Monitoring and evaluation of a ceramic water filter and hand-washing intervention in Northern Ghana

Abstract

Through a Rotary Club contract, PHW will sell Kosim filters and install Tippy-Tap hand-washing stations in 1250 households in Northern Ghana. This thesis presents the following project monitoring and evaluation components: (1) three-part evaluation framework; (2) baseline results; and (3) recommendations for an objective measure of Kosim filter use. The evaluation framework consists of a baseline survey, one-month follow-up survey, and six-month follow-up survey, and includes a staggered cross-sectional study that compares health outcome between purchasers and non-purchasers, and between purchasers from exposure households and purchasers from control households. January 2012 baseline surveys collected information on household characteristics, water source, household water management, hand-washing practices, diarrheal disease prevalence, and respiratory disease prevalence. In total 429 households were sampled from 20 villages, and the results from 10 villages are reported in this thesis. Overall, 98.6% of the survey population uses surface water as a primary dry season drinking water source, and 79.9% uses unprotected water sources in the wet season. An estimated 52.6% of households use cloth filters to treat their drinking water at home. Only 5.0% of households practice hand-washing with soap, yet 99.2% of households have soap present in the home. The prevalence rate for diarrhea was 23% (95% CI 17% to 29%) for children under the age of five and 9% (95% CI 5% to 13%) for the general population. For cough and difficulty breathing, prevalence rates were 25% (95% CI 19% to 31%) for children under the age of five and 13% (95% CI 8% to 17%) for the general population. Regarding an objective measure of Kosim filter use, the Camelbak@ Flow MeterTM accurately measures flow of at least 0.8 L/min, and is therefore sufficient to measure most flow rates through the spigot of the Kosim filter. PHW should choose one of three options obtain an objective measure of Kosim filter use: (1) adapt and develop a method to retrieve data from the Camelbak@ Flow MeterTM; (2) adopt the SWEETSenseTM monitoring and data retrieval system, or (3) develop a method to measure and retrieve data on total time that the spigot is in the "open" position.