Assessing Drinking Water Safety and Identifying the Gaps - an Epidemiological Study in
A Slum Area near Chandigarh
 
Nair Balakrishan
Goel Naveen
Zarabi Dazy    
 
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Introduction

Clean drinking water, one of the basic requirements of a healthy human population has now become a public health challenge, threatening the sustainability of social and economic development across the world. Improper sanitation, pollution and lack of awareness are the main reason of water contamination in developing countries. It has been observed that Asia’s major rivers have faecal coliform counts 50 times higher than the guidelines set by WHO1. Educating people about point of use water purification methods (right before intake) like sedimentation, rapid sand filtration etc, followed by disinfection through methods like boiling, pasteurisation, ultraviolet light, and reverse osmosis can help in substantial improvement of the health of population. Social marketing, community mobilisation, motivational interviewing, communication and education will help in increasing the awareness of drinking water safety, which require an action oriented approach. Therefore, this study was planned with the objectives of assessing the awareness level with respect to the safety of drinking water and its association with the water handling practices and also, providing intervention for purification.

Background

Punjab is one of the northern states of India. Its drinking water sources include 3148 piped water supply schemes provided by the Department of Water Supply and Sanitation (DWSS) and private hand pumps in individual households. About 80% schemes are tube well based and remaining 20% schemes are canal based. Safe water supply is available only in 74 % of the 14,605 total habitations of Punjab2. Water supply and sanitation board are responsible for executing various water supplies and sewerage works through the local bodies with specific objectives of investigating and survey of the water requirements and provision of safe drinking water and sewerage facilities. Still, 95% of Punjab’s rural population lacks sanitation facilities and this condition contributes to the contamination of runoff water and underground water during the rainy season which causes chronic diarrhea and other water borne diseases which are particularly harmful to the health of infants. 2

India is the second most populous country with an alarming figure of 1.21 billion and Punjab resides 2.29 percent of it3. The literacy rate of Punjab is 76.7 percent and has more literate males than females3. One fourth of the Punjab’s urban population lives in slums.4 One such urban slum is Janta colony, situated behind PGIMER, Chandigarh. The residents of this slum face conditions which might seem to be deplorable. Most dwellings consist of one room (less than 12sq ft) and have open sewers and drains running along the streets where children play. Pigs, sifting through garbage and sewage, are reared for income. It seems that the high instances of morbidity found here can be attributed to preventable diseases caused by unsafe drinking water such as diarrhea, amebiasis, worm infestation, and the more serious diseases of cholera, typhoid, and hepatitis.

Aim

This study aims at assessing the level of awareness and need of the community with respect to drinking water safety and identifying the gaps so as to educate the residents and provide them with the interventions of point of use water purification.

Objectives

  1. To assess the awareness level of the community with respect to importance of safe drinking water.
  2. To identify the gaps so as to educate the residents and provide them with the interventions to use different methods of water purification.
  3. To generate awareness about the link between safe water and good health.
  4. To make the programme as community participatory programme.
  5. To assess impact of the programme both from qualitative and quantitative aspects over a period of one year.

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Study Setting

The study was carried out in the coolest month of January 2010, in Janta Colony, an urban slum located in the northwestern part of Chandigarh, the capital of Punjab. The area was chosen as a field area for a post graduate dissertation of the Center for Public Health, IEAST, Panjab University, and Chandigarh where the study was conceived. The area has nine equal blocks with an estimated population of 12,500 living in 2697 households (as reported by a local NGO – DIR India).

Study Subjects

People in the age group of 18-40, residing in Janta Colony, were eligible to participate in this study. Women were particularly focused, due to their availability during the interventions and also because they were the individuals involved in handling drinking water.

Sample Size

All the households in the nine blocks of Janta Colony formed the universe of the study. A multistage sampling design was adopted. Three blocks were selected through lottery method and 90 households (30 percent) from each block were included through systematic random sampling which came to 270 in toto. These households have numbers assigned by the administration which formed the baseline for systematic selection procedures. It was assumed that there would be at least one woman in the age group of 18-40 years in each household. If more than one female of the specified age was there in any household, only one was taken by random selection and if found unavailable then the man dealing with the household was included. Study was initiated in mid January 2010 while the protocol development commenced in October 2009 with a cross sectional community based study design. A pilot study was also conducted on 30 households.

A total of 270 households were randomly selected and later contacted to determine their willingness to participate in the study. As a thumb rule, in case of denials, the next household was chosen. Interviews were conducted by the chief investigator assisted by three local members from the community. The purpose of study was explained and written informed consent was received by the individual prior to participation.

