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Distribution of Intermittent Slow-Sand Filtration
Systems in Macuelizo, Honduras
Philip Turner, Robert Turner, Matthew Turner, and George Turner
Abstract: The purpose of this mission is to supplement a pre-existing deworming and
vitamin distribution program with the provision of sustainable access to clean drinking
water. This will be achieved specifically with the implementation of intermittent slow-
sand filters at the household level as well as in schools chiefly in the Municipality of
Macuelizo, Santa Barbara, Honduras, but also in the greater Valle de Quimistan.
Additional strategies include the promotion of hygiene education, proper water storage,
the distribution of shoes and sandals, basic first aid, and exploring the possibilities of
expanding deworming as a method of treating morbidity associated with helminthiasis,
primarily among children. Because of disparities in access to healthcare and aid this
work will be primarily focused on affecting the lives of the poorest in these communities.
Introduction:
Almost half the world's population suffers from diseases associated with insufficient or contaminated water and is at risk from waterborne and food borne diseases. Access to sources ofclean drinking water, sanitation facilities, and education about hygiene are necessary for goodpublic health. Fortunately intermittent slow sand water filters offer an effective and cheap way ofproviding clean water for households and schools. Likewise educational materials are abundantand readily available.
Diarrhoeal disease caused over three million deaths in 1995, 80% of which were among children under the age of five. It was estimated that 88% of that burden is attributable to unsafewater supply, sanitation and hygiene and is mostly concentrated on children in developingcountries. Approximately 5000 children die every day from diarrhea acquired from unsafedrinking water. (1-2) It is difficult to estimate the total burden of morbidity due to unsafe drinking water, but over 1 billion episodes of gastroenteritis and other infections are attributed to it each year. Thereare about 16 million cases of typhoid fever causing over 600,000 deaths a year. Epidemics ofcholera and dysentery cause severe disease, and high death rates. Worldwide, approximately 140million people develop dysentery each year, and about 600,000 die.(3). Seventy-nine millionpeople are estimated to be currently at risk of cholera infection in Africa, and the disease causes120,000 deaths a year.
Soilborne infections affect several million people a year, intestinal worm infections being the most prevalent. Depending upon severity these infections can lead to malnutrition,anaemia or retarded growth. Children are particularly susceptible to the effects and typicallyhave the largest number of worms. About 400 million school-age children are infected byroundworm, whipworm and/or hookworm. Roundworm and whipworm alone are estimated toaffect one-quarter of the world’s population.(4) It was recently reported in Science magazine that rotaviruses leads to 20–60 deaths a year in the United States and about 600,000 in the developing world.(11) This is one of the manytroubling health statistics that illustrates the grotesque disparity between health care in thedeveloped and the developing world. Mortality among children under the age of 5 yearscurrently averages 6 per 1000 births in industrialized countries, but is as high as 91 per 1000 inthe developing world.(9) Substantial progress has been made in child health care in the developing world. In 1960, 105 out of 1000 children born in Latin America or the Caribbean died before their firstbirthday; by 1999 that figure had fallen to 30 in 1000. However, progress has been uneven withone common theme emerging: poor children lag behind their better-off peers. This is true notonly between the industrialized and developing world, but also among the poor within countries.
In Brazil over the period 1987 to 1992 the mortality in children under 5 in the poorest third of thepopulation was six times greater than among the richest 10% of children (113 vs 19 per 1000 livebirths).(5) Reductions in infant and under-5 mortality have been fastest among the richestcountries,(6) and rates of child mortality and malnutrition have fallen faster among the better-off.
(7) This is evidence of an unfortunate trend of increasing socioeconomic inequalities, andtherefore increasing inequalities in child healthcare. The standard of living in terms of quality ofchild healthcare operates through determinates such as access to save drinking water andsanitation, and socioeconomic inequalities are highly visible not only between countries but alsowithin them.
Lack of access to clean drinking water is a major feature of extreme poverty, which almost exclusively affects the poor in the developing world. This is especially true in expanding
urban areas, poor rural areas, and indigenous communities. Community and municipal water
treatment systems are frequently impractical and often unaffordable. Water filtration on the
house-hold level is the most reasonable alternative for these people. Intermittent slow sand water
filtration, also commonly known as Biosand Filtration , provides an affordable and effective (see
Materials and Methods) option for treating drinking water in urban and rural communities of the
developing world.
