Sandec: Sanitation, Water and

Solid Waste for Development

SODIS manual
Guidance on solar water disinfection
 About the publishers

About the publishers

Eawag, the Swiss Federal Institute of Aquatic Science and
Technology, is concerned with concepts and technologies for deal-
ing sustainably with water bodies and with water as a resource. In
collaboration with universities, other research institutions, public
bodies, industry and non-governmental organisations, Eawag
works to harmonise ecological, economic and social interests in
respect of water usage.
>> www.eawag.ch

Sandec is the Department of Sanitation, Water and Solid Waste

for Development at Eawag. It develops new concepts and
technologies adapted to the physical and socio-economic condi-
tions in low- and middle-income countries to improve sustainable
access to safe drinking water and environmental sanitation.
>>www.sandec.ch

Eawag
P.O. Box 611
8600 Dübendorf
Switzerland
Phone: +41 (0)58 765 52 86
Fax: +41 (0)58 765 53 99
Email: info@sandec.ch

Copyright: This document is an open-source document – copying

and adapting is allowed provided that proper acknowledgement
of the source is made. You can download a free PDF copy of this
publication from >>www.sandec.ch or >>www.sodis.ch.

Authors: Samuel Luzi, Monika Tobler, Fabian Suter, Regula

Meierhofer

Acknowledgements: We would like to thank Tamar Kohn for her

inputs and comments on the chapter on inactivation of viruses.

Text editing: Paul Donahue, Anna Muntwyler

Layout and figures: Fabian Suter

Photos: All photos are from Sandec if not mentioned otherwise.

Photos from Bolivia are from Fundación SODIS.

Cover: Women in Nepal applying SODIS

ISBN: 978-3-906484-59-4

2
 Foreword

Pupil collects SODIS bottles at a rural school in Bolivia

The SODIS Reference Centre of Eawag/Sandec extends thanks to all the institutions and persons involved in the SODIS program and grate-
fully acknowledge their collaboration and assistance. In particular, we would like to express our gratitude to the directorate of Eawag for sup-
porting research on SODIS and hosting the SODIS promotion program as a spin-off of this research. We thank the Swiss Agency for
Development and Cooperation for its support in the first phases of the SODIS program, and various other donors for their financial support of
SODIS projects. These include, among others: Solaqua Foundation, Lions Clubs, Rotary Clubs, Symphasis Foundation, Tiberius Foundation,
Fondation Ensemble, Fondation Bay, Avina Foundation, Addax Foundation, Georg Fischer Foundation, Max Hauri Foundation, Medicor Foun-
dation, Michel Comte Foundation, Lotteriefonds St.Gallen, City of Zurich, Von Opel Foundation, Carl Hirschmann Foundation, Broillet AG,
Jansen AG, IBM, Gobafund, and the Swiss Development Cooperation. We also acknowledge the fruitful collaboration with Helvetas Swiss
Intercooperation, a Swiss NGO that continues the implementation of SODIS projects as part of their own water and sanitation program.

Dübendorf, January 2016

Regula Meierhofer Christoph Lüthi

Head of SODIS Reference Centre Head of Sandec

3
 Table of Contents

1 SODIS at a glance  8
1.1 The SODIS method 8
1.2 Niche of SODIS in the context of HWTS and WASH 9
1.3 Health benefits of SODIS  10
1.4 History of SODIS 10

2 Technical aspects of the SODIS method  12

2.1 Mechanism of solar water disinfection 12
2.2 Factors of pathogen removal capacity 13
2.2.1 Type and origin of pathogenic organisms 14
2.2.2 Irradiation intensity 17
2.2.3 Place and position of bottle exposure  20
2.2.4 Material and size of bottles 20
2.2.5 Turbidity and dissolved organic matter 22
2.2.6 Oxygen content 22
2.2.7 Water temperature 23
2.2.8 Re-growth 23

2.3 Advanced designs  24

2.4 Implications for the application of the SODIS method 26

3 Promotion of the SODIS method 28

3.1 Evidence on uptake, sustainability, and health impact  28
3.1.1 Evidence on uptake 28
3.1.2 Evidence on sustainability 29
3.1.3 Evidence on health impact 30

3.2 Elements to consider during the planning phase 32

3.2.1 Planning a behaviour change intervention 32
3.2.2 Selection of intervention area  33
3.2.3 Development of a monitoring and evaluation scheme 35
3.2.4 Impact evaluation 37
3.2.5 Definition of project scope  40
3.2.6 Assessment of bottle supply 41
3.2.7 Creation of an enabling environment 42

3.3 Addressing behaviour change factors  43

3.3.1 Addressing risk factors  43
3.3.2 Addressing attitude factors 44
3.3.3 Addressing norm factors 44
3.3.4 Addressing ability factors  45
3.3.5 Addressing self-regulation factors  46

3.4 Recommendations for the promotion  48

3.4.1 Use multiple promotion channels  48
3.4.2 Engage community promoters  48
3.4.3 Integrate water quality tests to the promotion campaign  48
3.4.4 Develop comprehensive and attractive IEC materials 50
3.4.5 Promote an integrated HWTS approach  51

4 Appendices 52
4.1 References 52

4
 Acronyms

Acronyms
Eawag Swiss Federal Institute of Aquatic Science and Technology

HWTS Household Water Treatment and Safe Storage

LRV Log reduction value: used to specify by what order of magnitude concentrations of pathogens are reduced
(1 log = factor 10, 2 log = factor 100, etc.)

POU Point of use, also referred to as point of consumption

SDG Sustainable Development Goal

SODIS or SODIS method Standard water treatment method based on the principle of solar (water) disinfection

Solar water disinfection Inactivation of pathogens in water caused by irradiation of sunlight through direct and indirect mechanisms

SODIS Reference Centre Program of Eawag to support the research and promotion of SODIS

UNICEF United Nations Children's Fund

WASH (Drinking) Water, Sanitation and Hygiene

WHO World Health Organization

Mother and child in Cameroun

5
 About this manual

About this manual

This manual presents an overview of the SODIS method based on 20 years of research and
practice. It is structured into three parts:

1. SODIS at a glance
The first part presents the basic facts about solar disinfection and the SODIS method, gives in-
formation about the history of the SODIS method and highlights its benefits. It also discusses
the niche of SODIS in the context of HWTS and WASH and the potential impact and role of SO-
DIS in relation to programs aiming at reducing the prevalence of diarrheal disease.

SODIS users in Laos, India and Bolivia

2. Technical aspects of the SODIS method

The second part addresses the technical aspects that influence the efficacy of the SODIS
method in removing pathogens from water. This information aims at providing a solid under-
standing of the correct application of SODIS in the field, and of the expected outcomes under
various conditions.

Water quality testing in Guinea, Switzerland and Laos

3. Promotion of the SODIS method

The third part reviews specific approaches and tools used to promote the SODIS method to tar-
get populations. It aims at supporting experts with the integration of the SODIS method into
HWTS, WASH and health projects.

Promotion in Togo, Bolivia and India

6
 About this manual

...

7
 SODIS at a glance

1 SODIS at a glance
1.1 The SODIS method
The SODIS method is a water disinfection method, making use of
the sun’s energy and using PET bottles. It exploits the germicidal
effect of solar radiation – especially UV-A radiation - on diarrhoea
causing pathogens.

The SODIS method consists of the following simple steps:

1. Wash a plastic bottle: The bottle must be clean, transparent, col-

ourless, 2l in volume or smaller, and have all plastic or paper labels
removed. We recommend using PET bottles and to wash them with
soap before the first usage.

2. Fill bottle with water: Potentially contaminated water is filled into

a PET bottle. The water should not be very turbid.

3. Expose bottle to the sun: The bottle is exposed to direct sunlight

for one full day (at least 6 hours including noon hours) on mostly
sunny days, or 2 days when the sky is more than 50% clouded. On
days of continuous rainfall, SODIS should not be used.

4. Store water: The treated water is stored in the bottles until con-
sumption in order to avoid re-contamination.

The SODIS methd has specific comparative advantages and draw-

backs: Figure 1: SODIS steps

Specific comparative advantages of SODIS

• Effectiveness against pathogenic bacteria
• Easy to understand and to apply
• Zero or very low cost
• Independent from energy sources other than sunlight
• Independent from supply chains for products other than PET
bottles
• Integrated protection from re-contamination if water is stored in the
SODIS bottles
• No adverse effect on the water’s taste

Specific comparative drawbacks of SODIS

• Limited effectiveness against certain pathogenic viruses and
protozoa
• Dependent on access to sufficient numbers of PET-bottles
• Dependent on sufficient sunlight
• Relatively high daily labour demand
• Relatively high treatment time
• Limited aspirational appeal (poor people’s method)

Children in Nepal drinking SODIS water

8
 SODIS at a glance

SODIS bottles in India

Beyond the integrated promotion of different HWTS technologies,

1.2 Niche of SODIS in the it is important to understand HWTS as one element in broader
context of HWTS and WASH strategies of diarrhoea prevention that also include the improve-
ment of water supply and sanitation systems, and the promotion
SODIS is recognized as one of several viable methods for house- of improved hygiene practices. A holistic perspective on all these
hold water treatment. It has been promoted, both as a stand-alone issues allows HWTS interventions to be targeted specifically at ar-
intervention and as one component in broader HWTS (Household eas of greatest potential, and can exploit the synergies available by
Water Treatment and Safe Storage) or WASH (Water, Sanitation & integrating HWTS promotion within broader WASH and health pro-
Hygiene) programs. Different HWTS methods have existed for grams.
years (SODIS and biosand filtration), decades (chlorination and ce-
ramic filtration) or even longer (boiling). New technologies are be- SODIS and other HWTS methods are particularly relevant in areas
ing developed and introduced into the market. And yet, the where universal household connections, offering reliable supplies
principle of water treatment at the household level is still not a of good quality water are not available in the short and mid-term.
mainstream practice. All common HWTS methods have disadvan- HWTS is seen as an effective complementary strategy to acceler-
tages and have so far failed to achieve large scale uptake. ate the progress towards universal safe water consumption. How-
ever, the provision and maintenance of functional and reliable
The niche for the SODIS method can only be evaluated in the con- water supply systems is - and continues to be - the central pillar of
text of other HWTS technologies, and the benefits it offers can most national programs to increase safe water consumption.
vary significantly from one location to another. As a low-cost meth-
od that is independent from supply chains for products other than
PET bottles, SODIS has comparative advantages particularly
among the poorest segments of the population, and in areas
where no other HWTS technologies are marketed. As only sunlight
and PET bottles are required for the application of the method, SO-
DIS promotion mainly consists of measures aiming at a behaviour
change in the target communities. Therefore, the promotion of SO-
DIS is more rapidly scalable compared to the promotion of HWTS
methods that require the establishment of supply chains for spe- Box 1: Key criteria of HWTS-methods
cific products. As new affordable HWTS technologies that are su- • high effectiveness against the full range of pathogens (and possibly
perior to SODIS in terms of convenience, efficacy, and aspirational chemical contaminants) under a wide range of conditions
appeal become available in a given location, the niche for SODIS is • affordable cost
expected to shrink. The same is true when income levels increase • low labour inputs for operation and maintenance
• high productivity (litres/day)
in a community.
• positive effects on water aesthetics and taste
• high robustness and user safety
This manual advocates an integrated HWTS promotion approach • attractive design
that enables water users to make informed choices among a range • automatic shut-down mechanism if treatment effectiveness is compro-
of technology options. The promotion of a range of HWTS methods mised
• integrated safe storage
can more effectively address the diverse needs, capacities, and
• local availability of product and replacement parts
preferences of water users.

9
 SODIS at a glance

1.3 Health benefits of SODIS 1.4 History of SODIS

The main purpose of SODIS and other HWTS methods is to reduce The principle of water disinfection by solar radiation was first discov-
the risk of infection from diarrheal disease by improving drinking ered in 1984 by Prof. Aftim Acra of the American University in Beirut.
water quality.
In the 1990s, researchers at Eawag/Sandec launched extensive labo-
Safe drinking water is recognized as a basic requirement for ratory studies to evaluate the potential of solar radiation to inactivate
healthy development and a dignified life. Despite significant pro- bacteria and viruses. Based on the findings of these experiments,
gress in reducing the consumption of contaminated water in low- they designed a standard procedure – the SODIS method. After suc-
and middle-income countries during the last decades, more than cessful field testing, Eawag initiated a program in 2001 to dissemi-
748 million people still lack access to an improved source of drink- nate the SODIS method through promotion projects in more than 25
ing water (WHO/UNICEF 2014). This means that they have to rely low- and middle-income countries to ensure that the SODIS method
on drinking water from rivers or ponds, unprotected springs or dug becomes available to the people most in need. In 2011, Eawag und
wells, or water transported by trucks. Moreover, many people with the Swiss NGO Helvetas Swiss Intercooperation entered into a part-
access to improved water sources (i.e., household connections, nership with the goal to jointly promote the SODIS method world-
public standpipes and tube wells, protected springs or dug wells, wide. In the context of this partnership, various projects supporting
and rainwater harvesting) are still exposed to contaminated water. the promotion of household water treatment, including the SODIS
This is the case because either their source does not supply path- method, are being carried out by Helvetas.
ogen free water, or the water is re-contaminated during transport
from the source to the household, or it is stored and handled un- Today, the SODIS method is recognized as one viable HWTS option.
der unhygienic conditions. According to monitoring data from projects supported by Eawag, at
least 5 million people have started using the method to improve the
Drinking water contaminated with pathogens is a major transmis- quality of their drinking water.
sion route for diarrheal disease. 1.7 billion cases of diarrheal dis-
ease occur every year, and around 760’000 young children die
annually from the symptoms of diarrheal disease, most of them in
low- and middle-income countries. It is estimated that approxi-
mately 88% of infections from diarrheal diseases could be prevent-
ed by interventions to improve drinking water quality, sanitation,
and hygiene practices (Black et al. 2003).

Evidence indicates that water quality improvements at the point of

consumption are more effective in reducing diarrheal disease than
both increased access to clean water sources or quality improve-
ments at the source. However, it is important to note that health
benefits only accrue if SODIS and other HWTS methods are ap-
plied correctly, consistently, and sustainably.

