Household-based chlorination was the most cost-effective where resources are limited; household filtration yields additional health gains at higher budget levels, researchers report from a cost-effectiveness analysis to compare non-piped in source - (dug well, borehole and communal stand post) and four types of household- (chlorination, filtration, solar disinfection, flocculation/disinfection) based interventions to improve the microbial quality of water for preventing diarrhoeal disease [1]. They used effectiveness data from a recent systematic review and cost data from programme implementers and World Health Organization (WHO) databases. Results are reported for two WHO epidemiological sub-regions, Afr-E (sub-Saharan African countries with very high adult and child mortality) and Sear-D (South East Asian countries with high adult and child mortality) at 50% intervention coverage. Measured against international benchmarks, source- and household-based interventions were generally cost effective or highly cost effective even before the estimated saving in health costs that would offset the cost of implementation.

Flocculation/disinfection was strongly dominated by all other interventions; solar disinfection was weakly dominated by chlorination. In addition to cost-effectiveness, choices among water quality interventions must be guided by local conditions, user preferences, potential for cost recovery from beneficiaries and other factors.

[1] Clasen, T. … [et al.] (2007). Cost-effectiveness of water quality interventions for preventing diarrhoeal disease in developing countries. Journal of water and health ; vol. 5, no. 4 ; p. 599-608. DOI: 10.2166/wh.2007.010

Contact: Thomas Clasen, London School of Hygiene & Tropical Medicine, UK, thomas.clasen@lshtm.ac.uk

Tags: water quality, water-related diseases