Outcome evaluation of the Smart Electrochlorinator 200 (SE200)hwts.web.unc.edu/files/2014/09/5-3-Wilmouth... · Robyn Wilmouth, MScEng. PATH. WEF Disinfection Conference 2011. April
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Robyn Wilmouth, MScEng PATH WEF Disinfection Conference 2011 April 12 th , 2011 Outcome evaluation of the Smart Electrochlorinator 200 (SE200) Complete Manuscript Title: “Evaluation of the implementation (pilot) of a small community electrochlorination device – Smart Electrochlorinator (SE200)- at a field site in a peri-urban community (Kisumu, Kenya) “
Outcome evaluation of the Smart Electrochlorinator 200 (SE200)
Complete Manuscript Title:“Evaluation of the implementation (pilot) of a small community electrochlorination
device – Smart Electrochlorinator (SE200)- at a field site in a peri-urban
community (Kisumu, Kenya) “
Presenter
Presentation Notes
Good morning! My name is Robyn Wilmouth, and I am an environmental engineer for PATH, which is headquartered in Seattle, WA. Our mission is to improve the health of people around the world by advancing technologies, strengthening systems, and encouraging healthy behaviors. PATH has offices in 30 cities within 20 countries throughout the world, of which today’s presentation will reflect our activities in Kenya and the work of our community water team within our WaSH cohort at PATH. __________________________________________________________________________________________ PATH’s Mission: To improve the health of people around the world by advancing technologies, strengthening systems, and encouraging healthy behaviors. PATH’s Vision: A world where innovation ensures that health is within reach for everyone. Where we work PATH has offices in 30 cities in 20 countries. These countries are Belgium, Cambodia, China, Cote d'Ivoire, Ethiopia, France, Ghana, India, Kenya, Nicaragua, Peru, Senegal, South Africa, Tanzania, Thailand, Uganda, Ukraine, Vietnam, Zambia, and the United States. PATH works in more than 70 countries. Number of staff More than 800
PATH’s water quality interventionsWho? - To reach poor individuals with higher disease burden
What? – To improve the quality of drinking water
Where? - To reach homes in low-resource settings
How? - To ensure access to safe drinking water
Why? - To improve the quality of life and health within a family’s home
Presenter
Presentation Notes
Our WaSH team focuses upon disease prevention and treatment through projects and activities aimed at diverse areas such as water quality in the household and community domains, sanitation and hygiene behaviors, vaccine technology (including rotavirus), zinc supplements, nutrition, and oral rehydration solutions formulations. PATH’s approach to water quality interventions begins with the who, meaning who are we targeting. We aim to reach low income households with high disease burden by improving the quality of the household’s drinking water. [REMOVED due to previous presenters provided the motivation and background regarding global health burden…] In 2004, diarrheal disease was the third leading cause of death in low-income countries, causing 6.9% of deaths overall. Diarrheal disease is a leading cause of child mortality and morbidity in the world, and mostly results from contaminated food and water sources. In children under five years old, diarrheal disease is the second leading cause of death – second only to pneumonia. Out of the 1.5 million children killed by diarrheal disease in 2004, 80% were under two years old. ____________________________________________________________________________________________ WHO FACT SHEET No.330 (http://www.who.int/mediacentre/factsheets/fs330/en/index.html) Scope of diarrhoeal disease Every year there are about two billion cases of diarrhoeal disease worldwide. Diarrhoeal disease is a leading cause of child mortality and morbidity in the world, and mostly results from contaminated food and water sources. Worldwide, around 1 billion people lack access to improved water and 2.5 billion have no access to basic sanitation. Diarrhoea due to infection is widespread throughout developing countries. In 2004, diarrhoeal disease was the third leading cause of death in low-income countries, causing 6.9% of deaths overall. In children under five years old, diarrhoeal disease is the second leading cause of death – second only to pneumonia. Out of the 1.5 million children killed by diarrhoeal disease in 2004, 80% were under two years old. In developing countries, children under three years old experience on average three episodes of diarrhoea every year. Each episode deprives the child of the nutrition necessary for growth. As a result, diarrhoea is a major cause of malnutrition, and malnourished children are more likely to fall ill from diarrhoea.