Martin Wegelin receiving the Red Cross Price for SODIS at the Swiss parliament (2006)

10
SODIS at a glance

11
 Technical aspects

2 Technical aspects of the SODIS method

This chapter explains the disinfection mechanism of solar water ROS (Bosshard et al. 2010 ). With continued irradiation, structural pro-
disinfection (chapter 2.1) and the various factors influencing the teins and enzymes responsible for different cellular functions (e.g.,
pathogen removal capacity of the SODIS method, such as irradia- the transcription and translation apparatus, transport systems, amino
tion intensity, material of bottles or water turbidity (chapter 2.2). It acid synthesis and degradation, respiration, ATP synthesis, etc.) are
also presents the most important advanced designs that have damaged as well, leading to cell inactivation and death (Bosshard et
been proposed to improve the SODIS method (chapter 2.3) and al. 2010).
summarizes the key implication for the application of the SODIS
method in the field (chapter 2.4). The disinfection mechanism during solar disinfection is less under-
stood for viruses and protozoa than for bacteria. Viruses do not have
a cell membrane, which means that the endogenic inactivation pro-
2.1 Mechanism of solar cess is less important than for bacteria. Virus inactivation during SO-

water disinfection DIS, thus, likely occurs through the exogenous production of reactive
oxygen species - mediated through photosensitizers dissolved in the
The term solar water disinfection describes the process of inactiva- water – which then damage the viruses’ genome and/or capsid shell,
tion of pathogens in water through the direct effects of solar irradia- while direct inactivation is of minor importance in PET bottles be-
tion. It takes place in the top layer of surface water bodies, and is cause they block most of the UV-B radiation. Virus inactivation in PET
harnessed for drinking water disinfection. The spectrum of solar radi- bottles is, therefore, typically slower and more dependent on water
ation reaching the Earth’s surface consists of radiation of different composition than the inactivation of bacteria. Many protozoa that can
wavelengths, i.e., ultraviolet, visible, and infrared radiation. The main form cysts or spores are particularly resistant to environmental
mechanism of pathogen inactivation during solar disinfection is direct stress, including solar UV radiation. As a consequence, most patho-
or mediated damage to proteins and the DNA of the organisms, in- genic protozoa are less removed efficiently by the SODIS method, or
duced by radiation in the UV-B, UV-A, and possibly the lower visible require higher irradiation doses for complete inactivation (see chap-
range. ter 2.2.1).

The relatively small fraction of solar UV-B radiation that reaches the
earth’s surface can inactivate pathogens by degrading the organisms’ Box 2: Terminology Solar Water Disinfection vs. SODIS
DNA or RNA (Jagger 1985). This direct inactivation mechanism is of • The term solar water disinfection describes the process of the inactiva-
minor importance to the SODIS method based on the use of PET bot- tion of pathogens in water through the direct effects of solar irradiation.
tles, however, because PET absorbs most of the UV-B radiation. • The term SODIS or SODIS method commonly refers to the standard
method formulated for household use with PET bottles and one to two
days of solar exposure.
The UV-A fraction of the solar spectrum does not directly affect the
DNA or RNA in pathogens. It does, however, cause the formation of
reactive oxygen species (ROS, e.g., singlet oxygen, superoxide, hy-
drogen peroxide, and hydroxyl radical), which then react with and
damage the DNA or proteins of microorganisms (Whitlam & Codd
1986). ROS formation can be mediated by organic photosensitizers
dissolved in the water, such as organic molecules or iron (exogenous
mechanism), or by molecules of the pathogenic organisms them-
selves (endogenic mechanism).

The observed - though relatively small - germicidal effect of radiation

in the lower range of the visible spectrum is mediated by sensitizers
rather than by direct absorption (Rincon & Pulgarin 2004c).

Heat also damages the molecular structure of pathogenic organisms,

a mechanism known as thermal inactivation or pasteurization. Ther-
mal inactivation sets in at temperatures as low as 40ºC degrees for
Vibrio Cholerae (Berney et al. 2006). During solar exposure, the wa-
ter is typically heated up by solar infrared radiation, depending on the
irradiation intensity, ambient temperature, and location (wind cooling,
heat absorbing background). At temperatures above 45-50ºC, a syn-
ergistic effect of thermal inactivation and UV-A radiation occurs which
strongly enhances the inactivation rate of solar disinfection (see chap-
ter 2.2.7).
In the case of bacteria, membrane enzymes, e.g., enzymes of the
respiratory chain and the F1F0-ATPase, are the likely first targets of SODIS bottles on a corrugated iron sheet in Togo

12
 Technical aspects

Laboratory tests at Eawag

2.2 Factors of pathogen This section postulates the typical pathogen removal levels in tropi-
removal capacity cal/subtropical countries at temperatures up to 45ºC, assuming that
SODIS has been correctly applied. Higher reduction rates are possi-
Numerous studies under laboratory and field conditions have docu- ble for strong irradiation conditions or water temperatures above
mented the pathogen removal capacity of solar water disinfection in 45ºC, and lower rates occur especially if several unfavourable condi-
general, and of the SODIS method using PET bottles in particular. Ac- tions co-exist (i.e., winter season, cloudy weather, turbid water,
cording to the findings of these studies, the disinfection efficacy of scratched bottles, etc.). These values are based on published results
the SODIS method depends on a number of factors: of field and lab studies. Note that the measured ‘reduction’ in patho-
• Type and origin of pathogenic organism gen concentrations always depends on the method of analysis. There
• Irradiation intensity is evidence that the assessment of viability/cultivability of pathogens
• Material and size of bottles can lead to overestimations of the actual infectivity (Smith et al. 2000;
• Place and position of bottle exposure McGuigan et al. 2006), or underestimations, i.e., if re-growth occurs.
• Turbidity and dissolved organic matter
• Oxygen content
• Water temperature Box 3: Measuring disinfection effectiveness
• Re-growth • The pathogen removal capacity of a technology is often described in
units of ‘log reduction values’ (LRV). A log reduction value of 1 corre-
The available data do not allow for a complete and systematic under- sponds to a reduction in pathogen concentrations by 90%, a LRV of 2 to
standing of the influence of all of the above different factors, or for a reduction by 99%, etc.
• Another common measure for the pathogen removal efficiency is the in-
the construction of predictive models that show the combined effect
activation rate coefficient k. The inactivation rate can be calculated from
of these factors on the disinfection effectiveness. the ratio of the start and end concentration of pathogens, and the treat-
ment time (t) or received irradiation dose (Fluence, F), respectively, as-
For practical applications, standard recommendations are applied suming first order inactivation kinetics: ln[C/C0]=-k*t
that reduce the complexity for the users, but which allow for satisfac- • The extent of pathogen removal for the SODIS method is often specified
as a function of the received dose of solar radiation - or the exposure
tory pathogen inactivation results most of the time under most cir-
time at a specific irradiation intensity required to reduce the pathogen
cumstances. Some of these recommendations were formulated concentrations by a certain factor, e.g., by 3 LRVs (99.9%). The fact that
somewhat heuristically based on the limited available data (e.g., the different SODIS studies measured the intensity of solar radiation (real or
thresholds for turbidity level, bottle volume or geographical latitudes simulated) for different wavelength ranges (e.g., full spectral light, UV-A:
where SODIS can be applied), and substantiated by the results of 320-400nm, or arbitrary range: e.g., 350-450nm) makes the comparison
of results across studies difficult.
field tests.

13
 Technical aspects

2.2.1 Type and origin of patho- spore-forming bacteria, viruses, and protozoa. Inactivation studies for
SODIS based on the concentration of total coliforms likely underes-
genic organisms timate the effectiveness for pathogenic bacteria, as some coliforms
adapt to environmental stress and are, therefore, more resistant to
The resistance to UV-A irradiation varies considerably between differ- solar radiation.
ent types of pathogens. Generally, pathogenic bacteria are less capa-
ble of withstanding the effects of solar UV radiation compared to Pathogen Log Reduction Approx. Reference
most viruses and spore or cyst forming protozoa. Many viruses are reduc- of patho- time re-
tion gen con- quired for 3
strongly affected by UV-B radiation, which plays a minor role in the value centration log reduc-
SODIS process with PET bottles. Differences in terms of resistance (6h)* (6h)* tion*
to solar radiation are observed also between different species of Escherichia 2-5 99 – 1 day (McGuigan et al. 1998; Ke-
pathogenic bacteria, though the variance is smaller than for different coli 99.999% hoe et al. 2001; Fujioka &
Yoneyama 2002; Berney
viruses and protozoa. et al. 2006; Boyle et al.
2008; Fisher et al. 2008;
Tables 1-3 provide log reduction values of SODIS for different patho- Fisher et al. 2012; Kruti &
Shilpa 2012)
gens. These figures are based on published studies. Log reduction
Vibrio chol- 3-5 99.9- 3h (Kehoe et al. 2004; Berney
values relate to the solar exposure of water in PET bottles or compa-
era 99.999% et al. 2006)
rable lab experiments (UV-B cut off for studies with viruses) and tem-
Salmonella 2-4 99 – 1 day (Smith et al. 2000; Kehoe
peratures below 40ºC (i.e., no synergistic effect of radiation and spp. 99.99% et al. 2004; Berney et al.
temperature). These results are believed to be representative of the 2006; Bosshard et al.
efficacy of SODIS under typical field conditions in tropical countries, 2009)
assuming the correct application of SODIS according to the standard Shigella 2-4 99 – 1 day (Kehoe et al. 2004; Berney
recommendations. For particularly favorable or unfavorable condi- flexneri 99.99% et al. 2006; Bosshard et al.
2009)
tions (in terms of water composition, solar intensity and temperature)
Shigella dys- >4 >99.99% < 1day (Kehoe et al. 2004)
the inactivation rates may also be higher or lower than specified here.
enteriae
Campylobac- >4 > 99.99% < 1 day (Boyle et al. 2008)
ter jejuni
Bacteria Yersinia en- >3 > 99.9% 1 day (Boyle et al. 2008)
terocolitica
Bacteria cause some of the most dangerous diarrheal diseases, in-
Enterococ- 2-5 99 – 1 day (Reed 1997; Fujioka &
cluding cholera and bacterial dysentery. None-spore forming diar- cus feacalis 99.999% Yoneyama 2002)
rhoea-causing bacteria are among the pathogens that are most
Table 1: Inactivation of bacteria
effectively inactivated by solar irradiation. SODIS typically reduces *estimations for irradiation intensities in tropical countries, for mostly sunny
the concentrations of these pathogens by several orders of magni- weather, i.e. for average daily UV-doses of 1MJ/m2.
tude on a typical day in tropical or subtropical regions. Inactivation
rates vary from species to species. For example, the dose and solar
exposure time required to reduce the concentration of Vibrio Choler-
ae by 90% [165 kJ/m2 in the range of 350-450 nm corresponding to
24 minutes of exposure in the experiment conducted by Berney
(2006)] is substantially lower than the required dose and exposure
time for E.coli (1210 kJ/m2, 182 minutes, respectively). Table 1 pre-
sents the typical removal rates for different types of pathogenic bac-
teria that have been reported in scientific literature.

Evidence from E.coli studies suggest that bacteria extracted from

wastewater are more resistant to solar radiation than bacteria cul-
tured in the laboratory (see Fisher et al. 2012 and references cited
therein). It is, thus, likely that SODIS experiments with lab-cultured
organisms somewhat overestimate the disinfection efficacy of SO-
DIS in field applications, and the results of these studies must be in-
terpreted cautiously.

The disinfection efficacy of SODIS was investigated for a number of

different pathogenic organisms. The majority of scientific studies on
SODIS focus on pathogenic bacteria, indicator bacteria like E.coli, or
indicator groups (total coliforms, thermotolerant coliforms), because
the analytical procedures to quantify viruses and protozoa are more
difficult and costly. However, SODIS efficacy results for E.coli cannot
be directly extrapolated to other pathogen types. And the SODIS ef-
ficacy for E.coli underestimates the efficacy for less resistant patho-
gens (e.g., Vibrio Cholerae), but overestimates the efficacy for most Water quaility tests in Laos

14
 Technical aspects

Viruses perature, inactivation rates greater than 3-4 LRV can be expected for
the more susceptible viruses. Some virus concentrations may be
Major waterborne viruses include Rotavirus, Caliciviruses, Coxsacki- hardly affected by SODIS (LRV < 1), especially under unfavourable
evirus, Enterovirus (e.g., Poliovirus, Echovirus), Adenovirus, Hepatitis conditions (e.g., in water with much organic material and low tem-
A and E virus, Coronavirus and Astrovirus (SuSanA 2009). Viruses are peratures), and for the more resistant types.
responsible for a substantial share of total infections with diarrheal
disease. However, evidence suggests that rotavirus - which causes
most virus-related diarrhoea cases in children - is mainly transmitted Pathogen Log re- Reduction Time for Remarks Reference
via contaminated hands or other surfaces (Percival et al. 2004), duction of patho- 3 log re-
value gen con- duction
though drinking water is also a possible transmission route. (6h) centration (h)
(6h)
As infective viruses are often more difficult to quantify than bacteria, Bovine ro- 0.5-1 70% - 90% >20 Lab experi- (Wegelin et al.
there is less data available on the inactivation efficacy of SODIS for tavirus ments with cut 1994)
off filter for UV-
viruses than for bacteria. Furthermore, some of the available SODIS B
studies used bacteriophages as models for human viruses, instead
Coliphage 1 90% >15 Lab experi- (Wegelin et al.
of actual pathogens, and used experimental set-ups that are not rep- f2 ments with cut 1994)
resentative for the standard SODIS method in PET bottles (i.e., not off filter for UV-
B
cutting off the radiation in the UV-B range). Table 2 presents only data
that are believed to be representative for the standard SODIS meth- EMCV >0.5 Very low >50 Lab study with (Wegelin et al.
cut off filter for 1994)
od. UV-B
Wild <1 50% >30 Field study with (Dejung et al.
An early study on solar disinfection found that solar radiation affects coliphag- PET bottles 2007)
the encephalomyocarditis virus, bacteriophage f2 and bovine rotavi- es
rus in approx. in the same rate as bacteria, i.e. 3-4 log removal for 6 Polio Virus Very Very low >50 Lab study with (Fujioka &
hours, (Wegelin et al. 1994). This was also confirmed in later studies low cut-off at 360nm Yoneyama
or UV-B 2002; Silver-
for poliovirus (Heaselgrave et al. 2006), coxsackievirus, poliovirus and
man et al.
hepatitis A virus (Heaselgrave & Kilvington 2012), as well as for echo- 2013)
virus, coxsackievirus and poliovirus (Fujioka & Yoneyama 2002). How- Murine 1.3 95% 1.8 PET bottles (Harding &
ever, this high observed inactivation rate was probably caused norovirus Schwab 2012)
mainly by the small fraction of UV-B radiation in sunlight that reaches MS2 1-4 90-99.99% <6 - 33 PET bottles. (Fisher et al.
the earth’s surface. coliphage High values for 2012; Harding
swiss tap water, & Schwab
low values for 2012; Dionisio
Studies with SODIS using PET bottles (which block most of the UV-B Indian tap and Calado 2013)
radiation) yielded far lower inactivation rates (> 30 hours exposure groundwater in
time needed for 3 LRV for Rotavirus, corresponding to only 0.5 LRV the study by
Caldao
in 6 hours (Fisher et al. 2012)). A recent study investigating virus re-
Echovirus 1 90% >12 PET bottles. In- (Fujioka &
moval in PET containers indicates that the inactivation rate strongly
dian groundwa- Yoneyama
depends on the type of virus, and on the water composition (Dionisio ter. 2002; Dionisio
Calado 2013). Inactivation rates were higher in Swiss tap water than Calado 2013)
in tap and groundwater from Chennai, indicating that the higher lev- Coxsacki- Very Very low >50 Cut-off at (Fujioka &
els of dissolved organic material in the Indian groundwater hinder the evirus low 360nm Yoneyama
2002)
production of reactive oxygen species. Viruses that are more suscep-
tible to oxidants (bacteriophage MS2 and echovirus) were inactivated PhiX174 0-0.5 0 – 70% >12 PET bottles (Dionisio Cala-
bacterio- do 2013)
effectively in Swiss tap water (4 log removal in 6 hours), while inacti- phage
vation was much slower in water samples from India (1 log removal
Adenovi- Very Very low >40 PET bottles (Di- (Gall 2010; Di-
in 6 hours). More resistant viruses (bacteriophage Phi X174, adenovi- rus low onisio Calado onisio Calado
rus) were inactivated at even lower rates in all water samples. The dis- 2013) 2013; Silver-
man et al.
infection of viruses in this study was significantly faster at higher
2013)
temperatures, but more research is required to determine which vi-
ruses are efficiently inactivated at temperatures typically reached in Table 2: Inactivation of viruses

SODIS bottles in tropical countries (i.e., around 40ºC) for different wa-
ter compositions.

