Access to safe drinking water is essential to reduce the risk of water-borne diarrhoeal diseases such as typhoid and cholera. These diseases are particularly dangerous in children under five-years old living in low-income settings and the second leading cause of death in this age group (source: WHO).
Water purification using chlorination is a simple, cost-effective solution to ensure safe water in emergency and development settings where water is scarce and there aren’t systems for mass water disinfection.
The safe, measured use of chlorine at either the source of water or the point of collection, disinfects the water by reducing the disease-causing pathogens. Studies have shown a decrease in diarrhoeal diseases in under-fives when disinfectant is used. (Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial. The Lancet Global Health, Volume 7, Issue 9, e1247 – e1256)
Access to safe water has also shown to protect people over five-years old from diarrhoeal disease, as well as reduce medical costs and the incidence of other diseases with a potential for lasting impact on children’s development.
Several approaches to water disinfection in rural areas where piped water systems are non-existent can be considered such as door to door disinfection (mostly useful in emergencies) or point of collection disinfection. For both, community engagement and information are essential to ensure high acceptance of the interventions and water safe from pathogens.
MENTOR’s emergency programme in Cabo Delgado Province, Mozambique include improvements to water access, sanitation, and hygiene to address the high rates of disease and suffering. During a cholera outbreak in 2024, we coordinated the distribution of chlorine and soap to health centres and communities to reduce the risk of water-borne diseases.
Around 109,000 bottles of chlorine were distributed door-to-door and to health units with cholera treatment centres at the start of rainy season. In total, 81,947 bottles of chlorine were distributed in the communities, improving the quality of water for around 385,150 people.
During a midline survey of the acceptance and use of chlorine, 59% of respondents had chlorine in their water and 53% had the recommended values (0.2mg/1 – 5mg/l). Compared to the baseline when only 8% of households had chlorine in their water, this shows a significant number of people were protected from diseases spread in unsafe water, only nine months after the intervention started.
Of the 304 people who stated they used chlorine to treat drinking water in the past week, 82% reported no cases of diarrhoea in the household that week, while only 18% reported cases of diarrhoea. Of those reporting diarrhoea cases, 43% had chlorine levels below 0,2mg in the FCR test results.
Strong community mobilisation activities were implemented to provide information about chlorination benefits for health and clarify any misinformation around water disinfection. The endline survey found 40% of people interviewed had chlorine in their water, a drop attributed to the costs of buying chlorine when it is not available for free. These results and learnings highlight that:
- community engagement is key to ensure high chlorination uptake, and
- in highly vulnerable settings, market solution approaches for water chlorination may not be viable as an immediate option if the aim is high rates of safe water.