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• 1. [Article] Behavioral Reactivity Associated With Electronic Monitoring of Environmental Health Interventions-A Cluster Randomized Trial with Water Filters and Cookstoves

  Subject reactivity—when research participants change their behavior in response to being observed—has been documented showing the effect of human observers. Electronics sensors are increasingly used to ...

  Citation × Citation Citation Abstract Copy Title: Behavioral Reactivity Associated With Electronic Monitoring of Environmental Health Interventions-A Cluster Randomized Trial with Water Filters and Cookstoves Author: Thomas, Evan A., Tellez-Sanchez, Sarita, Wick, Carson, Kirby, Miles Year: 2016 Subject reactivity—when research participants change their behavior in response to being observed—has been documented showing the effect of human observers. Electronics sensors are increasingly used to monitor environmental health interventions, but the effect of sensors on behavior has not been assessed. We conducted a cluster randomized controlled trial in Rwanda among 170 households (70 blinded to the presence of the sensor, 100 open) testing whether awareness of an electronic monitor would result in a difference in weekly use of household water filters and improved cookstoves over a four-week surveillance period. A 63% increase in number of uses of the water filter per week between the groups was observed in week 1, an average of 4.4 times in the open group and 2.83 times in the blind group, declining in week 4 to an insignificant 55% difference of 2.82 uses in the open, and 1.93 in the blind. There were no significant differences in the number of stove uses per week between the two groups. For both filters and stoves, use decreased in both groups over four-week installation periods. This study suggests behavioral monitoring should attempt to account for reactivity to awareness of electronic monitors that persists for weeks or more. Title: Behavioral Reactivity Associated With Electronic Monitoring of Environmental Health Interventions-A Cluster Randomized Trial with Water Filters and Cookstoves Author: Thomas, Evan A., Tellez-Sanchez, Sarita, Wick, Carson, Kirby, Miles Year: 2016 Subject reactivity—when research participants change their behavior in response to being observed—has been documented showing the effect of human observers. Electronics sensors are increasingly used to monitor environmental health interventions, but the effect of sensors on behavior has not been assessed. We conducted a cluster randomized controlled trial in Rwanda among 170 households (70 blinded to the presence of the sensor, 100 open) testing whether awareness of an electronic monitor would result in a difference in weekly use of household water filters and improved cookstoves over a four-week surveillance period. A 63% increase in number of uses of the water filter per week between the groups was observed in week 1, an average of 4.4 times in the open group and 2.83 times in the blind group, declining in week 4 to an insignificant 55% difference of 2.82 uses in the open, and 1.93 in the blind. There were no significant differences in the number of stove uses per week between the two groups. For both filters and stoves, use decreased in both groups over four-week installation periods. This study suggests behavioral monitoring should attempt to account for reactivity to awareness of electronic monitors that persists for weeks or more. Close

• 2. [Article] Assessing Latrine Use in Rural India: A Cross-Sectional Study Comparing Reported Use and Passive Latrine Use Monitors

  Although large-scale programs, like India's Total Sanitation Campaign (TSC), have improved latrine coverage in rural settings, evidence suggests that actual use is suboptimal. However, the reliability ...