The values presented in Table 2 are derived from studies using PET
bottles or other set-ups that cut off UV-B radiation. Higher inactivation
rates observed for the full solar spectrum are not shown as they are
not representative of the standard SODIS method using PET bottles.

Based on these findings, it is difficult to postulate one single approx-

imate log-reduction value for viruses in real world SODIS applications.
Under favourable conditions in terms of water composition and tem-

15
 Technical aspects

Protozoa Other micro-organisms

The most important-diarrhoea causing protozoa are species of Gi- The effectiveness of SODIS against other pathogenic organisms was
ardia, Cryptosporidium, and Amoeba. Protozoa can form cysts or oo- investigated in several studies. The results for the inactivation of hel-
cysts that are typically very resistant to environmental stress, minth eggs (Ascaris suum) and two types of fungi are listed below.
including chemical drinking water treatment in some cases. While the
symptoms of diarrheal disease caused by protozoa are often less The reported results suggest that expected removal values are in the
acutely live-threatening compared to infections with viral or bacterial range of 1LRV only under typical SODIS conditions, though the re-
pathogens, Cryptosporidiosis is a serious health threat for immuno- sults for fungi are somewhat inconclusive, i.e., in Lonnen (2005) vs.
compromised persons, e.g., for people living with HIV/Aids. Haeselgrave (2010). Compared to bacteria, viruses, and protozoa,
these microorganism contribute only marginally to the health burden
Table 3 shows inactivation rates for protozoa. Cysts of Giardia species of waterborne diseases.
and other types of protozoa are inactivated by SODIS at approx. the
same rate as diarrhoea causing bacteria (Table 1). Cysts of Crypto- Pathogen Log re- Reduction of Approx. Reference
duction pathogen time for 3
sporidium species require a significantly higher irradiation dose than
value concentration log reduc-
E.coli. Amoeba are only significantly affected by solar UV radiation at (6h) (6h) tion (h)
temperatures above 50ºC. Ascaris 1 90% >15 (Heaselgrave & Kilv-
suum ington 2011)
Pathogen Log re- Reduction of Approx. Reference Fusarium 0.7 70% >20 (Heaselgrave & Kilv-
duction pathogen time for 3 solani ington 2010)
value concentration log reduc-
Candida albi- 1 90% >15 Heaselgrave 2010
(6h) (6h) tion (h)
cans (Heaselgrave & Kilv-
Giardia spp 2 - >3 99 – >99.99% <6-9 (McGuigan et al. ington 2010)
2006; Heaselgrave &
Kilvington 2011) Table 4: Inactivation of helminths and fungi
Crypto- 0.3 - >0.4 45- >92% >10 - 70 (Mendez-Hermida et
sporidium al. 2005; McGuigan
spp. et al. 2006; Mendez-
Hermida et al. 2007;
King et al. 2008;
Gomez-Couso et al.
2009; Heaselgrave &
Kilvington 2011)
N.Guberi 3.6 > 99.99% <6 (Heaselgrave & Kilv- Box 4: Pathogen removal capacity of SODIS
ington 2011)
• The SODIS method, if applied correctly, substantially increases the safe-
Entamoeba 1.9 < 99.99% >9 (Heaselgrave & Kilv- ty of drinking water. Substantial reduction of pathogen concentrations
invadens ington 2011)
can be expected for pathogenic bacteria and for certain types of proto-
Acanthamoe- Inactivation (Lonnen et al. 2005; zoa. For Cryptosporidium, Amoeba and most viruses, a substantial inac-
ba polyphaga only > 50ºC Heaselgrave et al. tivation can only be expected under favourable conditions (high water
/ histalogica 2006; Mtapuri- temperatures for protozoa, high steady state concentration of reactive
Zinyowera et al. oxygen species for viruses, and high irradiation dose).
2009)
• The inactivation rate for bacteria in real field applications of SODIS is
Acanthamoe- >2 > 99% <9 (Heaselgrave & Kilv- comparable to chlorination and ceramic filtration. In the classification of
ba castellanii ington 2011) HWTS systems based on performance targets proposed by the WHO
(2011), SODIS would likely be ranked as an ‘interim’ solution, though this
Table 3: Inactivation of protozoa
depends on the specific indicator organisms selected for the evaluation.
• The exponential relationship between irradiation dose and log removal
value means a fraction of the pathogen population - also bacteria - may
survive the SODIS treatment if initial concentrations are very high. SO-
DIS does not completely sterilize the water. Many non-pathogenic mi-
croorganisms and algae are not affected by solar radiation, and survive
the SODIS treatment.

Box 5: UV-Index
The UV-Index is an indicator designed to inform the public about UV
intensity and to help them choose the appropriate protection from
sunburn and skin cancer. The UV-index is calculated from the UV-radiation
intensity in a given location weighted for the damaging effect of different
wavelengths on the human skin. Radiation in the lower wavelength range
(UV-B) is more harmful than radiation of longer wavelengths (UV-A), and,
therefore, has a greater weight in the UV-index. The intensity of UV-B
varies more strongly than visible light and UV-A radiation depending on,
e.g., season, altitude, ozone layer, and zenith angle. This means that the
UV-index is not an ideal proxy for the potential efficacy of SODIS, and is
not reliable as a guide for SODIS users to adapt exposure times. Local
weather conditions (sunny/cloudy) is a better guide for practical purposes
in most cases.
Examining petri dishes

16
 Technical aspects

2.2.2 Irradiation intensity 350-

450 nm
UV UV-A UV&Vis 200-1100
nm
Full
spectrum
The most important determinant of the rate of pathogen inactivation
Dose (Wh/m2) 555 270 263 2816 4764 5667
in the process of solar disinfection is the intensity of solar UV radia-
Dose (MJ/m2) 2.00 0.97 0.95 10.14 17.15 20.40
tion. Figure 1shows a typical inactivation curve for E.coli concentra-
tions as a function of the cumulative irradiation dose, also called Dose (J/cm2) 199.8 97.4 94.7 1013.8 1715.0 2040.0

fluence. After a shoulder or lag period during which the concentration Intensity (6h) 93 45 44 469 794 944
of viable cells remains more or less constant, the concentrations of W/m2
viable cells drop exponentially as a function of the received UV dose. Intensity (5h) 111 54 53 563 953 1133
W/m2

Table 5 Estimated threshold irradiation dose (and corresponding irradiation inten-

sity values for a 5 or 6 hours exposure period), for different wavelength ranges

The exposure time required to reach the threshold dose of solar ra-
diation mainly depends on the location and weather conditions. Aver-
age daily doses of UV radiation are displayed on the map below.
Between 30 degrees latitude North and South, the average daily UV
doses are > 1.3 times higher than the required threshold dose for SO-
DIS, except for regions with frequent cloudy or rainy weather.

Table 6 presents SODIS efficacy results for bacteria, and E.coli in

particular, as a function of the irradiation dose. Note that different
studies report doses or irradiation intensities for different wave-
Figure 1: Inactivation curve of Escherichia coli exposed to sunlight (350–450 nm)
on three different days at a constant temperature of 37°C (Berney et al. 2006) length ranges, which means that the results cannot be directly
compared. This table aims to provide a better idea of the efficacy
In spite of the critical importance of the irradiation dose for the effi- results that can be expected in practical applications based on the
cacy of SODIS, it is difficult to postulate a minimum dose required for available studies, rather than the definition of a single ‘true’ thresh-
effective disinfection. On the one hand, this is because different ad- old value, though most studies suggest that the recommendation
ditional factors influence the treatment efficiency, including type, or- of at least 6h exposure in tropical countries for 3 log reduction of
igin and physiological state of pathogens, water temperature, and bacteria is realistic. Possible reasons for the observed differences
water composition. On the other hand, different experimental set- other than irradiation dose in the cited studies may relate to factors
ups applied in available studies on SODIS make it difficult to directly that are discussed in the following sections. Lab studies relying on
compare observed inactivation rates. irradiation intensities much greater than those occurring naturally
may produce results that are not representative for real life SODIS
For example, studies were conducted with natural sunlight (varying applications (Bosshard et al. 2009).
according to season, location, and time of the day) or artificial lamps
and filters with different radiation spectrums. Irradiation doses are re-
Box 6: Recommended exposure time
ported either for the full solar spectrum or only for part of the spec-
• Based on the data inTable 5, a recommendation for minimal exposure
trum (e.g., UV, UV-A), or as an intensity (average, peak, or range) for time of 6 hours on sunny days in tropical countries was formulated. In
a certain treatment time. A comprehensive model for the efficacy of order to increase the safety margin, and to prevent impatient SODIS us-
SODIS in relation to the irradiation dose and other influence factors ers from shortening the exposure time to less than 6 hours, we recom-
does not exist. mend the promotion of a minimal exposure for a full day even under
sunny weather conditions.
–– 1 day of exposure to direct sunlight on mostly sunny days (less than
In the absence of such a model, this manual aims at providing a dif- 50% cloud cover)
ferentiated picture of the dose-response relationship by listing the –– 2 full consecutive days of exposure to direct sunlight on mostly cloudy
days (more than 50% cloud cover)
range of inactivation rates reported in SODIS studies. The log reduc-
–– On days of continuous rainfall, SODIS is not performing effectively
tion values postulated and minimal exposure time for effective treat- and should not be used
ment (3 log reduction for pathogenic bacteria) in Chapter 2.2.1 above
are based on these data, assuming typical irradiation intensities in • Given the key role of radiation intensity for a high disinfection rate, it is
very important to adhere to the recommendations for the duration of so-
tropical and subtropical (up to 35˚ latitude) countries.
lar exposure. In locations closer to the equator and in summer months,
the solar irradiance can easily exceed the required intensity. This repre-
Wegelin et al. (1994) postulated a threshold dose for 3 log inactiva- sents a safety margin that ensures effective disinfection even for short-
tion of bacteria of 555 Wh/m2 in the range of 350-450nm. Table 5 pre- er exposure times. In winter months and in locations further away from
sents corresponding doses for different wavelength ranges calculated the equator, this safety margin becomes smaller. In this case, the temp-
tation to shorten the exposure time, e.g., to drink treated water after
using a model spectrum (ASTMG173). The table also provides corre-
lunch or to treat two batches of water in a day with the same bottles,
sponding values for average irradiation intensities to reach the holds a high risk of infection because the water is only partially disinfect-
required dose, assuming an exposure time of five or six hours, re- ed. Adherence to the application guidelines is, thus, critically important
spectively. Note that the fraction of UV radiation as part of the full and must be stressed in the promotion.
spectrum may deviate significantly from this model spectrum de- • Note that these guidelines do not apply to regions beyond 30 degrees
latitude North and South, where solar intensity can be much lower, par-
pending on location and season. Threshold irradiation doses present-
ticularly in winter.
ed below are, thus, only rough estimates.

17
 Technical aspects

Author Irradia- Wave- Dose Intensity Result (selected pathogens) Remarks Comparison
tion length with Wegelin
type range re- 1994
ported
(Wegelin et Simulat- 350- 555 111 W/m2 3- 4 LRV =
al. 1994) ed sun- 450nm Wh/m2 in five hours for E. coli and St. faecalis,
light
(Heasel- Simulat- Wave- 150W/m2 E.coli: 5.7 log reduction after 4h wave- Not compara-
grave & Kilv- ed sun- length length ble, wave-
ington 2010) light range not range un- length range
specified clear not specified

(Bosshard et Simulat- 350- various E.coli: Loss of culturability (0.1 % surviv- =

al. 2009) ed and 450nm al) at 1700kJ/m2
natural
sunlight

(Dejung et al. Natural UV-A (320- UV: 16.9Wm2 (average day) Postulated minimum UV-A dose for 3LRV Mean wa- ++
2007) sunlight 400nm) vegetative bacteria incl. E.coli: 60Wh/m2 ter tem-
( 4h on average days) perature
44 de-
grees
(Fisher et al. Natural UV-A (320- 73W/m2 (calculated) 3 log reduction of lab cultured E.coli in 3h, Lab cultured: =
2012) sunlight 400nm) 3 log reduction of wastewater derived W-derived: -
E.coli in 7h

(Reed 1997) Natural Not speci- 600-750W/m2 (full spectrum?) E.coli: 6log inactivation in 3h under aero- Tempera- Not compara-
sunlight fied: Full bic conditions ture < 28 ble, wave-
spectrum? Enterococcus feacalis: similar degrees length range
not specified

(McGuigan Simulat- 20200 700 W/m2 (corresp. sunny weath- 3 log inactivation -
et al. 1998) ed sun- KJ/m2 er) 2.5 log inactivation
light, 11500 400 W/m2 (corresp. to partly 2 log inactivation
300- KJ/m2 cloudy weather)
1020nm: 2900 100 W/m2 (corresp. to overcast
KJ/m2 conditions

(Lonnen et Simulat- 300- 200W/m2 E.coli: 5.5 log inactivation in 2.5h Higher intensi-
al. 2005) ed sun- 400nm ty than Wege-
light lin
(Berney et al. Natural 350- 2400 E.coli: 3 log reduction requires 2000kJ/ =
2006) sunlight 450nm KJ/m2 m2
in 6-7h

(Boyle et al. Natural 295-385 Maximum noon intensity: >1000 Dose of 125 kJ/m2 (295-385 nm) re- +
2008) sunlight nm W/m2 (full spectrum) quired for 2 log inactivation of E.coli
Time for 4-log-unit reduction: C. jejuni, 20
min; S. epidermidis, 45 min; enteropatho-
genic E. coli, 90 min; Y. enterocolitica, 150
min.

