1. How
to sustain use for the long term
Past experience
has shown that high rates of SWS use are achievable in the short term
or during disease outbreaks. However, we do not know yet how well use
of the SWS will be maintained over the long term. Through the CARE/CDC
Health Initiative (CCHI), we are currently studying the impact of community
mobilization and social marketing on adoption of the SWS, and we will
monitor continued use.
2.
How to ensure economic sustainability
Maintaining
long-term use of the SWS requires sufficient resources to continue project
activities such as social marketing, promotion, and product distribution.
Full cost recovery is desirable, but if the prices of products are too
high, target populations may not have access to them. If full cost recovery
is not possible, donor support will be necessary for continuation of
SWS projects. CDC is currently monitoring the economic progress of ongoing
projects.
3.
Impact on health of immunocompromised hosts
Immunocompromised
individuals often have higher rates of diarrhea, and diarrhea from different
causes, than the general population. CDC, in collaboration with the
Uganda Virus Research Institute,
is currently evaluating the effectiveness of the SWS in preventing diarrhea
among HIV-infected persons and their family members.
4.
Optimal mix of SWS with other appropriate technologies (e.g., settling,
filtering, flocculating)
While the
SWS is effective in improving the quality of water from a variety of
sources, there are times when additional strategies are needed to augment
the effectiveness of point-of-use treatment and safe storage. For example,
some communities have very turbid water that must be filtered or allowed
to settle before chlorination. CDC, in collaboration with public and
private sector partners, is evaluating other promising point-of-use
technologies that could be used in combination with chlorination.
5.
Optimal behavior change methods
One of
the greatest challenges for SWS projects is encouraging people to modify
their behavior to use the SWS on a regular basis. CDC, CARE, and the
Medical University of South Carolina are implementing and evaluating
promising behavior change methodologies such as motivational interviewing
and community mobilization.
6.
Effectiveness
in making stored water safe for infant formula
HIV-infected
mothers in the developing world are increasingly choosing to feed their
infants with formula instead of breast milk to reduce the risk of HIV
transmission from mother to infant through breast milk. However, many
water sources in developing countries are fecally contaminated (Dunne, et al, 2001). As a
result, formula made with unsafe water may cause serious diarrheal illness
in children receiving it. In Abidjan, Côte d'Ivoire, CDC completed a study investigating the quality of stored water used for infant feeding and formula, and was planning an evaluation of
the effectiveness of the SWS in helping mothers give their children
microbiologically safe infant formula. The study was postponed due to political instability.
If
you have experience with any of these or related issues, we would like
to hear about it. Please email us at safewater@cdc.gov.
What
we know about the SWS
