Date Published: April 04, 2019
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Andrea L. Martinsen, Erin Hulland, Raina Phillips, Jean Allain Darius, Erica Felker-Kantor, Dan Simpson, Mariana Stephens, Evan Thomas, Rob Quick, Thomas Handzel.
The PackH2O water backpack carrier was developed to provide safe storage and relieve stress of head-loading during water transport with traditional containers such as buckets and jerry cans. We conducted an evaluation to assess both self-reported and observed use over a 6-month period between November 2014 and May 2015. A total of 866 packs were distributed to 618 households in six communities in rural Haiti, and 431 and 441 households were surveyed at midline and end line, respectively. We performed linear regression to assess change of self-reported use over time. Although 79.3% of respondents reported continued use of the 20-L pack after 6 months, other measures of self-reported use were low, with only 16.8% reporting to have used the pack the last time they collected water and 10.3% preferring the pack over other water collection containers. In addition, only 10.2% of all people collecting water at community sources were observed using packs and 12.0% of all households surveyed had water in the pack at the time of visit. Pack use varied by community and demographics. Although women were targeted during distribution, men preferred the pack and were more commonly observed using it at the community water sources. In conclusion, the use of the PackH2O was not widely adopted in rural Haiti; however, further research is needed to assess the pack acceptance in areas where back-loading is more common and in emergency settings.
Water collection is both a physical and time burden when not available on household premises, and women and children have primary responsibility of collection in almost three quarters of global households.1–4 Global access to basic drinking water services, defined as improved sources requiring no more than 30 minutes to collect, increased from 81.1% in 2000 to 88.5% in 2015. Despite this progress, an estimated 263 million people still have only limited access and spend more than 30 minutes per round trip to collect drinking water from improved water sources. Furthermore, unimproved sources, such as surface water and unprotected springs, are often located farther from home than improved sources.5
Of the 618 registered households from six communities, 613 received a 20-L pack, 253 households received a 10-L pack in addition to the 20-L pack, and five households received only a 10-L pack. In three of the six communities, approximately 100% of the total estimated households were reached. In Achen and Anger, 40% and 72% of households received the packs, respectively. Finally, in Vielot, 25% of the total population received packs; however, only one geographic area was targeted. The number of surveys administered in each of the six communities was proportional to the number of PackH2Os distributed, with a roughly equal proportion of surveys to packs distributed in each community (Table 1). Surveys were administered predominately to female household members (87.0%), as they were the primary targeted recipients of PackH2Os.
We compared self-reported and objective measures of use to assess acceptability of the PackH2O in rural Haiti. Both measures indicated a decrease in the overall pack use over 6 months; however, 79.3% of respondents reported to still use the 20-L pack after 6 months. Self-reported measurements may be subject to courtesy, social desirability, and recall biases, and past studies have shown that respondents may exaggerate some hygiene behaviors compared with structured observations.14 When asked additional questions about use in this study, such as which container was used the last time for collecting water and preferred container to collect water, results aligned more closely with observed use. At end line, only 16.8% reported to have used the 20-L pack the last time they went to collect water and 10.3% preferred the 20-L pack to collect water (compared with roughly 8% of the people observed at the local water points carrying either a 20-L pack or a 10-L pack and 12% of households visited had water stored in a pack at the time of visit). This suggests that whereas households may exaggerate some behaviors when asked general questions around the use of water, sanitation and hygiene (WASH) services, additional probing during surveys may yield more accurate self-reported data.
The survey data are self-reported and those questions regarding the PackH2O are subject to self-reporting bias. Therefore, the actual usage for water transport and storage may be lower than the reported use. The water point observations provided additional evidence regarding the use and nonuse of the packs. However, these were only conducted at two time points, and we did not have any water point observations during the first 3 months when use may have been higher. Age of community members at the water point observations was estimated by the data collectors and not corroborated.
Although reported use was relatively high when asked about use of the pack in general, it was much lower and more aligned with observed use when more specific questions were asked, such as the last time water was collected and the preferred container. In conclusion, the PackH2O as an alternative water transport and storage device was not widely accepted or used to collect water in these study communities in rural Haiti. By many, it was considered too heavy, cumbersome, and difficult to carry, as the community is accustomed to carrying loads on the head.