household water treatment: contribution to the...

©©Medentech 2007Medentech 2007

AQUATABS®

Household Water Treatment: Contribution to the Millennium

Development Goals

Aquatabs


AquatabsPresentation

• Brief introduction to Medentech• Household Water Treatment

and relationship to the MDG’s for Safe Water

• Criteria for Household Water Treatment Products

• The Aquatabs experience


AquatabsAquatabs/Medentech

• Irish Company: Founded in 1984

• Pharmaceutical manufacturer – Certificate of Good Manufacturing Practice (GMP)

• ISO9001:2000• Registered UN supplier - UNGM #103143• Supplied Aquatabs for emergency relief

since mid-1980’s• This year 1 Billion Aquatabs will be used

around the world.


Aquatabs

U.N. Millennium Development

Goals• MDG Goal No 7: to reduce by half the

proportion of people without sustainable access to safe drinking water and basic sanitation by 2015 (UN World Summit 2002)

• 1.1 billion people do not have access to drinking water from improved sources (18% of world’s population)

• Up to an estimated 4 billion diarrhoeal episodes occur per year (1.2b associated with water), with up to 3.5 million deaths

• Every day diarrhoeal diseases kill 5000 young children

(Water for Life, WHO/Unicef, 2005. Household Drinking Water Systems and Their Impact on People with Weakened Immunity, MSF, 2005)


Aquatabs

Improved Drinking Water?

• Gundry et al study:South Africa and ZimbabweRandomized study – 254 children, aged 1-2 yearsDry and wet seasons

> 10 CFU/100ml E.coli

Improved(standpipe, borehole, protected

well)

Unimproved(unprotected well/spring,

river/canal)

At Source 12% 71%

Household Storage 41% 81%

Drinking Cup 51% 82%


Aquatabs

Achieving the MDG for Water

• To reach the MDG for drinking water requires 1.1billion people to gain access in the next decade:

300,000 people every day84% are in rural areasCoverage is lowest amongst the

most poor

Meeting the MDG Drinking Water and Sanitation Target: The Urban and Rural Challenge of the Decade. WHO/UNICEF, 2006

Cruzinho


Aquatabs

Prevention is Better than Cure

• The burden of unsafe water negatively effects:

the healthcare system – at any one time half the world’s hospital beds are occupied by people with water-borne disease1

the income generation of households, community and, therefore, the nation as a wholethe education capacity – children not attending schoolthe absorption of nutrients, especially in young children, reduced resistance to infection and, potentially, long-term gut disorders 2 – contributes to malnutritionpreventable mortality and morbidity

• Household water treatment can pay back US$60 forevery US$1 invested 3

(1. Water for Life Decade. UN Factsheet.2. T. Clasen et al. Interventions to improve water quality for preventing diarrhoea: review, 2006; 3. Water for Life. WHO/Unicef, 2005)


Aquatabs

Criteria for HWTS Products

• Safety and consistent quality• Biocidal effectiveness• Health-Impact/Water Quality• Acceptable by indigenous peoples• Affordable by low-income earners• Availability, Sustained use and

Scale-up


AquatabsAquatabs®

• Aquatabs are effervescent (self-dissolving) chlorine tablets

• Aquatabs kill micro-organisms in water to prevent diarrhoeal diseases such as cholera, typhoid, dysentery and other water-borne diseases

• They are used at household level for point- of-use disinfection of drinking water

2006: 80 million tablets – 1.4 billion litres water treated2007: 140 million tablets – 2.3 billion litres water treated

• They are used for emergency relief2006: 200 million tablets – 1 billion litres water treated2007: 400 million tablets – 2.4 billion litres water treated


Aquatabs

Aquatabs®

Composition• Biocide: sodium troclesene (organic

chlorine donor)Also known as sodium dichloro-s-triazine trione (NaDCC)

• Effervescent Base: Pharmaceutical and food gradeingredients


Aquatabs

Aquatabs®

Conformance• Effervescent NaDCC tablets are specified

for drinking water treatment by:WHO (The Interagency Health Kit 2006)UNDP/IAPSO (UNCCS Code 356461)International Red Cross and Red Crescent Movement (Code: DASDCHLA0005T to 5000T)Unicef (Codes: S1588350/158355/0003245)Médècins Sans Frontièrs (Codes: DDISNADC1T, CWATYCHN5T and DDISZBD0001)World Vision, Action Medeor, International Dispensary Association and many more NGO’s and Defence Forces


Aquatabs

Aquatabs®

Safety and Quality Control

•• Manufacture to pharmaceutical standards of Manufacture to pharmaceutical standards of GMP GMP

