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• 1. [Article] Process Evaluation and Assessment of Use of a Large Scale Water Filter and Cookstove Program in Rwanda

  Background: In an effort to reduce the disease burden in rural Rwanda, decrease poverty associated with expenditures for fuel, and minimize the environmental impact on forests and greenhouse gases from ...

  Citation × Citation Citation Abstract Copy Title: Process Evaluation and Assessment of Use of a Large Scale Water Filter and Cookstove Program in Rwanda Author: Barstow, Christina K., Nagel, Corey, Clasen, Thomas, Thomas, Evan A. Year: 2016 Background: In an effort to reduce the disease burden in rural Rwanda, decrease poverty associated with expenditures for fuel, and minimize the environmental impact on forests and greenhouse gases from inefficient combustion of biomass, the Rwanda Ministry of Health (MOH) partnered with DelAgua Health (DelAgua), a private social enterprise, to distribute and promote the use of improved cookstoves and advanced water filters to the poorest quarter of households (Ubudehe 1 and 2) nationally, beginning in Western Province under a program branded Tubeho Neza (“Live Well”). The project is privately financed and earns revenue from carbon credits under the United Nations Clean Development Mechanism. Methods: During a 3-month period in late 2014, over 470,000 people living in over 101,000 households were provided free water filters and cookstoves. Following the distribution, community health workers visited nearly 98 % of households to perform household level education and training activities. Over 87 % of households were visited again within 6 months with a basic survey conducted. Detailed adoption surveys were conducted among a sample of households, 1000 in the first round, 187 in the second. Results: Approximately a year after distribution, reported water filter use was above 90 % (+/−4 % CI) and water present in filter was observed in over 76 % (+/−6 % CI) of households, while the reported primary stove was nearly 90 % (+/−4.4 % CI) and of households cooking at the time of the visit, over 83 % (+/−5.3 % CI) were on the improved stove. There was no observed association between household size and stove stacking behavior. Conclusions: This program suggests that free distribution is not a determinant of low adoption. It is plausible that continued engagement in households, enabled by Ministry of Health support and carbon financed revenue, contributed to high adoption rates. Overall, the program was able to demonstrate a privately financed, public health intervention can achieve high levels of initial adoption and usage of household level water filtration and improved cookstoves at a large scale. Title: Process Evaluation and Assessment of Use of a Large Scale Water Filter and Cookstove Program in Rwanda Author: Barstow, Christina K., Nagel, Corey, Clasen, Thomas, Thomas, Evan A. Year: 2016 Background: In an effort to reduce the disease burden in rural Rwanda, decrease poverty associated with expenditures for fuel, and minimize the environmental impact on forests and greenhouse gases from inefficient combustion of biomass, the Rwanda Ministry of Health (MOH) partnered with DelAgua Health (DelAgua), a private social enterprise, to distribute and promote the use of improved cookstoves and advanced water filters to the poorest quarter of households (Ubudehe 1 and 2) nationally, beginning in Western Province under a program branded Tubeho Neza (“Live Well”). The project is privately financed and earns revenue from carbon credits under the United Nations Clean Development Mechanism. Methods: During a 3-month period in late 2014, over 470,000 people living in over 101,000 households were provided free water filters and cookstoves. Following the distribution, community health workers visited nearly 98 % of households to perform household level education and training activities. Over 87 % of households were visited again within 6 months with a basic survey conducted. Detailed adoption surveys were conducted among a sample of households, 1000 in the first round, 187 in the second. Results: Approximately a year after distribution, reported water filter use was above 90 % (+/−4 % CI) and water present in filter was observed in over 76 % (+/−6 % CI) of households, while the reported primary stove was nearly 90 % (+/−4.4 % CI) and of households cooking at the time of the visit, over 83 % (+/−5.3 % CI) were on the improved stove. There was no observed association between household size and stove stacking behavior. Conclusions: This program suggests that free distribution is not a determinant of low adoption. It is plausible that continued engagement in households, enabled by Ministry of Health support and carbon financed revenue, contributed to high adoption rates. Overall, the program was able to demonstrate a privately financed, public health intervention can achieve high levels of initial adoption and usage of household level water filtration and improved cookstoves at a large scale. Close

• 2. [Article] Combining Sensor Monitoring and Ethnography to Evaluate Household Latrine Usage in Rural India

  This paper advances research on methods used to evaluate sanitation usage and behavior. The research used quantitative and qualitative methods to contribute to new understanding of sanitation practices ...

  Citation × Citation Citation Abstract Copy Title: Combining Sensor Monitoring and Ethnography to Evaluate Household Latrine Usage in Rural India Author: O'Reilly, Kathleen, Louis, Elizabeth, Thomas, Evan A., Sinha, Antara Year: 2015 This paper advances research on methods used to evaluate sanitation usage and behavior. The research used quantitative and qualitative methods to contribute to new understanding of sanitation practices and meanings in rural India. We estimated latrine usage behavior through ethnographic interviews and sensor monitoring, specifically the latest generation of infrared toilet sensors, Portland State University Passive Latrine Use Monitors (PLUMs). Two hundred and fifty-eight rural households in West Bengal (WB) and Himachal Pradesh, India, participated in the study by allowing PLUMs to be installed in their houses for a minimum of 6 days. Six hundred interviews were taken in these households, and in others, where sensors had not been installed. Ethnographic and observational methods were used to capture the different defecation habits and their meanings in the two study sites. Those data framed the analysis of the PLUM raw data for each location. PLUMs provided reliable, quantitative verification. Interviews elicited unique information and proved essential to understanding and maximizing the PLUM data set. The combined methodological approach produced key findings that latrines in rural WB were used only for defecation, and that low cost, pit latrines were being used sustainably in both study areas. Title: Combining Sensor Monitoring and Ethnography to Evaluate Household Latrine Usage in Rural India Author: O'Reilly, Kathleen, Louis, Elizabeth, Thomas, Evan A., Sinha, Antara Year: 2015 This paper advances research on methods used to evaluate sanitation usage and behavior. The research used quantitative and qualitative methods to contribute to new understanding of sanitation practices and meanings in rural India. We estimated latrine usage behavior through ethnographic interviews and sensor monitoring, specifically the latest generation of infrared toilet sensors, Portland State University Passive Latrine Use Monitors (PLUMs). Two hundred and fifty-eight rural households in West Bengal (WB) and Himachal Pradesh, India, participated in the study by allowing PLUMs to be installed in their houses for a minimum of 6 days. Six hundred interviews were taken in these households, and in others, where sensors had not been installed. Ethnographic and observational methods were used to capture the different defecation habits and their meanings in the two study sites. Those data framed the analysis of the PLUM raw data for each location. PLUMs provided reliable, quantitative verification. Interviews elicited unique information and proved essential to understanding and maximizing the PLUM data set. The combined methodological approach produced key findings that latrines in rural WB were used only for defecation, and that low cost, pit latrines were being used sustainably in both study areas. Close