Environ Sci Technol. 2011 Jun 8.
Assessing the microbiological performance and potential cost of boiling drinking water in urban Zambia.
Psutka R, Peletz R, Michelo S, Kelly P, Clasen T.
Boiling is the most common method of disinfecting water in the home and the benchmark against which other point-of-use water treatment is measured. In a five-week study in peri-urban Zambia, we assessed the microbiological effectiveness and potential cost of boiling among 49 households without a water connection who reported “always” or “almost always” boiling their water before drinking it.
Source and household drinking water samples were compared weekly for thermotolerant coliforms (TTC), an indicator of fecal contamination. Demographics, costs and other information were collected through surveys and structured observations. Drinking water samples taken at the household (geometric mean 7.2 TTC/100ml, 95%CI 5.4-9.7) were actually worse in microbiological quality than source water (geometric mean 4.0 TTC/100ml, 95%CI 3.1-5.1) (p
Only 60% of drinking water samples were reported to have actually been boilded at the time of collection from the home, suggesting over-reporting and inconsistent compliance. However, these samples were of no higher microbiologial quality. Evidence suggests that water quality deteriorated after boiling due to lack of residual protection and unsafe storage and handling.
The potential cost of fuel or electricity for boiling was estimated at 5% and 7% of income, respectively. In this setting where microbiological water quality was relatively good at the source, safe-storage practices that minimize recontamination may be more effective in managing the risk of disease from drinking water at a fraction of the cost of boiling.
Trop Med Int Health. 2010 Jan 11.
Access to a health facility and care-seeking for danger signs in children: before and after a community-based intervention in Lusaka, Zambia.
Sasaki S, Fujino Y, Igarashi K, Tanabe N, Muleya CM, Suzuki H. Department of Infectious Disease Control and International Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Japan.
Objective – To assess the association of accessibility to a health facility with caregivers’ care-seeking practices for children with danger signs before and after community-based intervention in Lusaka, Zambia.
Method – Health education on childhood danger signs was started in September 2003 at the monthly Growth Monitoring Program Plus (GMP+) service through various channels of health talk and one-on-one communication in a peri-urban area of Lusaka. Two repeated surveys were conducted: in 2003 to collect baseline data before the intervention and in 2006 for 3-year follow-up data. Caregivers who had perceived one or more danger signs in their children within 2 months of the surveys were eligible for the analysis. The association between appropriate and timely care-seeking practices and socio-demographic and socio-economic factors, attendance at community-based intervention and the distance to a health facility was examined with logistic regression analysis.
Results – The percentage of caregivers immediately seeking care from health professionals increased from 56.1% (106/189) at baseline to 65.8% (148/225) at follow-up 3 years later (OR = 1.51, P < 0.05). Long distance to the health facility and low-household income negatively influenced caregivers’ appropriate and timely care-seeking practices at baseline, but 3 years later, after the implementation of a community-based intervention, distance and household income were not significantly related to caregivers’ care-seeking practices. Conclusion Poor accessibility to health facilities was a significant barrier to care-seeking in a peri-urban area. However, when caregivers are properly educated about danger signs and appropriate responses through community-based intervention, this barrier can be overcome through behavioural change in caregivers.
Yes, raw sewage is a cocktail of germs that can cause life-threatening illnesses. Sanitation officials in both Lusaka and the Copperbelt province are accusing peri-urban farmers of creating epidemics by nourishing their crops with foul water and partially-decomposed human poo.
But Irene Moonga, a sales assistant at one of the agricultural companies in Lusaka, sympathises with farmers trying to make a living as the price of fertiliser has risen over the past two years 58 dollars for a 50 kilogramme bag.
And as Zambia’s economy stumbles in the wake of fallen copper prices, hard-pressed consumers in urban centres are having to depend more and more on vegetables as their main relish.
A sackful of leaves from the rapeseed plant, treasured by Zambians as a table vegetable, costs as much as 30,000 Zambian kwacha ($6.50) wholesale at the fresh produce market where middlemen who buy from the “sewerage farms” bring the vegetables for onward sale.