Materials and Methods:
Funds are obtained from private donations in Boise, ID and throughout the United States. Water filters are purchased from the Aqua Pura Por El Mundo (Pure Water for the Worldof Rutland, VT) facility in Santa Barbara, Santa Barbara, Honduras, and implemented in homesand schools in the Valle de Quimistan. During the implementation of the filters, educationalmaterials (thanks in part to CAWST of Calgary, Alberta) explaining the importance of cleanwater as well as those promoting good hygiene habits and disease prevention are distributed.
Water quality testing is carried out to investigate and demonstrate the effectiveness of the filtersas well as to analyze the quality of the municipal water and its seasonal variation using ColiscanWater Monitoring Kits (Microbiology Laboratories, Goshen, IN, USA). As stated above, thewater filters purchased by this organization are Biosand water filters. Biosand Filtration wasdeveloped by Dr. David Manz at the University of Calgary, Canada in the 1990’s, and is nowused world wide. Modifications to conventional slow sand filter technology include: 1) reducingthe height of the supernatant to 5 cm to provide the schmutzdecke (the “biofilm”) with sufficientoxygen for sporadic use, and 2) eliminating the need for sand bed removal through a “clean inplace” technique. Biosand water filters have proven to be effective in cleaning the water andimproving its taste, smell, and appearance. Biosand filters are excellent for widespread use inhousehold water treatment among the poor because they are: 1) easy to operate and maintain, 2)affordable and durable, 3) manufactured in local communities using local materials, and 4)require no chemicals or energy for use. In a field study conducted in Haiti, 107 Biosand filterswere found to have an average bacterial removal of 98.5% overall.(10) Results:
This was the fourth trip to Honduras and to Macuelizo in a period of 12 months. In June of 2007, twenty-five water filters were distributed by the Boise State University Clean WaterClub and its local Honduran partners in addition to the 10 installed in January of 2007. Aroundone hundred pairs of children’s shoes and sandals along with vitamins and basic first aidmaterials were distributed. Antihelminthic medicine, 200 doses of Albendazol (400mg singleliquid dose), purchased from Farsiman Laboratories of San Pedro Sula were donated to AguaPura Por El Mundo. A donation of surplus of water quality testing equipment was also made tothe Aqua Pura Por El Mundo facility in Santa Barbara.
Conclusion:
The purpose of the mission is to provide access to clean drinking water through the implementation of Biosand water filters in the Valle de Quimistan region of Santa Barbara,Honduras. This work will focus on affecting the lives of the poorest in this area. The purchase of40 water filters from Aqua Pura has been secured for a December-January 2007-08 return trip,however, we would like to increase this number to 65.
Acknowledgements:
Scared Heart Catholic Church in Boise, Idaho, Don Julio Cesar and the whole Altamirano family, and especially Michael and Maria Turner, for their continuous support andkindness.
References:
1.
"Burden of Disease and Cost-Effectivness Estimates." World Sanitation and Health (WSH).
2007. World Health Organization. 7 Aug. 2007
<http://www.who.int/water_sanitation_health/diseases/burden/en/index.html>.
2. "The World Health Report." 2007. World Health Organization. 10 Aug. 2007
<http://www.who.int/whr/1996/media_centre/executive_summary1/en/index8.html>.
3. Perlin, David. "Water-Borne Diseases: Cholera and Dysentery." Infoplease. 2002. Pearson
Education. 14 Aug. 2007 <http://www.infoplease.com/cig/dangerous-diseases-
epidemics/epidemic-dysentery.html>.
4. "Common Water and Sanitation-Related Diseases." 2007. UNICEF. 1 Aug. 2007
<http://www.unicef.org/wes/index_wes_related.html>.
5. Progress Since the World Summit for Children: A Statistical Review. New York, NY:
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6. Prichett, Summers. Wealthier is Healthier. J Hum Resourc. 1996; 31: 841-868.