Peri-urban communities
• Minimal access to infrastructure such as municipal tap water• High prevalence of informal water vending practices• Purchase of water is common• Variety of water sources • Variable water quality
Presenter
Presentation Notes
The outcome evaluation that we will discuss today took place within the Kasule community of Kisumu, Kenya. Kisumu is the third largest city in Kenya, is located in the Nyanza province of western Kenya, and lays on the shores of Lake Victoria. More than 60% of the 300,000 residents of Kisumu live in peri-urban settlements (UN-HABITAT, 2005). The term peri-urban generally implies the perimeter of the urban environment. Centralized water and wastewater systems often cannot reach all populations in need, especially the poorer and more vulnerable residents of peri-urban settlements (Mintz, 2001). For example, the picture on the left depicts the closest municipal tap to the Kasule community [Click mouse for arrow]. The municipal tap water is chlorinated by the city water treatment facility. Measurements of FAC confirmed chlorination levels of ~1.5ppm. The push-cart noted in the image is indicative of the typical mode of transporting water from sources such as the tap to peri-urban residents. The primary GAP is that this tap is located ~2-3 kilometers away from Kasule. The photo on the right represents a household whose family members are residents of the Kasule community and where the father is also a cart vendor. A variety of water sources such as tap water (distributed via cart vendors only), rain water, and well water are available in the Kasule community. While the purchase of water is common and informal vending practices are prevalent, the price and quality of each source varies. Water quality interventions in such a setting need to be very low cost, improve water quality, and maintain safety until the point of consumption.
Chlorine-based approaches in KenyaTypes of approaches
• Point of use• Community based• Entrepreneurial• Institutional• Municipal/government
Complementary approaches• Generate demand for treatment of
drinking water• Overcome challenges of taste
aversion• Expand reach to various locations
and persons of different incomes
Presenter
Presentation Notes
In Kenya chlorine-based approaches are aiming to overcome two major challenges: 1) the need for a very low cost approach; 2) the need for residual protection from the water source to the point-of-consumption. Recontamination is prevalent both in the transport and the storage of water prior to consumption in the home. A myriad of treatment approaches are practiced and championed in Kenya, such as point-of-use (also called household treatment), community-based, entrepreneurial, institutional, and municipal. Each type of approach indicates a different type of management structure and varies as to who is the purchaser. All of these approaches should be seen as complementary, rather than competitive. Each approach generates demand amongst populations for treatment of their drinking water, aids in establishing acceptance of the taste, and finally expands the reach to various locations and persons of different incomes. [Click mouse for box] Today we will discuss an entrepreneurial approach to the use of the SE200. ____________________________________________________________________________ Differentiating factors Who manages? Who operates? Who pays? Who benefits?
Smart Electrochlorinator 200 Benefits• Single button operation• LED indicator lights• Fresh disinfectant • Off-grid operation - 40,000L/charge• Minimal dependency upon supply
chains• Eliminates cost of individual
packaging• Low environmental impact by
eliminating individual sachets/bottles from the waste stream
• Dosing responsibilities transferred to trained operator
Salt + Water + Electrodes + Power = Chlorine-based oxidant disinfectant
Batch production of 60mL of 0.75% in 6-8 min
Presenter
Presentation Notes
The Smart Electrochlorinator 200 evolved from the product development efforts of PATH in partnership with Cascade Designs, Inc., which is a local Seattle-based outdoor and military product developer. Through decades of experience with drinking water treatment technology and the use of electrode chemistry, CDI contributed their expertise to co-develop the SE200, which includes the patented electrodes of Miox Corp. I would like to acknowledge that we have personnel of both CDI and Miox in the audience and they will be invaluable for questions and inquiries about the core technology during the Q&A session. Electrochlorination is a process that utilizes salt, water, electrode chemistry, and power to produce a chlorine-based disinfectant solution. The device is deemed “smart” because its circuitry provides looped feedback on salt concentration to adjust production and run time and continuously reaches the final intended concentration (0.75%). [Click mouse to fade text box] The device is deemed simple due to a single button operation and LED light indicators for feedback on low salt concentration and/or low battery. Operational benefits include: Production of fresh disinfectant onsite Off-grid operation with a 40 to 80 amp-hr battery Other unique benefits include: -Minimal dependency upon supply chains Eliminates the cost of individual packaging Lowers the environmental impact Lastly… The responsibilities for correct dosing are transferred to a trained operator
