Papers by Regula Meierhofer
BMC Public Health
Background The COVID-19 pandemic drew hygiene to the center of disease prevention. The provision ... more Background The COVID-19 pandemic drew hygiene to the center of disease prevention. The provision of adequate water, sanitation, and hygiene (WASH) services is crucial to protect public health during a pandemic. Yet, access to levels of water supply that support adequate hygiene measures are deficient in many areas in Nepal. We examined WASH practices and their impact on child health and nutritional status in two districts before and during the COVID-19 pandemic. Methods A longitudinal and mixed method study was conducted in March–May 2018 and November–December 2021. In total, 715 children aged 0–10 years were surveyed at baseline. Of these, 490 children were assessed at endline. Data collection methods included observations, a questionnaire, stool analysis, anthropometric measurements, water quality analysis, and an assessment of clinical signs of nutritional deficiencies. We conducted 10 in-depth interviews to understand major problems related to COVID-19. Results Most respondents ...
International Journal of Environmental Research and Public Health
Many women in low-income countries carry heavy loads of drinking water for their families in diff... more Many women in low-income countries carry heavy loads of drinking water for their families in difficult terrain. This can adversely affect their health and well-being. The present study is the first to investigate the physical burden of water carrying and women’s psychosocial well-being, and how this relationship is moderated by environmental and health conditions. Trained local interviewers conducted interviews with 1001 women across five rural communities in Nepal. In addition, objective measurement was used to assess the weight carried and distance from the water source. The physical burden of water carrying was calculated from weight, distance, and frequency of trips. Its association with psychosocial well-being was modeled using generalized estimating equations. Two additional models included the terrain and uterine prolapse as moderators. The physical burden of water carrying is directly related to higher emotional distress and reduced daily functioning. This correlation was ex...
PLOS ONE
More than a third of women in Nepal have to carry water from source to home to satisfy their fami... more More than a third of women in Nepal have to carry water from source to home to satisfy their families’ daily needs. A cross-sectional study was carried out in a hilly area in Nepal to assess water-carrying practices and their association with women’s health. Quantitative interviews were conducted with 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water carrying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive physical stress due to water carrying during the dry season. Women suffered from a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk category of water ...
Additional file 6: Table E. Child health, health seeking behaviour and awareness on health protec... more Additional file 6: Table E. Child health, health seeking behaviour and awareness on health protecting behaviours.
Additional file 4: Table C. Nutrition provided to children between 6 months and 10 years.
Additional file 5: Table D. Water supply, water handling and water quality.
Additional file 3: Table B. Detailed information on Children's nutritional status in the four... more Additional file 3: Table B. Detailed information on Children's nutritional status in the four study sites.
Additional file 1. Questionnaire for the caretakers.
Publication details, including instructions for authors and subscription information:
Waterlines, 2021
Recontamination during transport and storage is a common challenge of water supply in low-income ... more Recontamination during transport and storage is a common challenge of water supply in low-income settings, especially if water is collected manually. Chlorination is a strategy to reduce recontamination. We assessed seven low-cost, non-electrically powered chlorination devices in gravity-driven membrane filtration (GDM) kiosks in eastern Uganda: one floater, two in-line dosers, three end-line dosers (tap-attached), and one manual dispenser. The evaluation criteria were dosing consistency, user-friendliness, ease of maintenance, local supply chain, and cost. Achieving an adequate chlorine dosage (∼2 mg/L at the tap and ≥ 0.2 mg/L after 24 h of storage in a container) was challenging. The T-chlorinator was the most promising option for GDM kiosks: it achieved correct dosage (CD, 1.5–2.5 mg/L) with a probability of 90 per cent, was easy to use and maintain, economical, and can be made from locally available materials. The other in-line option, the chlorine-dosing bucket (40 per cent CD...
The study was conducted in the catchment area of two Gravity Driven Membrane Filtration (GDM) wat... more The study was conducted in the catchment area of two Gravity Driven Membrane Filtration (GDM) water kiosks in Uganda. It assessed if the cleaning and disinfection of jerrycans with chlorine can reduce risks for regrowth and recontamination of treated water during storage in undisturbed containers, as well as at the household level. In addition, the impact of water handling, household hygiene and safe storage determinants on water quality was evaluated. Results indicate that the cleanliness of the water storage container has a critical impact on water quality changes during storage. Safe drinking water at the point of consumption after 24 hours of storage at the household level can be achieved with a combination of ultrafiltration and subsequent chlorination.