7. Wagstaff A. Socioeconomic inequalities in child mortality: comparisons across nine
developing countries. Bull World Health Organ. 2000; 78: 19-29.
8. Gwatkin, Rustein, Johnson, Pande, Wagstaff. Socioeconomic Differences in Health, Nutrition
and Population
. Wahington, DC: World Bank; 2000.
9. Wagstaff, Adam. "Child Health: Reaching the Poor." American Journal of Public Health os 94
(2004): 726-736
10. Baker, D L., and W F. Duke. "Intermittent Slow Sand Filters for Household Use- a Field
Study in Haiti." CAWST (2006). 5 Aug. 2007
<http://www.cawst.org/assets/File/Slow_Sand_Filter_Study.pdf>.
11. Parashar, Umesh. “Progress Toward Rotavirus Vaccines.” Science. Vol 312 (2006): 851-852.
Supplemental Resources:
Malla, B., Sherchand, J.B., Ghimire, P., B.C. Rajendra, Kumar, Gauchan
P. (2004) Prevalence of Intestinal Parasitic Infections and
Malnutrition among Children in a Rural Community of Sarlahi, Nepal.
Journal of Nepal Health Research Council Vol. 2 No. 1.
Uchenna Chinedu Ozumba, Nwora Abiodum Ozumba, Samuel Anya. (2005)Helminthiasis in Pregnancy in Enugu, Nigeria. Journal of HealthScience, 51(3) 291--293 Ozumba, U.C. and Ozumba, N. (2002) Patterns of Helminth infection inthe human gut at the University of Nigeria Teaching Hospital, Enugu,Nigeria. J. Health Sci., 48, 263--268 Lennartt Freji, M.D., Gunnar W. Meeuwisse, M.D., Nils Oskar Berg, M.D.,Stig Wall, Ph.D., and Mehari Gebre-Medhin, M.D. Ascariasis andMalnutrition. A study in urban Ethiopian children. The American Journalof Clinical Nutrition 32: JULY 1979, pp. 1545--1553 Cornu, Andre. (1993) Ascariasis and Digestibility: A study inCameroonian children. Food and Nutrition Bulletin, Vol. 7, No. 4 Food and Agriculture Organization of the United Nations, 2006. TheDouble Burden of Malnutrition: Case studies from six developingcountries, Rome Ijagbone, I.F. and T.F. Olagunju. (2006) Intestinal Helminth Parasitesin School Children in I ragbiji, Boripe Local Government, Osun State,Nigeria. African Journal of Biomedical Research, Vol. 9; 63--66 Braghetta, Anne, Ph.D., P.E. (2005) Drawing the Connection betweenMalnutrition and Lack of Safe Drinking Water in Guatemala.
Malnutrition--Diarrhea White Paper Wani, M.Y., Chechak, Bashir A., Reshi, Farooq, Pandita, Sanjay, Rather,Muddasar H., Sheikh, Tariq A., Ganie, Ishfaq. Our experience of biliaryascariasis in children. J Indian Assoc Pediatr Surg / Jul-Sept 2006 /Vol 11 / Issue 3 Al-Mekhlafi, Hesham M.S., Azlin, M., Aini, U Nor, Shaik, A., Sa'iah,A., Fatmah, M. S., Ismail, M. G., Ahmad, Firdaus, Aisah, M. Y.,Rozlida, A. R., Norhayati, M. Protie-energy malnutrition and soil-transmitted helminthiases among Orang Asli children in Selangor,Malaysia. Asia Pac J Clin Nutr 2005; 14 (2): 188-194 Rai, Shiba Kumar, Hirai, Kazuko, Abe, Ayako, Ohno, Yoshimi. InfectiosDisease and Malnutrition Status in Nepal: an Overview. Mal J Nutr 8(2):191-200, 2002 Stillwaggon, Eileen. The Ecology of Poverty: Nutrition, Parasites, andVulnerability to HIV/AIDS Oyewole F, Ariyo F, Oyibo WA, Sanyaolu A, Faweya T, Monye P, Ukpong M,Soremkun B, Okoro C, Fagbenro-Beyioku AF, Olufunlayo TF. Helminthicreduction with albendazole among school children in riverinecommunities of Nigeria. Journal of Rural and Tropical Public Health 6:6-10, 2007 Salazaar, Nelia P., Ph.D., Montalban, Cecilia S., M.D., Bustos, DorinaG., M.D., Laurente, Marietta C., B.S., Sabordo, Nellie T., M.D.,Tarrayo, Minerva G., M.S., Pasay, Cielo J. Pasay, B.S. A Model for Control of Soil-Transmitted Helminthiasis. Phil J Microbiol Infect dis1987; 