JMIR Publications

ABSTRACT

Background:

Handpumps are used by millions of people as their main source of water. While only being a basic form of water provision efforts to improve the performance of these systems continue as these pumps are likely to remain in use for many years to come. One of the drivers behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease.

Objective:

To assess whether improvements in operational performance from the data-driven professional maintenance of rural handpumps operating in southern Kenya lead to improved household health outcomes.

Methods:

From a sample of households that used handpumps as their primary water source in Kwale County in 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 handpumps were professionally and relatively rapidly repaired. We then conducted a cross-sectional analysis adjusting for household socio-economic characteristics, dwelling construction and WASH-related factors.

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 remains robust under multiple logistic regression models. No reduction was seen in households whose pumps had longer downtimes. Analysis of interaction terms showed that socio-economic and other factors combined non-linearly to reduce reported diarrhoea.

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.