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Pilot field comparison of traditional Pilot field comparison of traditional alum flocculation, chlorination, and alum flocculation, chlorination, and combined flocculation- -chlorination chlorination combined flocculation point- -of of-

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SLIDE 1 TM

Pilot field comparison of traditional Pilot field comparison of traditional alum flocculation, chlorination, and alum flocculation, chlorination, and combined flocculation combined flocculation-

  • chlorination

chlorination point point-

  • of
  • f-
  • use water treatment on

use water treatment on drinking water quality in Western drinking water quality in Western Kenya Kenya

  • John A. Crump

John A. Crump1

1, George O. Okoth

, George O. Okoth2

2, Laurence Slutsker

, Laurence Slutsker2

2, Bruce H. Keswick

, Bruce H. Keswick3

3, Stephen P. Luby

, Stephen P. Luby1

1

  • Foodborne

Foodborne and and Diarrheal Diarrheal Diseases Branch, Division of Bacterial and Diseases Branch, Division of Bacterial and Mycotic Mycotic Diseases, National Center for Infectious Diseases, Centers for Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA Disease Control and Prevention, Atlanta, Georgia 30333, USA1

1

  • Kenya Medical Research Institute/United States Centers for Disea

Kenya Medical Research Institute/United States Centers for Disease Control and Prevention se Control and Prevention Kisian Kisian Field Station, PO Box 1578, Field Station, PO Box 1578, Kisumu Kisumu, Kenya , Kenya2

2

  • Procter & Gamble Health Sciences Institute, 8700 Mason Montgomer

Procter & Gamble Health Sciences Institute, 8700 Mason Montgomery Road, Mason, Ohio 45040, y Road, Mason, Ohio 45040, USA USA3

3

  • John A. Crump, MB, ChB, DTM&H

John A. Crump, MB, ChB, DTM&H

  • Foodborne and Diarrheal Diseases Branch

Foodborne and Diarrheal Diseases Branch

  • Division of Bacterial and Mycotic Diseases

Division of Bacterial and Mycotic Diseases

  • National Center for Infectious Diseases

National Center for Infectious Diseases

  • Centers for Disease Control and Prevention

Centers for Disease Control and Prevention

  • Atlanta, GA 30333

Atlanta, GA 30333

  • United States of America

United States of America

  • Tel +1

Tel +1-

  • 404

404-

  • 639

639-

  • 2206

2206

  • Fax +1

Fax +1-

  • 404

404-

  • 639

639-

  • 2205

2205

  • E

E-

  • mail jcrump@cdc.gov

mail jcrump@cdc.gov

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SLIDE 2

Woman collects drinking water from a turbid pond Woman collects drinking water from a turbid pond Asembo Asembo, Western Kenya , Western Kenya

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SLIDE 3

Background Background

  • 1.1

1.1 billion persons lack access to improved water billion persons lack access to improved water

  • Diarrheal

Diarrheal disease kills >2 million persons disease kills >2 million persons annually annually

  • ‘

‘Point Point-

  • of
  • f-
  • use’ approaches to improving drinking

use’ approaches to improving drinking water water

  • Require little infrastructure

Require little infrastructure

  • Are suited to rural settings

Are suited to rural settings

  • Empower individuals to make water safe for

Empower individuals to make water safe for their their families families

  • ‘

‘Point Point-

  • of
  • f-
  • use’ disinfectants (e.g., sodium

use’ disinfectants (e.g., sodium hypochlorite hypochlorite) are likely to perform poorly for ) are likely to perform poorly for highly highly turbid source turbid source water water

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SLIDE 4

Aim Aim

  • To

To compare the effect on water quality compare the effect on water quality indicators of traditional alum flocculation, indicators of traditional alum flocculation, chlorination, and combined flocculation chlorination, and combined flocculation-

  • chlorination (

chlorination (P Pu ur r A and A and P Pu ur r B) point B) point-

  • of
  • f-
  • use

use water treatment on drinking water quality in water treatment on drinking water quality in Western Kenya Western Kenya over a range of source water

  • ver a range of source water

turbidities turbidities

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SLIDE 5

Methods and Materials Methods and Materials

  • 30 water sources

30 water sources

  • Six treatments

Six treatments

  • Combined flocculation

Combined flocculation-

  • chlorination product yielding ~3.5

chlorination product yielding ~3.5 mg/L free chlorine ( mg/L free chlorine (P Pu ur r A) A)

