Barriers and Facilitators to Chlorine Tablet Distribution and Use in Emergencies: A Qualitative Assessment
2. Materials and Methods
2.1. General Key Informant Interviews
2.2. Taste and Odor Specific Interviews
2.3. Taste and Odor Literature Review
3.1. Key Informant Interviews
3.1.1. Treatment Options
“It’s difficult to make generalizations … but the approach would be to identify a source and then assess whether, A, [there’s] enough quantity, then B, go towards making efforts to improve the quality”—WASH Practitioner (Taste and Odor KII)
“The advantage of [HWTS] specifically is when you know you need to transform the quality of your water at the household level in areas where either you cannot update facilities, or you don’t have the time to.”—WASH Practitioner (General KII)
“Truly speaking, except chlorination, there was no other effective treatment which has been adopted in any of the places because it was easy to handle, easy to take from one place to another, easy to operate.”—WASH Practitioner (General KII)
3.1.2. Chlorine Tablet Use in Emergencies
“[It’s] cheap, easy to use, highly effective against most of the pathogens we encounter in our [emergency] settings”—WASH Practitioner (Taste and Odor KII)
“It doesn’t pose a big challenge because it is easy to handle, easy to maintain, and you can easily train. You can inform the participants this is how we would be using it and there’s nothing hidden.”—WASH Practitioner (General KII)
“I would say in the conflict settings it’s just kind of set up differently. So, I would say mainly in natural disasters, it is quite common to be doing really a household level distribution.”—WASH Practitioner (General KII)
3.1.3. Chlorine Tablet Distribution and Program Monitoring
“One of the biggest limitations on Aquatabs is education. You are still trying to educate people to do something with the water. And the second thing is you are trying to convince them to do it on a continuous basis.”—WASH Practitioner (General KII)
“In our literature and guidelines, we always have statements that we should consider user input. We don’t often do that until things are stable enough.”—WASH Practitioner (Taste and Odor KII)
3.1.4. Technical and Social Challenges
“The taste is normally the biggest drawback I think I have heard about [chlorine tablets].”—WASH Practitioner (General KII)
“People are just not used to the taste. So, it’s not even that the levels were extremely high, people’s acceptance of the taste was not there.”—WASH Practitioner (Taste and Odor KII)
“Or the perception that chlorination or chlorinated water is associated with adverse health outcomes, which are not really fact based, but they’re definitely opinions and perceptions that people hold.”—WASH Practitioner (General KII)
“On the other hand, folks who are accustomed to drinking chlorinated water will only drink chlorinated water and will be suspicious of water that does not have an obvious taste and odor to it.”—WASH Practitioner (General KII)
“Encourage your own staff to drink the water themselves. If they will not drink it, there is no way that we can expect or should we expect other people to.”—WASH Practitioner (General KII)
3.1.5. Chlorine Tablet Dosage
“Well then of course it’s possible to tailor. You could have a photograph or a picture of container X with a picture of one, two, or three tablets underneath it.”—WASH Practitioner (General KII)
“It confuses partners. It confuses then what’s messaged. It confuses, you know, what you accompany. Do you give a 10 L jerrican? Do you give a 20 L jerrican? How much water are we supposed to be treating with this dosage?”—WASH Practitioner (General KII)
“Currently, the guidelines are based on no evidence.”—WASH Practitioner (Taste and Odor KII)
3.1.6. Intervention Effectiveness
“I don’t think [having different dosages available] compromised my decision to use them, it impacts the planning on how I would use it and how I’m going to coordinate. Obviously, it’s an effective treatment method.”—WASH Practitioner (General KII)
“In the end it’s an ethical issue. Essentially at the end of the day there may be people who think that they’re treating their water and they’re not.”—WASH Practitioner (General KII)
3.1.7. Recommendations for Distributors and Implementers
“Community engagement is probably the key. …getting people to understand that, okay, the taste might not be what they’re used to, but it’s a safety issue.”—WASH Researcher (Taste and Odor KII)
“The main thing is responding to complaints. …having a mechanism by which you get this feedback is already a good start.”—WASH Practitioner (Taste and Odor KII)
“I think what’s important from a product perspective is the dosing. So I think there needs to be clear instructions or guidelines as to when different doses would be appropriate in different settings.”—WASH Practitioner (General KII)
“For the most part, it’s just thinking about the coordination issue and trying to get on top of that at the beginning.”—WASH Practitioner (General KII)
3.2. Taste and Odor Literature Review
Conflicts of Interest
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© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Mitro, B.; Wolfe, M.K.; Galeano, M.; Sikder, M.; Gallandat, K.; Lantagne, D. Barriers and Facilitators to Chlorine Tablet Distribution and Use in Emergencies: A Qualitative Assessment. Water 2019, 11, 1121. https://doi.org/10.3390/w11061121
Mitro B, Wolfe MK, Galeano M, Sikder M, Gallandat K, Lantagne D. Barriers and Facilitators to Chlorine Tablet Distribution and Use in Emergencies: A Qualitative Assessment. Water. 2019; 11(6):1121. https://doi.org/10.3390/w11061121Chicago/Turabian Style
Mitro, Brittany, Marlene K. Wolfe, Mateo Galeano, Mustafa Sikder, Karin Gallandat, and Daniele Lantagne. 2019. "Barriers and Facilitators to Chlorine Tablet Distribution and Use in Emergencies: A Qualitative Assessment" Water 11, no. 6: 1121. https://doi.org/10.3390/w11061121