“I treat my water according to my pocket”
Schlanger, Karen Lee
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Diarrheal illness due to consumption of contaminated drinking water is a leading cause of morbidity for children under 5 years of age in developing countries. Programs promoting water treatment and storage at the point-of-use (e.g. at the household level) have demonstrated reductions in diarrheal disease by 29-44%. However, within the context of specific point-of-use interventions, little is known about how and why water treatment-related behavior change occurs among some targeted individuals and not others. In March 2010, eight health centers in rural Malawi began offering a safe water intervention to women receiving antenatal services. The intervention included education, free distribution of a covered water storage container with a tap, and a bottle of WaterGuard, a sodium hypochlorite solution used to disinfect water. In May 2011, we conducted 90 interviews and 11 focus groups with program participants, friends and relatives of participants, husbands of participants, health workers, and vendors of WaterGuard, to explore beliefs, attitudes, experiences and conditions which influence water treatment practices, and how safe water messages and behaviors diffuse across a community. The study revealed that many current and non-current users of WaterGuard reported similar attitudes, beliefs and even practices related to water treatment, although access to cash and perceptions about the value of WaterGuard and source water contamination at different times of the year appear to be strong influences on use over time. Our findings also suggest that while participation in the intervention was a key motivator for participants to use WaterGuard, on-going interpersonal communication and social reinforcements from family, neighbors, and health workers also appear critical for adoption and on-going use among both participants and their friends and relatives. We also found financial support from husbands necessary for women to sustain their use of WaterGuard. We did not find the chlorine scent and taste of WaterGuard to be as much of a barrier to use as has been reported in other studies of chlorine-based water treatment products. Our findings suggest that educational messages regarding the importance of treating drinking water throughout the year and the value of WaterGuard in relation costs for treating diarrhea should be emphasized.