Introduction In rural Nepal, 88 % of households have access to an “improved” drinking water sourc... more Introduction In rural Nepal, 88 % of households have access to an “improved” drinking water source [1]. Yet many of these water points cannot guarantee microbiologically safe drinking water. Water quality data is limited due to difficulties with systematic collection in remote communities, leaving program managers without the information needed to plan treatment strategies. A research team from Sandec’s Water Supply and Treatment and Safe Water Promotion Groups partnered with Helvetas Swiss Intercooperation in Nepal to assess household drinking water quality, behavioural factors determining water handling practices, and market conditions for treatment products using fieldrobust data collection techniques.
This paper presents results of the field evaluation of three gravity driven membrane (GDM) water ... more This paper presents results of the field evaluation of three gravity driven membrane (GDM) water kiosks purifying Victoria lake water in schools in Uganda. The study evaluated the technical performance of the systems and the feasibility of the operation and maintenance concepts over two years of operation, as well as the financial viability of the business model and management concept and overall system sustainability. The results show that GDM water kiosks are a simple technology capable of treating turbid surface water and can autonomously supply good quality water to schools and communities. They require little maintenance, are simple to operate and maintain, and with trained local O&M team support, they offer sustainability of operation in remote low-income areas. The business and management model evaluation has not yet been completed and is ongoing.
Introduction Four project sites were chosen in Kenya and in Bolivia for ceramic filter marketing ... more Introduction Four project sites were chosen in Kenya and in Bolivia for ceramic filter marketing trials. 300 households at each site received trainings through household visits and community training events, and surveys were done at baseline and after 11 months. Household information was collected with quantitative questionnaires, while qualitative information and sales records were gathered from sales staff.
Applied Psychology: Health and Well-Being, 2021
Daily carrying of heavy loads of domestic water, especially during pregnancy and postpartum, bear... more Daily carrying of heavy loads of domestic water, especially during pregnancy and postpartum, bears a threat to maternal health in low-income countries. Using an extended health action process approach (HAPA), we examined women's reasons for and psychosocial determinants of safe water-carrying during pregnancy and postpartum. In a mixed-methods study, trained local interviewers conducted 1001 quantitative interviews with women of reproductive age (n = 921 analyzed) and 21 qualitative interviews with women of reproductive age, in-laws, and spouses in rural Nepal. We analyzed the quantitative data with generalized estimating equations to model the HAPA-based psychosocial determinants of avoiding water-carrying during pregnancy and postpartum. Subjective perspectives were investigated with thematic analysis. Outcome expectancies (B = 0.24), self-efficacy (B = 0.20), and injunctive norms (B = 0.23) were significantly associated with the intention to avoid water-carrying. Self-efficacy (B = 0.36) and instrumental support (B = 0.05) are related to behavior (all p < 0.05). Women explained water-carrying during pregnancy by a lack of family support, a shift of health decision-making power to in-laws, and low behavioral
The Gravity-driven Membrane (GDM) technology reveals a high implementation potential for efficien... more The Gravity-driven Membrane (GDM) technology reveals a high implementation potential for efficient, robust, durable, low cost, and virtually maintenance-free household water filters. A project was recently launched in Kenya to establish filter efficiency in the field and develop a market-based approach for their sustainable use. Maryna Peter-Varbanets, Rick Johnston, Regula Meierhofer, Wouter Pronk
Assessments of WASH promotion programmes showed that it is difficult to produce sustainable habit... more Assessments of WASH promotion programmes showed that it is difficult to produce sustainable habit changes at community level. Teaching of children and transferring the message from school to the community is a promising approach to increase impact and sustainability. The Fundacion SODIS implemented projects promoting household water treatment, with a special focus on solar water disinfection, and improved hygiene in more than 1,000 schools in Latin America, training more than 8'000 teachers and 170'000 Students. The experiences made during these projects showed that children do assimilate new behaviour faster and better than adults and that they can function as triggers for behaviour change and consolidation of new habits in the community. The most important factor to support assimilation was the ritual combination of elements to a complex behaviour pattern. Implementation of SODIS in small, rural schools was very successful, while promotion in big urban schools encountered ...
Marketing trials for ceramic filters and other HWTS products were carried out in Kenya over 16 mo... more Marketing trials for ceramic filters and other HWTS products were carried out in Kenya over 16 months. Community education trainings and sales models were set up at four different sites with local entrepreneurs, Community Health Workers of the Public Health system, Community-based Organizations and staff of NGOs. Selling filters through the water utility, a community-based enterprise, was the most successful retail model, followed by sales done by Community Health Workers. Evidence showed that community-based organizations need to be equipped with adequate management and marketing skills to successfully sell products. Community education through household visits (independent of the stakeholder carrying out the activity) was an effective marketing strategy. Emotional attributes, social norms, if people think it is important to treat the water and education level had the highest influence on the frequency of household water treatment in households.
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Papers by Regula Meierhofer