JMIR Publications

ABSTRACT

Background:

Handpumps are used by millions of people as their main source of water. While they are only a basic form of water provision efforts to improve the performance of these systems continue as they are likely to remain in use for many years to come. The introduction of a professional maintenance service in southern Kenya has shown an order of magnitude improvement in operational performance over community-based management, with 90% of handpump faults repaired within three days of being reported. One driver behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease. It is not clear if operational improvements lead to health gains; there is limited empirical evidence, and some modelling studies suggest that even short periods of drinking contaminated drinking water can lead to disproportionate negative health impacts.

Objective:

The aim of this study is to assess whether the improvements in operational performance from the rapid professional maintenance of rural handpumps lead to improved household health outcomes.

Methods:

From a sample of households using handpumps as their primary water source in Kwale County, Kenya, we measured two-week period prevalence of WHO-defined diarrhoea in children, reported by the adult respondent for each household. We compared the rates before and after a period during which the households’ handpumps were being professionally maintained. We then conducted a cross-sectional analysis, fitting logistic regression models with reported diarrhoea as the dependent variable and speed of repair as the independent exposure of interest, adjusting for household socio-economic characteristics, dwelling construction and WAter, Sanitation, and Hygiene- (WASH-)related factors. We fitted an additional model to examine select interactions between covariates.

Results:

Reported diarrhoea in children was lower in households whose pumps had been repaired within 24 hours (AOR 0.35, 95% CI 0.24 to 0.51). This effect was robust to the inclusion of multiple categories of covariates. No reduction was seen in households whose pumps where repairs took more than 24 hours. Analysis of interaction terms showed that certain interventions associated with improved WASH outcomes were only associated with reductions in diarrhoea in conjunction with socio-economic improvements.

Conclusions:

Only pump repairs consistently made within 24 hrs of failure led to a reduction in diarrhoea in the children of families using handpumps. While the efficacy of reduction in diarrhoea is substantial, the operational challenges of guaranteeing same-day repairs limits the effectiveness of even best-in-class pump maintenance. Maintenance regimes that cannot bring handpump downtimes close to zero will struggle to generate health benefits. Other factors that reduce diarrhoea prevalence have limited effect in isolation, suggesting that WASH interventions will be more effective when undertaken as part of more holistic poverty-reduction efforts.