Interventions

The intervention part included the following phases:

The first phase involved educating the residents about the importance of water purification and making them aware of various point-of-use purification methods. In this part, one household was selected and the PowerPoint presentation on importance of safe drinking water and different purification methods was delivered, twice a week. People from the neighborhood whether part of the study or not were invited to attend the seminar and a focus group discussion was undertaken afterwards. The group was limited to not more than 25 and the rest were called for the next session.

The second phase involved providing the household with one of the three methods of point-of-use water purification. These methods were the solar disinfection, chemical treatment with sodium hypochlorite candle filtration. Solar disinfection consists of exposing glass bottles filled with water to bright sunlight in an undisturbed area (e.g.: rooftop) for a minimum of 6 hours. The chemical treatment required a small amount of sodium hypochlorite (4-6 drops) for a large amount (20 L) of water while candle filtration method uses a filter which removes and kills pathogens and chemicals by passing water through layers of activated charcoal and colloidal silver. Our design for the filtration system consists of the candle filter in a water-holding bucket on top of a dispensing container with a tap. In the three selected blocks, the pre selected 270 households were assigned the above said interventions. Each of the interventions were provided, giving a distribution of 30 houses to solar, 30 to chemical, and 30 to candle filtration technique per 90 households in a block. Each participating family was required to contribute towards this project, as it is believed that people are more willing to continue a project in which they have invested. The share paid by each household varied based on the method allotted to the household. Solar will cost each family Rs. 50, chemical will cost Rs. 50 and filter will cost Rs. 100. The households will be paying roughly two-thirds of the costs.

Ethical Considerations

This study was undertaken as a part of a post graduate dissertation under Center for Public Health, IEAST, Panjab University, and Chandigarh. Each subject signed an approved informed consent form prior to entering the study. A registered NGO named DIR-India was already working in this area and they agreed for undertaking this activity as one of their upliftment projects. They have also incorporated this study in their annual reports.

Data Collection and Analysis

Data was collected from individual study participants at their homes using a pre-designed semi-structured Performa containing the items of socio-demographic data, water source, storage and handling data and disease pattern. Household water storage samples were collected randomly and samples from all the main reservoirs were also collected for physiochemical and biological testing under APHA guidelines by Eureka Forbes Ltd. Data was entered and analysed in Microsoft Excel 2010 and SPSS version 12 for windows.

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Results

There were 267 respondents found willing to participate in the study which accounts to a response rate of 98.8 percent. Total number of females were 231 (86.4 percent) with their mean age group 28.3 years while that of males was 29.5 years. Half of the females had never gone to school while one third of the total had a chance to study above primary level. More than half of the families were living in a one room house (KHOLI or JHUGGIE. Hindu Community (96.3 percent) dominated the sample size following Muslims and Sikhs with nearly two third felling in the lower socioeconomic group as per Kuppusamy Scale. The mean no. of members per family was 4.67 with an average per capita income of a household ranging from 1000 – 5000 rupees per month. Most of the females were homemakers.

Two-third of the total population had their own taps while the rest shared their taps with others for drinking water. Commonly used method of storage was plastic buckets used by 45 percent of the population (most of the illiterates) and all of them used a lid to protect the water from getting contaminated. Water handling methods included dipping a tumbler into the storage container to draw water or using cup with long handles. Some of them also drew water by immersing the glass held in their hand. Both the groups i.e. educated and uneducated cleaned the storage containers at least once in a month (84.3 percent). Soap and water were the most widespread method of cleaning (62.5 percent) followed by detergent (23.2 percent). Few of them preferred using ash/soil with dry grass for cleaning (11.8 percent).

The prevalent purification methods were candle filters, cloth filters, alum/chlorine tablets and boiling out of which boiling was the most common one with a total percentage of more than 80 and the illiterate percentage of 26.7. Most of the literates practiced purification in rainy season and during epidemics which was less in the other category. Boiling was the most common method of purification used by most of the educated respondents (36.4 percent). Even though uneducated, 81 percent practiced carrying water bottles when they were away from home.

More than one fourth of the respondents were having an opinion that the water supplied to them was not good for drinking but still can be used for washing food items and dishes. Half of the population did not consider purification as an important affair and had never practiced purification ever. Majority of the respondents (259 out of 267 respondents) knew the importance of safe water and of half considered unsafe water as the cause of illness. Half of the uneducated population was not aware of this fact. When their history of illness was undertaken, it was found that around 19 adults and 18 children had suffered with diarrhea in the last six months and there were incidents of worm infestation in 22 members of different households which is again a water related condition.