  Citation × Citation Citation Abstract Copy Title: Assessing Latrine Use in Rural India: A Cross-Sectional Study Comparing Reported Use and Passive Latrine Use Monitors Author: Sinha, Antara, Nagel, Corey L., Thomas, Evan A., Schmidt, Wolf P., Torondel, Belen, Boisson, Sophie, Clasen, Thomas Year: 2016 Although large-scale programs, like India's Total Sanitation Campaign (TSC), have improved latrine coverage in rural settings, evidence suggests that actual use is suboptimal. However, the reliability of methods to assess latrine use is uncertain. We assessed the reliability of reported use, the standard method, by comparing survey-based responses against passive latrine use monitors (PLUMs) through a cross-sectional study among 292 households in 25 villages in rural Odisha, India, which recently received individual household latrines under the TSC. PLUMs were installed for 2 weeks and householders responded to surveys about their latrine use behavior. Reported use was compared with PLUM results using Bland–Altman (BA) plots and concordance statistics. Reported use was higher than corresponding PLUM-recorded events across the range of comparisons. The mean reported “usual” daily events per household (7.09, 95% confidence interval [CI] = 6.51, 7.68) was nearly twice that of the PLUM-recorded daily average (3.62, 95% CI = 3.29, 3.94). There was poor agreement between “usual” daily latrine use and the average daily PLUM-recorded events (ρc = 0.331, 95% CI = 0.242, 0.427). Moderate agreement (ρc = 0.598, 95% CI = 0.497, 0.683) was obtained when comparing daily reported use during the previous 48 hours with the average daily PLUM count. Reported latrine use, though already suggesting suboptimal adoption, likely exaggerates the actual level of uptake of latrines constructed under the program. Where reliance on self-reports is used, survey questions should focus on the 48 hours prior to the date of the survey rather than asking about “usual” latrine use behavior. Title: Assessing Latrine Use in Rural India: A Cross-Sectional Study Comparing Reported Use and Passive Latrine Use Monitors Author: Sinha, Antara, Nagel, Corey L., Thomas, Evan A., Schmidt, Wolf P., Torondel, Belen, Boisson, Sophie, Clasen, Thomas Year: 2016 Although large-scale programs, like India's Total Sanitation Campaign (TSC), have improved latrine coverage in rural settings, evidence suggests that actual use is suboptimal. However, the reliability of methods to assess latrine use is uncertain. We assessed the reliability of reported use, the standard method, by comparing survey-based responses against passive latrine use monitors (PLUMs) through a cross-sectional study among 292 households in 25 villages in rural Odisha, India, which recently received individual household latrines under the TSC. PLUMs were installed for 2 weeks and householders responded to surveys about their latrine use behavior. Reported use was compared with PLUM results using Bland–Altman (BA) plots and concordance statistics. Reported use was higher than corresponding PLUM-recorded events across the range of comparisons. The mean reported “usual” daily events per household (7.09, 95% confidence interval [CI] = 6.51, 7.68) was nearly twice that of the PLUM-recorded daily average (3.62, 95% CI = 3.29, 3.94). There was poor agreement between “usual” daily latrine use and the average daily PLUM-recorded events (ρc = 0.331, 95% CI = 0.242, 0.427). Moderate agreement (ρc = 0.598, 95% CI = 0.497, 0.683) was obtained when comparing daily reported use during the previous 48 hours with the average daily PLUM count. Reported latrine use, though already suggesting suboptimal adoption, likely exaggerates the actual level of uptake of latrines constructed under the program. Where reliance on self-reports is used, survey questions should focus on the 48 hours prior to the date of the survey rather than asking about “usual” latrine use behavior. Close

• 3. [Article] Assessing the Impact of Water Filters and Improved Cook Stoves on Drinking Water Quality and Household Air Pollution: A Randomised Controlled Trial in Rwanda

  Diarrhea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural ...

  Citation × Citation Citation Abstract Copy Title: Assessing the Impact of Water Filters and Improved Cook Stoves on Drinking Water Quality and Household Air Pollution: A Randomised Controlled Trial in Rwanda Author: Rosa, Ghislaine, Majorin, Fiona, Boisson, Sophie, Barstow, Christina, Johnson, Michael, Kirby, Miles, Ngabo, Fidele, Thomas, Evan A., Clasen, Thomas Year: 2014 Diarrhea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semicontinuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean fecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p,0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. Title: Assessing the Impact of Water Filters and Improved Cook Stoves on Drinking Water Quality and Household Air Pollution: A Randomised Controlled Trial in Rwanda Author: Rosa, Ghislaine, Majorin, Fiona, Boisson, Sophie, Barstow, Christina, Johnson, Michael, Kirby, Miles, Ngabo, Fidele, Thomas, Evan A., Clasen, Thomas Year: 2014 Diarrhea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semicontinuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean fecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p,0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. Close

• 4. [Article] A Proposed Integrated Data Collection, Analysis and Sharing Platform for Impact Evaluation

  Global poverty reduction efforts value monitoring and evaluation, but often struggle to translate lessons learned from one intervention into practical application in another intervention. Commonly, data ...