(Ubomba- Natural 295-385 Complete inactivation at 108 KJ/m2 (UV) ++

Jaswa et al. sunlight nm
2009)

(Kehoe et al. Natural 300- Full inactivation at 4-5 Mj(m2 High wa- Not compara-
2001) sunlight 20000nm ter tem- ble due to syn-
perature! ergistic effect

Table 6: SODIS efficacy as a function of irradiation dose

18
Technical aspects

19
 Technical aspects

2.2.3 Place and position of bottle 2.2.4 Material and size of bottles
exposure Due to the wide availability of PET bottles in low- and middle-income
The penetration depth of UV-light depends on the position of the bot- countries, the SODIS method was specifically designed and widely
tle in terms of exposure to sunlight. Penetration depth is minimal - tested with this type of container. Other types of containers can also
and treatment efficacy maximal - if the bottles are placed lying down, be used for solar disinfection for drinking water purposes as long as
and at a slight incline so that the sunlight hits them at a favourable they fulfil two key requirements: high transmittance for UV radiation
angle (ideally 90 degrees). As the position of the sun shifts during the and no migration of potentially harmful substances into the water.
day, the bottles should be placed so that the penetration depth is low
on average throughout the course of the day, which is usually the As the UV transmittance and safety cannot be easily evaluated by the
case if the bottles are placed horizontally. Readjusting the inclination water users themselves, we generally do not recommend using con-
of the bottles during the day is neither practical, nor necessary. tainers made of other materials, especially plastic bottles not made
from PET, unless they have been certified and specifically approved
for SODIS use. UV irradiation intensity decreases significantly with
penetration depth in the water column, even in clear water. SODIS
efficacy is, thus, higher in smaller bottles (Dessie et al. 2014). This ef-
fect is all the more important if the water contains suspended parti-
cles or dissolved organic material that absorb UV radiation (see
below). For this reason, it is recommended to use bottles that are not
larger than 2l in volume, with a maximum penetration depth of 10cm.

PET (Polyethylene terephthalate) is an inert plastic material that is

widely used for food packaging. ‘Plastic’ bottles used for water and
soda are almost exclusively made of PET. Only a small fraction of the
SODIS bottles in Cameroun widely available transparent ‘plastic’ bottles are made of other mate-
rials, such as PVC, and these bottles are mostly used for liquids such
More important than the inclination is that the bottles receive direct as edible oil rather than for water and soft drinks. PET bottles are la-
sunlight during the entire exposure time and are not shaded by hous- belled with the symbol “1”, though this label is sometimes missing
es, trees or other objects when the sun’s position shifts during the on bottles of local brands of bottled water. PVC (Symbol 3) can be dis-
day. Finding such suitable places can be a challenge, especially in tinguished from PET Bottles through a flame test: PET burns more
densely populated urban areas or in villages with dense vegetation easily and produces a sweet smoke, while the smoke of PVC is pun-
cover, but the exposure to direct sunlight is not an application factor gent. Bottles made of polycarbonate (PC: a durable sturdy plastic typ-
that can be compromised or relaxed. ically used for feeding milk bottles, Symbol 7) must not be used for
SODIS because they potentially release BPA, a carcinogenic com-
The surface on which bottles are placed is of secondary importance. pound not found in PET.
Treatment efficiency can be slightly increased if bottles are exposed
in a warm place, i.e., protected from wind cooling or on a dark back-
Box 7: SODIS with glass bottles
ground, or on a reflective surface, such as a metal sheet. The accel-
• Different types of glass have different chemical and physical properties.
erating effect of dark or reflective backgrounds is in the range of
Certain types (e.g., quartz glass) have a very high transmittance for UV
<30% (e.g., Mani et al. 2006) and, thus, not high enough to justify a radiation, while other types (e.g., window glass) effectively filter out this
reduction of the recommended exposure time. Due to the limited in- part of the solar spectrum. All commercial glass bottles used for bever-
crease of disinfection efficacy relative to a substantial increase in the ages that were tested so far at Eawag had a UV transmittance compara-
complexity of the SODIS method, an early recommendation to paint ble to PET bottles, and were, thus, suitable for SODIS. No differences
were found in studies of glass and PET bottles that compared their SO-
the back side of the bottles black is no longer promoted.
DIS effectiveness ( (Asiimwe et al. 2013).
• It is possible, however, that certain glass bottles available in target coun-
More sophisticated technical systems to increase radiation dose or tries have different UV transmittance properties, and we recommend
temperature, e.g., solar collectors, may significantly increase the testing UV transmittance of locally available bottles before promoting
treatment efficacy and shorten the required exposure time. None of them widely for SODIS use. Glass bottles also have certain disadvantag-
es compared to PET bottles which include their greater weight and risk
the devices designed so far have been promoted at scale at this point
of breaking, limited availability in suitable sizes, and the lack of reusable
(see chapter 2.3). caps.

20
 Technical aspects

Figure 2: Typical transmittance spectrum for PET bottles

The transmittance of PET for UV-A radiation is relatively high, espe-

cially in the longer wavelength range (see Figure 2). The absorption
of most of the UV-B radiation by the bottle material is a limitation to
the effectiveness of SODIS, especially in regard to the inactivation of
viruses. However, the use of containers with a higher UV-B transmit-
tance rate (e.g., bags made of PE) for solar water disinfection at large
SODIS bottles in India
scale would require a supply chain build-up of for new products, such
as containers made from properties that are not yet widely available.

Box 8: Safety of using PET bottles

Colorants in PET bottles can decrease the transmittance of UV-A ra-
• Certain types of plastics contain and leach chemical compounds that are
diation. While some blue colorants only insignificantly affect the UV-
harmful to human health, such as Bisphenol-A, that leaches from rigid
transmittance, brown or green colour additives effectively block most plastic bottles made of polycarbonate. It is, thus, important to carefully
UV radiation. As a general recommendation, only colourless, trans- evaluate all potential health concerns associated with the (re-)use of PET
parent bottles should be used for SODIS. All bottles with a light blue bottles for SODIS. Nobody wants to substitute one serious health risk -
tint tested by Eawag exhibited a high UV-transmittance, and these from infection with diarrheal disease - with another related to chemicals
leaching from bottles into the water.
bottles can, thus, be used for SODIS. Chemical UV-blockers are
• Available data indicates that there is no significant health risk related to
sometimes added to PET for the purpose of protecting sensitive con- the release of chemicals from PET bottles. E-mails warning of health
tents, such as cosmetic products, fruit juice, or beer. However, high risks related to the consumption of water from ‘plastic’ bottles left in the
costs and problems with the recyclability of PET bottles that contain sun have been circulating for years and will probably continue to do so.
additives have so far limited the use of UV-blockers even for these liq- Compounds like Bisphenol A or dioxin that are sometimes associated
with ‘plastic bottles’ in these e-mails are not used in the production of
uids. There is no reason to assume that UV-blockers will ever be add-
PET. The claim that the consumption of water stored in PET bottles (new,
ed to bottles used for water or soda. re-used, or exposed to sunlight) causes cancer is not supported by any
scientific evidence.
• The available scientific studies show that solar exposure and the corre-
sponding increase of water temperature can slightly increase the rate of
migration of organic substances into water. However, the concentra-
tions of these substances after SODIS treatment were still in the same
order of magnitude as were the controls in dark storage, and well below
WHO drinking water guideline values. This was shown for two com-
pounds suspected of leaching into the drinking water from PET bottles
[two plasticizers: DEHA and DEHP; (Schmid et al. 2008)]. A similar study
conducted in India by IIT Chennai found the same results for different
PET bottles used for SODIS (new bottles and bottles used previously for
SODIS, big brands and local brands, unpublished report), and in Pakistan
(Mustafa et al. 2013). Other studies investigating the migration of organ-
ic compounds from PET also did not find any reason for concern (Franz
& Welle 2009; Ubomba-Jaswa et al. 2010; Guart et al. 2011; Bach et al.
2013, 2014) though uncertainties remain related to analytical procedures
and the quality of PET raw materials (Keresztes et al. 2009; Bach et al.
2012). Antimony, a catalyst in the PET production process, migrates into
the water at significant rates only in the case of very high temperatures
(> 60 degrees Celsius) and/or long storage times (Westerhoff et al.
2008; Andra et al. 2011; Welle & Franz 2011; Rungchang et al. 2013;
Sanchez-Martinez et al. 2013).
• Overall, the scientific evidence indicates that the health risk for SODIS
users from using PET bottles is very low, and in the same order of mag-
nitude as the risk to people from consuming beverages from regular PET
bottles without solar exposure.

21
 Technical aspects

There is no simple indicator available to SODIS users to determine

2.2.5 Turbidity and dissolved the level of organic material in water. Dissolved organic material can
organic matter be removed to some degree by coagulation/filtration processes, but
Suspended particles in the water absorb and scatter radiation in the this relies on the availability of coagulants and requires an additional
visible and UV range and can, thus, reduce the disinfection effective- treatment step.
ness of solar radiation. Sommer, Marino et al. (1997) found that at a
turbidity level of 26 NTU (Nepherometric Turbidity Units), the intensi-
ty of UV radiation is decreased by approx. 50% after 10 cm penetra-
tion depth, compared to 25% reduction in clear water. The part of
radiation that is scattered by the suspended particles is not lost, and
can still produce reactive oxygen species that inactivate pathogens.
Other studies also showed that the pathogen removal rate of SODIS
decreases with the increasing turbidity of water (McGuigan et al.
1998; Kehoe et al. 2001; Gomez-Couso et al. 2009). The high disinfec-
tion efficacy in highly turbid water observed in some cases may be
attributable to thermal inactivation as a result of the absorption of IR
radiation and not due to photochemical reactions.

Estimating the water turbidity

2.2.6 Oxygen content

The damaging effect of UV-A radiation to cell structures is mediated
by the reactive oxygen species (ROS) that are produced by photosen-
sitizers. Photosensitizers are either dissolved organic compounds
(exogenous pathway), or molecules of the pathogenic cell itself (en-
dogenous pathway). Due to the critical role of ROS, the SODIS pro-
cess does not perform efficiently in anaerobic (oxygen free) water. At
50% oxygen saturation, the disinfection rate for E.coli and Enterococ-
cus faecalis is approximately half the rate at full oxygen saturation
(Reed 1997). Early SODIS application guidelines recommended shak-
ing partly filled bottles for oxygen saturation before solar exposure.
Figure 3: Effect of turbidity on radiation intensity, for different water depths. This recommendation is no longer upheld as shaking the bottles com-
Source: (Sommer et al. 1997) plicates the process and water is oxygenated during the process of
filling the bottles prior to solar exposure.
Based on these studies a turbidity level of 30 NTU was postulated as
a threshold for the upper limit for effective SODIS treatment. Water
with higher turbidity should be pre-treated, e.g., through settling and
decanting, cloth or sand filtration, or flocculation. In areas where
drinking water is turbid – both below or above 30 NTU – the use of al-
ternative water treatment methods, which also improve water aes-
thetics, should be considered, as these are likely to appeal to users
and hence would have higher uptake and sustained use.

The threshold turbidity value of 30 NTU can be estimated using a sim-

ple test: if the font of a typical newspaper headline is still readable
vertically looked at through the mouth of a full bottle, the turbidity is
lower than 30 NTU.

Dissolved organic material, i.e., large molecules, such as humic ac-

ids, can also decrease the potential disinfection efficacy of SODIS.
Dissolved organic matter can both directly absorb UV-A radiation, act-
ing as an internal UV filter, and quench reactive organic species (ROS)
that cause damage to the pathogenic organisms. The opposite ef-
fects of dissolved organic matter - i.e., producing and quenching ROS
- are not fully understood and may vary considerably depending on
the type and concentration of the organic material (Wilson & An-
drews 2011). Some dissolved organic compounds absorb light in the
Figure 4: Effect of oxygen concentration on the rate of inactivation of Escheri-
visible range and, thus, act as colorants in the water, while others do chia coli (o) and Enterococcus faecalis ( ). Air-equilibrated water (100%) con-
not change the water’s appearance. tained oxygen at 8.4mgL-1 Source: (Reed 1997)

22
 Technical aspects

2.2.7 Water temperature 2.2.8 Re-growth

Pathogenic microorganisms are inactivated by high temperatures in The available literature does not provide a conclusive picture as to
the absence of UV radiation (pasteurization). The temperatures at whether pathogens do recover from the effects of solar radiation or
which pathogens are killed within 60 minutes vary between species increase in number after solar exposure, and under which conditions
and are in the range of 45ºC (Vibrio cholerae) to 63ºC (Enteroviruses) this could be expected. Based on lab experiments, Bosshard et al.
(Berney et al. 2006). Even below pasteurization temperatures, the ef- postulate that the damage done to the cell as an effect of UV-A radia-
ficacy of SODIS significantly increases with higher temperatures. Be- tion is irreversible. Several studies found no re-growth after SODIS
low approximately 45ºC, the temperature dependency of inactivation treatment (McGuigan et al. 1998; Boyle et al. 2008; Bosshard et al.
rates is weak and approximately linear (Wegelin et al. 1994; Fisher et 2009; Dessie et al. 2014). Wegelin at al. (1994) observed a regrowth
al. 2008). At 50ºC, the required irradiation dose and/or exposure time of E.coli to original concentration within one week after a short (32
are reduced by as much as two thirds (Wegelin et al. 1994), or a 3 log min) irradiation with artificial light, but no re-growth after 3 hours of
difference of pathogen reduction compared to the calculated sum of irradiation with sunlight. Amin and Han (2009) observed only very
the individual effect of radiation and heat (Theitler et al. 2012). This limited regrowth of E-coli and total coliforms even for moderate treat-
means that at favourable conditions - hot weather, strong irradiation ment efficacy under weak sunlight conditions. Rincon and Pulgarin
– complete disinfection can be achieved faster than within the recom- (2004a) observed re-growth of E-coli to initial levels within 24 hours
mended exposure time of one day (6 hours minimum). after irradiation. Gelover, Gómez et al. (2006 ) found moderate re-
growth of total coliform within the first day after SODIS treatment.
However, water users cannot easily determine the water tempera- Sciacca, Rengifo-Herrera et al. (2010) observed re-growth of Salmo-
ture inside SODIS bottles. Therefore, it is not recommended to short- nella sp. reaching initial concentrations within 18 hours after treat-
en the exposure time even if irradiation conditions and temperature ment, and further growth by about 1 log thereafter. AL-Gheethi, Norli
seem favourable. We also do not recommend shortening the expo- et al. (2013) found decreasing concentrations of bacteria when the
sure time if bottles are placed on a dark surface to maximize the ther- SODIS treated water was stored at room temperature, but re-growth
mal effect. if the treated water was stored at 37ºC. The presence of nutrients in
the water and the origin (wild vs. laboratory cultured) and physiologi-
cal state (steady state or exponential growth state) of pathogens are
believed to influence if and to what extent bacteria populations can
recover from solar irradiation. As E.coli and other faecal bacteria do
not typically multiply in the environment (except, e.g., Salmonella),
the apparent re-growth in water samples could indicate an incom-
plete inactivation and sub-sequent repair of cells or could relate to the
analytical procedures overestimating the inactivation effect (Reed
2004; Khaengraeng & Reed 2005).

