What point-of-use water treatment products do consumers use? Evidence from a randomized controlled trial among the urban poor in Bangladesh.
BACKGROUND
There is evidence that household point-of-use (POU) water treatment products can reduce the enormous burden of water-borne illness. Nevertheless, adoption among the global poor is very low, and little evidence exists on why.


METHODS
We gave 600 households in poor communities in Dhaka, Bangladesh randomly-ordered two-month free trials of four water treatment products: dilute liquid chlorine (sodium hypochlorite solution, marketed locally as Water Guard), sodium dichloroisocyanurate tablets (branded as Aquatabs), a combined flocculant-disinfectant powdered mixture (the PUR Purifier of Water), and a silver-coated ceramic siphon filter. Consumers also received education on the dangers of untreated drinking water. We measured which products consumers used with self-reports, observation (for the filter), and chlorine tests (for the other products). We also measured drinking water's contamination with E. coli (compared to 200 control households).


RESULTS
Households reported highest usage of the filter, although no product had even 30% usage. E. coli concentrations in stored drinking water were generally lowest when households had Water Guard. Households that self-reported product usage had large reductions in E. coli concentrations with any product as compared to controls.


CONCLUSIONS
Traditional arguments for the low adoption of POU products focus on affordability, consumers' lack of information about germs and the dangers of unsafe water, and specific products not meshing with a household's preferences. In this study we provided free trials, repeated informational messages explaining the dangers of untreated water, and a variety of product designs. The low usage of all products despite such efforts makes clear that important barriers exist beyond cost, information, and variation among these four product designs. Without a better understanding of the choices and aspirations of the target end-users, household-based water treatment is unlikely to reduce morbidity and mortality substantially in urban Bangladesh and similar populations.
RAND Corporation, Santa Monica, California, United States of America. jluoto@rand.org
Jill
J
Luoto
Nusrat
N
Najnin
Minhaj
M
Mahmud
Jeff
J
Albert
M Sirajul
MS
Islam
Stephen
S
Luby
Leanne
L
Unicomb
David I
DI
Levine
D001459:Bangladesh; D002947:Cities / Q000191:economics; D003258:Consumer Behavior / Q000191:economics; D004202:Disinfectants / Q000008:administration & dosage / Q000494:pharmacology; D004203:Disinfection / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D060766:Drinking Water / Q000382:microbiology; D004926:Escherichia coli / Q000302:isolation & purification; D005374:Filtration / Q000706:statistics & numerical data; D005506:Food Contamination / Q000517:prevention & control; D006801:Humans; D011203:Poverty; D057566:Self Report; D012923:Social Class; D018508:Water Purification / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data
D004202:Disinfectants; D060766:Drinking Water