Access to Household Water Quality Information Leads to Safer Water: A Cluster Randomized Controlled Trial in india

Household-specific feedback on the microbiological safety of drinking water may result in changes to water management practices that reduce exposure risks. We conducted a randomized, controlled trial in India to determine if information on household drinking water quality could change behavior and improve microbiological quality as indicated by <i>Escherichia coli</i> counts. We randomly assigned 589 participating households to one of three arms: (1) a <i>messaging-only arm</i> receiving messaging on safe water management (<i>n</i> = 237); (2) a <i>standard testing arm</i> receiving the same messaging plus laboratory <i>E. coli</i> testing results specific to that household’s drinking water (<i>n</i> = 173); and (3) a <i>test kit arm</i> receiving messaging plus low-cost <i>E. coli</i> tests that could be used at the household’s discretion (<i>n</i> = 179). Self-reported water treatment increased significantly in both the <i>standard testing arm</i> and the <i>test kit arm</i> between baseline and follow-up one month later. Mean log₁₀ <i>E. coli</i> counts per 100 mL in household stored drinking water increased in the <i>messaging-only arm</i> from 1.42 to 1.87, while decreasing in the standard testing arm (1.38 to 0.89, 65% relative reduction) and the test kit arm (1.08 to 0.65, 76% relative reduction). Findings indicate that household-specific water quality information can improve both behaviors and drinking water quality