1. Appropriate Water Purification Technology and Sanitation Promotion in Rural Communities: The Dominican Republic Dr. Pedro Bernal Chemistry Department, Rollins College, Winter Park, FL

2. The Magnitude of the Water Problem Worldwide 3.4 million people, mostly children, die annually from water-related diseases Approximately 4 billion cases of diarrhea each year cause 2.2 million deaths 2.4 billion people lack access to basic sanitation services Sanitation coverage in rural areas is less than half that in urban areas WHO 2000

3. The Magnitude of the Water Problem Global morbidity and mortality rates of some water-related diseases. Adopted from WHO 1995 - 2000

4. The Magnitude of the Water Problem

5. The Dominican Situation There are approximately 300,000 reported cases of diarrhea each year Diarrheal diseases account for approximately 30.4% of all diagnosed deaths from communicable diseases Acute diarrhea is the leading cause of diagnosed mortality among children aged 1 to 4 PAHO 1994

6. The Nature of the Water Problem Several factors influence water-related disease transmission Water quality Water quantity/availability Personal and environmental hygiene and sanitation

7. Why Both Quality and Quantity are Important Diarrhea is the most important public health problem affected by water and sanitation and can be both waterborne and water- washed. -- WHO 2000

8. Routes of Disease Transmission Excreta WaterHandsFlies Food Mouth Courtesy of WHO: Principal elements of fecal-oral disease transmission

9. Impact of Water Quality Adopted from WHO 1995 Potential reductions in morbidity of different water-related diseases as a result of improvements in water supply and sanitation

10. Our Approach to the Problem Distribution of a technologically simple family-based water filter Hygiene and sanitation promotion Chemical and microbiological testing of sources and filtered water Assessment of the health impact of the filter program An attack on water quality...

11. The System: A Description 3-bucket system designed to eliminate the bacteria responsible for water- related disease Chlorination Sediment removal Chlorine removal

12. Filter Distribution Currently ~ 3000 units distributed throughout 40 communities

14. Sabaneta de Yasica Summer 2002, West Jacksonville Rotary Club ~ 240 units Rincon La Piña Islabon

16. Haitian/Dominican Border Summer 2002, Ecological Unit of the Dominican Army

18. Hygiene Promotion ILAC network of health promoters Brochures and pictorial publications

19. What Do We Measure? The WHO Drinking-Water Guidelines Chemical parameters Turbidity < 5 NTU Residual Chlorine 0.2 - 0.5 ppm pH 6.5 - 8.5 Microbiological parameters E. coli 0 cfu * /100 mL * colony forming units

20. Chemical Testing Water from the filters and sources is analyzed for: Turbidity Residual chlorine pH

21. Red colonies = Total coliforms Blue colonies = E. coli Microbiological Testing Determine the number of colony forming units per 100 mL of water (cfu/100 mL) Total coliforms: ubiquitous in tropical environments Fecal coliforms (E. coli): indicative of fecal contamination Incubation in m-ColiBlue24 for 24 hours

22. Results of Chemical and Microbiological Testing Village of El Venú, Dominican Republic, Summer 2001 and 2002 Sources 2 local rivers Rainwater Filters

23. Chemical Parameters - Sources Thiele & Bray 2001 - 2002 Rivers Stored Rainwater Ranges

24. Chemical Parameters - Filters Thiele & Bray, 2001 - 2002 60 filters were tested Total of 75 tests -- 12 filters were revisited

25. Why Are These Parameters Important to the Filters? High turbidity provides a more adequate environment for microorganisms. At a pH of around 6 the chlorine is almost 100% effective. As the pH increases the effectiveness of the chlorine decreases. (pH 9 ~ 5% efficacy) Residual chlorine helps to maintain the disinfection.

26. Results of Microbiological Testing: Sources Thiele & Bray 2001 - 2002 Stored Rainwater Rivers

27. How Bad Can Bad Water Be? High Risk>50D Intermediate Risk11-50C Little Risk1-10B No Risk0A HEALTH RISK Fecal Coliforms/100mL CATEGORY Courtesy of WHO How Many Colonies are Dangerous? Under conditions of widespread fecal contamination, … surveillance agencies are recommended to set intermediate goals that … will not lead to improper condemnation of relatively acceptable supplies. -- WHO 2000 WHO Guidelines:

28. Results of Microbiological Testing: Are the Filters Reducing the Risk? Thiele & Bray 2001-2002 Bacterial content of crude river water Bacterial content of river water after filtration 60 filters were tested Total of 75 tests -- 12 filters were revisited

29. Are the Filters Reducing the Risk? 58%28% 9% 5% 0 cfu/100 mL No risk 1-10 cfu/100mL Little risk 11-50 cfu/100mL Intermediate Risk >50 cfu/100mL High Risk Thiele & Bray, 2001-2002

30. Conclusions The water problem is complex, but the appropriate interventions can make a difference The vast majority or filters (~90%) are producing water that presents little or no risk to the consumer The reduction of water related diseases requires an improved water supply and an effective hygiene promotion program

31. Future Work Distribution of filter systems in cooperation with interested organizations Further development of the sanitation and hygiene education promotion Continued assessment of filter performance Continued student involvement in all aspects of the project

32. Acknowledgements Rollins College Associated Colleges of the South (ACS) Operation Blessing International Eagle Springs Filtration Port Orange Ministerial Association Institute of Latin American Concern (ILAC) West Jacksonville Rotary Unidad Ecológica del Ejército Nacional de la República Dominicana