A post-implementation evaluation of ceramic water filters distributed to tsunami-affected communities in Sri Lanka Lisa M. Casanova, Adam Walters, Ajith Naghawatte and Mark D. Sobsey ABSTRACT Sri Lanka was devastated by the 2004 Indian Ocean tsunami. During recovery, the Red Cross distributed approximately 12,000 free ceramic water filters. This cross-sectional study was an independent post-implementation assessment of 452 households that received filters, to determine the proportion still using filters, household characteristics associated with use, and quality of household drinking water. The proportion of continued users was high (76%). The most common household water sources were taps or shallow wells. The majority (82%) of users used filtered water for drinking only. Mean filter flow rate was 1.12 L/hr (0.80 L/hr for households with taps and 0.71 for those with wells). Water quality varied by source; households using tap water had source water of high microbial quality. Filters improved water quality, reducing Escherichia coli for households (largely well users) with high levels in their source water. Households were satisfied with filters and are potentially long-term users. To promote sustained use, recovery filter distribution efforts should try to identify households at greatest long-term risk, particularly those who have not moved to safer water sources during recovery. They should be joined with long-term commitment to building supply chains and local production capacity to ensure safe water access. Lisa M. Casanova (corresponding author) Institute of Public Health, Georgia State University, P.O. Box 3995, Atlanta GA 30302, USA E-mail: lcasanova@gsu.edu Adam Walters Watsan Specialist Medecins Sans Frontieres Ajith Naghawatte Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka Mark D. Sobsey Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina Chapel Hill, USA Key words | ceramic water filter, disaster, point-of-use, Sri Lanka, tsunami INTRODUCTION As point-of-use (POU) water treatment gains acceptance and uptake accelerates in populations needing access to safe water, there is an increasing need to examine the long-term sustainability of various POU options. While adoption may be high in the context of intensive intervention trials and implementation campaigns, rates of long-term use after initial implementation can vary greatly (Sobsey et al. ). There have been post-implementation studies examining long-term uptake and sustainability of POU technologies that were intro- duced in programs designed to support adoption and sustained use in people’s daily lives (Brown et al. ; Liang et al. ). However, POU use and adoption results may be different if distribution and implementation are part of disaster recovery efforts (Clasen et al. ). There is some research on the effectiveness of POU technologies for meeting the immediate need for safe water in the aftermath of disasters (Dunston et al. ; Mong et al. ; Doocy & Burnham ). However, there are gaps in our understanding of the long-term uptake and use of POU devices distributed as part of disaster recovery and rebuilding efforts. Once disaster- affected communities begin to rebuild, re-establishing access to safe water may be a long-term process, and households may be at continued or periodic risk from unsafe water as rebuilding proceeds and displaced persons relocate and reset- tle into permanent homes. In this context, there is a lack of information about whether such households continue to use POU devices received during relief and recovery efforts, and what factors affect continued and effective POU use. These issues were considered by relief and response agencies participating in the post-tsunami disaster relief in Sri Lanka over the past several years. Sri Lanka, an island nation, was one of the countries devastated by the Decem- ber 2004 Indian Ocean tsunami. One of the worst natural disasters in recorded history, the tsunami killed over 209 © IWA Publishing 2012 Journal of Water and Health | 10.2 | 2012 doi: 10.2166/wh.2012.181 Downloaded from https://iwaponline.com/jwh/article-pdf/10/2/209/395252/209.pdf by guest on 29 May 2020