  • Combined flocculation

Combined flocculation-

  • chlorination product yielding ~2.0

chlorination product yielding ~2.0 mg/L free chlorine ( mg/L free chlorine (P Pu ur r B) B)

  • Locally produced water disinfectant yielding ~5.0 mg/L

Locally produced water disinfectant yielding ~5.0 mg/L free chlorine ( free chlorine (Klorin Klorin) )

  • Locally available alum

Locally available alum flocculant flocculant ~100 g for 60 seconds ~100 g for 60 seconds

  • Alum +

Alum + Klorin Klorin

  • Untreated control

Untreated control

10 high turbidity (>100 NTU) 10 medium turbidity (10-100 NTU) 10 low turbidity (<10 NTU)

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SLIDE 6
  • Turbidity

Turbidity measured by measured by Hach Hach 2100P Portable 2100P Portable Turbidimeter Turbidimeter ( (Hach Hach Company, Loveland, CO) Company, Loveland, CO)

  • Free and total chlorine concentration measured

Free and total chlorine concentration measured by by Hach Hach Portable DR/890 Colorimeter ( Portable DR/890 Colorimeter (Hach Hach Company, Loveland, CO) Company, Loveland, CO)

  • pH measured by

pH measured by IQ 150 Handheld pH Meter (IQ IQ 150 Handheld pH Meter (IQ Scientific Instruments Inc, San Diego, CA) Scientific Instruments Inc, San Diego, CA)

  • E.
  • E. coli

coli concentration measured by concentration measured by Colilert Colilert Quantitray Quantitray 2000 system (IDEXX Laboratories 2000 system (IDEXX Laboratories Incorporated, Westbrook, ME) Incorporated, Westbrook, ME)

Outcomes Outcomes

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SLIDE 7

Point-of-use water treatments evaluated Combined Combined flocculation flocculation-

  • chlorination product

chlorination product Sodium Sodium hypochlorite 1% hypochlorite 1% Alum ‘ Alum ‘dawa dawa’ ’

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SLIDE 8

Turbid water after treatment with Pur

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SLIDE 9

Results Results

Before treatment, turbidity and Before treatment, turbidity and Escherichia Escherichia coli coli concentrations were highest in pond concentrations were highest in pond water, followed by stream, river, lake, spring, water, followed by stream, river, lake, spring, and borehole water and borehole water

Turbidity by untreated source water Turbidity by untreated source water type type, , Asembo Asembo and Gem, 2002 and Gem, 2002

1 10 100 1,000 Pond Stream River Lake Spring Borehole

Mean NTU

E.

  • E. coli

coli concentration by untreated source concentration by untreated source water water type, type, Asembo Asembo and Gem 2002 and Gem 2002

1 10 100 1,000 10,000 Pond Stream River Lake Spring Borehole

Mean CFU/100 mL*

*WHO guideline <1 E. coli CFU/100 mL

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SLIDE 10

Turbidity by untreated source water Turbidity by untreated source water type, type, Asembo Asembo and Gem, 2002 and Gem, 2002

1 10 100 1,000 Pond Stream River Lake Spring Borehole

Mean NTU

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SLIDE 11

Visual impact of water treatments on highly turbid source water

Untreated Untreated control control Klorin Klorin P Pu ur r B B P Pu ur r A A Alum Alum Alum + Alum + Klorin Klorin

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SLIDE 12

Effect of water treatments on turbidity Effect of water treatments on turbidity by by turbidity, turbidity, Asembo Asembo and Gem, 2002 and Gem, 2002

1 10 100 1,000 Pur A* Pur B* Klorin Alum Alum + Klorin Untreated control

Mean NTU

Low turbidity (n=10) Low turbidity (n=10) Medium turbidity (n=10) Medium turbidity (n=10) High turbidity (n=10) High turbidity (n=10)

*Includes two water sources where one sachet of Pur failed to form floc

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SLIDE 13

Although Although Klorin Klorin delivers a higher chlorine dose delivers a higher chlorine dose compared to compared to P Pu ur r A, free chlorine levels measured A, free chlorine levels measured 30 minutes after water treatment were higher for 30 minutes after water treatment were higher for P Pu ur r A compared to A compared to Klorin Klorin alone alone

