The Impact of an educational intervention on the microbiological infection risk posed by water stored in households

Abstract

The aim of this study was to investigate whether a water-handling hygiene education programme could contribute to improving the health-related microbiological quality of container water stored and used in households in the dense urban settlement of Botshabelo in the Free State Province. Previous studies in the area indicated that stored container water became contaminated during the fetching, storing and handling of the water at home. These practices exposed the study population to a potential risk of microbiological infection. An intervention, in the form of the education programme, was implemented simultaneously with a water quality assessment component. Members of a sample of households from the study population participated in a series of domestic water-handling hygiene education training sessions over a period of eight of the twelve-month study period. The sample was eventually divided into three sub-groups based on attendance of the training sessions (never, intermittent and frequent (NIF)) and water samples from each group analysed during and after the programme (after data). This was done to determine any changes in the health-related microbiological water quality during training. The water quality of the NIF groupings before (baseline data from previous studies) and after the hygiene education intervention programme, was also assessed for significant changes. Seasonal influence was also investigated. Turbidity was used to indicate biofilm formation on the inner sidewalls of storage containers, which implied changes in container-washing practices. Heterotrophic bacteria (HB) numbers were used as indicators of general microbial water quality. Total coliform (TC) bacteria were used to indicate organic pollution, while E. coli (EC) bacteria were used to indicate faecal pollution. There were significant changes between the before and after data for all the indicators examined. Turbidity decreased to levels below the risk of slight potential health effects after the intervention period, indicating less biofilm formation that could be attributed to improved container hygiene. However, the bacterial indicators still indicated potential risk of infection for consumers. HB numbers indicated an increased risk of infectious disease transmission. Slight decreases in TC numbers indicated reductions in organic pollution of the container water, but still posed a significant chance of infection. EC numbers were also lower, but still rendered the water unsafe for domestic, especially potable use. Despite improved container washing, large HB numbers were still being introduced into container-stored water, probably from the domestic environment during water handling. TC and EC numbers still indicated hazardous microbiological contamination of container water by faecal as well as other organic matter during water use, probably from aspects such as unwashed hands. Generally no significant changes were found in water quality between NIF groupings, either before or after the programme, even though the frequent group attended all the training sessions. This indicated that the programme did not have a particular influence on anyone group. The lower levels of turbidity did not necessarily reflect an effect from the programme but was possibly an effect of awareness created during related studies done before in the area. Climate appeared to have played a role in TC and EC counts during the programme because the counts were higher for both indicator organisms in warmer than in colder and moderate months. Container water was still contaminated during storage despite the water-handling hygiene education programme. The water still posed a potential risk of infection when consumed. An effective hygiene education programme should be so designed and implemented that those inherent, deep-rooted, individual personal behaviours such as handling stored water with unwashed hands can be changed. The programme should bring about improved domestic water management by members of households, such as protection of containerstored water from environmental contamination. Changes such as these, brought about by sustainable awareness creation and education should contribute towards sustained improved health-related quality of water stored in domestic environments.