Drinking water quality and the long handled mukombe cup : acceptability and effectiveness in a peri-urban settlement in Zimbabwe
Introduction: In-house contamination of drinking water stored in wide-mouthed buckets (even with lids) has been widely reported in epidemiologic investigations as vehicles for diarrhoea disease transmission. The long handled mukombe cup (LHM cup), recently developed by the National Institute of Health Research (NIHR), a department of the Ministry of Health and Child Care (MoHCC) in Zimbabwe, is a promising low cost dipping devise for extraction of water from wide-mouthed containers. Aim: The study aim was to assess the effectiveness and household acceptability of the long handled mukombe cup in reducing bacteriological contamination of drinking water stored in wide-mouthed vessels in the home in a peri urban settlement in Harare, Zimbabwe. Methodology: A randomised controlled trial of a long handled mukombe cup was conducted in Hatcliffe, Harare. After collecting baseline data on demographics, household water quality, and other sanitation and water handling practices, households were given basic health education before the two selected communities were randomly assigned to one of the two groups of 119 households each. The intervention group received the LHM cup while the control group received no intervention. Households were followed up after two months and assessed effectiveness and user acceptability of the intervention. Data Analysis: Data analysis was conducted using STATA 11. Descriptive statistics were calculated and reported as percentages, proportions, frequencies and measures of central tendency. Bivariate statistics were carried out to test independent associations between use of the LHM cup and E. coli. All analyses were conducted in an intention-to-intervene analysis. Results: A total of 230 households were analysed during follow-up. Samples of stored drinking water from intervention households were significantly lower in E. coli levels than those of control households (geometric mean E. coli of 0.8/100 ml vs 13.0/100 ml, p <0.0001). Overall, 78.4% (987/111) of samples from the intervention households met World Health Organization (WHO) guideline value of 0 cfu/100ml sample, while 52.1% of the 119 samples from control households met such a benchmark (p < 0.0001). In addition, 94.6% of intervention household samples were in compliance with this intervention or presented low risk, 27.7% of samples from control group households presented intermediate or high risk. There was a statistically significant association between LHM cup use and reduced E. coli bacterial contamination in stored drinking water (p < 0.05). There was no statistically significant difference in turbidity in both intervention and control groups, both for turbidity <5 and >5 (p = 0.071). Acceptability of the LHM cup was very high (100%). Conclusion: To our knowledge, this is the first study on the evaluation and acceptability of the LHM cup in the Sub-Saharan Africa. Positive results were recorded that showed that the LHM cup was effective in minimising E. coli contamination in the intervention group as compared to the control group. It is postulated that this is because the LHM cup reduces hand contact with stored water during scooping, thus maintaining improved water quality in communities in Zimbabwe that collect and store drinking water in wide-mouthed containers with lids where extraction is by scooping. However, more research is required to document the LHM cup's continued and effective use, durability and overall sustainability in the absence of any serious sampling or monitoring.