Core technology leveraged from outdoor and military product development of Cascade Designs, Inc., and Miox Corporation
Electrochlorination: Iterative design
Salt + Water + Electrodes + Power = Chlorine-based oxidant disinfectant
0.5 to 4 L in 1-2 minutes
20-L Prototype
20L in 2 minutes
200-L Prototypes
200L in 6-8 minutes
Presenter
Presentation Notes
Product development is not a stagnate process. My colleagues and I focus upon three critical “I” steps in product development: Innovate, Introduce, and Integrate. We began with building relationships and partnerships. By leveraging prior work conducted by CDI and Miox Corporation, we were able to innovate and apply the core electrochlorination technology to a different context of use (low resource settings) and a vastly different final market (low income consumers). We recognized a technology gap between the individual treatment technologies and the larger scale municipal level options. Hence we iterated up from the individual capacity to a scale for 10s to 100s of beneficiaries per unit per day. [Click on mouse] We began with a 20L prototype which was tested in Kenya for user feedback. The desire for a larger capacity device was a key finding. [Click on mouse] Then we iterated with a functional 200L black prototype and obtained feedback in Kenya regarding: 1) aesthetic appeal (blue was denoted as a favorable color – not black) and 2) the “wow” factor with the inclusion of LED lights illuminating the solution while bubbles were generated (bubbles and lights excites users, general onlookers, and even technology gurus such as yourselves). Finally in 2010 we introduced the 200L blue prototype and field tested in a multitude of user contexts (entrepreneurial, community water committee, etc.) and field locations. While the product development efforts (including technology development and user feedback) are critical for improving the robustness and usability of the technology, our team recognized gaps in our knowledge. To enhance our understanding of the appropriateness of the technology for addressing a community’s health based need and the potential for health impact, a small-scale outcome evaluation was proposed by my community water team and we solicited internally for modest funding. NOTE: Describe difference between feedback and needs assessment and field based assessments.
Conceptual framework
Presenter
Presentation Notes
Our audience today is eager to learn about the criticality of evaluations as noted by your choice to attend this session. Prior to implementing an intervention and beginning an evaluation, one should plan ahead of time to clearly identify the purpose of the intervention and the desired outcome. Creating a conceptual framework is one of the tools and best practices of evaluation. The diagram demonstrates the use of a conceptual framework. [Reference diagram] Both upstream and downstream moderating factors are identified in order to understand the relationship of external factors that may influence the ability to reach outcomes. The intervention discussed today is the use of source chlorination of well water using the SE200 at a micro-entrepreneur’s water kiosk. Identifying key behavior mediators are important for acknowledging the potential behavioral barriers that may hinder successful uptake and acceptance of the intervention. Another instrumental aspect of planning is to understand the capacity of one’s evaluation to measure outcomes. The intervention and scope of this evaluation was only able to assess proximal outcomes, [Click mouse] which were identified to be decreased exposure of clients to fecal and/or microbiologically contaminated drinking water 1) as compared to the micro-entrepreneur’s untreated water and 2) as compared to the households within the same community that were not accessing the micro-entrepreneur’s kiosk (deemed as non-clients). Overall the diagram demonstrates the relationship to the downstream health outcome (distal outcome), which could be assessed through more extensive and expensive health-outcomes studies. The distal outcome is decreased diarrheal morbidity and/or mortality from microbiologically contaminated drinking water.
1. Surveys of non-clients: To assess the variability, accessibility, and preferences of sources of drinking water available in a peri-urban community
2. Water quality of non-clients: To assess the extent of fecal contamination of household (non-clients) drinking water and the subsequent need for water treatment within the general community
3. Water quality of clients: To assess the efficacy of the SE200 system to treat water at a field site in a peri-urban setting
Study objectives
Presenter
Presentation Notes
NOTE the images and significance.
