title: Factors affecting continued use of ceramic water purifiers distributed to tsunami-affected communities in Sri Lanka.
abstract: OBJECTIVE
  There is little information about continued use of point-of-use technologies after disaster relief efforts. After the 2004 tsunami, the Red Cross distributed ceramic water filters in Sri Lanka. This study determined factors associated with filter disuse and evaluate the quality of household drinking water.
  
  
  METHODS
  A cross-sectional survey of water sources and treatment, filter use and household characteristics was administered by in-person oral interview, and household water quality was tested. Multivariable logistic regression was used to model probability of filter non-use.
  
  
  RESULTS
  At the time of survey, 24% of households (107/452) did not use filters; the most common reason given was breakage (42%). The most common household water sources were taps and wells. Wells were used by 45% of filter users and 28% of non-users. Of households with taps, 75% had source water Escherichia coli in the lowest World Health Organisation risk category (<1/100 ml), vs. only 30% of households reporting wells did. Tap households were approximately four times more likely to discontinue filter use than well households.
  
  
  CONCLUSIONS
  After 2 years, 24% of households were non-users. The main factors were breakage and household water source; households with taps were more likely to stop use than households with wells. Tap water users also had higher-quality source water, suggesting that disuse is not necessarily negative and monitoring of water quality can aid decision-making about continued use. To promote continued use, disaster recovery filter distribution efforts must be joined with capacity building for long-term water monitoring, supply chains and local production.
authors.affiliation: Institute of Public Health, Georgia State University, Atlanta, GA, USA  Medecins Sans Frontieres, New York, NY, USA  Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka  Department of Environmental Sciences and Engineering, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Casanova
authors.forename: Adam
authors.initials: A
authors.lastname: Walters
authors.forename: Ajith
authors.initials: A
authors.lastname: Naghawatte
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sobsey
mesh_terms: D002516:Ceramics; D003430:Cross-Sectional Studies; D004190:Disasters; D060766:Drinking Water / Q000592:standards*; D005374:Filtration / Q000295:instrumentation*; D006801:Humans; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013188:Sri Lanka; D013997:Time Factors; D057192:Tsunamis; D018508:Water Purification / Q000295:instrumentation / Q000379:methods*; D060753:Water Quality / Q000592:standards*
chemical_list: D060766:Drinking Water