Re-growth or recovery as reported in some of these studies would

seriously compromise the viability and potential health impact of the
SODIS method. Water quality tests conducted in many SODIS pro-
motion projects did not produce evidence for considerable re-growth,
and instead indicate a substantial improvement of water quality. And
yet, based on the inconclusive evidence, the re-growth of bacteria in
Figure 5. Inactivation curve of faecal coliforms in glass bottles, water turbid-
ity 17 NTU display synergistic effect of UV-irradiation and temperature above
SODIS treated water must be considered as a potential limitation to
50°C. Source: (Sommer et al. 1997) the efficacy of SODIS and could have health impacts in real life appli-
cations. While the reasons and conditions for re-growth or revival are
not yet completely clear, it is advisable to store SODIS treated water
in a cool place and to consume it within a short time (a few hours up
to one day) after treatment.

Proposed measures to inhibit re-growth, e.g., adding H2O2 or TiO2 to

the water (Rincon & Pulgarin 2004b) may be technically viable, but do
not seem realistic in practice due to the increased complexity of the
treatment process, and the need to establish supply chains for such
additives. If a chemical substance is added to the water, it may as well
be one that disinfects the water without creating an additional need
for irradiation (e.g., chlorination).

Family applying SODIS in Laos

23
 Technical aspects

4. Additives
2.3 Advanced designs A number of additives have been studied that can enhance the
A number of technological designs have been proposed to in- treatment efficacy of SODIS, including TiO2 or H2O2 (Byrne et al.
crease the technical efficacy or practical aspects related to the SO- 2011). Some of these additives substantially enhance the treat-
DIS method. As none of these designs have yet to evolve into ment effectiveness. There are two major constraints, however, to
widely promoted commercial products, they are only briefly ad- their being widely promoted and used in target countries. First, the
dressed in this manual (for a review, see McGuigan et al. 2012). addition of a substance to the water significantly complicates the
While potentially more effective and attractive than PET bottles, process for the user, while the additional benefit is limited. Even if
the marketing of advanced SODIS products will have to address exposure times can be reduced to only one to two hours, the la-
several challenges, including higher costs for water users and the bour input remains the same or even increases, and exposing the
need to establish sustainable supply chains and business models bottles for one to two (midday) hours is still a practical challenge
in target areas. Advanced designs based on solar disinfection, for people who work outside their homes. Second, the regular and
thus, do not share two of the main comparative advantages of the consistent use of a SODIS catalyst depends on the existence of
standard SODIS method, i.e., the very low or zero cost and the reliable supply chains for such a product, and relies on recurring
wide availability of required materials. The potential uptake of an purchases. There is no compelling reason for water users to buy
advanced SODIS container in relation to other water treatment and use a catalyst for solar disinfection, if they could just as well
products is at present unknown. buy and use a chemical disinfectant, e.g., chlorine, which directly
kills pathogens.
Generally, five types of technical advances can be distinguished.
5. Indicators
1. Simple local modifications for SODIS use in bottles One disadvantage of the SODIS method is that there is no visual
Different simple modifications have been proposed to increase the indication for water users to know when the water is ready for con-
efficiency of SODIS, including self-made solar reflectors to con- sumption. Technologies that measure UV radiation and that pro-
centrate sunlight, or boxes/covers for additional heating effects. duce a signal when the required dose has been received can help
While such modifications can somewhat accelerate the treatment to mitigate this constraint. Both electronic and chemical indicators
process, the magnitude of this effect is usually in the range of less are being designed and field tested. In addition to increasing us-
than 50%. Effectively motivating water users to construction and ers’ confidence in the effectiveness of SODIS, such indicators may
maintain such systems is considered challenging, and not justified add a certain modern or ‘high tech’ appeal to the method and coun-
given the limited effect. No commercial product has emerged so teract the perception of SODIS as a poor man’s solution.
far.

2. Bottle and bag designs

New types of containers for solar water disinfection could provide
different types of benefits compared to regular PET bottles. First,
a higher transmittance for UV radiation would increase treatment
efficacy (especially for viruses if transmittance for UV-B is high).
Second, less bulky containers, e.g., collapsible bags, could be
transported to target areas much more easily than empty bottles.
This would increase the scope of potential use for, e.g., disaster
relief operations, and makes business models for sales potentially
more profitable. Third, an attractive commercial product that offers
advantages compared to regular PET bottles (e.g., larger volume,
convenient outlet/tap, aesthetical appeal) is likely to be more val-
ued and more consistently used by target households. Designs for
SODIS bags are currently being field-tested.

3. Solar disinfection reactors

The idea of using solar radiation for the treatment of larger water
volumes – typically a few hundred litres a day – for sale or distribu-
tion at the communal level has been pursued in a number of re-
search groups (e.g., Gill & Price 2010; Kalt et al. 2014) The design
of a reliable solar disinfection reactor system (batch or continuous-
flow) is technically challenging for a number of reasons, including
cleaning. The material and construction cost of solar reactors and
the need for operation and maintenance may also be significant
and, thus, limit the cost-effectiveness of solar reactors compared
to other technologies used to treat large volumes of drinking wa-
ter (including chlorination).

24
Technical aspects

25
 Technical aspects

2.4 Implications for the Turbidity and dissolved organic matter

application of the SODIS • Use SODIS for water with no or very low turbidity (maximum 30
NTU)
method • Pre-treat turbid water before SODIS, e.g., by filtration, flocculation
The SODIS method, if applied correctly, substantially increases the or settling.
safety of drinking water. It can effectively inactivate diarrhoea caus-
ing bacteria and - to a lesser extent - pathogenic viruses and protozoa. Water storage
The following list summarizes the key implication for the application • Store SODIS water in the SODIS bottles themselves, as this reduc-
of the SODIS method. es the risk of re-contamination.
• Water should not be stored for long periods to minimize the risk of
Irradiation intensity bacterial re-contamination or re-growth. Consumption within a day
• Expose bottles for a full day (minimum of 6 hours including noon or two is recommended.
hours) on sunny days (less than 50% cloud cover). Expose bottles • Water should be consumed directly from the bottles, or poured into
for 2 consecutive days during mostly cloudy days (more than 50% a clean cup or glass. If another container is used for storage and/or
cloud cover). Do not use SODIS on days of continuous rainfall, or cooling, the guidelines for safe storage must be followed: clean
in very foggy conditions. container, narrow opening, lid to cover the opening, water stored
• Make sure bottles are exposed to direct sunlight during exposure away from animals and small children, and withdrawal through a
and are never shaded by trees, houses or other objects. Expose tap/spigot integrated in the storage container or with a clean ladle.
bottles horizontally, or slightly inclined, so that the penetration
depth for radiation is minimized (long side facing the sun).

Material and size of bottles

• Use bottles made of PET (other containers should be used only if
they are specifically approved for solar disinfection)
• Use only bottles up to 2l of volume, i.e., that allow for a short pen-
etration depth for UV radiation

Application of SODIS in India

26
27
 Promotion of the SODIS method

3 Promotion of Study

(Rainey &
Adoption rate

10% routine adoption

Remarks

Very small sample

the SODIS method Harding

2005)
(n=40 HHs)

(Christen et 32% compliance (total Multi-parameter indicator for SO-

This chapter addresses key factors contributing to the successful al. 2011) sample: 216 HHs) DIS compliance used
promotion of the SODIS method and it highlights lessons learnt (Heri & Mos- 60% self-reported SO- SODIS water amounted for only
from SODIS projects in more than 30 countries in Africa, Asia and ler 2008) DIS users (n= 644HHs) 33% of the water, many SODIS
Latin-America. It does not prescribe a specific one-size-fits-all ap- users also used boiling
proach. (Mosler et al. 65% SODIS use if Data collection six months after
2013) household training were the promotion, adoption lower in
The chapter presents: evidence of uptake, the sustainability of the conducted (n= 364 HHs) areas with other promotion strat-
egies
health impact of SODIS projects (chapter 3.1), the important ele-
ments of the planning phase of a SODIS project (chapter 3.2), how (Tamas & 45-59% SODIS water Adoption depending on promo-
Mosler consumption (n=337 tion strategy, 32% SODIS water
behaviour change factors can be addressed (chapter 3.3) and the
2009) HHs) consumption in the control group
promotion tools that were applied successfully (chapter 3.4).
(Graf et al. 69% of children con- Multiple answers possible: 53%
2008) sume SODIS water also reported consumption of
(n=717) boiled water, 23% reported raw
3.1 Evidence on uptake, water consumption

sustainability, and health Table 7: Uptake of SODIS

impact
early, middle, and late adopters, and that different motivational fac-
The studies related to uptake, sustainable use and the health im- tors are particularly relevant for each of these groups (e.g., Moser
pact of SODIS show that the challenges faced by SODIS users are & Mosler 2008; Tamas & Mosler 2011).
not unique, but are rather typical for the most common HWTS
methods. Scientific studies testing the effect of different promotion ap-
proaches on uptake yielded valuable insights:
• Altherr, Mosler et al. (2008 ) highlight the importance of a favour-
3.1.1 Evidence on uptake able attitude, while the intention to use also depends on perceived
Most of the available information about the uptake of SODIS social pressure and actual use on action knowledge.
stems from monitoring data from promotion projects that were • Christen, Pacheco et al. (2011) reported that the frequency of pro-
typically collected by the implementing organizations at the end motional interactions, the gender of household members, owner-
of a promotion phase. This monitoring data, however, has to be ship of a latrine, and the presence of malnourished children
carefully interpreted as the reporting biases because of the water correlated with higher SODIS uptake.
users, field workers, and implementing agencies could affect • The study of Heri and Mosler (Heri & Mosler 2008) highlighted the
the quality of the data by exaggerating the impact of the project. importance of frequent promotional interactions, and found statis-
Also, the monitoring data only provides an understanding of the tically significant correlations with SODIS use for the following be-
situation over a short-term and does not allow for extrapolations haviour change factors: daily tasks and habit, the descriptive norm
concerning long term use rates. (practice by relevant peers), perceived threat of diarrhoea, per-
ceived benefits of SODIS (cost savings, better taste) and the avail-
In projects supported by Eawag, application rates ranged from very ability of PET bottles in sufficient numbers. The intention to use
low uptake in some areas (particularly when SODIS was promoted SODIS was strongly determined by affective beliefs in this study.
along with other HWTS options) to nearly 100% SODIS use in pi- • Kraemer and Mosler (2010) found that the intention to use SODIS
lot projects with a high promotion intensity and favourable condi- increases if it is easier for people to remember to use SODIS, if
tions. The average adoption rates were in the range of 30-60% at they are convinced that untreated water is unhealthy, and if people
the end of a promotion phase, and typically dropped after promo- believe that others think positively about them when they use SO-
tion activities were discontinued. DIS (Kraemer & Mosler 2010).
• Moser and Mosler (2008) found that the involvement with the is-
The following table summarizes the adoption rates published in sue of safe water is particularly relevant for early adopters, while
scientific articles. Note that many of these results were generated middle adopters are influenced by different factors including opin-
in the context of SODIS promotion research projects where the ion leaders, and late adopters are more strongly influenced by the
main objective was to assess the effectiveness of promotion tools behaviour of the majority (Moser & Mosler 2008).
and the relevance of different influencing factors. The promotion • Graf, Meierhofer et al. (2008) found that biomedical knowledge of
methodology and resulting outcomes are not necessarily repre- the causes of young children’s diarrhoea, increased knowledge of
sentative for promotion campaigns implemented by governments the proper handling of water, stronger beliefs about the important
or NGOs. role of water in causing diarrhoea, and higher social norms con-
cerning water treatment were associated with the use of SODIS.
One important finding is that neither the adoption, nor the relapse, • Two studies investigated how psychological factors change from
are homogeneous processes, but that distinct patterns occur for initial uptake to long term use (or relapse), and suggested the fol-

28
 Promotion of the SODIS method

lowing recommendations for successful promotion: increase visi-

bility in the community, include daily routine planning as part of
3.1.2 Evidence on sustainability
household trainings and fostering remembrance of SODIS use by Sustained application of SODIS is a necessary condition for its health
distributing stickers and posters (Tamas & Hans-Joachim 2011 ; impact. It can be considered as the first step in the potential health
Mosler & Kraemer 2012). impact of a project.
• A study in Bolivia found that household visits by promoters were
more effective than promotion through opinion leaders or events A research project conducted by Eawag systematically addressed the
like health fairs (Tamas et al. 2009). long term application of SODIS use in different countries (Tamas et
• A study in Zimbabwe tested the effectiveness of different promo- al. 2011).
tion strategies, and found that interventions involving household
trainings through promoters were much more effective than cam- • In Nepal, long term SODIS user rates have been about 60% lower
paigns without promoters (Mosler et al. 2013). two to four years afterwards than at the immediate end of the pro-
• Tamas and Mosler (2009) compared different promotion approach- motion (21% vs. 60% SODIS users in the promotion areas). About
es and found that, including public commitments and prompts for two thirds of the people in these areas treat their water with one
remembering as promotion tools in the promotion conducted by or several HWTS methods, ceramic filters being the most common
health volunteers, schools and radio had a positive effect on up- technology. 50% of the households reported that they still mostly
take. or occasionally consumed untreated water.
• Meierhofer and Landolt (2009) and Gurung, Grimm et al. (2009) • In Indonesia, an average of 21% of the people were found to still
highlight key success factors for SODIS uptake based on non-re- use SODIS (thereof: 2/3 daily users ) up to five years after the pro-
search SODIS projects, including the commitment and authority of motion, but with high local variation. The application of SODIS was
promoters, promotion frequency, the visibility of SODIS used in only sustained in areas with continued promotion, while in other
the community, bottle availability, appropriate promotion materials, former project areas, all former SODIS users reverted back to boil-
and an enabling environment. ing, which was common in the area already before the SODIS pro-
ject. The highest long-term application rates of SODIS were found
in Bolivia with an average use of 62% several years after the pro-
motion, whereas many households use both SODIS and boiling.
• A study in rural Peru reported between 32% (observed) and 42%
(self-reported) SODIS use seven years after the promotion project
(Halperin et al. 2011)

