Safe Water System (SWS) - Where Has the SWS Been Used?-
| Safe Water Home
Population Services International (PSI)
National CDC Foundation
Centre National de Recherches sur l'Environnement
Catholic Relief Services
Target Populations and
- The project began with a PSI-distributed product
for water treatment branded Sûr'Eau targeting
populations in the urban flood zone of Antananarivo
in CARE’s Programme MAHAVITA as well as populations
affected by cyclones and cholera epidemics. It has
grown to a national-scale program with national-level
PSI-distribution combined with local implementation
by CARE and Catholic Relief Services community motivators.
- Stage 1: In 2000, a pilot SWS implementation
project, funded by the CARE/CDC Health Initiative,
was incorporated into CARE’s existing Programme
MAHAVITA in communities within the urban flood zone
of Antananarivo. PSI developed a water disinfectant
solution that was given the brand name Sûr'Eau
and embarked on a social marketing campaign. CARE
utilized a community mobilization
approach to promote Sûr'Eau. In response to
cyclones on the east coast of the country and a
nation-wide cholera outbreak, the project was launched
four months early, and expanded more quickly than
- Stage 2: The Sûr'Eau social marketing campaign
has expanded to a national scale, with PSI concentrating
on wide distribution of Sûr'Eau in urban and
rural areas. CARE has continued with community mobilization
efforts, focusing on working with teams of community
based sales agents to sell a basket of health products
within their communities.
CARE has community health agent coverage in two
large geographical areas on the eastern coast of
Madagascar, and is actively working to expand this
program. This combined top-down and bottom-up approach
has led to both wide availability of Sûr'Eau,
and the mobilization necessary to encourage use
of the product. PSI and CARE, in cooperation with
CDC, recently changed the Sûr'Eau product
to a smaller bottle with more concentrated solution
to facilitate transport and adoption in rural and
remote areas. The new bottle has been well received
by rural populations in Madagascar.
- Sodium hypochlorite solution produced locally
by a private company. The brand name is Sûr’Eau.
- Community mobilization by CARE.
- Social marketing coordinated by PSI.
- Limited distribution and marketing of both the
CDC safe water storage vessel and a locally available
safe water storage vessel.
Results of Project Evaluations
- Results of Project MAHAVITA Evaluation (CDC):
Observed use of Sūr’Eau, as determined by
the presence of detectable free chlorine residual
in the stored water, was 11.2% of the total population
after six months. In neighborhoods that had undergone
the full community mobilization process, observed
Sûr'Eau use was 19.7, while neighborhoods
in early stages of the mobilization process had
utilization of 8.4%. Use of improved storage containers
increased from 2.9% to 12.2% during the first 6
months of the project. The free chlorine levels
did not appear to be higher in the jerry can than
in the bucket, and the cover on the bucket did not
seem to make a difference in the ability of the
treated water to maintain its free chlorine concentration.
- In response to the April 2000 landfall of Cyclone
Hudah in Madagascar, 11,700 relief kits (consisting
of a 5-gallon foldable jerry can, Sûr'Eau
disinfectant, and education messages) were distributed
to affected populations between April 13 and August
14, 2000. A follow-up survey to determine the impact
of this intervention was conducted in 12 villages
in September 2000. In unannounced visits, 43% of
households were using the jerry cans for drinking
water storage. Of the 43% of households using the
jerry cans from drinking water storage, 78% had
detectable total chlorine residual, and 45% had
detectable free residual chlorine. In microbiological
testing of drinking water stored in the home, jerry
cans had significantly lower E. coli colony
counts than buckets. This research
PDF 168KB was published in the American Journal
of Public Health.
- A case-control study to investigate risk factors
for cholera transmission was conducted in Fort-Dauphin,
Madagascar from February 11 to 20, 2001. Cholera
reached Fort-Dauphin in February of 2000, and Sûr'Eau
was introduced to the region in December 2000. Patients
were more likely than control subjects to have drunk
untreated water. Boiling water, treating water with
Sûr'Eau, drinking heated rice water, and drinking
from a tap were all protective against cholera.
In addition, using soap to wash hands was protective
against cholera. This study showed that untreated
water was the principal vehicle of endemic cholera
in Fort-Dauphin, and that the SWS and handwashing
initiatives can reduce the risk of this disease.
PDF 215KB was published in the American Journal
of Public Health.
- In addition to these two research studies, the
project partners also wrote a paper describing the
implementation process of the project. This paper
PDF 167KB was published in the American Journal
of Public Health.
- In 2002, CDC evaluated SWS project impact in coastal
eastern Madagascar. The implementation approach
in this area consisted of community mobilization
through entrepreneurial community-based sales agents
(CBSA). The evaluation was performed in five villages
during the rainy season. A standardized questionnaire
to assess water-handling practices and self-reported
SWS utilization was administered and chlorine residuals
were tested in stored water during surprise home
visits. We conducted 276 household interviews in
five villages. 90% reported having used the SWS
at least once and 60% reported current use. 43 to
75% of households who reported SWS use had detectable
chlorine residuals in stored water at the time of
surprise visits. The relative risk of diarrheal
illness among users vs. non-users, was 0.37 [p=
.065]. This evaluation in a remote, impoverished
population demonstrated high SWS adoption rates
and suggests that the CBSA can be a highly effective
behavior change agent. This data was presented at
the American Society of Tropical Medicine and Hygiene
meeting in December 2003. For more information,
please contact firstname.lastname@example.org.
For More Information
- CARE/Madagascar: email@example.com
Dunston C, McAfee D, Kaiser R, Rakotoarison
D, Rambeloson L, Hoang A, and Quick R. Collaboration,
Cholera, and Cyclones: Improving Point-of-Use
Water Quality in Madagascar. American Journal
of Public Health. October 1, 2001; 91 (10).
- Mong Y, Kaiser R, Ibrahim D, Rasoatiana, Razafimbololona
L, and Quick R. Impact
of the Safe Water System on Water Quality in
Cyclone-Affected Communities in Madagascar.
American Journal of Public Health. October 1,
2001; 91 (10).
- Reller M, Mong Y, Hoekstra M, and Quick R.
Cholera Prevention With Traditional
and Novel Water Treatment Methods: A Report
of an Outbreak Investigation in Fort-Dauphin,
Madagascar. American Journal of Public Health.
October 1, 2001; 91 (10).
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August 26, 2005
Content source: National Center for Infectious Diseases