Effect of water treatments on free Effect of water treatments on free chlorine chlorine, , Asembo Asembo and Gem, 2002 and Gem, 2002

0.0 0.5 1.0 1.5 Pur A Pur B Klorin Alum Alum + Klorin Untreated control

M e d i a n f r e e C l

  • m

g / L * *Measured 30 minutes after treatment

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SLIDE 14

Effect of water treatments on pH Effect of water treatments on pH Asembo Asembo and Gem, 2002 and Gem, 2002

2 4 6 8 Pur A Pur B Klorin Alum Alum + Klorin Untreated control

Mean pH pH 7.0

Alum Alum-

  • based treatments lower pH substantially

based treatments lower pH substantially

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SLIDE 15

Effect water treatments on Effect water treatments on E.

  • E. coli

coli concentration, concentration, Asembo Asembo and Gem, 2002 and Gem, 2002

1 10 100 1,000 10,000 Pur A Pur B Klorin Alum Alum + Klorin Untreated control Mean CFU/100 mL*

*WHO guideline <1 E. coli CFU/100 mL

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SLIDE 16

Proportion waters with <1 Proportion waters with <1 E.

  • E. coli

coli/100 /100 mL mL after after treatment, treatment, Asembo Asembo and Gem, 2002 and Gem, 2002

20 40 60 80 100 Pur A Pur B Klorin Alum Alum + Klorin Untreated control

% with <1 E. coli/100 mL Low turbidity (n=10) Low turbidity (n=10) Medium turbidity (n=10) Medium turbidity (n=10) High turbidity (n=10) High turbidity (n=10)

Only Only treatments that combined flocculation and treatments that combined flocculation and chlorination performed well in high chlorination performed well in high-

  • turbidity

turbidity waters waters Treatments Treatments that included disinfectant performed well in that included disinfectant performed well in low low-

  • and medium

and medium-

  • turbidity

turbidity waters waters

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SLIDE 17

Conclusions Conclusions

  • P

Pu ur r A A

  • Mitigates turbidity

Mitigates turbidity

  • Achieves <1

Achieves <1 E. E. coli coli/100 mL in even /100 mL in even high high-

  • turbidity water

turbidity water

  • Maintains neutral pH

Maintains neutral pH

  • P

Pu ur B r B

  • Mitigates turbidity

Mitigates turbidity

  • Achieves <1

Achieves <1 E. E. coli coli/100 /100 mL mL in low in low-

  • and medium

and medium-

  • turbidity

turbidity water water

  • Maintains neutral pH

Maintains neutral pH

  • Alum alone

Alum alone

  • Mitigates turbidity

Mitigates turbidity

  • Lowers

Lowers E.

  • E. coli

coli concentration, concentration, but not to <1/100 but not to <1/100 mL mL

  • Lowers pH

Lowers pH

  • Klorin

Klorin alone alone

  • No impact on turbidity

No impact on turbidity

  • Achieves <1

Achieves <1 E.

  • E. coli

coli/100 /100 mL mL in in low low-

  • and medium

and medium-

  • turbidity

turbidity water water

  • Does not render high

Does not render high-

  • turbidity

turbidity water potable water potable

  • Alum +

Alum + Klorin Klorin

  • Mitigates turbidity

Mitigates turbidity

  • Achieves <1

Achieves <1 E.

  • E. coli

coli/100 /100 mL mL in in high high-

  • turbidity water

turbidity water

  • Lowers pH

Lowers pH

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SLIDE 18

Ongoing health outcome study Ongoing health outcome study

  • Launched in

Launched in Asembo Asembo and Gem, Western Kenya, 2003 and Gem, Western Kenya, 2003

  • 600

600 homes (>6,500 persons) randomly assigned to homes (>6,500 persons) randomly assigned to use use

  • P

Pu ur r A , or A , or

  • Klorin

Klorin, or , or

  • Traditional practices

Traditional practices

  • 20

20 week duration week duration

  • Main

Main outcomes

  • utcomes
  • Diarrhea prevalence (especially of children <2 years)

Diarrhea prevalence (especially of children <2 years)

  • Intervention acceptability

Intervention acceptability

  • Water

Water quality quality