Pupils in Bolivia learning how to treat their water with SODIS

29
 Promotion of the SODIS method

3.1.3 Evidence on health impact for-age measures in a SODIS intervention area reported that
children aged six months to five years were 0.8 cm taller on aver-
The ultimate goal of every SODIS or HWTS promotion activity is to age in households using SOIDS compared to children in the con-
reduce the health risks associated with diarrheal disease in the tar- trol group (95% confidence interval: 0.7 to 1.6 cm, P = 0.031) after
get population. Impact studies of HWTS projects mainly focus on one year of intervention (Du Preez et al. 2011). The same study also
the reduction of diarrhoea incidence or infection risk ratios, either found a tendency that children from SODIS households were heav-
before and after an intervention, or by comparing the intervention ier than those drinking raw water on average (Median weight-for-
population to a control group. age: higher by average of 0.23 kg over a 1-year period in the SODIS
group (95% confidence interval: 0.02 to 0.47 kg, P = 0.068).
A meta-analysis of high quality studies found an average 44% risk
reduction of diarrhoea disease due to interventions to improve wa- Considering the methodological challenges in assessing and inter-
ter quality at the household level [95% confidence interval: 0,48– preting health impact data, it is recommended that health impact
0,65 (Waddington & Snilstveit 2009)]. However, the observed studies be conducted only by professional epidemiologists. Quan-
health impact varies considerably across the different studies. SO- titative studies that do not effectively control for bias or qualitative
DIS health impact studies yielded risk reduction values in a similar health impact studies conducted as part of the monitoring and
range, with studies measuring no statistically significant effect evaluation process of promotion projects are likely to produce dis-
(Mausezahl et al. 2009) to studies showing more than 80% risk re- torted and unreliable results. Data on diarrhoea cases from health
duction for cholera among children below 5 drinking SODIS treated centres and hospitals are less bias-prone than self-reported diar-
water (Conroy et al. 2001). An overview of results from SODIS rhoea incidence, but are also limited as indicators for the health im-
health impact studies is summarized in Table 8: Results from health pact of a project (inconsistent data quality, mismatch between
impact studies in SODIS promotion areas. areas reported to be covered by the health centre and the project,
and normal seasonal and inter-year fluctuations that need to be
There are different reasons for the large observed variance. First, considered in longitudinal comparative analyses).
pathogens that can cause diarrheal disease in humans are trans-
mitted through different pathways. The relative dominance of the
different transmission routes can vary substantially from one loca-
tion to the next, and is typically neither known, nor easily measur-
able. SODIS (and other HWTS methods) can only prevent infections
with diarrheal disease that are caused by contaminated water. The
greatest health impact resulting from SODIS promotion can, thus,
be expected in areas where diarrhoea is mainly transmitted by
drinking water. In contrast, in a location with relatively good raw
water quality, but widespread open defecation and inadequate hy-
giene, the potential health impact of SODIS is limited. Another rea-
son for the variable health impact findings relates to the technical
limitations of different methods for different pathogen types. Tech-
Box 9: Measuring health impact
nologies with a limited pathogen removal capacity for certain path-
• Health impact studies aim to measure the extent of the reduction in dis-
ogens (e.g., SODIS and ceramic filtration for viruses, chlorination
ease incidence or in the risk of infection that results from an interven-
for certain protozoa) will yield a lower health impact in area where tion, e.g., the promotion of SODIS. The main challenge in health impact
these pathogens are responsible for a large share of the infections. studies is to collect reliable, representative, and robust data, and to sta-
The third - and very important - determinant of the health impact tistically isolate the effect of the intervention from other intervening var-
of a HWTS intervention like SODIS is the consistent and correct iables.
• Most existing studies on the health impact of SODIS (or WASH interven-
application of the method (including safe storage), as well as the
tions in general) are designed as ‘randomized controlled trials’ that com-
consequent safe water consumption by the water users. Studies pare the diarrhoea incidence in an intervention group vs. a control group.
show that the consumption even of small quantities of contami- Diarrhoea incidence data are typically collected from water users direct-
nated water in the range of 5-10% of the total consumption can ly through surveys. Self-reported diarrhoea incidence is a problematic
practically nullify the health effect of water treatment (Brown & indicator for different reasons:
• The recall period of respondents is typically very short, which means
Clasen 2012). Achieving such high consistency of safe water con-
that the user data are only reliable for a short time, typically 48h prior to
sumption is a major challenge in pilot projects, and even more so the data collection.
in large scale promotion programs. • Data collection through surveys is prone to bias at different levels. Wa-
ter users, data collectors and data evaluators tend to exaggerate the ef-
fect of an intervention, often unconsciously. This can influence the way
Beyond their limited generalizability due to variable local influence
they answer question, ask questions, or analyse data, respectively. This
factors, health impact studies for HWTS interventions have been
is particularly problematic if health data are collected by project staff that
criticised for methodological weaknesses. Most of the published were also involved in the promotion. Hunter (2009) postulates that the
health impact results for HWTS interventions are based on rand- reported health benefit in many HWTS studies is as least in part - if not
omized controlled trials and rely on diarrhoea incidence data pro- entirely – explained by responder and reporting bias.
• More reliable results can be gained from blinded studies (i.e., placebo-
vided by the water users themselves. Such data are prone to bias
controlled), double-blinded studies (placebo-controlled, data collectors
(see Box 9). The assessment of clinical data or anthropometric
do not know if the surveyed household used the real product or the pla-
changes of height and weight in children arguably yields more ob- cebo), or objectively verifiable indicators (e.g., clinical diarrhoea data, ef-
jective results. A first study assessing weight-for-age and height- fect on growth and weight gain).

30
 Promotion of the SODIS method

Author, Con- Study Type/indicator Result Remark

year try group
(Conroy et Kenya Children Odds ratio for all diar- Diarrhoea (odds ratio 0·66 [0·50–0·87]), severe di-
al. 1996) 5-16y rhoe episodes, and ‘se- arrhoea (0·65 [0·50–0·86])
vere’ diarrhoe
(Conroy et Kenya Children Odds ratio for infec- Odds ratio 0.12, 95% CI 0.02 to 0.65 No significant effect for older children
al. 2001) < 5y tions with cholera 81% less cholera cases among children <5 and adults
(Conroy et Kenya Children Odds ratio for diarrhoe Odds ratio 0.69, 95% CI 0.63 to 0.75 High turbidity water
al. 1999) < 6y
(Rose et al. India Children Incidence rate ratio, du- IRR 0.64 (40% reduced risk of infection) 86% also consume other type of wa-
2006) < 5y ration, severity ter
(Arnold et al. Guate- Children No difference between the intervention and con- Post intervention study; very low
2009) mala <5y trol villages in the prevalence of child diarrhoe or compliance for HWTS (8.7% con-
child growth firmed HWTS use in control group vs.
3.3% in interv. group)
(Mausezahl Bolivia Children Self-reporte diarrhoe Relative rate of diarrhoe: 0.81 (95% CI 0.59–1.12) Statistically not significant, low com-
et al. 2009) < 5y (diarrhoe diary) pliance with SODIS (32.1%)
(du Preez et South Children Dysentery, non-dysen- Dysentery: IRR 0.64, IRR for dysentery statistically only
al. 2010) Africa < 5y tery type diarrhea 95% CI 0.39-1.0, P 0.071) significant for households with “high
Non-dysentery: no statistically significant effect motivation”
(Du Preez et Kenya Children Incidence rate ratio Dysentery IRR = 0.56 (95% CI 0.40 to 0.79) Difference in weight for age indicator
al. 2011) 6 Height to age Dysentery episodes IRR = 0.55 (95% CI 0.42 to not statistically significant
months – Weight to age 0.73)
5y nondysentery days IRR = 0.70 (95% CI 0.59 to
0.84)
nondysentery episodes IRR = 0.73 (95% CI 0.63
to 0.84).
Median height-for-age: higher by average of 0.8
cm over a 1-year period in SODIS group (95% CI
0.7 to 1.6 cm, P = 0.031).
Median weight-for-age: higher by average of 0.23
kg over a 1-year period in the SODIS group (95%
CI_0.02 to 0.47 kg, P = 0.068).
(Graf et al. Came- Children Odds ratio OR (intervention group vs control group) : 0.63
2010) roon < 5y OR (SODIS users vs none-users) : average 0.45
(McGuigan Cam- Children Dysentery, non-dysen- Dysentery: IRR 0.50 (95% CI 0.27_0.93, p =
et al. 2011) bodia 6 tery type diarrhoe 0.029)
months – Non-dysentery: IRR of 0.37 (95%CI 0.29_0.48, p
5y < 0.001)

Table 8: Results from health impact studies in SODIS promotion areas

Explanations:
Measures for the magnitude of the effect of an intervention:
- Incidence rate ratio (IRR): Ratio of the incidence rates (% of population with disease) between the intervention and control group. An IRR of 0.50 means
that the incidence rate of diarrhoe cases in the intervention group was half that of the control group.
- Odds Ratio (OR): Ratio between the odds of infection between different groups (the odd is the ratio between people with and without disease). An OR<1
means that the odds of infection with diarrhoe are lower in intervention households (e.g., 5 times lower for an =R of 0.20).
- Relative risk: Ratio of the probability of the event occurring in the intervention group versus a control group.

31
 Promotion of the SODIS method

3.2 Elements to consider safe water), followed by the determination of the factors steering
the targeted behaviour. The factors can be defined based on evi-
during the planning phase dence or estimation (see Box 10). Based on these factors, promo-
tion tools (e.g., community trainings, household visits, etc.) can be
selected and designed.
3.2.1 Planning a behaviour
change intervention
Information
Risk Determinants:
Behavior Change
The SODIS method, and HWTS in general are practices that bring Perceived Vulnerability Behavior
Techniques
Perceived Severity
about the reduction in health risks. As such, they are comparable A
Health Knowledge
to other preventive health practices, such as physical exercise, Persuasion Intention
Behavior Change Attitudinal Determinants:
dental hygiene, healthy diet, safer sex, non-smoking, etc. The po- Benefits/Costs (Instrumental Attitudes)
Techniques Use/
tential health impact of these practices critically rely on instituting Emotions (Affective Attitudes) Behavior
an effective and sustainable behaviour change among the target Norm
Behavior Change Normative Determinants: Habit
population. Such transformations are typically difficult to achieve, Techniques Others Behavior (Descriptive Norm)
Others Approval (Injunctive Norm)
take much time, and require concerted and coordinated campaign
efforts through different promotion channels. Infrastructural,
Ability Determinants:
Skill & Ability Behavior
How-to-do Knowledge (Action
Behavior Change B
Health programs often concentrate on the educational aspects to Knowledge)
Techniques Perceived ability (Self-Efficacy)
persuade people to adopt a healthy practice. And yet, many exam- Perceived Impediments Intention
ples show that increased awareness alone is seldom sufficient to Use/
Planning &
change a behaviour across the target population. Successful be- Relapse Prevention Self-Regulation Determinants: Behavior
Behavior Change Action Control/Planning
haviour change promotion requires a more comprehensive ap- Barrier Planning (Coping Planning) Habit
Techniques
proach. According to the RANAS model (see Fig. 10), behaviour Remembering
Commitment
change depends on factors relating to risks, attitudes, norms, abil-
ity, and self-regulation, all of which can be influenced by targeted Figure 10: RANAS model (for details, see Mosler (2012))
interventions.

A behaviour change campaign should always start with the defini-

tion of the target group (e.g., all people of municipality X, all teach-
ers in district Y, all women of the city X, all children under five years
in region Y), the behaviour to be changed in the target population
(e.g., people drink contaminated water -> people drink exclusively
Box 10: How to apply behaviour change models in the planning of
projects
Few non-governmental organizations are in a position to implement
a large-scale and evidence-based behaviour change campaign due to
limited financial and human resources. It is, therefore, important to note
that behaviour change models are also useful if the importance of critical
factors can only be estimated or as a source for inspiration.

• Behaviour change campaign based on evidence: A behaviour change

model can be the conceptual framework for data collection to assess the
relative importance of different psychological and practical factors by
baseline surveys. Such an assessment can provide the basis to design
behaviour change campaigns that are evidence-based and tailored to the
specific context. The requirements (expertise, time, budget, etc.) for a
quantitative study are substantial, and may exceed the capacities of
most small organizations. More information on conducting comprehen-
sive behaviour change assessments can be found at: http://www.
eawag.ch/fileadmin/Domain1/Abteilungen/ess/schwerpunkte/ehpsy/be-
havioural_march_2013.pdf

• Behaviour change campaign based on estimation: The RANAS mod-

el can influence project planning by providing a systematic understand-
ing of the critical factors that may have to be addressed, even if their
relative importance can only be estimated, e.g., based on previous ex-
periences, expert opinion or qualitative data.

• Behaviour change model as inspiration: Organizations that promote

health practices without the capacity or ambition to implement evi-
dence-based behaviour change campaigns may find specific ideas in the
behaviour change models on how to strengthen their promotion ap-
proaches by integrating new promotion tools to influence previously ne-
glected parameters.
Wall sticker in India

32
 Promotion of the SODIS method

3.2.2 Selection of intervention

area
The prioritization and selection of target areas for SODIS or HWTS Box 11: SODIS/HWTS promotion in areas affected by chemical
promotion should be based on a needs assessment and the poten- water pollution
tial impact of the intervention. Key factors determining the poten- • Special criteria apply to areas where chemical contaminants - e.g., arse-
tial impact include the extent of consumption of contaminated nic, fluoride, or organic pollutants - are present in the drinking water in
potentially harmful concentrations. The most common HWTS technolo-
water and the applicability of different HWTS methods in view of
gies - boiling, chlorination, ceramic, biosand or membrane filtration, and
different context-specific factors, including physical, economic, SODIS - do not eliminate these contaminants from the water. Additional
and psychological aspects. Analysis of the potential impact can or alternative treatment technologies must be employed to remove
draw from available data, water quality tests, surveys, and/or these compounds. While such technologies exist for use at the house-
through participatory appraisals with experts and local stakehold- hold level, their relatively high cost and requirements in terms of opera-
tion and maintenance render centralized applications more cost-effective
ers.
in many circumstances. Unlike for microbial contaminants, re-contami-
nation from chemical pollutants in the water supply system or during
HWTS promotion can only yield health benefits if the target popu- handling and storage by water users is not a major concern.
lation actually consumes water contaminated with pathogens, and
consequently suffers from diarrheal disease. This is more likely in • Areas affected by chemical water contamination should receive priority
with regard to the improvement of centralized water supply and treat-
areas where the water is contaminated by pathogens at the source
ment. The application of SODIS or other HWTS methods is nevertheless
level, and/or is at a high risk of secondary contamination during col- advisable, if:
lection, transport and storage. Water quality tests can be used to –– no treatment facilities to remove the chemical contaminants are avail-
estimate the typical level of contamination from faecal pathogens able, at least not in the short term -> HWTS at least reduces the risk
at the point of consumption, and possibly to identify the critical of infection from diarrheal disease, while the need to improve chemi-
cal water quality remains urgent.
points where the contamination occurs. Note that drinking water
–– treatment technologies to remove chemical pollutants are available,
contamination may vary considerably from one source to the next, but only remove chemical contamination and not pathogens, and do
and from one day to the next. not reduce the risk of microbial re-contamination during transport and
storage -> HWTS closes the remaining gap to safe water consump-
In areas where one or several HWTS methods are already widely tion.
–– alternative water sources are available that are free from chemical pol-
used, the promotion of a new technology only makes sense if it
lutants, but are potentially contaminated with pathogens -> HWTS
offers additional benefits - e.g., higher disinfection efficacy, lower lowers the risk of using chemically safe sources as alternative options.
costs, convenience and, therefore, potentially more consistent use
- or if they can reach population segments that are not yet benefit-
ing from the available HWTS systems.

