title: Subsidized Sachet Water to Reduce Diarrheal Disease in Young Children: A Feasibility Study in Accra, Ghana.
abstract: Use of drinking water sold in plastic bags (sachet water) is growing rapidly in west Africa. The impact on water consumption and child health remains unclear, and a debate on the taxation and regulation of sachet water is ongoing. This study assessed the feasibility of providing subsidized sachet water to low-income urban households in Accra and measured the resultant changes in water consumption. A total of 86 children, 6-36 months of age in neighborhoods lacking indoor piped water, were randomized to three study arms. The control group received education about diarrhea. The second arm received vouchers for 15 L/week/child of free water sachets (value: $0.63/week) plus education. The third arm received vouchers for the same water sachet volume at half price plus education. Water consumption was measured at baseline and followed for 4 months thereafter. At baseline, 66 of 81 children (82%) drank only sachet water. When given one voucher/child/week, households redeemed an average 0.94 vouchers/week/child in the free-sachet-voucher arm and 0.82 vouchers/week/child in the half-price arm. No change in water consumption was observed in the half-price arm, although the study was not powered to detect such differences. In the free-sachet-voucher arm, estimated sachet water consumption increased by 0.27 L/child/day (P = 0.03). The increase in sachet water consumption by children in the free-sachet-voucher arm shows that provision of fully subsidized water sachets might improve the quality of drinking water consumed by children. Further research is needed to quantify this and any related child health impacts.
authors.affiliation: Geography and Environment, University of Southampton, Southampton, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Wright
authors.affiliation: Ghana School of Public Health, University of Ghana, Legon, Ghana.
authors.forename: Mawuli
authors.initials: M
authors.lastname: Dzodzomenyo
authors.affiliation: Department of Global Health and Population, School of Public Health, Harvard University, Boston, Massachusetts.
authors.forename: Günther
authors.initials: G
authors.lastname: Fink
authors.affiliation: Geography and Environment, University of Southampton, Southampton, United Kingdom.
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Wardrop
authors.affiliation: Ghana School of Public Health, University of Ghana, Legon, Ghana.
authors.forename: Genevieve C
authors.initials: GC
authors.lastname: Aryeetey
authors.affiliation: Ghana School of Public Health, University of Ghana, Legon, Ghana.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Adanu
authors.affiliation: Social Sciences, University of Southampton, Southampton, United Kingdom.|Department of Global Health and Population, School of Public Health, Harvard University, Boston, Massachusetts.
authors.forename: Allan G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000191:economics* / Q000517:prevention & control*; D060766:Drinking Water / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D005380:Financing, Government / Q000191:economics*; D005869:Ghana; D006801:Humans; D007223:Infant; D008297:Male; D014871:Water Microbiology / Q000592:standards; D014881:Water Supply / Q000191:economics*
chemical_list: D060766:Drinking Water