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Strengthening The Capacity Of Households And Communities For Improved Water, Sanitation And Hygiene: Water Testing Experiments With School Children And Adult Household Members In Ghana

Congress: 2015
Author(s): Charles Okyere (Bonn, Germany), Evita Hanie Pangaribowo, Felix Ankomah Asante
Center for Development Research (ZEF)1, University of Ghana, Institute of Statistical, Social and Economic Research (ISSER) 2

Keyword(s): Sub-theme 14: Valuing water: monetary and non-monetary dimensions,
AbstractAbstract Introduction About 1.8 billion of the world's population consumes water from highly contaminated sources. Level of fecal contamination of water differs between point-of-source (POS) and point-of-use (POU). Further several water sources considered to be "improved" (based on WHO/UNICEF criteria) are not good enough for consumption (Bain et al. (2014)). Providing water quality information to households is known to improve water, sanitation and hygiene behaviors and reduction of diarrheal diseases. Ghana is prone to several forms of WATSAN related diseases. For instance, cholera outbreak in 2014 has claimed about 150 lives nationwide as at October 2014, with Greater Accra region being the hardest hit with over 100 deaths). Despite several studies on water quality testing and dissemination of drinking water contamination data to households, rigorous impact evaluation studies are needed (Lucas et al., 2011). The study applies multiarm randomized trials to test the information effect through different household members (school children vs adult household members). Previous studies (eg. Brown et al., 2014; Madajewicz et al., 2007; Hamoudi et al., 2012; Jalan and Somanthan, 2008) applied "two-study-arm study" (i.e. either control or treatment). This study provides evidence on experience on self- water testing and recording of results at the household level. The study uses a water testing toolkits (Acquagenx's CBT) that quantifies the level of E. coli (MPN) present in a given water sample. This is an improvement on previous studies (eg. Brown et al., 2014; Madajewicz et al., 2007; Hamoudi et al., 2012; Jalan and Somanthan, 2008) that used presence or absence test kits. This study intends to make a contribution on the relevance of including microbial water testing at the household level in the proposed SDGs. The main research objective of the study is as follows: to determine the impact of water testing toolkits on household health outcomes and WATSAN behavior in Ghana. Methods/Materials Studies in which water quality information is disseminated to randomly selected households potentially underestimate the impacts, missing the potential learning experiences from household self-water testing and also missing the most effective channels in the delivery of such information to the treatment groups. We conducted water testing experiments in southern Ghana (Greater Accra region) in which students in public basic schools, and adult household members were randomly assigned to receive water testing kits and water quality improvement messages. The study applied cluster-randomized controlled trials design with the level of randomization being public basic schools. Two districts (one rural and one urban) in Greater Accra region were selected based on location of multipurpose water systems. 16 public basic schools were randomly assigned into the treatment and control groups. This yielded four public schools as child treatment group; four public basic schools as child control group; four public basic schools as adult treatment group; and four public basic schools as adult control group. In each public basic school, 32 students from grade five to eight were randomly selected to represent the households. This yielded a targeted sample size of 512 households. The baseline survey yielded 505 households; representing a success rate of 98.6 percent. Selected participants were also trained on the use of water testing kits in testing for E. coli; an indicator bacteria of fecal contamination of water. Baseline orthogonality tests are used to check the similarities and differences between the intervention groups (clustered randomized design). Heterogeneous impacts of the water testing experiment is analysed by estimating difference in difference (or comparison of means) for outcome variables based on gender and type of participants (students vs adult household members). Robustness checks and sensitivity analysis are performed by testing for heterogeneity in treatment effects in order to limit false predictions/estimates. Short-run program effects are estimated for a wide range of outcome variables including water sources, diarrheal diseases, water transportation, and handling and storage techniques, among others. Results and Discussion Hired field assistants administered community, school, household and pupils questionnaires in December 2013 and also in April-May 2014. Prior to the water testing experiment, the groups had largely similar characteristics in terms of socioeconomic indicators, water supply ad water quality. This means the randomization largely achieved its target of generating groups with similar characteristics. The mean tests show no statistically significant differences among the intervention groups in terms of water quality level for general purpose water supply, household size, number of children under 7, age of household head, socioeconomic status, hygiene and sanitation indicators, water storage and transport and handling techniques, self-reported diarhoea, among others. To some extent significant differences (based on the mean tests) exist in child height, and weight, expenditure on water and sanitation, water quality information for drinking water. This makes some of the intervention groups worse off at the baseline level creating a potential source of bias for the estimated program effects. Demand for water testing (measured by participation rate) was high for students' intervention group compared to adult household members group. Participation rate (used to proxy demand) was slightly higher for females compared to males. Conclusion Methods applied in the study are rigorous enough to identify changes in health outcomes and WATSAN behavior changes. The household baseline data are largely balanced based on the mean tests (using the F- and T-tests of difference between means of the study arms). Uptake rate for the water testing experiment is high for school children compared to adult household members. The uptake rate is slightly higher for females than males. Subsequent analysis will test the hypothesis of no statistically significant in key outcomes between school children and adult household members' intervention groups. 1.Bain, R., R. Cronk, R. Hossain, S. Bonjour, K. Onda, J. Wright, H. Yang, T. Slaymaker, P. Hunter, A. Prüss-Ustün and J. Bartram (2014). Global assessment of exposure to faecal contamination through drinking water based on a systematic review. Tropical Medicine and International Health, 19(8), pp. 917–927. 2.Brown, J., A. Hamoudi, M. Jeuland and G. Turrini (2014). Heterogeneous effects of information on household behaviors to improve water quality. The Duke Environmetal and Energy Economic Working paper EE 14-06, pp.1-44. 3.Hamoudi, A., M. Jeuland, S. Lombardo, S. Patil, S. K. Pattanayak and S. Rai (2012). The effect of water quality testing on household behavior: Evidence from an experiment in rural India. Am. J. Trop. Med. Hyg. 87(1), pp.18-22. 4.Jyotsna, J., and E. Somanathan (2008). The importance of being informed: Experimental evidence on demand for environmental quality. Journal of Development Economics , 87, pp.14-28. 5.Lucas, P. J., C. Cabral, J. M. Colford Jr. (2011). Dissemination of drinking water contamination data to consumers: A systematic review of impact on consumer behaviors. PLoS One, 6(6), pp.1-9. 6.Madajewicz, M., A. Pfaff, A. van Geen, J. Graziano, Iftikhar Hussein, H. Momotaj, R. Sylvi and H. Ahsan (2007). Can information alone change behavior? Response to arsenic contamination of groundwater in Bangladesh. Journal of Development Economics, 84, pp.731-754. 7.Prüss-Ustün, A., J. Bartram, T. Clasen, J. M. Colford Jr., O. Cumming, V. Curtis, S. Bonjour, A. D. Dangour, J. De France, L. Fewtrell, M. C. Freeman, B. Gordon, P. R. Hunter, R. B. Johnston, C. Mathers, D. Mäusezahl, K. Medlicott, M. Neira, M. Stocks, J. Wolf and S. Cairncross (2014). Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Tropical Medicine and International Health, 19(8), pp 894–905.
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