Rosemary Mwamba, a market woman at Kaunda-Square Market in Lusaka, says they do not ask where the produce – rape, beans, green maize and sugarcane are among the vegetables being grown – is coming from before they decide to buy from a farmer.
“We are driven more by the quality of the vegetables. If the leaves are fresh and big then we buy. In any case, even if we were to ask questions I don’t think that would help us, because if a person knows they are selling something bad they will not tell,” she observed.
Human waste as fertiliser
There are a number of techniques for composting human waste to produce fertiliser. In Malawi, for example, farmers add wood ash and soil to faeces and urine, producing fertiliser over a period of six months.
But the addition of ash and the composting time are crucial to the elimination of harmful micro-organisms. The Zambian farmers growing vegetables near municipal waste plants are simply dumping fresh, untreated waste on their crops.
Health officials are concerned. Jacob Bwalya, a health inspector with the Kitwe City Council, 470 kilometres north of Lusaka, runs through a list of diseases untreated waste can spread: dysentery, typhoid, gardiasis, infectious hepatitis and salmonella…
“It is because of this that under the Food and Drugs Act it is a big offence for one to use raw sewerage to water vegetables that are going to be sold to members of the public,” Bwalya added.
“They will puncture the sewer pipe as it traverses a vacant lot and use the raw sewerage to water and fertilise their vegetables,” he said.
The managing director of the Lusaka Water and Sewerage Company, George Ndongwe, failed to respond to inquiries about the extent of the problem in the capital, but an official at the utility, speaking on condition of anonymity, explained that the company is engaged in a “Tom-and-Jerry” game with the farmers.
“The moment they see our men at the sewerage ponds, these people bolt into the bush only to return after we are gone. To access the water, they first vandalise the settling ponds and the sewer pipes in order to tap into the raw effluent,” he said.
Margaret Zulu, spokesperson for Kafubu Water and Sewerage Company which manages potable water and sanitation on the Copperbelt, admits that vandalism of sewer pipes and ponds to hijack waste is a big headache for the company.
“Every once in a while we join hands with the councils to slash all the vegetable (gardens) using raw sewerage and clear the illegal farmers from the area, but they always come back. With cholera a persistent threat, we have to be on guard, especially now when we are going towards the rain season,” she explained.
Since 1991, Zambia has suffered regular cholera outbreaks, typically occurring at the start or in the middle of the rainy season that lasts from November to April.
Most of the recorded cholera cases – often in excess of 10,000 each year – occur in the unplanned settlements of Lusaka.
But it’s interesting to note that last year’s epidemic, for example, did not start in either Lusaka or the Copperbelt where many eat the waste-fertilised vegetables, but in fishing camps in Mpulungu district of Northern Province on the shores of Lake Tanganyika before spreading to high density locations in Lusaka and Kitwe.
Farmers seize on this to justify continuing to use raw sewage in their plots, though cholera is only one of a host of potential diseases. Farmer Samson Zulu, who has a vegetable patch at the foot of Lusaka’s Kaunda-Square settling ponds, is unrepentant.
“What do they want us to do? We have families to look after and this government, even the one that was there before it, have failed to give anybody a job,” Zulu declared bitterly.
Zambia: Water Programmes to Rid Water-Borne Diseases
THE rainy seasoning is apparently bidding farewell, so is cholera-the unwelcome annual waterborne disease every rainy season.
Clearly, a long-term solution has to be found to this perennial problem and that solution lies in long-term and adequate investment in water supply and sanitation infrastructure.
The Government has already started the process of dealing with perennial waterborne diseases on a long-term basis through the development of the national rural water supply and sanitation programme (NRWSSP) to address these problems in rural areas.
For urban areas, a comprehensive national urban water supply and sanitation programme (NUWSSP) is being developed.
Both the NRWSSP and the NUWSSP are being implemented through the Ministry of Local Government and Housing (MLGH) under the department of housing and infrastructure development (DHID).
DHID is the former department of infrastructure and support services (DISS) under which both the urban and rural water sections fall.
The Government is now building the required capacity to effectively and sufficiently improve access to clean and reliable water supply and sanitation (WSS) facilities and services through the NRWSSP and the NUWSSP which are national road maps for the WSS sector.
