1. Engineering in: Water and Sanitation in Developing Countries Daniele S. Lantagne, PE CDC / LSHTM

2. Career Path Raised in suburban WA State Boston:MIT ‘96, Env. Eng. Work:1996-2000 –Consulting (9 months), IRWA and teaching Masters:MIT ‘01 –Household water treatment Haiti, 1/2 courses at KSG 2001-2003:Consulting, teaching at MIT 2003-ongoing:CDC, Atlanta, Certification 2008-ongoing:PhD at LSHTM

3. Countries I’ve Worked In

4. Causes of Death for Children < 5 Years Acute respiratory infections 19% Neonatal causes 37% Others 10% Malaria 8% Diarrheal diseases 17% HIV/AIDS 3% Injuries 3% Measles 4%

5. What is safe water? Health workers –Water that does not cause morbidity or mortality in children < 5 Engineers –Water without bacterial contamination at exit of plant or pump Millennium Development Goals –Protected Sources –Goal: reduce in half those without access to “improved water” by 2015 Safe water is water that is safe to drink in the users’ cup.

7. Proven HWTS Options Ceramic Filtration SWS SODIS Biosand Filtration PuR

8. What makes HWT work? 1.Quality product 2.Distribution, marketing, profit 3.Behavior change communication 4.User adoption

9. 1. Quality (local) product

10. 2. Distribution, marketing, profit

11. 3. Behavior Change Communication

12. 4. Sustained adoption and monitoring

13. Technological Verification Cost Effective Implementation Consumer Demand Sustainability

14. Note: Other Options 1. Laboratory Testing 2. Field testing 3. Health Impact Analysis 4. Scalability

15. Counter-example A BCDE Influent Holding Tank Pump 1 1 micron bag filter Ozonator Ozone Contact Tank 3 micron Filter UV light Chlorine Flow Meter Chlorine Contact Tank Pump 2 0.2 Micron Filter Effluent

17. Opportunities for Research Each step of process –Focus on end goals: feasibility, impact Research in developing countries –Give something back –Not an excuse for poor quality control –Modified laboratory testing –Cross-major collaborations critical

18. Create trial Opportunity Ability Motivation Maintenance: Consistent purchaser Contemp- lation: User never purchased Action: Inconsistent purchaser Create aware- ness and trial Create repeat purchases Pre- contemp- lation: Non-user Knowledg e Social Support Ability to pay for bucket Social Norm s Availability / Transport costs Attitude s Outcome Expectations Quality of care Summary construct PSI “Bubbles” determinant Stage of change Behavior change objective KEY

20. Thank you. I am happy to take questions, and appreciate the opportunity to speak here. dlantagne@cdc.gov daniele.lantagne@lshtm.ac.uk