Adoption of the SAWYER Water Filter in Peru

In Peru, lack of water, sanitation, and hygiene (WASH) results in 6,600 deaths per year that represents approximately 3.9% of total deaths. Three thousand and nine hundred of these deaths were due to diarrheal diseases (Prüss-Üstün et al., 2008). Systematic reviews suggest that interventions to improve microbial quality of drinking water are successful in reducing diarrheal diseases (Fewtrell et al., 2005; Clasen et al., 2007; Fry et al., 2013). Interventions for household water treatment and safe storage to ensure safe drinking water reduce diarrhea by 31-52% (WHO/UNICEF, 2013). The SAWYER PointONE filter, a portable and adaptable membrane filtration device as small as the hand, is one point-of-use (POU) technology option for populations that rely on unsafe water from an improved source, or for areas that still rely on unimproved water sources for drinking and cooking. The filter functions strictly through mechanical exclusion accomplished by a hollow fiber membrane. The filters are certified for 0.1 μm as the largest pore size; therefore preventing diarrhea-causing bacteria such as E. coli, cholera, and typhoid to pass through the membrane. This research focuses on SAWYER water filter users who use a filter purchased through a sales agent in Independencia, Ica, Peru. Fifteen households in 9 communities and a total of 39 individuals were surveyed with the overall goal of better understanding the adoption of the SAWYER water filter as a POU water treatment technology in relation to three themes of: 1) household socio-economic factors 2) water, sanitation and hygiene (WASH) related characteristic and behaviors of users, and 3) Health Belief Model factors. The results showed SAWYER water filter users to have higher socio-economic status on average. All households had a high Progress out of Poverty Index® (PPI®) score. The heads of households, both male and female, were found to be more educated than the national average. Female heads of house were more educated than the male heads of house. There was a significant difference in the education levels of the female heads of house as compared to the national levels (p =0.006), with the female heads of house in the study having superior university degrees at three times the national percentage. The heads of house were also married at a higher percentage than the national average. SAWYER water filter users also have greater access to media than the regional average. All homes were equipped with at least one TV with cable. Results showed a significant difference in households having a computer within the home as compared to the regional percentage (p \u3c 0 .001) and also in having Internet in the home as compared to the regional percentage (p \u3c 0.001). Most houses (13/15) have running water all the time and all have a sink, shower, and toilet. Indoor connection and sewage type were not found to be statistically different from national average. Most people (67%) reported to always use soap and several participants mentioned liquid handwashing soap. Users reported handwashing after going to the bathroom (64.1%) more than before eating (38.5%) or cooking (46%). The Health Belief Model survey revealed that SAWYER water filter users perceive diarrhea as more severe for children, even though they do consider themselves susceptible. Clear benefits of adopting the filter include saving money, improving water quality, and saving time, but the barriers to filter adoption were unclear. Most users had contact with another person who demonstrated or recommended the filter prior to adopting the filter, highlighting the importance of interpersonal contact for promoting filter use. Turbidity during rainy season was also found to be an important cue to action