“This novel technology requires no behaviour change or effort by users — safe water comes straight out of the tap. This point-of-collection approach to water treatment could be a transformative strategy for reducing gastro-intestinal disease burden in low-income urban communities” Amy Pickering, Tufts University

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[SYDNEY] A low-cost device that infuses small amounts of chlorine into water drawn from public taps can reduce child diarrhoea by 23 per cent, according to a study conducted in Bangladesh.Diarrhoeal disease is the second leading cause of death in children under five years of age and is responsible for killing some 525,000 children every year, according to the WHO , while UNICEF says nearly 60 per cent of deaths due to diarrhoea worldwide are attributable to unsafe drinking water and poor hygiene and sanitation.Results of the study, published in Lancet Global Health this month (8 August), showed a reduction in the consumption of antibiotics among families that used water from taps fitted with special dispensers containing chlorine tablets that gradually dissolve and treat flowing water.“While we don't have data on specific pathogens, the intervention did reduce antibiotic consumption among treatment households, which is exciting considering that antibiotic resistance is a major public health issue in urban low-income Asian settings,” Amy Pickering, an author of the study and research leader, tells SciDev.NetThe double-blind randomised trial done in low-income communities within Dhaka city and in Tongi, on the outskirts of the capital, involved using identical dispensers made by Aquatabs Flo (Medentech, Inc, Wexford, Ireland) installed at 100 randomly assigned, shared water points that either dispensed chlorine (intervention) or vitamin C (control group).A total of 1,036 under-five children from 920 households were enrolled for the study.“This novel technology requires no behaviour change or effort by users — safe water comes straight out of the tap. This point-of-collection approach to water treatment could be a transformative strategy for reducing gastro-intestinal disease burden in low-income urban communities,” says Pickering, assistant professor at Tufts University in the US.Previous research focused on household-level water treatment that required people to add their own doses of chlorine. “Chlorination is one of the cheapest and most widely available methods to make drinking water safe, but poor taste and bad smell of chlorinated water are major barriers to adoption,” explains study co-author Sonia Sultana from the International Centre for Diarrhoeal Diseases Research , Bangladesh.The new device uses a low-residual chlorine dose (0·3–0·5 parts per million), which increases taste acceptability and improves drinking water quality. The researchers are hopeful that the study will help catalyse scale-up of automated chlorination technologies, which could contribute to global progress towards the UN Sustainable Development Goal 6.1 for universal access to safe, affordable drinking water.An estimated one billion people globally have access to piped water that does not meet international safety standards. More than 50 per cent of piped water samples in Dhaka were found to be contaminated with Escherichia coli, a bacterium responsible for diarrhoea and an important cause of childhood mortality in the Asia-Pacific region. Trevor Duke, director of the Centre for International Child Health at the University of Melbourne and Royal Children’s Hospital in Melbourne, tells SciDev.Net, “This device and technique for chlorine purification of water will reduce E. coli diarrhoea, which is particularly severe and is over represented in childhood deaths in the Asia Pacific.”Duke says that while the device has potential applicability in many areas of the Asia Pacific, especially in rural areas and urban settlements where communal water supplies are common, it will not prevent all cases of diarrhoea as some are viral or not water-borne.“The Aquatabs Flo chlorine device seems to be easy to apply to taps and other water outlets, and apparently provides chlorination for up to 180,000 litres. I would be a little concerned with theft of the device from some communal water sources in some areas, as it seems easy to apply and remove from a tap,” adds Duke.This piece was produced by SciDev.Net’s Asia & Pacific desk.