P2B142: Clean Water for Rural Guatemala: An Assessment of the Practicality and Microbiological Efficacy of Point-of-use Water Filters in the Boca Costa Region

Background: Infectious intestinal diseases and malnutrition, both often associated with lack of clean drinking water, are leading causes of death among Guatemalan children 5 years of age or less. Prior studies have shown a reduction in familial report of childhood diarrhea after implementation of point-of-use water filters in impoverished communities around the world. Little has been reported on how much of a child’s water is sourced from the filter once it is installed or what barriers impact continued use. While these filters have shown acceptable microbiological efficacy in laboratory settings, there has been less reported on actual use. We sought to provide family-centered water filter education followed by in-home follow-up to assess water usage characteristics and microbiological efficacy of two point-of-use water filters in a rural Guatemalan community.

Methods: Families with at least one child 5 years old or younger were invited to participate while visiting a primary care clinic in November 2021. Participants completed a survey assessing baseline water usage characteristics and were given the choice between a ceramic or hollow-membrane fiber water filter. They received filter education in their primary language. Home visits with reiteration of filter education, administration of follow-up surveys, and fecal coliform testing of filtered water were completed at several intervals.

Results: Thirty families were enrolled in the study. Half received a ceramic filter and half received a hollow-membrane fiber filter. Coliform testing was performed three months after filter distribution (February 2022). Five hollow-membrane fiber filters were tested, and all showed unacceptable levels of coliforms in filtered water. None of the ceramic filters tested positive for coliforms. Families were immediately instructed to discontinue use of the hollow-membrane fiber filters, and these were replaced with ceramic filters in April 2022. In September 2022, repeat coliform testing showed unacceptable levels from three of the eight ceramic filters tested. These three families were instructed to discontinue filter use.

Survey data in February 2023 (15-month follow-up) showed that 76% of filters (N=19/25) were still in use. Prior to filter distribution, 20% (N=6/30) of parents reported their children were in poor health. At 15-month follow-up, 0% (N=0/24) of parents reported their children were in poor health. At 15-month follow-up, 24% of families (N=6/25) reported accurate filter maintenance.

Conclusion: In-home, water filter use is sustainable in rural Guatemala and associated with a perceived improvement in child health. Ceramic filters demonstrated better coliform clearance than hollow-membrane fiber filters. Accurate filter maintenance is difficult to achieve despite ongoing, one-on-one, education. Further data are needed to determine if ceramic filters maintain adequate filtration for their two-year lifespan, to identify factors contributing to filter contamination, to determine best practices for filter education, and to further assess the impact of filter use on child health.