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Global Trends in Household Water Treatment 225

G L OB A L TRE N DS I N HOUSE HOL D WATE R TRE ATM E NT

Since 1996, a growing body of research has examined the health impact of inter-
ventions to improve household water treatment and safe storage (HWTS; Fewtrell,
Kaufman, Kay, Enanoria, Haller, et al., 2005). The results of these studies, including
several randomized controlled intervention trials, have highlighted the public
health implications of post-source contamination of drinking water during collec-
tion, transport, and storage and the health value of effective HWTS (Luby, et al.,
2004). A recent meta-analysis found that hygiene education and water quality in-
terventions were effective in reducing diarrheal disease by 42% and 39%, respec-
tively (Fewtrell & Colford, 2004).
In 2003, as the evidence base for the health benefits of HWTS methods ac-
cumulated, academic and government institutions, NGOs, and private sector
organizations engaged in research and implementation of HWTS approaches
formed the International Network to Promote Household Water Treatment and
Safe Storage, with a secretariat hosted by the World Health Organization
(WHO). Its stated goal is “to contribute to a significant reduction in waterborne
disease, especially among vulnerable populations, by promoting household
water treatment and safe storage as a key component of water, sanitation and
hygiene programmes” (WHO, 2003). The network serves as a forum for profes-
sional collaboration and a technical resource for starting and implementing
water treatment programs.
The four proven household water treatment options are chlorination, ceramic
filtration, solar disinfection, and combined filtration/disinfection (Centers for
Disease Control and Prevention [CDC], 2009). Chlorination was first used for dis-
infection of public water supplies in the early 1900s, contributing to dramatic re-
ductions in waterborne disease in cities in the developed world.
Although small trials of point-of-use chlorination had been implemented,
larger-scale trials only began in the 1990s as part of the Pan-American Health
Organization and the CDC’s response to epidemic cholera in Latin Amer-
ica. The CDC developed the Safe Water System (SWS), which included three
elements:

1. A water treatment product consisting of a diluted sodium hypochlorite (chlo-
rine) solution.
2. Storage of water in a safe container.
3. Education to improve hygiene and water use practices.