Date of Award

9-2011

Document type

Thesis

Degree Name

PhD (Doctor of Philosophy)

First Supervisor

Dr. Kevin McGuigan

Funder/Sponsor

Funded under the European Commission Sixth Framework Programme

Keywords

Water, Drinking, Disinfection, Outcome Assessment (Health Care), Africa

Abstract

The European Union (EU) under the Specific Programme, Integrating and Strengthening the European Research Area, Call Title: Specific Targeted Projects for African, Caribbean, Pacific Partner Countries, Call Identifier: FP6-2004-INCO-DEV-3, funded the project titled: Solar Disinfection of Drinking Water in Developing Countries or in Emergency Situation (SODISWATER), grant agreement number 013650. The project started in October 2006 and ended in March 2010.

The aim of SODISWATER was to demonstrate that Solar Disinfection (SODIS) of drinking water is an appropriate, effective and acceptable intervention against waterborne disease for vulnerable communities in developing countries without reliable access to safe water.

The scientific objectives for the overall project were to initialise in depth research in each of the following topics:

1. Health impact assessment studies in three African countries.

2. Microbiological studies to determine the response of the most important

untested waterborne pathogens to solar disinfection.

3. Enhancement techniques designed to improve the efficiency of inactivation (e.g. continuous flow systems, compound parabolic reactors).

4. Socio-psychological studies concerned with successful diffusions and behavioural change strategies for sustainable adoption of solar disinfection.

This thesis describes the rationale, methods and findings of the first scientific objective "Health impact assessments in three African countries." The author was responsible for the overall coordination of the three African studies based on the protocol of the health impact assessments she developed during the proposal development phase. The health impact assessments were undertaken in South Africa by the Council for Scientific and Industrial Research (CSIR), and two non-governmental organisations (NGOs), the Institute for Water and Sanitation Development (IWSD) in Zimbabwe and the International Community for the Relief of Starvation and Suffering (ICROSS) in Kenya.

The study design of the health impact assessments were undertaken by amultidisciplinary research team consisting of a software developer, a statistician and the author who is a trained microbiologist Standardisation of the procedures for the multi-country health impact assessments was made possible by the development of two manuals: 1) SODISWATER Field Manual (Appendix A) and 2) Diarrhoea1 Diaries Data Entry Manual (Appendix 6). The author provided the basis appropriate for inclusion of all relevant aspects for the development of the manuals and contributed to the design and contents of these manuals. The development of the manuals was undertaken in collaboration with a software developer who was also responsible for the development of the database and accompanying software used for managing and verifying the captured data. The software developer also assisted with programming the handheld computers that were used for capturing field data.

Field workers and field coordinators from South Africa as well as the field coordinators from Kenya and Zimbabwe attended a five day course developed and presented by the author. The course content was based on the procedures described in the manuals. To familiarise the attendees with the use of the electronic equipment, anthropometry equipment, water analysis method and interpretation of the results, practical sessions were conducted at the CSIR. The attendees were trained in the use of handheld computers, downloading information onto the database, use of the dedicated project computers and how to correct mistakes in the data when possible. A small pilot study, undertaken in the study area, provided the opportunity to apply the knowledge gained under real field conditions. The attendees were encouraged to use the manuals as guidance during execution of all procedures necessary to conduct the health impact assessments in the respective countries. Ethical issues were highlighted and advice given on how to approach and address potential study participants respectfully.

The author was responsible for the initial questionnaire development. These were refined in collaboration with the project teams from Kenya and Zimbabwe. The author also acquired the equipment and consumables for the respective studies.

The author personally co-ordinated the South African trial and was closely involved in all the activities, including overseeing the field workers, data collection, data capturing, data correction and initial analysis. The study teams and study areas in Kenya and Zimbabwe were visited in person by the author when specific problems had to be resolved. General problems experienced by field co-ordinators in Kenya and Zimbabwe were resolved by using electronic mail and the telephone.

Basic statistical analyses were performed by the author. However the bulk of the subgroup analyses were performed by a fully trained statistician. The author endeavoured to understand the basis of sub-analyses and the interpretation thereof.

The author compiled the entire thesis.

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Comments

A thesis submitted to the Royal College of Surgeons in Ireland for the degree of Doctor of Philosophy from the National University of Ireland in 2011.