Methods
Period
10 Clients Non-clients20 Households
Water Quality Water Quality
Source Household Surveys Source Household Surveys
April to May YES YES* NO NO YES YES
July n/a* n/a* NO NO YES NO
Surveys of water practices (sources, storage, handling), preferences, and basic hygiene
Water quality tests (free available chlorine & MPN enumeration of total Coliforms and E. coli)
Sampling: Purposive sampling due to logistical constraints and preference for non-disruptive interactions with clients
Presenter
Presentation Notes
To reach the first objective a series of surveys were completed with the non-clients (20 households) - at the beginning of the assessment in April 2010. Household participation was accomplished through the assistance of the village elder and by guidance of local PATH Kenya staff, who spoke Swahili and Luo (the local dialect) and who aided in locating representative families in homes of variable quality, of variable ownership (rental versus privately owned), and of various socio-economic income levels. [Click mouse] Objective 2 was addressed by completing water quality tests of the drinking water stored within the homes of the 20 non-clients, which occurred in both seasons. [Click mouse] Objective 3 was focused on both the source water quality of the micro-entrepreneur and her clients. The clients were not surveyed due to the request of the micro-entrepreneur to mitigate against impact upon her business (meaning have a light touch on her clients). We intended to assess source and point-of-use water quality with the micro-entrepreneur in the dry season as well; however, the water-selling operations of the kiosk was unexpectedly closed for the duration (1 month) of the study in July. Field work is challenging and unexpected alterations occur. Plan well, and adjust accordingly.
Non-clients drinking water practices 12 HHs report never treating6 HHs report sometimes treating2 HHs report frequent treatment with chlorine disinfectant
1/84 samples confirmed (FAC >0.2 mg/L) treatment with chlorine product
Obj
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Sur
vey
of n
on-c
lient
s
Presenter
Presentation Notes
First, note the low frequency of treatment at a household level. Second, note the decreased availability of rain water (primarily due to lack of water storage capacity) Third, note the increased dependence upon both tap water and well water in the dry season.
Non-clients drinking water qualityHow does the shift in source water selection affect non-clients?
Obj
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Wat
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non
-clie
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Presenter
Presentation Notes
First, note higher quality of the rain water. Second, note the low quality of well water. Third, note distribution of the claimed-to-be “tap” water samples. The values (pH and E. coli) of the samples >100 were indicative of local well water and not the tap water, which highlights a possible lack of integrity of some of the local cart vendors.
Non-clients drinking water qualityHow many samples PASS recognized drinking water recommendations?
Obj
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Wat
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non
-clie
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Presenter
Presentation Notes
The table benchmarks against two criterion: 1) E. coli value must be below 10 CFU/100 mL 2) E. coli value must demonstrate no detectable presence (<1 CFU/100mL). This table indicates a passing rate (not a failing rate) and we illustrate the pass rates for both criterion as a comparison. The table highlights the poor drinking water quality for each water type collected in the non-client’s homes within the Kasule community. [Click mouse] Water sourced from local wells demonstrated the type of water in need of address first (meaning the highest loading of fecal contamination). [Click mouse] The claimed-to-be “tap” water also triggers an area for concern and again illustrates the potentially questionable integrity of the local cart vendors. NOTES for reference: Debate exists about the relationship between indicator values (not actually measurements of disease-causing organisms), disease burden, and the subsequent drinking water recommendations. The WHO recommends no detection of E. coli in water sources, while numerous researchers and other national bodies do not align to the stringent recommendations, which were relied heavily upon the US Environmental Protection Agency’s standards for the U.S. Some parties (including the South African Research Commission) recommend a less stringent domestic drinking water value of <10 CFUs.
Micro-entrepreneur’s water quality
Obj
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Wat
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Presenter
Presentation Notes
The second portion of the evaluation focused upon the source water and clients of the local micro-entrepreneur, who operated a manual, bucket extraction well of ~24m depth. The micro-entrepreneur was identified through a collaborating organization (The Aquaya Institute) as a willing and able entrepreneur who maintained records and provided feedback through prior engagements. She and her niece were provided with training on operating the device. Her kiosk was located in the Kasule community and was ~2-3 kilometers from the closest municipal tap (source of water for local “tap” water vended by cart vendors). [HIGHLIGHT the tap on the map] [Click mouse] During 10 days of evaluation in April-May 2010, the source water of the micro-entrepreneur was tracked for water quality pre and post treatment (3 replicates each day) at two time periods: 1) indicative of treatment time; 2) indicative of anticipated period of consumption within the home. Twenty liters of water was extracted manually, a clean research vessel was dosed, and then the water was funneled into the 20L vessel for assessment. (NOTE: The dosing first followed by filling with a funnel allowed for agitation and mixing that is not achieved by manual shaking. We will now include this recommendation in trainings and the manual) [Click mouse] All samples passed the WHO recommended value of no detectable presence of E. coli.