•• ISO9001:2000 CertifiedISO9001:2000 Certified•• The only International NSF Certified tablet.The only International NSF Certified tablet.•• Stability data to ICH standardsStability data to ICH standards

•• NaDCC in conformance with NSF/ANSI NaDCC in conformance with NSF/ANSI Standard 60, EN standard EN12931:2000 and Standard 60, EN standard EN12931:2000 and (WHO/FAO) JECFA(WHO/FAO) JECFA11 specificationspecification

purity limitspurity limitsheavy metalsheavy metals

•• US EPA approved for routine drinking water US EPA approved for routine drinking water treatmenttreatment

1. Joint Expert Committee on Food Additives

Certified to NSF/ANSI

Standard 60


Aquatabs

Aquatabs®

Usage• The Aquatabs are simply added to the

water storage vessel• Wait 30 minutes before use• The tablets do not need crushing• No stirring or shaking is necessary• Aquatabs do not colour the water, or

leave objectionable smells or tastes• Residual chlorine level after 24 hours


Aquatabs

Aquatabs®

Biocidal Efficacy Field Parameters

•• Effectiveness in natural water Effectiveness in natural water sources:sources:

organic/faecal contamination (high NTU)organic/faecal contamination (high NTU)varied pHvaried pH

•• Critical water quality parameters:Critical water quality parameters:no faecal or total coliforms (100ml samples)no faecal or total coliforms (100ml samples)< 10 faecal coliforms/100ml for emergencies < 10 faecal coliforms/100ml for emergencies (WHO low risk)(WHO low risk)““free chlorinefree chlorine”” residual of about 0.5mg/l residual of about 0.5mg/l after 30 minutesafter 30 minutes


AquatabsField Evaluations

• Field trials have been independently undertaken in:

Bangladesh (AIT)Brazil (Min of Marine/ ABES)Dom. Rep (Dom. Inst of Industrial Technology)El Salvador (Central American University)France (Min of Defence)Honduras (Min of Health)India (Bayer)Kenya (Min of Water)Pakistan (Citilab)South Africa (Ngangane Lab)Spain (Pharmaceutical College) Swaziland (Min of Water) Tanzania (Min of Water)Vietnam (Inst Military Medicine)Zimbabwe (Pub Health Lab)

He needs water, so he finds it where he can

• On-going studies


AquatabsLaboratory Trials

• Independent laboratory trials have been undertaken in:

Argentina (Min of Health)Brazil (Adolfo Lutz Inst)India (Indian Inst. Technology) New Zealand (Cawthron)South Africa (Bur of Stds) UK (LSHTM)


Aquatabs

Trial Conclusions

•• Consistently produced a Consistently produced a ““free free residualresidual”” chlorine level, in a widechlorine level, in a wide range of water conditionsrange of water conditions

•• Consistently reduced total and Consistently reduced total and faecal coliform levels (and other faecal coliform levels (and other microorganisms) to zero or low microorganisms) to zero or low riskrisk

•• Including household studiesIncluding household studies


Aquatabs

Health Impact/ Water Quality

•• Brazil Brazil -- 12 month study in a village of 618 people in the Bangu 12 month study in a village of 618 people in the Bangu region, without safe water or adequate sanitation region, without safe water or adequate sanitation –– 44% 44% difference in levels of pathogens in stool samples between difference in levels of pathogens in stool samples between treated and control groupstreated and control groups

•• Bangladesh Bangladesh –– 4 week pilot study in a slum area of Dhaka, 50 4 week pilot study in a slum area of Dhaka, 50 householdshouseholds Prior to the trial 100% of children under 5 years Prior to the trial 100% of children under 5 years old (70 children) had severe diarrhoea. 65% of the children old (70 children) had severe diarrhoea. 65% of the children were reported as free from diarrhoea during the trialwere reported as free from diarrhoea during the trial

Study SupervisionDhaka, Bangladesh

•• Bangladesh Bangladesh –– 16 week blind trial, in a slum area 16 week blind trial, in a slum area of Dhaka, 100 householdsof Dhaka, 100 households

Period No Incidents

Intervention Control

Baseline 68 (12%)

1st 4 weeks 7 16

2nd 4 weeks 3 12

3rd 4 weeks 1 8

Final 4 weeks 2 6

Total 13 (5%) 42 (14%)


AquatabsAcceptability

•• Honduras Honduras -- 3 month study in the rural village of 3 month study in the rural village of Tierra Blanca with 200 people, without a safe Tierra Blanca with 200 people, without a safe water supply water supply (Christian Children(Christian Children’’s Fund of Honduras) s Fund of Honduras)

