervention (10 trials), sanitation improvement (7 trials), all threecomponents of WASH (4 trials), combined water and sanitation (1 trial), and sanitation and hygiene (1 trial).Outcome Measures: (i) Anthropometry: weight, height, weight-for-height, mid-arm circumference; (ii) Prevalence of malnutrition; (iii)Non-diarrheal morbidity; and (iv) mortality.Results: There may be little or no effect of hygiene intervention on most anthropometric parameters (low- to very-low quality evidence).Hygiene intervention reduced the risk of developing Acute respiratory infections by 24% (RR 0.76; 95% CI 0.59, 0.98; moderate qualityevidence), cough by 10% (RR 0.90; 95% CI 0.83, 0.97; moderate quality evidence), laboratory-confirmed influenza by 50% (RR 0.5; 95%CI 0.41, 0.62; very low quality evidence), fever by 13% (RR 0.87; 95% CI 0.74, 1.02; moderate quality evidence), and conjunctivitis by51% (RR 0.49; 95% CI 0.45, 0.55; low quality evidence). There was low quality evidence to suggest no impact of hygiene intervention onmortality (RR 0.65; 95% CI 0.25, 1.7). Improvement in water supply and quality was associated with slightly higher weight-for-age Z-score(MD 0.03; 95% CI 0, 0.06; low quality evidence), but no significant impact on other anthropometric parameters or infectious morbidity (lowto very low quality evidence). There was very low quality evidence to suggest reduction in mortality (RR 0.45; 95% CI 0.25, 0.81).Improvement in sanitation had a variable effect on the anthropometry and infectious morbidity. Combined water, sanitation and hygieneintervention improved height-for-age Z scores (MD 0.22; 95% CI 0.12, 0.32) and decreased the risk of stunting by 13% (RR 0.87; 95% CI0.81, 0.94) (very low quality of evidence). There was no evidence of significant effect of combined WASH interventions on non-diarrhealmorbidity (fever, respiratory infections, intestinal helminth infection and school absenteeism) (low- to very-low quality of evidence). AnyWASH intervention (considered together) resulted in lower risk of underweight (RR 0.81; 95% CI 0.69, 0.96), stunting (RR 0.77; 95% CI0.68, 0.86) and wasting (RR 0.12, 0.85) (low- to very-low quality of evidence).Conclusion: Available evidence suggests that there may be little or no effect of WASH interventions on the anthropometric indices inchildren from low- and middle-income countries. There is low- to very-low quality of evidence to suggest decrease in prevalence ofwasting, stunting and underweight. WASH interventions (especially hygiene intervention) were associated with lower risk of non-diarrhealmorbidity (very low to moderate quality evidence). There was very low quality evidence to suggest some decrease to no change inmortality. These potential health benefits lend support to the ongoing efforts for provision of safe and adequate water supply, sanitationand hygiene.