January 2014. Data collected over the past 10 years shows that drinking water quality has improved with the use of the Simple Field Test.
TASCA now has active programs in the 6 departments of Nicaragua listed at the right in which live 40% of the rural population of Nicaragua, about 1 million people. With support from TASCA the Nicaraguan Ministry of Health (MINSA) is using the Simple Field Testfor control of rural water quality in 5 of these departments, León being the exception (also the most urban).
The Simple Field Test was first used by the Dirección de Acueductos Rurales (DAR), the rural arm of the Nicaraguan Water Ministry in Matagalpa (2001) and later in Chontales (2003) but testing lapsed in these departments when the DAR was disbanded in 2006.
TASCA offered to support MINSA in reactivating the use of the test in Matagalpa in 2008, Chontales in 2009 and in both cases the offer was enthusiastically received. As you can see from the graphs below the use of the test (blue line) has been extensive and generally increasing. But most important are the red bars which show the percentage of samples tested that are free of fecal contamination, that is, the percentage of drinking water supplies that are fit for human consumption. Starting from 30% before 2006 it has steadily increased in both departments to about 70 - 80%. Analysis showed that the increase in water quality was statistically significant.
In 1995 and 1996 TASCA had established new laboratories in the Departments of Jinotega and Madriz in collaboration with MINSA. The primary function of these laboratories was initially measurement of drinking water quality using the standard membrane filtration method. Samples were collected from both urban and rural areas and delivered to the central laboratory for processing. In 2003 - 2004 TASCA introduced the Simple Field Test to MINSA in these Departments, providing much wider and more intensive testing of rural water samples and allowing the central laboratories to focus on urban water testing and surveillance of endemic and epidemic disease. Data from the use of the test in Jinotega and Madriz are shown below. In Madriz the results are very similar to those from Matagalpa and Chontales, showing a significant increase in water quality with use of the Simple Field Test. We do not have complete data from Jinotega but the results from 2011-12 show that about 70% of the water sources tested are providing clean water, compared to the <10% found in earlier testing.
In 2011 TASCA introduced the Simple Field Test to MINSA health workers in the South Atlantic Region of Nicaragua (RAAS, Región Autónoma Atlántico Sur). The results of the first 18 months of testing are shown in the graphs below and confirmed what MINSA workers had believed, that water quality in the RAAS was not good. Since there had been limited water testing facilities previously SILAIS RAAS understandably wished to use the Simple Field Test to test both urban and rural water sources. The results from the entire region are thus somewhat biased by the higher water quality in the urban areas, where there is more regular chlorination of wells and other sources. For example the percentage of clean water samples in Bluefields averaged between 50% and 60% far above the 20% to 30% for the entire region.
The results from Kukra Hill are more typical of the rural areas of the region; in the first round of testing all 33 samples showed fecal contamination. Over the next 18 months the use of SFT allowed the percentage of clean water samples to increase to 24%
So the results from the past 10 years show that where the Simple Field test has been used water quality has significantly improved. How can simply testing do this? By itself it cannot; what it does is place in the hands of the health workers a powerful and reliable tool that allows them to focus their work on problem water sources, taking corrective action by repair and/or chlorination of these systems. Certainly construction of new water systems and installation of automatic chlorinators has also contributed to improvement of water quality, but only as long as testing of water quality is available to ensure their proper maintenance.
The Simple Field Test is also an excellent tool for education of the communities using the water sources; seeing a sample of their clear water turn black and begin to smell of hydrogen sulfide (see the photo below) the users are readily convinced that their water has serious problems and more than willing to follow the recommendation of the health workers on how to improve and maintain the quality of their water.
Improvement of water quality should result in a decrease in the incidence of diarrheal disease, but properly representative statistics on this are difficult to obtain. But comprehensive infant mortality data are available (see the graph below) and show that in Nicaragua this dropped from 70 to 27 per 1000 live births over the past 20 years. Improved water quality has certainly contributed to this, but improvements in sanitation, pre- and postnatal care and vaccination are also major factors. The introduction of oral rehydration therapy for treatment of diarrheal disease has also been important.
Samples A & B: Fecal contamination. Sample C: Other types of bacteria. Samples D & E: No contamination. The yellow color of the samples is from the added testing medium.
This is all very good, excellent progress, but it is not enough, there is more to do. The goal must be to have 100% of water supplies free of fecal contamination and infant mortality must be reduced to below 10 per 1000 live births.
Supplying clean water with zero fecal contamination is possible and has been achieved in many of the urban areas supported by our programs. But progress beyond the level of 70 - 80% clean water supplies may be more difficult in rural areas; in fact the data above from Jinotega, Madriz and Matagalpa suggest that progress in improvement of water quality has slowed over the past 2 years. Improvement in infant mortality has also slowed.
Our Nicaraguan colleagues believe that their limited human resources are a major barrier to further progress; they have a limited number of hygiene promoters in the field and these promoters have many other responsibilities beyond their oversight of water systems. Introduction of the Simple Field Test has made this part of their work much more efficient and effective and TASCA will continue to support the programs that we have in place, always encouraging MINSA to provide them with more human resources. MINSA has been able to do this for the laboratories supported by TASCA, although it has always been a slow process.
Meanwhile, since the current TASCA rural water testing programs are in areas with less than 50% of the total rural population of the country we can provide a major impact by extending the program to other Departments of Nicaragua, beginning with the RAAN in 2014.