Factors associated with compliance among users of solar water disinfection in rural Bolivia

Andri Christen, Gonzalo Duran Pacheco, Jan Hattendorf, Benjamin F Arnold, Myriam Cevallos, Stefan Indergand, John M Colford, Daniel Mäusezahl, Andri Christen, Gonzalo Duran Pacheco, Jan Hattendorf, Benjamin F Arnold, Myriam Cevallos, Stefan Indergand, John M Colford, Daniel Mäusezahl

Abstract

Background: Diarrhoea is the second leading cause of childhood mortality, with an estimated 1.3 million deaths per year. Promotion of Solar Water Disinfection (SODIS) has been suggested as a strategy for reducing the global burden of diarrhoea by improving the microbiological quality of drinking water. Despite increasing support for the large-scale dissemination of SODIS, there are few reports describing the effectiveness of its implementation. It is, therefore, important to identify and understand the mechanisms that lead to adoption and regular use of SODIS.

Methods: We investigated the behaviours associated with SODIS adoption among households assigned to receive SODIS promotion during a cluster-randomized trial in rural Bolivia. Distinct groups of SODIS-users were identified on the basis of six compliance indicators using principal components and cluster analysis. The probability of adopting SODIS as a function of campaign exposure and household characteristics was evaluated using ordinal logistic regression models.

Results: Standardised, community-level SODIS-implementation in a rural Bolivian setting was associated with a median SODIS use of 32% (IQR: 17-50). Households that were more likely to use SODIS were those that participated more frequently in SODIS promotional events (OR=1.07, 95%CI: 1.01-1.13), included women (OR=1.18, 95%CI: 1.07-1.30), owned latrines (OR=3.38, 95%CI: 1.07-10.70), and had severely wasted children living in the home (OR=2.17, 95%CI: 1.34-3.49).

Conclusions: Most of the observed household characteristics showed limited potential to predict compliance with a comprehensive, year-long SODIS-promotion campaign; this finding reflects the complexity of behaviour change in the context of household water treatment. However, our findings also suggest that the motivation to adopt new water treatment habits and to acquire new knowledge about drinking water treatment is associated with prior engagements in sanitary hygiene and with the experience of contemporary family health concerns.Household-level factors like the ownership of a latrine, a large proportion of females and the presence of a malnourished child living in a home are easily assessable indicators that SODIS-programme managers could use to identify early adopters in SODIS promotion campaigns.

Trial registration: ClinicalTrials.gov: NCT00731497.

Figures

Figure 1
Figure 1
Cluster analysis dendogram. Horizontal axis denotes the linkage distance (R-square distance) between households according to their SODIS-use indicators listed in Table 1
Figure 2
Figure 2
Box-plots of four SODIS-user groups differing in six SODIS-use indicators (see Table 1)
Figure 3
Figure 3
Weekly observed proportion of households using SODIS in four SODIS-user groups. Open triangles: self-reported SODIS-use at the beginning (after 3 month of initial SODIS promotion) and at the end of follow-up; filled dots: SODIS-use observed by project staff living in the community (see table 1 for definition); open grey circles: SODIS bottles observed on the roof; open black circles: SODIS bottles observed ready to drink

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