An educational intervention to study the awareness of solar disinfection of drinking water among residents of an urban slum of a city in Central India

A total of 884 million people-25% of whom live in sub-Saharan Africa-still use unimproved sources for drinking water.[1] At the current rate of progress, the world is expected to exceed the Millennium Development Goal (MDG) target of halving the proportion of the population without sustainable access to safe drinking water. Even so, 672 million people will still lack access to improved drinking water sources in 2015.[2]


INTRODUCTION
A total of 884 million people-25% of whom live in sub-Saharan Africa-still use unimproved sources for drinking water. [1]At the current rate of progress, the world is expected to exceed the Millennium Development Goal (MDG) target of halving the proportion of the population without sustainable access to safe drinking water.Even so, 672 million people will still lack access to improved drinking water sources in 2015. [2]usehold water treatment and safe storage (HWTS) interventions are proven to improve water quality and reduce diarrheal disease incidence in developing countries.Four of these proven HWTS options-chlorination, solar disinfection (SODIS), ceramic fi ltration, and fl occulation/disinfection-are widely implemented in developing countries.Organizations wanting to develop HWTS programs are often faced with the diffi cult decision of selecting which option or options are appropriate for their particular circumstances.The most appropriate HWTS option for a location depends on existing water and sanitation conditions, water quality, cultural acceptability, implementation feasibility, availability of HWTS technologies, and other local conditions. [3]DIS is a simple, environmentally sustainable, low-cost solution for drinking water treatment at household level for people consuming microbiologically contaminated raw water.SODIS uses solar energy to destroy pathogenic microorganisms causing water borne diseases and therewith it improves the quality of drinking water.Pathogenic microorganisms are vulnerable to two effects of the sunlight: radiation in the spectrum of ultraviolet (UV)-A light (wavelength 320-400 nm) and heat (increased water temperature).A synergy of these two effects occurs, as their combined effect is much greater than the sum of the single effects.This means that the mortality of the microorganisms increases when they are exposed to both temperature and UV-A light at the same time.SODIS is ideal to disinfect small Solar disinfection (SODIS) is a simple, environmentally sustainable, low-cost solution for drinking water treatment at household level.It uses solar energy to destroy pathogenic microorganisms causing water borne diseases.Contaminated water is fi lled into transparent plastic bottles and exposed to full sunlight for 6 h.During the exposure to the sun, the pathogens are destroyed.Objective: To study the awareness of SODIS of drinking water among residents of an urban slum.Materials and Methods: A crosssectional study imparting educational intervention to spread the awareness of SODIS of drinking water among residents of an urban slum.Result: A total of 50% increase in awareness regarding concept of SODIS; 66% increase in awareness regarding method of SODIS.The study was carried out with sample size of 100 which was not suffi cient to corroborate the fi ndings on a larger picture, needs more sample size to be incorporated which unfortunately was not contemplated owing to time constraint.International  quantities of water of low turbidity.Contaminated water is fi lled into transparent plastic bottles and exposed to full sunlight for 6 h.During the exposure to the sun, pathogens are destroyed.If cloudiness is greater than 50%, the plastic bottles need to be exposed for 2 consecutive days in order to produce water safe for consumption.However, if water temperatures exceed 50°C, 1 h of exposure is suffi cient to obtain safe drinking water.The treatment effi ciency can be improved if the plastic bottles are exposed on sunlight refl ecting surfaces such as aluminium-or corrugated iron sheets. [4]DIS was developed in the 1980s to inexpensively disinfect water used for oral rehydration solutions used to treat diarrhea.In 1991, the Swiss Federal Institute for Environmental Science and Technology (SANDEC, EAWAG) began to investigate and implement SODIS as a HWTS option, to prevent diarrhea in developing countries.Users of SODIS fi ll 0.3-2.0liter plastic soda bottles with low-turbidity water, shake them to oxygenate, and place the bottles over the roof or rack for 6 h (if sunny) or 2 days (if cloudy).The combined effects of UV-induced deoxyribonucleic acid alteration, thermal inactivation, and photooxidative destruction inactivate disease-causing organisms.In the laboratory, SODIS has been proved to inactivate the viruses, bacteria, and protozoa that cause diarrheal diseases.Field data have also shown reductions of bacteria in developing country waters treated with SODIS.In four randomized, controlled trials, SODIS has resulted in reductions in diarrheal disease incidence ranging from 9% to 86%. [5]The present study was undertaken with aim to study the awareness of SODIS of drinking water among residents of an urban slum of a city in central India and to improve their knowledge with the help of an educational intervention, also to cite recommendations based in the present study.

Study area
Urban slum of Indore district

Study subjects
100 inhabitants each of 100 selected households in this urban slum (household-A group of persons who normally live together and took food from a common kitchen-National Sample Survey Offi ce (NSSO) 1999).

Sampling technique
Simple random sampling using lottery method

Ethical clearance
Written informed consent was obtained from each study subject

Study Tool
i.A predesigned pretested semistructured questionnaire ii.Pamphlets, posters, and AV aids along with lecture method for educational intervention

Inclusion criteria
Inhabitants of selected households of identifi ed urban slum who gave consent.

Exclusion criteria
Inhabitants of selected households of identifi ed urban slum who did not give consent.

Study process
The study was conducted in 100 inhabitants each of 100 selected households in this urban slum of Indore district of Madhya Pradesh.The semistructured questionnaire, included the biographical data of the inhabitants that is age, address, education, occupation, and type of family was used for demographical data collection.