Context of use Learning from process indicators:• Dosing regimen• Mixing regimen• Variable microbial loading (spikes)
Lessons for improved components
Presenter
Presentation Notes
The table demonstrates some challenges that are being noted by the field research team and the product developers. TC values are not necessarily indicative of a health risk but rather serve as a process indicator, which allows evaluators to understand when a system is challenged and improvements can be made. The presence of TC in the <1 hr time frame demonstrates potential challenges to the dosing and mixing regimen, while the presence of TC in the 8-24 hour time frame demonstrates additional challenges such as how variable loading (notably spikes) may provide a re-growth potential of microbial organisms in domestic water sourced from highly contaminated source waters.
Clients drinking water qualityHow does adding treatment to local well water affect clients?
Obj
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Wat
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Presenter
Presentation Notes
[Note the variable water quality of the micro-entrepreneur’s untreated well water and the spike on 5/11/2010.] [Note all samples meet WHO guideline value for source water sampled from client’s containers.] [Note the challenges of assessing POU water quality, including the time constraints, consumption of water prior to arrival of researcher, low client numbers, and the closure of the kiosk during the July dry season]. [Note Client 1 had a POU value of <1, while client 8 had POU E. coli values of 2.1 and 33.2]
Key findings for non-clients• Poor water quality for families
accessing untreated well water sources
• Low prevalence of treating within local Kasule homes
• Vulnerability due to source water shifts from wet to dry season
• Questionable water quality for families purchasing water from cart vendors
Key findings for entrepreneur & clients• Efficacious treatment against
fecal contamination (E. coli)• Dosing mechanism and mixing
mechanism as areas for enhancement
• Peri-urban setting in Kenya is appropriate due to water vending practices, but competition is high and promotion and differentiation is necessary
• Client outreach would be more targeted by focusing upon community members who drink well water already
Five areas for future research1. Household income & willingness to pay for treated water
2. Role of cart vendors and willingness to ensure treatment of their vended water
3. Lending schemes for micro-entrepreneurial model
4. Variable fecal loading and oxidant demand in field settings for understanding ability of device to provide role of both primary treatment and residual protection along the pathway from source to point-of-consumption
5. Improved dosing and mixing options with subsequent field assessments
Funders:Lemelson FoundationIndividual donors to PATH
Co-authors:Jenna ForsythJ. Scott Meschke
PATH’s Kenyan staff:Agnes A’AballahStephen Sitati
Presenter
Presentation Notes
Funding for product development and field trials of the SE200 was generously provided by the Lemelson Foundation, while the outcome evaluation was funded by individual donors to PATH. My co-authors include my graduate student intern - Jenna Forsyth – and Scott Meschke from the University of Washington. Jenna (pictured here) was instrumental to the success of both the field work and synthesis of data, while Scott provided both guidance and support for the analyses. I would also like to acknowledge my Kenyan colleagues – Agnes A’Aballah and Stephen Sitati, who were instrumental to the success of the project.
Appendix
SE200 field trial locations
IDEXX Quanti-tray 2000
Presenter
Presentation Notes
Since tracking the multitude of pathogenic organisms causing disease through the fecal-oral route is challenging, methods have been and continue to be developed to monitor water quality. Both Liz and I utilized the same tools – the IDEXX Quanti-Tray system. This slide demonstrates how testing methods can allow researchers to identify and quantify the presence of microbes of fecal origin. Of the Enterobacteriaceae family only E. coli (noted in blue) is both a fecal indicator and NOT of non-fecal origin (meaning specific to fecal sources). Fecal (as emphasized in the F diagram) contamination is used as a proxy (or indicator) of the presence of potential disease causing matter (human or general animal fecal matter). Hence, E. coli is indicator of interest for tracking diseases attributed to the fecal-oral route. The number of wells in the trays allows for enumeration (meaning counting) of contamination levels.