Discussion

Education is a necessary means not only to increase awareness but also to understand the implication of certain actions and the necessity of implementing certain practices into our daily routine which would help make lives better. Majority of the respondents fell in the age group of 21 – 30, an effective category for health education, making it easier to spread awareness regarding water purification, its necessity and importance. These age groups being on the crux of adulthood adapt and learn newer practices along with easier understanding of rights and wrong. Very few respondents came within the age group of 50 and above, but have been given maximum importance because as per the Indian social system elders play an important role as mentors, counselors and advisors to the youngsters in society and will therefore help to improve the drinking water quality and storage practices among the residents of Janta Colony. Most of the females were housewives with more than half only having primary schooling or no education at all. The right method of water storage has an important role in water safety. Wider the mouth of the storage container, more are the chances of contamination. Out of the total number of children affected by diarrhea in the past 3 – 6 months, 40 percent were found to use bucket as a storage container. Bottles were less commonly used. Most of the bucket users practiced cup in hand method to draw water out of the container. This practice allowed easy contamination of water as children dipped their hands in it for both consumption or just for fun. This increases the chances of faecal contamination.

We know that literacy has a direct relationship with the hygiene practices but here in Janta Colony in spite of the major population being illiterate, most of them cleaned the storage container, though not very frequently. Soap and detergent were the two most preferred ways of cleaning. For Better health of the population, improvement in storage behavior and compliance of good cleaning practices need to be ensured through health education and awareness.

Water purification was found mandatory in this scenario as chances of contamination were high5. According to the data collected, half of the children affected by diarrhea fell into the category of non-purifiers signifying the need to incorporate behavioral change in the community while the other affected half in the purifying category emphasised that the purification methods adopted by them were not effective enough to clear out bacterial contamination.

Water intake ranges differently in different seasons. One needs more drinking water in summer as compared to other seasons which has a direct relation with purification behavior6. Slum residents are supplied with chlorine tablets during rainy seasons and in epidemics. Intake of water along with the chances of its contamination in certain seasons should not be the reason of purification rather the process of purification should be independent and practiced always. Seasonal variations in quality of drinking water may be seen especially when the water is drawn from natural sources. Children under 5 years of age whose families were not using chlorinated water had twice the risk of diarrhea. The use of chlorinated water was associated with a fifty percent reduction in diarrhea cases. These results indicated that the chlorination of water can be successfully carried out locally in rural areas to improve the health of the population.

Mobilisation Activities

The trainings and interventions proved helpful. 15 to 20 seminars were conducted with the help of power point presentations which received a very good response rate. People of the nearby areas also came to attend it. Tools like image of a child drinking dirty water, hospitalised patients etc were used for sensitisation and a focus group discussion was conducted at the end of the session.

The administration of point-of-use water purification method in the second phase showed a different response. The solar disinfection method proved to be a total failure because of the irregular roof tops, leaking bottle caps, glass bottles breaking easily and water getting warmer in the sun. The chemical treatment with sodium hypochlorite and candle filtration were a success with more supporters to candle filtration method, as it looks like an asset to the households and doesn’t produced an alkaline taste which was witnessed in case of chemical treatment. Each participating family contributed the prescribed amount towards this project. It was found on re-evaluation that the usage rate after six months was significantly good.

Conclusion

Since it is possible to get ill from drinking unsafe water and the need for purification is high this analysis was needed to know the percentage of people involved in water purification practices and to understand that the attitude of people pertaining to purification of water, its storage and maintenance. Half of the respondents agreed to the fact or statement that drinking water can cause illness, with an equal percentage disagreeing it. Two-thirds never thought that water purification was important. This can mainly be due to their belief that the Municipal Corporation provides good water which does not require any more purification which is a myth. Therefore, there is a strong need for good purification practice along with advocating and mobilising of the community to practice point-of-use purification methods through health education workshops and trainings setups. So, we it can be concluded that education is the key to making any good decision.

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References


  1. United Nations Environment Programme, “Global Environment Outlook 2000”, World Health Organisation, Earthscan Publications, London, 1999.
  2. Accelerated Rural Water Supply Programme (ARWSP), Department of Water Supply and Sanitation, Government of Punjab, http://dwsspunjab.gov.in/html/ arwsp.html, accessed on May 5, 2010
  3. Provisional Population Totals; Series 1; Office of the Registrar General and Census Commissioner, India, Ministry of Home Affairs, 31 March 2011, Data Product No. 00-001-2011-Cen-Book (E)
  4. Singh, Bajinder Pal. “25 pc of Punjab urban population stays in slums.” Indian Express Newspapers (Bombay) Ltd, January 21, 1998.
  5. Perry, Julie. “Facts about the water purification process” Article No. 15873, My Free Article Central. Accessed on 10 May 2010
  6. Goel Naveen et al. “Surveillance of quality of drinking water”. Bahrain Medical Bulletin, ISSN: 15088602, Vol. 29, No. 2, June 2007