Analysis
The data were analyzed using appropriate statistical software (SPSS).
McNemar's test and Pearson's chi-square test were used wherever required.

RESULT
Present study was carried out in 100 household of urban slum of Indore, Among the participants most were of age group 35-45 years (56%).A total of 58% participants were females and 42% were males.A total of 33% participants were graduates and 31% were higher secondary pass.And 20% participants were illiterate.55% respondents belong to joint family and 45% to nuclear family.34% were skilled workers, 22% unskilled workers, and 14% were shop owners/clerical (based on modifi ed Kuppuswamy classifi cation).
Table 1 suggests that 75% households were using water from municipal tap.15% were using tube well/well and 10% were dependent on water tankers.80% were of the opinion that they get suffi cient drinking water from principal sources throughout year [Table 2].
As far as method used for fi ltration of drinking water was concerned [Table 3 A total of 60% respondents were unaware of the concept of SODIS.After educational session, 90% were aware (50% increase in awareness, ² = 14.359,P = 0.000, statistically signifi cant) [Table 8].
A total of 90% study subjects did not know about method of SODIS.Educational intervention increase the awareness by 66% (² = 24.502;P = 0.000, statistically signifi cant) [Table 9].
Both pre-and postintervention, respondents were well aware regarding the spread of water borne disease due to contaminated water (nonpurifi cation of water) [Table 10].

DISCUSSION
As per the knowledge of authors, there is no study so far in India of this type to assess the awareness of SODIS and to incorporate knowledge among respondents of techniques and feasibility of SODIS.Since both World Health Organization and Centre of Disease Control Atlanta (CDC) have reckoned SODIS as technically simplest and most practical and economical solar treatment system of water.As per CDC Atlanta document, in Assam University provided technical and training support for a SODIS promotion project with a local nongovernmental organization. [5] per NSSO report 70% of urban households use tap in our study, 75% households were using municipal tap.The NSSO report on drinking water sanitation and hygiene in India claims that 85% urban households get suffi cient drinking water from their principal source.
In our study, 80% had the same response.The NSSO report claims that 35% urban households fi lter the drinking water and 11% boil it, whereas in the present study 62% urban households fi lter the       cap on annual LPG cylinder quota makes boiling a very expensive option for boiling.On the contrary, SODIS is a cheap, cost-effective, and economical method. [6]eld tests show that transparent positron emission tomography (PET) bottles of 2 L volume are very appropriate containers for SODIS.Coloured bottles do not transmit enough UV radiation; these bottles should not be used for SODIS. [4]Authors also feel that this will lead to a proper and judicious usage of PET plastic bottles.
The EAWAG consortium has clearly mentioned that awareness alone is not enough.But there are defi nite advantages of SODIS.The benefi ts of SODIS are as follows: Proven reduction of viruses, bacteria, and protozoa in water; Proven reduction of diarrheal disease incidence in users; Acceptability to users because of the simplicity of use; No cost to the user after obtaining the plastic bottles; Minimal change in taste of the water; and, Although SODIS does not have a chemical residual, recontamination is unlikely because water is served directly from the small, narrow-necked bottles with caps in which it is treated. [3] the same time, there are certain disadvantages of SODIS.The major drawbacks of SODIS are as follows: The need for pretreatment (fi ltration or fl occulation) of waters of higher turbidity; User acceptability concerns because of the limited volume of water that can be treated at once and the length of time required to treat water; and, The large supply of intact, clean, suitable plastic bottles required. [3]DIS is most appropriate in areas where there is availability of bottles and community motivation and training for users on how to correctly and consistently use SODIS for treating household drinking water.[3] Over 2 million people in 28 developing countries use SODIS for daily drinking water treatment.Over 2 million people in 28 developing countries use SODIS for daily drinking water treatment.[3] A controlled fi eld trial has been successfully carried out regarding SODIS of drinking water and diarrhoea in Maasai children.[7] Scientifi c evidence clearly opines that SODIS of water reduces diarrhoeal disease.[8][9][10][11] Conroy et al., [12] are of the opinion that SODIS of drinking water protects against cholera in children under 6 years of age.
The study was carried out with sample size of 100 which was not suffi cient to corroborate the fi ndings on a larger picture, needs more sample size to be incorporated which unfortunately was not contemplated owing to time constraint.Considering the potential of SODIS which the authors found they recommend to fi nd the utility of SODIS on a scientifi c basis and in Indian context so that this cost-effective method can be utilized on a larger scale for the betterment of society.
Journal of Medicine and Public Health | Jan-Mar 2014 | Vol 4 | Issue 1

Figure 1 :
Figure 1: Methods used for fi ltration of drinking water

Table 1 : Source of the drinking water
commonly due to lack of awareness.96%respondentsstorewater in home utensils [Table4].These storage utensils are washed daily in 73% cases, alternate days in 20% cases, alternate days in 20% cases, and weekly in 7% cases [Table5].
*Water tankers both private and municipal corporation International Journal of Medicine and Public Health | Jan-Mar 2014 | Vol 4 | Issue 1

Table 4 : Storage of drinking water in home utensils
*96% respondents store drinking water in home utensils

Table 6 : Awareness of household water treatment and safe storage
drinking water with cloth, 8% boil it, and 9% use chemicals (alum, chlorine, and KMnO 4 ).In the present study, all the respondents who boil the water use LPG cylinder hike of LPG cylinder prices & the International Journal of Medicine and Public Health | Jan-Mar 2014 | Vol 4 | Issue 1