To enhance capacity in the management of the NRWSSP, structures are being put in place from national to grassroots levels in line with the requirement of implementing this programme on decentralisation principles.
It is therefore encouraging that area development committees (ADCs), which are sub-district structures, are being established in line with the decentralisation policy to facilitate community participation.
The ADCs are supposed to mobilise and sensitise communities so that they actively participate in initiating and implementing programmes, such as the NRWSSP, for their own benefit.
For instance, communities are supposed to participate in assessing the WSS situation in their own areas, participate in the allocation of water points to be constructed in their districts, ensure that the selected sites for construction of water points can be accessed using big drilling machines, mobilise each other to contribute towards the construction of water points and also operate and maintain the WWS facilities.
According to the NRWSSP community contribution towards the construction of water points is K1,500,000 per water point and each water point is estimated to carter for 250 people within a distance of 500 metres.
This means that if each person contributes K6,000 or each household contributes K42,000, the community would be able to raise the required contribution.
This contribution is insignificant compared to huge resources in terms of time and money spent on caring for and treating people suffering from waterborne-related diseases.
A good number of communities appreciate this valuable investment in their good health and living conditions and are already contributing towards the construction of boreholes in provinces such as Southern and Western provinces.
Communities that have not yet contributed should do so to facilitate the provision of clean and safe drinking water.
Community contribution towards infrastructure development is not new as it has been done under various projects where communities have contributed building sand, blocks and labour towards construction of schools and clinics.
However, because of the technical nature of constructing water points, communities are instead asked to provide a token in form of money as a demonstration of community ownership of the facilities.
At district level, each council is supposed to create a rural water supply and sanitation (RWSS) section within the council structure and recruit a focal point person to co-ordinate the implementation of the NRWSSP.
The MLGH has already written to the 63 districts being covered by the NRWSSP to establish RWSS Sections and some of them have already approved that structure and have advertised for the jobs, while others have already recruited.
This measure is expected to improve co-ordination and efficiency in the implementation of the NRWSSP, thereby improving access to clean and safe drinking water and proper sanitation facilities.
Being a national programme that is supposed to deliver 10,000 water points and about 700,000 household latrines by 2015, the NRWSSP requires a fully fledged national structure in order to meet this national commitment.
Being alive to this fact, the Government is also establishing programme support teams (PSTs) in all the nine provinces to co-ordinate and oversee the implementation of the programme.
The MLGH has already written to all the provincial permanent secretaries requesting them to identify and second officers who will head the PSTs. So far, there are four PSTs spearheading the implementation of the programme in Luapula, Northern, and Western Provinces while the fourth one covers Lusaka and Southern Provinces.
While the PSTs will comprise technical advisors, they will be managed by a Government officer to promote Government responsibility, ownership and leadership in the implementation of the NRWSSP.
The ultimate goal of the NRWSSP is increased proportion of rural population with access to clean and safe water from 37 per cent in 2006 to 55 per cent in 2010 and 75 per cent by mid 2015.
It also aims at providing increased access to improved sanitation facilities from less than 13 per cent in 2006 to 33 per cent by 2010 and 60 per cent by 2015.
This is supposed to result in reduced cases of water-borne diseases by 30 per cent by 2015 and therefore improved health and poverty alleviation as individuals, households and the Government will spend their resources in terms of efforts, time and money on productive and income generating activities rather than on medical expenses and containing perennial outbreaks of water borne diseases such as cholera.
To achieve this national vision, in addition to putting in place these programme management structures, it is envisaged that there will be gradual increment of the proportion of the budgetary allocation to the water supply and sanitation sector in the national budget from 1.2 per cent to eight per cent by 2010.