  Citation × Citation Citation Abstract Copy Title: A Proposed Integrated Data Collection, Analysis and Sharing Platform for Impact Evaluation Author: Kipt, Andreas, Brunette, Waylon, Kellerstrass, Jordon, Podolsky, Matthew, Rosa, Javier, Sundt, Mitchell, Wilson, Daniel, Borriello, Gaetano, Brewer, Eric, Thomas, Evan A. Year: 2015 Global poverty reduction efforts value monitoring and evaluation, but often struggle to translate lessons learned from one intervention into practical application in another intervention. Commonly, data is not easily or often shared between interventions and summary data collected as part of an impact evaluation is often not available until after the intervention is complete. Equally limiting, the workflows that lead to research results are rarely published in a reproducible, reusable, and easy-to-understand fashion for others. Information and communication technologies widely used in commercial and government pro- grams are growing in relevance for international global development professionals and offer a potential towards better data and workflow sharing. However, the technical and custom nature of many data management systems limits their accessibility to non-ICT professionals. The authors propose an end-to- end data collection, management, and dissemination platform designed for use by global development program managers and researchers. The system leverages smartphones, cellular based sensors, and cloud storage and computing to lower the entry barrier to impact evaluation. Title: A Proposed Integrated Data Collection, Analysis and Sharing Platform for Impact Evaluation Author: Kipt, Andreas, Brunette, Waylon, Kellerstrass, Jordon, Podolsky, Matthew, Rosa, Javier, Sundt, Mitchell, Wilson, Daniel, Borriello, Gaetano, Brewer, Eric, Thomas, Evan A. Year: 2015 Global poverty reduction efforts value monitoring and evaluation, but often struggle to translate lessons learned from one intervention into practical application in another intervention. Commonly, data is not easily or often shared between interventions and summary data collected as part of an impact evaluation is often not available until after the intervention is complete. Equally limiting, the workflows that lead to research results are rarely published in a reproducible, reusable, and easy-to-understand fashion for others. Information and communication technologies widely used in commercial and government pro- grams are growing in relevance for international global development professionals and offer a potential towards better data and workflow sharing. However, the technical and custom nature of many data management systems limits their accessibility to non-ICT professionals. The authors propose an end-to- end data collection, management, and dissemination platform designed for use by global development program managers and researchers. The system leverages smartphones, cellular based sensors, and cloud storage and computing to lower the entry barrier to impact evaluation. Close

• 5. [Article] Evaluating Cellular Instrumentation on Rural Handpumps to Improve Service Delivery—A Longitudinal Study in Rural Rwanda

  In rural sub-Saharan Africa, where handpumps are common, 10–67% are nonfunctional at any one time, and many never get repaired. Increased reliability requires improved monitoring and responsiveness of ...

  Citation × Citation Citation Abstract Copy Title: Evaluating Cellular Instrumentation on Rural Handpumps to Improve Service Delivery—A Longitudinal Study in Rural Rwanda Author: Nagel, Corey, Beach, Jack, Iribagiza, Chantal, Thomas, Evan A. Year: 2015 In rural sub-Saharan Africa, where handpumps are common, 10–67% are nonfunctional at any one time, and many never get repaired. Increased reliability requires improved monitoring and responsiveness of maintenance providers. In 2014, 181 cellular enabled water pump use sensors were installed in three provinces of Rwanda. In three arms, the nominal maintenance model was compared against a “best practice” circuit rider model, and an “ambulance” service model. In only the ambulance model was the sensor data available to the implementer, and used to dispatch technicians. The study ran for seven months in 2014–2015. In the study period, the nominal maintenance group had a median time to successful repair of approximately 152 days, with a mean per-pump functionality of about 68%. In the circuit rider group, the median time to successful repair was nearly 57 days, with a per-pump functionality mean of nearly 73%. In the ambulance service group, the successful repair interval was nearly 21 days with a functionality mean of nearly 91%. An indicative cost analysis suggests that the cost per functional pump per year is approximately similar between the three models. However, the benefits of reliable water service may justify greater focus on servicing models over installation models. Title: Evaluating Cellular Instrumentation on Rural Handpumps to Improve Service Delivery—A Longitudinal Study in Rural Rwanda Author: Nagel, Corey, Beach, Jack, Iribagiza, Chantal, Thomas, Evan A. Year: 2015 In rural sub-Saharan Africa, where handpumps are common, 10–67% are nonfunctional at any one time, and many never get repaired. Increased reliability requires improved monitoring and responsiveness of maintenance providers. In 2014, 181 cellular enabled water pump use sensors were installed in three provinces of Rwanda. In three arms, the nominal maintenance model was compared against a “best practice” circuit rider model, and an “ambulance” service model. In only the ambulance model was the sensor data available to the implementer, and used to dispatch technicians. The study ran for seven months in 2014–2015. In the study period, the nominal maintenance group had a median time to successful repair of approximately 152 days, with a mean per-pump functionality of about 68%. In the circuit rider group, the median time to successful repair was nearly 57 days, with a per-pump functionality mean of nearly 73%. In the ambulance service group, the successful repair interval was nearly 21 days with a functionality mean of nearly 91%. An indicative cost analysis suggests that the cost per functional pump per year is approximately similar between the three models. However, the benefits of reliable water service may justify greater focus on servicing models over installation models. Close