Woman applying SODIS in India

33
 Promotion of the SODIS method

The applicability of a HWTS system typically depends on specific Tools for the selection of an intervention area inlcude:
local conditions. For the SODIS method, the following factors must • The review of available data on water quality at different points and
be considered: times, diarrhoea incidence, water supply, water quality, water con-
• Irradiation: The SODIS method should only be promoted in areas sumption and treatment practices, climatic conditions, and house-
where solar radiation is strong enough year round for effective re- hold income
liable disinfection, i.e., in tropical and sub-tropical regions up to 35 • Doing water quality tests to assess the extent of water contamina-
degrees latitude with only limited foggy or rainy periods. The appli- tion
cability of SODIS can be limited for people residing in multi-story • Surveys, expert consultations, focus group discussions or obser-
buildings or in areas with dense vegetation due to their limited ac- vations to assess factors relating to the applicability of the SODIS
cess to places that receive at least 6 hours of direct sunlight each method, to patterns and habits of water collection, transport, stor-
day. age and consumption, current HWTS use, as well as people’s per-
• Water turbidity: As suspended particles absorb solar radiation, SO- ceptions, attitudes, preferences, and needs.
DIS is unsuitable for areas with turbid water supply (>30 NTU), un- • Expert consultation and community or group meetings for a quali-
less a pre-treatment method can be successfully promoted. tative participatory assessment of potential impact
• Bottle availability: Targeted water users in SODIS promotion areas
must be able to collect or buy bottles for SODIS in sufficient quan-
tities. If water or soda bottles are not readily available, the potential
to set up a sustainable bottle sourcing system must be evaluated
based on realistic assumptions (see Chapter 3.2.6).
Box 12: SODIS in disaster situations
Beyond these ‘external’ conditions determining the applicability of • The availability of safe drinking water and the prevention of epidemics
SODIS, the potential uptake and impact also depends on a number are key concerns in the aftermath of many natural disasters, including
earthquakes, floods, or storms that destroy the water supply infrastruc-
of factors related to people’s economic capacities, perceptions, at-
ture. The focus of disaster response efforts often is on the centralized
titudes and habits. The reasons why people do or do not consume treatment and distribution of treated drinking water. In recent years, dis-
untreated water or use HWTS methods should be assessed at aster relief agencies have evaluated the use of HWTS systems as a com-
least qualitatively before defining the range of HWTS technologies plementary strategy with varying success (Lantagne & Clasen 2012).
to be promoted and the set of promotion tools. Furthermore, the Promotion of SODIS in the aftermath of a disaster may be less suitable
than, e.g., chlorine tablets, for a number of reasons:
assessment should cover the conditions in which the promotion
–– The capacities of local and external disaster relief agencies to conduct
takes place, including political, legal, institutional, economic, and trainings on the correct application of a practice like SODIS is limited.
socio-cultural factors (see Chapter 3.2.7). Note that many factors –– The people affected by a disaster have more urgent priorities than at-
influencing the potential uptake of a new practice like SODIS, in- tending a SODIS training.
cluding attitudes towards the technology (e.g., preferences in –– The logistics of distributing empty bottles are not favourable (refer to
SODIS bags, chapter 2.3), especially compared to chemical disinfect-
terms of taste, look and temperature of treated water, and willing-
ants.
ness to invest labour) are difficult to assess before the method has –– SODIS may not be applicable due to cloudy or rainy weather.
been introduced and applied in the community. A pre-test at a
small scale can help to evaluate these issues and plan the interven- • However, the promotion of SODIS can be beneficial in the context of dis-
aster preparedness programs. If people have been trained on how to use
tion more specifically.
SODIS and do have access to PET bottles, they can start treating their
water before relief activities reach them.

SODIS bottles in Bolivia

34
 Promotion of the SODIS method

3.2.3 Development of a moni- and the related rate of safe water consumption. Outcome data are
typically analysed in relation to the situation at the beginning of the
toring and evaluation scheme intervention (baseline data), and are typically generated from sur-
An effective monitoring and evaluation scheme should be part of veys, observations, or analysis of physical parameters (e.g., water
every SODIS/HWTS promotion project. This subchapter highlights quality).
specific SODIS-related parameters and indicators that can be inte-
grated into a monitoring and evaluation-scheme. A standard If the promotion relies on regular visits, outcome data can be col-
scheme differentiates between outputs, outcome and impact pa- lected through monitoring forms used each time the promoter vis-
rameters. Comprehensive guidelines on appropriate indicators and its the users. Continuous outcome monitoring allows projects to
implementation aspects for the monitoring and evaluation of identify challenges and adapt the promotion methodology during
HWTS projects are provided in a toolkit developed by WHO and the course of the implementation. In small projects, data for pro-
UNICEF (2012). ject evaluation can be collected from all trained users. In larger pro-
jects, data are typically collected through surveys covering a
random sample of the trained users (see Box 13). As for the out-
Output level put monitoring, data collected and reported by the promoters
The main output monitoring parameters in SODIS projects are should be verified through spot checks by project supervisors or
the number and coverage of promotion events, user trainings, external partners mandated with project monitoring.
follow up visits, the production and distribution of IEC materials
and, if necessary, the establishment of bottle supply. Safe water consumption depends on water treatment and con-
sumption patterns, as well as on the effectiveness of the water
Outputs are typically monitored through records of field workers, treatment itself on the water quality. SODIS can only contribute to
and are cross-checked by supervisors and verified through (ran- reducing infection risks if users exclusively consume safe drinks
dom) field visits. The quality of the training can be monitored by (correctly treated water, bottled water, tea, soft drinks, etc.). It is,
joining promoters during field work, and qualitatively assessing the therefore, important to also include indicators about the consump-
know-how of randomly selected target households. tion of safe drinks to the monitoring and evaluation scheme.

Outcome level The selection of indicators should be adapted to the data collection
framework. Several simple indicators should be selected for regu-
The outcome is defined as the immediate effects resulting from
lar monitoring, while multiple and more refined indicators are ad-
project activities. It can be monitored continuously, or evaluated at
equate for evaluations.
a specific point in time. The key outcome parameter for the suc-
cess of a SODIS project is the level of consistent water treatment

NGO member in Togo explaining transmission routes of diarrheal diseases

35
 Promotion of the SODIS method

Box 13 – List of questions to assess outcome on household level

Consumption of safe drinks
• Do the bottles show signs of regular use (scratched and slightly milky
The level of safe water consumption is difficult to assess. Direct questions
surface due to regular solar exposure)?
on whether and how much raw water is consumed by the family members
• Does the household have a sufficient number of bottles? (enough to
are likely to produce differing answers. A detailed account of all drinks con-
meet the drinking water demand of the household, plus to possibly store
sumed by the family members may produce a more accurate picture, but
water treated the previous day)
is also time consuming and, thus, more appropriate as part of an outcome
• Is the water in the bottles warm (indicating that the bottles were ex-
survey than as parameters for the continuous monitoring framework. In
posed for some time before the visit)?
spite of the expected bias, changes in self-reported raw water consump-
• Is the treated water stored safely? (If treated water is transferred to an-
tion can be used as a first approximation for project outcomes:
other container for storage, are precautions taken for safe storage ->
• Do some household members regularly/occasionally consume poten-
container covered, withdrawal through a spigot, narrow mouth, or with
tially contaminated water (e.g., untreated water from potentially unsafe
a ladle)?
sources or water stored with a risk of re-contamination)?
• The correct use of SODIS can also be assessed through water quality
tests of the treated drinking water. Due to high costs and logistical chal-
HWTS application
lenges, water quality tests are typically employed in outcome evaluation
For most families, treated drinking water potentially constitutes an impor-
studies among a sample of households rather than as an integrated ele-
tant share of their safe drinks. It is advisable to evaluate the uptake and use
ment of monitoring frameworks. Note that positive test results can have
of all methods in an integrated manner using method-specific indicators.
other causes besides incorrect SODIS use (incomplete disinfection due
The most basic indicator is the use or non-use of a HWTS system for the
to very high raw water contamination, re-contamination after treatment
treatment of water. Furthermore, it is relevant if the users have the capac-
or during analysis).
ity to meet the entire drinking water demand
• The different indicators for consistent SODIS use and safe water con-
• Is any method for water treatment used at the household? Which
sumption can be aggregated into an index to classify households as ‘reg-
one(s)?
ular’ and ‘irregular’ SODIS users, or ‘regular’ or irregular’ safe water
• How many litres of water are treated every day, using which HWTS
consumers. For example, households may be counted as ‘regular SO-
method(s)? For consistent safe water consumption, the total volume of
DIS users’ if the data indicate correct methodological know-how, suffi-
treated water must be sufficient for the number of people living in the
cient number of bottles, and evidence of their regular use. A household
household (at least 1-2 litres per person per day), taking into account oth-
can be considered a ‘regular safe water consumer’ household if moni-
er safe drinks consumed, and consumption outside the household, e.g.,
toring data indicate that only water from safe sources, treated water, or
at school or at work.
other safe drinks are consumed.
• How is the treated water stored?
Reasons for using/not using SODIS
SODIS application
The following questions can yield qualitative insight regarding the effective-
The correct and consistent use of SODIS should be assessed in more de-
ness of the deployed promotion tools:
tail through a combination of indicators and observations, such as:
• How did you learn about the SODIS method (e.g., household visits, ra-
• Can the person in charge of drinking water supply correctly explain the
dio campaigns, promotion through health professionals, street theatre,
application steps for SODIS -> colourless PET-bottles are exposed hori-
etc.)?
zontally to the sun for at least 6 hours on a sunny day, or 2 days if the sky
• For users: What convinced you to start using SODIS (knowledge about
is mostly overcast, safe storage in bottles, etc.)?
germs in the water, fear of disease, promoter’s advice, doctor’s advice,
• How frequently is SODIS practiced (-> daily, almost daily, occasionally,
example of neighbours, etc.).
rarely) ? On which day was SODIS last done? On days when SODIS is
• For non-users: Why do you not practice SODIS, or treat your drinking wa-
not used, does the household use another method for drinking water
ter? (promotion not convincing, no time, neighbours also do not do it,
treatment, and which one?
doctor does not recommend it, government does not recommend it, not
• How many SODIS bottles are exposed daily?
enough bottles available, etc.)
• Is there an adequate access (in terms of access, prize, type, quality) to
bottles?
Hygiene application
Hygiene education is a component integrated in most HWTS promotion
The credibility of the provided answers can be checked with observations,
projects, and indicators for hygiene practices can also be included in the
such as the following:
monitoring and evaluation. Specific indicators for hygiene practices and use
• How many bottles are exposed to the sun?
of other HWTS methods are described in other manuals (UNICEF 2013). A
• How many bottles with treated water are stored?
more in-depth assessment of how the different promotion tools influenced
• Are the bottles exposed to the sun correctly (-> no shade during entire
behaviour change factors (e.g., based on the RANAS model) requires a
day, colourless bottles, labels removed, clean and not heavily scratched
more stringent methodology in terms of sample size, sampling procedure,
bottles)?
formulation of questions, etc., and should be conducted by professional
social scientists.

36
 Promotion of the SODIS method

If reliable data on diarrhoea incidence is available, e.g., from health

3.2.4 Impact evaluation centres, these data can be used to document the health effects of
Impact refers to lasting changes of key target parameters (e.g., the intervention. As seasonal and inter-year variations of diarrhoea
health, wealth) that are often difficult to accurately assess, and de- incidence can be substantial, diarrhoea data from the intervention
pend on a multitude of influencing factors. In SODIS projects, the should be analysed relative to a control group not receiving inter-
main targeted impact are health benefits, i.e., a reduction of diar- vention, but otherwise living in similar conditions. Measurements
rhoea incidence or infection risk in the target community. of anthropometric changes, such as weight for age or eventually
height for age among children, is considered a more reliable indi-
Self-reported diarrhoea incidence data can be collected through cator or health impact than self-reported diarrhoea incidence.
questionnaires or diarrhoea diaries in which households note the
occurrence of diarrhoea each day for each family member. Children Assessing the magnitude of the health impact resulting from a SO-
below the age of five are most vulnerable to infection with diar- DIS or HWTS project is a non-trivial task that usually exceeds the
rhoea, and are, thus, often the focus of health impact studies. The capacity of implementing organizations (see chapter 3.1.3). In or-
recommended recall period for diarrhoea incidence are the 48 der to gain statistically significant results on health impact, the
hours prior to the interview. If a longer reference period is chosen, study design, sample and the data analysis need to meet scientif-
interviewees are less likely to correctly remember diarrhoea inci- ic standards. Health impact studies should, thus, always be
dences (Zafar et al. 2010). One particular challenge in health impact planned and implemented by experienced epidemiologists. Given
studies based on self-reported diarrhoea data is responder bias. the methodological challenges of health impact assessments and
Surveyed households in non-blinded studies tend to over-estimate the fact that numerous scientific health impact studies for SODIS
the health impact either because they genuinely hold an overly and HWTS interventions already exist, it is neither feasible nor nec-
positive view of the effects, or because they adjust their answer to essary to conduct a health impact study in every SODIS promotion
what they think the interviewer wants to hear. project.

