In the poorest, least industrialized nations, diarrheal diseases caused by contaminated food and water remain a leading cause of death in childhood. Many of these deaths could be prevented by simple sanitation measures.

With assistance from ministries of health, funding from USAID and Rotary International, and special expertise from nongovernmental organizations and the private sector, CDC has developed a sustainable way to improve the safety of household drinking water. The components of CDC's safe water system, as implemented in pilot projects in Zambia, include

• Water disinfection. Population Services International (PSI) has marketed a locally produced disinfectant solution for water treatment (CLORIN) to communities in the southern, eastern, and western regions of Zambia. A CDC case-control study documented a 65% reduction of risk of cholera in Zambian households that use CLORIN.

• Safe storage of water. CDC, the Procter and Gamble Company, and Rotary International have contributed to the design of a narrow-mouthed vessel for safe storage of water. The mold for the new vessel was shipped to South Africa in January 2000, where vessels have been produced for use in Zambia, Madagascar, Kenya, Côte d’Ivoire, and Pakistan.

• Social marketing. PSI has trained public health workers in Lusaka, Kitwe, and Ndola, Zambia, on how to involve their communities in the safe-water effort.

USAID has increased funding for the safe water project in Zambia to permit nationwide coverage within the next few years, and the CARE/CDC Health Initiative is funding similar projects in western Kenya and in Antananarivo, Madagascar. Each CARE/CDC Health Initiative project will target a population of 200,000 people and combine the methods of the Zambian project with the community organizing techniques of CARE.

In the future, the elements of the Safe Water System may also be used to promote:

• Safe preparation of foods and beverages by street vendors

• Safe preparation of medications, such as oral rehydration solutions to treat cholera

• Safe preparation of formula for use by HIV-infected women who choose not to breast-feed their infants

• Handwashing and improvements in hygiene

• The addition of nutritional supplements to drinking water

A safe water storage vessel employed by participants in an ongoing Safe Water System implementation project in Homa Bay, Kenya, initiated in October 2000 in collaboration with CARE Kenya. The vessel was designed to eliminate a major source of diarrheal disease contamination that results when hands, cups, ladles, or other objects are dipped into open buckets to remove water for drinking. Because the local population in Homa Bay preferred to use vessels made of clay rather than plastic, CDC and CARE Kenya incorporated a narrow mouth, lid, and spigot into traditional clay pots to ensure safe water storage. The use of plastic vessels with similar characteristics, in combination with water disinfectants, has reduced diarrheal diseases by 30–50% in communities in Zambia, Pakistan, and Bolivia. 14 Photographer: Bobbie Person, Office of Health Communication, National Center for Infectious Diseases, CDC