•• Brazil Brazil -- a 3 week study in a village near São Paulo, a 3 week study in a village near São Paulo, with 350 people (70% preference compared to with 350 people (70% preference compared to hypochlorite)hypochlorite)

•• Bangladesh Bangladesh –– 4 week study in a slum area of 4 week study in a slum area of Dhaka, (78% mothers satisfied)Dhaka, (78% mothers satisfied)

•• Bangladesh Bangladesh –– 16 week study in Geneva Camp: 16 week study in Geneva Camp: (86% acceptability rate)(86% acceptability rate)

•• Tanzania Tanzania –– Focus group study, in 3 municipalities, Focus group study, in 3 municipalities, each with 2 groups (70% preference compared to each with 2 groups (70% preference compared to hypochlorite) hypochlorite)

(Population Services International, Dar es Salaam) (Population Services International, Dar es Salaam)

WaterGuard/AquatabsTanzania

Happy with Aquatabs

Dhaka, Bangladesh


AquatabsAcceptability

• Key features:People comparatively liked

the taste. Ease of useAffordabilitySafe to store and handleLightweight and

transportable


AquatabsAffordability

• Consumer cost at a local shop (based on a “20 litre” tablet):

Approximately 500 IDR per 20 litre tablet about 3 US cents.

Maria Alves Costa, Cruzinho, Brazil


AquatabsBoiling

• Inconvenient and time consuming• Safety – fire hazard• Health hazard – smoke (400-700m women

with health problems)• Environmental pollution• Cost – 5 to 20 times the cost of Aquatabs• Efficacy –no residual effect; in studies 47-

67% of boiled water with E.coli

• Using Aquatabs is simpler, safer and cheaper than boiling water


AquatabsAvailability

• Aquatabs now introduced into:AlgeriaGhana KenyaSudanSwazilandTanzaniaUganda• Plans:Benin D.R. CongoEthiopiaMali NigerNigeria

ChinaBangladeshIndia Indonesia PakistanPhilippinesVietnam

HaitiVenezuela

Carrying Water Home

Dar es Salaam, Tanzania


AquatabsAquatabs®Dosage


Aquatabs


AquatabsConclusions

• Household chlorination reduces diarrhoea by almost 40%

• HWTS interventions contribute to the MDG’s• HWTS interventions are affordable and cost

effective• They can make an immediate impact• They are “need” driven and not “supply”

driven• Paradigm shift from “Cure” to “Prevention”• HWTS interventions need sustainable scale-up• HWTS interventions need greater advocacy

and adoption by Governments and NGO’s

• Aquatabs Makes water safe and keeps it safe.Water is Life


AquatabsAcknowledgements

• Dr. Thomas Clasen, London School of Hygiene and Tropical Medicine, London• Drs Robert Quick, Seema Jain & Daniele Lantagne, Centers for Disease Control, Atlanta• The International Network to Promote Household Water Treatment & Safe Storage, Geneva• Occidental Chemical Corporation, Dallas• Ministry of Land Reclamation, Regional & Water Development, Nairobi• Ministere de la Defense, Laboratoire Central, Paris• Ministério da Marinha, Hospital Central da Marinha, Rio de Janeiro• Institute of Military Medicine, Hanoi• Associação Brasileira de Engenharia e Ambiental/Associação Portuguesa dos Recursos Hídricos

Paraíba, Brazil• Universidad Centroamericana “José Simeón Cañas”, San Salvador• Bayer Environmental Science, India• Ministry of Water and Livestock, Dar es Salaam, Tanzania• South African Bureau of Standards, Pretoria, South Africa• Fundaçao Oswaldo Cruz, Fiocruz, Rio De Janeiro• Neelima Afroz Molla & Tanveer Ferdous Saeed, Asian Institute of Technology, Bangkok,

Thailand• Christian Children’s Fund of Honduras/Eyl S.A., Tegucigalpa, Honduras• Data Kirsten, São Paulo• Population Services International, Dar es Salaam, Tanzania


Aquatabs

Medentech Ltd.,Medentech Ltd.,Whitemill Industrial Estate,Whitemill Industrial Estate,

Clonard Road.,Clonard Road.,Co. Wexford,Co. Wexford,

IrelandIreland

Tel : + 353 53 9160040Tel : + 353 53 9160040

Fax : + 353 53 9141271Fax : + 353 53 9141271

EE--mail : [email protected] : [email protected]

Website : www.medentech.comWebsite : www.medentech.com

household water treatment: contribution to the...

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