• 6. [Article] The Effectiveness of Sanitary Inspections as a Risk Assessment Tool for Thermotolerant Coliform Bacteria Contamination of Rural Drinking Water: A Review of Data from West Bengal, India

  The use of sanitary inspections combined with periodic water quality testing has been recommended in some cases as screening tools for fecal contamination. We conducted sanitary inspections and tested ...

  Citation × Citation Citation Abstract Copy Title: The Effectiveness of Sanitary Inspections as a Risk Assessment Tool for Thermotolerant Coliform Bacteria Contamination of Rural Drinking Water: A Review of Data from West Bengal, India Author: Snoad, Christian, Nagel, Corey L., Bhattacharya, Animesh, Thomas, Evan A. Year: 2017 The use of sanitary inspections combined with periodic water quality testing has been recommended in some cases as screening tools for fecal contamination. We conducted sanitary inspections and tested for thermotolerant coliforms (TTCs), a fecal indicator bacteria, among 7,317 unique water sources in West Bengal, India. Our results indicate that the sanitary inspection score has poor ability to identify TTC-contaminated sources. Among deep and shallow hand pumps, the area under curve (AUC) for prediction of TTC > 0 was 0.58 (95% confidence interval [CI] = 0.53–0.61) and 0.58 (95% CI = 0.54–0.62), respectively, indicating that the sanitary inspection score was only marginally better than chance in discriminating between contaminated and uncontaminated sources of this type. A slightly higher AUC value of 0.64 (95% CI=0.57–0.71) was observed when the sanitary inspection score was used for prediction of TTC > 0 among the gravity-fed piped sources. Among unprotected springs (AUC = 0.48, 95% CI = 0.38–0.55) and unprotected dug wells (AUC = 0.41, 95% CI = 0.20–0.66), the sanitary inspection score performed more poorly than chance in discriminating between sites with TTC < 1 and TTC > 0. Aggregating over all source types, the sensitivity (true positive rate) of a high/very high sanitary inspection score for TTC contamination (TTC > 1 CFU/100 mL) was 29.4% and the specificity (true negative rate) was 77.9%, resulting in substantial misclassification of the sites when using the established risk categories. These findings suggest that sanitary surveys are inappropriate screening tools for identifying TTC contamination at water points. Title: The Effectiveness of Sanitary Inspections as a Risk Assessment Tool for Thermotolerant Coliform Bacteria Contamination of Rural Drinking Water: A Review of Data from West Bengal, India Author: Snoad, Christian, Nagel, Corey L., Bhattacharya, Animesh, Thomas, Evan A. Year: 2017 The use of sanitary inspections combined with periodic water quality testing has been recommended in some cases as screening tools for fecal contamination. We conducted sanitary inspections and tested for thermotolerant coliforms (TTCs), a fecal indicator bacteria, among 7,317 unique water sources in West Bengal, India. Our results indicate that the sanitary inspection score has poor ability to identify TTC-contaminated sources. Among deep and shallow hand pumps, the area under curve (AUC) for prediction of TTC > 0 was 0.58 (95% confidence interval [CI] = 0.53–0.61) and 0.58 (95% CI = 0.54–0.62), respectively, indicating that the sanitary inspection score was only marginally better than chance in discriminating between contaminated and uncontaminated sources of this type. A slightly higher AUC value of 0.64 (95% CI=0.57–0.71) was observed when the sanitary inspection score was used for prediction of TTC > 0 among the gravity-fed piped sources. Among unprotected springs (AUC = 0.48, 95% CI = 0.38–0.55) and unprotected dug wells (AUC = 0.41, 95% CI = 0.20–0.66), the sanitary inspection score performed more poorly than chance in discriminating between sites with TTC < 1 and TTC > 0. Aggregating over all source types, the sensitivity (true positive rate) of a high/very high sanitary inspection score for TTC contamination (TTC > 1 CFU/100 mL) was 29.4% and the specificity (true negative rate) was 77.9%, resulting in substantial misclassification of the sites when using the established risk categories. These findings suggest that sanitary surveys are inappropriate screening tools for identifying TTC contamination at water points. Close