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National Institute of Environmental Health Sciences

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Treatment and Refill Kiosks Provide Communities with Cleaner Drinking Water

By: Megan Avakian

Water Filtration Systemin Indonesia

A water filtration system in Indonesia
(Photo courtesy of Laura Sima)

A new study by a team at Yale University has shown that consumption of water from community-scale water treatment and refill kiosks decreased the risk of diarrhea in an urban slum in Jakarta, Indonesia. Diarrhea is the second leading cause of death among young children. “People assume that you need very low-tech and cheap solutions for low-income people, but we saw a reduction in diarrhea rates for people living in very low-income areas in Southeast Asia that were using these novel technologies,” says lead author Laura Sima, Ph.D. “This solution is about one-fourth the price of bottled water in Jakarta and is showing similar reductions in diarrhea risk for the population of children we monitored.”

Most people living in developing countries do not have access to safe piped drinking water and cannot afford expensive bottled water. Purchasing water from community-scale water treatment and refill kiosks may provide a safe, affordable alternative to more expensive water sources. These decentralized water sources use novel membrane technologies to filter water, which is then decontaminated using either an ultraviolet disinfection or reverse osmosis purification process.  

Sima and colleagues monitored water source and diarrhea rate for 1,000 children ages 1 to 4 years in Jakarta, every day for five months. They found diarrhea incidence in an urban slum varied significantly by water source and was more than two fold higher for children consuming tap water compared to children consuming bottled water or refill kiosk water as their primary water source. The study, supported in part by NIEHS, was an interdisciplinary effort between the Department of Chemical and Environmental Engineering and the School of Public Health at Yale University, and is among the first to examine the impact of community-level water treatment and refill kiosks on health outcomes.

These findings may have promising implications for developing countries because current interventions to reduce diarrhea rates have not seen considerable success. Even when water is initially treated with a residual disinfectant, recontamination is a major concern. People living in developing countries commonly transport and store drinking water in open receptacles and use their hands or a ladle to scoop the water, practices that can re-introduce bacteria into water after disinfection. Other potential interventions, such as household-treatment of water with chlorine, have had very low adoption rates in Southeast Asia due to a cultural aversion to the smell and taste of chlorine.

“Community-scale water treatment and refill kiosks use membrane and purification technologies to remove and inactivate pathogens without leaving any taste of a residual chemical,” says Sima, who posits that the use of capped bottles at refill stations reduces recontamination because people transport and pour water from a clean, closed container rather than using a potentially contaminated tool to scoop the water.

As a postdoctoral fellow with the Environmental Health Sciences Department at Johns Hopkins University, Sima is now studying how switching water sources affects diarrhea risk. Because of widespread financial instability in low-income countries people cannot always purchase clean water, and they commonly switch water sources. “When working with low-income people you have to be aware that their financial stream may not be consistent and they might have different water purchasing habits throughout the month. We are trying to understand the correlation between how people are switching water and their diarrhea risk,” says Sima.