16(2): 65-72 WHO (2003) Controlling disease due to helminthic infections, WorldHealth Organization PAHO/WHO (2005) 14th Inter-American Meeting, at the Ministerial Level,on Health and Agriculture, Empowering and Expanding the Role of Womenin Food Security and Local Development. Mexico City, D.F., Mexico, 21-22 April 2005; Pan American Health Organization, World HealthOrganization RIMSA14/22 WHO (2001) Nemer, L., Gelband, H., Jha, P. The Evidence Base forInterventions to Reduce Malnutrition in Children Under Five and School-age Children in Low and Middle-Income Countries; World HealthOrganization Commission on Macroeconomics and Health, WG5:11 WHO (2007) Combating Waterborne Disease at the Household Level, WorldHealth Organization, The International Network to Promote HouseholdWater Treatment and Safe Storage, Geneva Harris, John. Challenges to the Commercial Viability of Point-of-Use(POU) Water Treatment Systems in Low-Income Settings. OxfordUniversity. 2005 WHO (2006) Guidelines for Drinking-water Quality; First Addendum to theThird Edition, World Health Organization WHO (2002) Evaluation of the H2S Method for Detection of FecalContamination of Drinking Water, World Health Organization,WHO/SDE/WSH/02.08.
Chiller, Tom M., Mendoza, Carlos E., Lopez, M. Beatriz, Alvarez,Maricruz, Hoekstra, Robert M., Keswick, Bruce H., Luby, Stephen P.
Reducing diarrhoea in Guatemalan children: randomized controlled trialof flocculant--disinfectant for drinking-water. Bulletin of the WorldHealth Organization, January 2006, 84(1) Laurent, P. Household Drinking Water Systems and Their Impact on Peoplewith Weakened Immunity. MSF-Holland Public Health Department, February2005 WHO (2002) Managing Water in the Home: Accelerated Health Gains fromImproved Water Supply, World Health Organization, WHO/SDE/WSH02.07 UNICEF (2002) Facts for Life, United Nation's Children's Fund, New York WHO (2005) "Alliances for the promotion of safe water and hygiene forthe families of Latin America", World Health Organization,International Network to Promote Household Water Treatment and SafeStorage, 6-7 October 2005 meeting, Quito, Ecuador WHO (2000) Brikke, Francois. Operation and Maintenance of rural watersupply and sanitation systems: A training package for managers andplanners, World Health Organization, Operation and Maintenance Networkof the Water Supply and Sanitation Collaborative Council, IRC International Water and Sanitation Centre Delft, Netherlands, Geneva WHO (1974) Huisman, L., Wood, W.E. Slow Sand Filtration, World HealthOrganization, Geneva WHO (2005) Meeting on Small Community Water Supply Management,Reykjavik, Iceland, 24-26 January 2005, World Health OrganizationWHO/SDE/WSH/05.02 CAWST, Water Treatment Implementation for Developing Countries, Centrefor Affordable Water and Sanitation Technology, Calgary, Alberta WHO/UNICEF (2005) Water for Life, World Health Organization and UNICEF WHO/UNICEF (2004) Meeting the MDG Drinking Water and Sanitation Target;A Mid-Term Assessment of Progress, World Health Organization and UnitedNation's Children's Fund WHO (2004) Hutton, Guy, Haller, Laurence. Evaluation of the Costs andBenefits of Water and Sanitation Improvements at the Global Level,World Health Organization; Water, Sanitation and Health; Protection ofthe Human Environment, WHO/SDE/WSH/04.04 UNDP/WHO (1994) Food, Water and Family Health: A Manual for CommunityEducators, United Nations Development Programme, World HealthOrganization, WHO/HEP/94.2

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