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Journal of Water and Health Vol 5 No 4 pp 599–608 © IWA Publishing 2007 doi:10.2166/wh.2007.010

Cost-effectiveness of water quality interventions for preventing diarrhoeal disease in developing countries

Thomas Clasen, Sandy Cairncross, Laurence Haller, Jamie Bartram and Damian Walker

London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK Tel: +44 (0) 20 7636 8636Fax: +44 (0)20 7436 5389thomas.clasen@lshtm.ac.uk
World Health Organization, Avenue Appia 20, CH - 1211 Geneva 27, Switzerland
Johns Hopkins University School of Public Health, 615 N. Wolfe Street / Room E8616, Baltimore, MD 21205, USA


Using effectiveness data from a recent systematic review and cost data from programme implementers and World Health Organization (WHO) databases, we conducted a cost-effectiveness analysis to compare non-piped in source- (dug well, borehole and communal stand post) and four types of household- (chlorination, filtration, solar disinfection, flocculation/disinfection) based interventions to improve the microbial quality of water for preventing diarrhoeal disease. Results are reported for two WHO epidemiological sub-regions, Afr-E (sub-Saharan African countries with very high adult and child mortality) and Sear-D (South East Asian countries with high adult and child mortality) at 50% intervention coverage. Measured against international benchmarks, source- and household-based interventions were generally cost effective or highly cost effective even before the estimated saving in health costs that would offset the cost of implementation. Household-based chlorination was the most cost-effective where resources are limited; household filtration yields additional health gains at higher budget levels. Flocculation/disinfection was strongly dominated by all other interventions; solar disinfection was weakly dominated by chlorination. In addition to cost-effectiveness, choices among water quality interventions must be guided by local conditions, user preferences, potential for cost recovery from beneficiaries and other factors.

Keywords: cost-effectiveness; diarrhoea; drinking water; household treatment; microbial water quality; water supplies

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