This 511 page DHS report, Zambia Demographic and Health Survey 2007 (pdf, full-text) was just released. Below are excerpts from the sections on Drinking Water and Household Sanitation
P. 22 – 2.4.1 Drinking Water
Increasing access to improved drinking water is one of the Millennium Development Goals that Zambia and other nations worldwide have adopted (United Nations General Assembly, 2001). Table 2.6 includes a number of indicators that are useful in monitoring household access to improved drinking water (WHO and UNICEF, 2005). The source of drinking water is an indicator of whether it is suitable for drinking. Sources that are likely to provide water suitable for drinking are identified as improved sources in Table 2.6. They include a piped source within the dwelling or plot, public tap, tube well or borehole, and protected well or spring.1 Lack of ready access to water may limit the quantity of suitable drinking water that is available to a household, even if the water is obtained from an improved source. Water that must be fetched from a source that is not immediately accessible to the household may be contaminated during transport or storage. Another factor in considering the accessibility of water sources is that the burden of fetching water often falls disproportionately on female members of the household. Finally, home water treatment can be effective in improving the quality of household drinking water.
The table shows that only 41 percent of the households have access to improved sources of water. Households in urban areas are more likely to have access to improved sources of water than those in rural areas (83 percent compared with 19 percent). More than half of the households (56 percent) draw their water from an unimproved source. Almost half of the households in urban areas (49 percent) have water on their premises, while about one in every ten households (8 percent) in rural areas have water on their premises. Overall, 23 percent of the households take 30 or more minutes to obtain water; 8 percent in urban areas compared with 30 percent in the rural areas.
It can also be observed that adult females collect drinking water more often than adult males (66 and 7 percent, respectively). Results also show that both male and female children below age 15 are involved in collecting drinking water. Most of the households (65 percent) do not treat their water, while only 34 percent use an appropriate method to treat their water. Bleach, chlorine or Clorin use and boiling are the most common methods used by households for water treatment (27 and 15 percent, respectively). Treating drinking water with Clorin, a locally produced solution of 0.5% sodium hypochlorite, is promoted throughout Zambia to make the water safer to drink. Table 2.7 shows that 91 percent of Zambians have heard of Clorin. The sources of where Clorin messages are heard differ by urban and rural residence. Forty percent of respondents living in urban areas have heard Clorin messages on the radio, compared with only 17 percent in rural areas. Respondents living in rural areas are informed of Clorin primarily at health facilities (38 percent). Overall, 13 percent of respondents use Clorin, of which 24 percent are in urban areas and 8 percent are in rural areas.
P. 24 – Household Sanitation
Ensuring adequate sanitation facilities is another of the Millennium Development Goals that Zambia shares with other countries. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2004).
Table 2.8 shows that almost four in ten households in Zambia (39 percent) use pit latrines that are open or have no slab: 27 percent in urban areas and 45 percent in rural areas. Flush toilets are mainly found in urban areas and are used by 26 percent of households, compared with 1 percent in rural areas. Overall, 25 percent of households in Zambia have no toilet facilities. This problem is more common in rural areas (37 percent) than in urban areas (2 percent).
Zambia – Street vending contributes to cholera – Mangani
Government has observed that street vending and unsanitary conditions at public places were some of the major contributing factors to the out break of cholera in the country.
Lusaka Province Minister, Lameck Mangani, said the general public should be mindful of the manner they dispose off refuse in order to avoid and control diarrheal diseases.
Mr. Mangani said this yesterday when a 33 member committee of the Soweto Market Development committee paid a courtesy call on him to urge government to open the market soon.
He has meanwhile, pledged government’s commitment to improving the social sector aimed at uplifting the welfare of Zambians by encouraging them to participate in income generating activities.
He said government would soon work on the access road leading to the new market and establish a bus station in line with Bus Station and Market Act.
Lusaka province minister Lameck Mangani is mobbed by marketeers at the newly erected soweto market when he went to inspect the facility.
Lusaka province minister Lameck Mangani is mobbed by marketeers at the newly erected Soweto market when he went to inspect the facility
Mr. Mangani said government was ready to open the market to the public.
He reiterated that government would ensure that transparency prevails in the allocation of trading spaces especially to those who had their stalls razed down to pave way for the construction of the market.
Earlier, Soweto Market Development Committee Chairperson, Albert Phiri appealed to the government to expedite the commissioning of the market to curb street vending in town.
Mr. Phiri told the minister that his committee had also identified two sites in Lusaka which have about 5,000 trading spaces, adding that one of them has all the necessary social amenities for use by the marketeers.
Yesterday, Mr. Mangani toured the new Soweto market to ensure that everything was in place before President Rupiah Banda commissions it.