Safe Water in the Developing World

Angelica K. Thevos, PhD
Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina
thevosak@musc.edu

Diarrheal diseases remains a major contributor of morbidity and mortality in the developing world, particularly in children under 5 years old. Drinking water is an important route for diarrheal disease transmission and over 1 billion economically disadvantaged people in the world lack access to safe water.

The Centers for Disease Control and Prevention and the Pan American Health Organization have developed a simple, inexpensive, and effective system to improve drinking water and hygiene and in turn, reduce diarrhea rates (Quick, RE; Venczel, LV; Mintz, ED, et al, Epidemiology and Infection 122:83-90, 1999). It involves the use of a locally produced disinfectant (chlorine), a 20 liter narrow-mouthed plastic storage vessel with a lid and spigot, and education in using the system. Motivational Interviewing (MI) has been used to augment the educational component and increase the adoption of the use of the system at the household level.

In one study conducted in Zambia, 5 neighborhood health volunteers were trained in MI and made household visits to encourage use of the safe water system. Rates of purchase of the disinfectant were much higher in the MI condition (mean = 1.03 bottles sold/month) than a comparison condition of health education only (mean = .29 bottles sold/month), t(7) = 10.69, p < .001. Higher purchase rates in the MI condition were sustained over 8 months of sales monitoring (Thevos, Quick, & Yanduli, Health Promotion International, in press). Another study in a different community in Zambia coincided with a social marketing campaign of the safe water system. Eighteen neighborhood health volunteers were trained in MI which was delivered in 4 weekly visits to households. Measurement of chlorine residuals in household water took place three months following the MI intervention. These follow up measurements revealed a 16-fold increase in chlorine residuals in the MI group (65%) compared to the health education group (4%).

Previous studies of MI have been undertaken solely in developed countries with skilled professionals. The studies reported here on safe water represent the first application of its principles in the developing world using health workers directly from the community. The results indicate that MI is a promising approach which deserves more study for public health applications in the developing world. Work is ongoing in this area.

Chris Wagner, Ph.D. and Wayne Conners, M.Ed.
Mid-Atlantic Addiction Technology Transfer Center
A CSAT Project
mid-attc@mindspring.com
http://www.mid-attc.org

In cooperation with the Motivational Interviewing Network of Trainers (MINT), William R. Miller, Ph.D., and Stephen Rollnick, Ph.D. 

Revised 4/00