Mother and child in Kenya

37
 Promotion of the SODIS method

Box 14 Methodological aspects of monitoring and evaluation

The following sections provide some guidance on the collection of Data collection
reliable monitoring and impact data and point to specific weaknesses • In order to minimize responder and reporting bias, data should be col-
often found in semi-scientific studies. lected by external and independent persons who the interviewees do
not associate with the intervention. If data are collected by the promot-
ers themselves, it is more likely that the interviewees exaggerate the ef-
Reference data fect of the project. For the same reason, questions that specifically
• Outcome and health impact data must be evaluated relative to a refer- relate to the promoted behaviour change (SODIS/HWTS) should be
ence. In longitudinal studies, the same indicators are assessed before asked at the end of the questionnaire.
and after an intervention in the target area. The data in the baseline sur- • A standardized data collection methodology - how questions are asked,
vey must be of the same type and format as the data collected in the observations made, answers recorded, etc. - has to be used consistent-
monitoring or end line evaluation. For new technologies like SODIS that ly by all interviewers, which requires thorough training of the interview-
have been introduced in a community by a project, detailed indicators ers. Questionnaires must be pre-tested to make sure that the questions
regarding correct and consistent use obviously cannot be collected at and the local language translations for terms, such as microorganisms,
baseline. If no comprehensive baseline study can be conducted, at least disinfection or diarrhoea, are understood by responders in the same way.
a basic set of household data (i.e., prevailing HWTS practices) should be
recorded during the initial promotion at the group or household level. Statistical analysis
This approach is bias-prone, but still allows for a simple outcome evalu- • Descriptive statistics are used to characterize the sample population and
ation. to summarize the data of the key target parameters. Typical descriptive
• Alternatively, an outcome or impact can be evaluated through compari- indicators in health impact studies include percentages of different vari-
son with the same indicators assessed in a control group. Control ables (e.g., HWTS users, diarrhoea cases, etc.) for the intervention and
groups need to be as similar to the intervention group as possible (e.g., the control groups. For statistically significant conclusions regarding dif-
with regard to age, ethnic background, education, income level, water ferences in diarrhoea incidence or infection risks between intervention
source, etc.) but unaffected by the project intervention. and control groups, inferential statistics have to be applied using appro-
priate software and in-depth statistical expertise.
Random sampling
• If only a part of the entire target population can be included in the out-
come evaluation, it is important to choose these households randomly
in order to minimize selection bias. For example, households close to
the main road are more likely to be included in the survey in a non-rand-
omized selection procedure than households at the far end of the village,
which could distort the results. One way to conduct a random sampling
is to assign a number to each household and to use a random number
generator for the selection. If this is not possible, walking transects (e.g.,
selecting every 5th household while walking along randomly selected
roads in the target area) is a viable substitute method if it is assured that
all households in the area have the same chance to be selected (Tamas
et al. 2009).

Sample size
• If the sample size of an outcome or impact evaluation is too small, sta-
tistical analysis cannot determine whether the observed results actually
reflect significant differences between the control and intervention
groups (longitudinal studies: differences before/after the intervention) or
could also be explained by chance (i.e., due to random selection among
two populations with internal variance).
• For a non-scientific project evaluation, at least a hundred households
should be covered in each intervention and control group. The minimal
sample size required for statistical analysis depends on the expected fre-
quency of the target parameter (e.g., safe water consumption, diarrhoea
incidence). For health impact studies, several hundred or more house-
holds must be included so that at least a few dozen diarrhoea cases are
recorded. The minimal sample size is larger if diarrhoea prevalence is
low, and if a short recall period is applied (which is recommended).

38
 Promotion of the SODIS method

39
 Promotion of the SODIS method

3.2.5 Definition of project scope means that public supply fails to achieve safe water consumption.
Water supply agencies, thus, are more likely to support HWTS
SODIS projects should not be conceptualized as a stand-alone in- campaigns if the focus is on mitigating the problem of re-contam-
tervention. Potential synergies with other programs and cam- ination at the household level, rather than source contamination.
paigns can be explored during the planning phase. If conditions
vary widely across the project area, a segmentation of different tar- On a third level, HWTS can be integrated within other health and
get groups and a tailored promotion approach for each segment development programs and campaigns, in particular with programs
should be considered. that already have a focus on behaviour change, i.e., maternal and
child health, malaria, nutrition, etc.
The most basic level of integration relates to different HWTS tech-
nologies, as opposed to single-technology promotion. An integrat- While the integration of HWTS within other programs can help the
ed HWTS promotion approach is strongly recommended, as a HWTS promotion reach a large population faster, the trade-off is
range of methods to choose from is more likely than a single tech- that the HWTS issues could get diluted among the other promot-
nology to meet the needs, preferences, and needs of all the popu- ed messages, and the promotion intensity might not be high
lation in a given area, and result in a more consistent water enough for an effective behaviour change to take root.
treatment practice.

On a second level, HWTS promotion can be integrated with other

interventions that also target a reduction of diarrheal disease. The
rationale and the awareness component of HWTS promotion cam-
paigns – i.e., information on diarrhoea causing pathogens and the
barriers to their transmission routes – directly relate to the issues
of personal and environmental hygiene, as well as sanitation. Pro-
motion of hand washing can and should always be integrated with
HWTS promotion. Vice versa, HWTS can be integrated as a com-
ponent in ongoing or new hygiene and sanitation promotion pro-
grams. The potential synergies between public water supply
Box 16: Pilot project vs. large scale promotion
programs and HWTS promotions are somewhat more difficult to
• So far, most SODIS promotion projects were implemented in a ‘pilot
address in practice. Water supply agencies may be hesitant to ac-
mode’. This means that the promotion approach was designed with the
tively promote household water treatment because this implicitly main purpose to establish the practice of water treatment using SODIS
in a geographically limited target area. The same is true for most projects
that promote other HWTS technologies, though the marketing of filters
or of chlorine has expanded to a national scale in some countries (private
Box 15: Single-method vs. multi-barrier approach sector and social marketing programs). The recommendation to boil
drinking water has been promoted by national health authorities for dec-
• None of the common low-cost HWTS methods - except boiling – can ef-
ades.
fectively remove or inactivate all types of pathogens that can cause diar-
• Both small and large scale promotion approaches offer specific advan-
rhoea. Moreover, the effectiveness of most technologies is reduced for
tages. Small scale projects typically allow for a high level of promotion
water with high turbidity. A multi-step approach consisting of pre-treat-
intensity though interpersonal communication - considered to be very
ment, e.g., sedimentation, filtration, and disinfection, allows for a more
effective for successful behaviour change. Many SODIS projects have
effective removal of both turbidity and pathogens. However, each addi-
relied on paid ‘SODIS promoters’ to do trainings at the community,
tional treatment step complicates the process and increases the time
group and household level on information dissemination through IEC
and labour demand and, therefore, is also likely to decrease user accept-
materials, and on regular household visits for follow up. In pilot projects,
ance and uptake. Considering the limited and slow uptake for single-step
promotion tools can be tailored specifically for the local target popula-
HWTS technologies (e.g., boiling, chlorination, filters, SODIS, etc.) ob-
tion. At the same time, a new practice like SODIS may be viewed rather
served in many promotion projects, it seems unlikely that a multi-step
sceptically if it is only promoted at pilot scale, i.e., when the target
treatment approach will be adopted at large scale. Advanced technolo-
households realize that the practice is neither widely known, nor used
gies that combine multiple treatment steps inside a single device (‘mul-
by people outside the project area, and is not actively promoted by influ-
ti-barrier systems’) can be both highly effective and perceived as
ential institutions, e.g., the Ministry of Health or the water supply agen-
attractive and convenient by water users. To date, such integrated multi-
cies.
barrier systems’ are typically more expensive than single step treatment
• Large scale health campaigns are typically coordinated by national health
systems, and are mostly marketed towards middle-class populations.
authorities. National health campaigns often have fewer financial re-
• Safe water storage to avoid secondary contamination after water collec-
sources per target family compared to pilot projects, but have privileged
tion and/or treatment is a practice that most households can easily im-
access to existing institutions for the promotion activities, e.g., the edu-
prove on with already available resources and, hence, is probably a more
cation and health extension system or mass media. Messages endorsed
promising target behaviour than combinations of treatment methods.
by the government and transmitted through these channels have high
Several HWTS methods also provide protection from recontamination
credibility and potentially impact societal norms more effectively than
(SODIS bottles, residual chlorine, and closed storage compartment of
small NGO projects. The downside is that the promotion intensity may
filters).
not be very high if HWTS is merely integrated in the curriculum of teach-
• To avoid project implementations that are too complex, a manageable
ers or health workers and risks to be marginalized among all the other
number of HWTS methods can be pre-selected. The key criteria deter-
educational messages which they are expected to transmit.
mining their selection are the potential of the method to meet the peo-
• For example, SODIS use at the end of pilot projects in Pakistan relying
ple’s needs and preferences, affordability, and local availability of
on paid promoters was around 50%. When SODIS was promoted at the
products. This should also allow for flexibility to expand the range of pro-
district level as one additional message in the curriculum by “Lady
moted methods if new products and/or financing mechanisms (e.g., mi-
Health Workers” working for a national health program , uptake was only
cro-credits) become locally available.
5-10% - though at a much larger scale.

40
 Promotion of the SODIS method

3.2.6 Assessment of bottle supply it impossible to generate income sufficient to cover the collection,
transport and distribution expenses, and to render bottle sales as
The existence of functional and sustainable supply chains is not a an attractive long-term business opportunity for local entrepre-
dominant constraint to the application of SODIS in many locations. neurs.
In most urban and peri-urban settings, used PET bottles are widely
available, and are often also collected for recycling. In many rural In the absence of a viable bottle supply scheme, only the most
areas, empty bottles are available, but are considered a valuable committed households in remote areas usually invest the efforts
resource that can be used for different purposes in households, and resources necessary to source the required amount of bottles
and are sold in local markets at a price of around 2-20 US$ cents (e.g., organizing transport through visitors from urban centres, pur-
per bottle. Wherever possible, water users should be advised and chasing soft drinks in suitable bottles for subsequent SODIS use).
motivated to collect or buy bottles for SODIS use from existing Unfortunately, the local availability and affordability of products is
sources. In some rural and remote areas, however, PET bottles also typically limiting for other HWTS methods (chemical disinfect-
may not be available in the quantities required for consistent SO- ant, filters, etc.) in remote areas. A pragmatic HWTS strategy for
DIS use. In these areas, the promotion of SODIS is not recom- remote areas is, thus, to focus on the promotion of HWTS technol-
mended unless effective measures can be adopted to strengthen ogies for which sustainable supply systems can be established
the bottle supply. The present bottle availability and the potential (products that are affordable and easy to transport, and which gen-
to strengthen the bottle supply should be carefully evaluated be- erate reasonable profits), and to reinforce safe storage and already
fore initiating a SODIS promotion program. The design of a sustain- known, but inconsistently practiced, water treatment methods
able bottle supply system must be based on a thorough and (e.g., boiling). SODIS can be promoted as an option if at least part
realistic assessment of both the availability of bottles in sufficient of the population can source bottles on their own.
quantities from potential sources, such as local shops, hotels or
restaurants, and the viability of possible distribution channels. In Given limited global success in the promotion of low tech HWTS
particular, project planners must be careful to not overestimate the methods (SODIS, chlorination, ceramic filters, etc.) through behav-
willingness of SODIS promoters or local entrepreneurs to collect iour change campaigns, some experts believe that a breakthrough
and sell bottles unless they can receive an adequate profit. towards large scale HWTS adoption will more likely be achieved
through the marketing of new and attractive commercial HWTS
Pilot projects that have strengthened bottle availability for SODIS products by the private sector. Commercial HWTS devices are suc-
have yielded the following insights: cessfully marketed in middle-income segments of the population
in many countries. New financing mechanisms, e.g., micro-credit
• Free distribution of bottles is not conducive to the sustainable prac- schemes, are increasingly applied to make HWTS technologies af-
tice of SODIS. Though free distribution often results in a high initial fordable also to the lower income segments of the population. The
adoption rate, it also creates dependency and expectation for a incentive for the private sector to engage in the promotion of SO-
continued bottle supply, preventing water users from developing DIS is limited by the low potential profit margins that can be de-
their own strategies to find and collect enough bottles. Once free rived from the sales of empty PET bottles. Advanced SODIS
distribution stops, most former SODIS users are likely to abandon systems that are being developed - such as SODIS bags, UV indi-
the practice. Free or highly subsidized distribution of bottles is also cators, or reactor systems (see chapter 2.3) – are potentially more
not recommended because it distorts people’s perception of the attractive to private enterprises as they could yield higher profits
value and cost of PET bottles, which can negatively affect their will- that would sustain the promotional activities.
ingness to invest their own resources to have PET bottles and their
motivation to use a ‘cheap’ product for water treatment.

• There is only little room - if any - for the generation of sufficient prof-
its from the sale of empty bottles as an economically viable entre-
preneurial activity to sustain the bottle supply. Their bulky volume
makes the transport of PET bottles logistically challenging and ex-
pensive, and people’s willingness to pay for empty bottles limits
the potential sales price and related profit margins. Bottle supply
schemes that are financially or logistically dependent on the pro-
ject and the implementing organization are likely to collapse after
the support ends.

• In some cases, the sales or distribution of bottles through the pro-

ject created the wrong impression among the target population Box 17: Bottle supply schemes applied in SODIS promotion
that these bottles had special properties which make them particu- projects:
larly effective for SODIS. If people fail to realize that other locally • Collection of bottles from urban centres, hotels/restaurants/party-ven-
available PET bottles are also suitable for SODIS, they are likely to ues, etc., by promoters, paid bottles collectors or other local institutions.
abandon the practice when the bottle supply stops. • Bulk purchase of new bottles from bottle manufacturers.
• Distribution/sale to SODIS users
• Free distribution by promoters and health centres (not recommended)
• Most bottle supply systems established in rural areas as part of SO-
• Direct sales with a profit margin through promoters and health workers
DIS promotion projects did not last in the long run. The low cost of • Retail sales with a profit margin through local shops, health centres, etc.
a PET bottle and the low willingness to pay for empty bottles made

41
 Promotion of the SODIS method

3.2.7 Creation of an enabling fensively against the inherent criticism of existing water supplies.
Try to convince them that the goal of the project is universal safe
environment water consumption, and that public supply, private sector and
The enabling environment is a key determinant for successful HWTS promotion can play complementary roles towards this end,
project interventions. The following six elements that define the with low tech HWTS being an intermediary solution.
enabling environment and that need to be pro-actively fostered • Make sure the prerequisites for a rapid uptake are in place when
are: the promotion starts. This particularly applies to the local availabil-
ity of SODIS bottles, or other HWTS products, respectively. If
1. Socio-cultural Acceptance measures to strengthen supply chains are planned as part of the
2. Legal and Regulatory Framework project, this activity should be launched ahead of the main behav-
3. Institutional Arrangements iour change campaign. Promoting the use of a method or product
4. Financial Arrangements that is not available to people is a futile exercise.
5. Government Support • In many countries, comprehensive national HWTS strategies are
6. Skills and Capacity under discussion. In order to support this process, organizations
implementing SODIS/HWTS projects are encouraged to engage in
Most of the elements critical to support an enabling environment advocacy activities, which can include:
should be identified or become evident during the planning pro- • Active participation in WASH expert meetings and HWTS working
cess (for a more detailed definition, see Eawag-Sandec/WSSCC/ groups
UN-HABITAT (2011)). Some elements of the enabling environment • Sharing of experiences and results from projects with relevant
can be influenced by local level stakeholders and institutions, while stakeholders, particularly with government water and health au-
aspects at higher levels, such as national policies, are more diffi- thorities
cult to influence. The following activities are recommended to in- • Active lobbying for the integration of HWTS in the activities of or-
crease the likelihood of successful implementation: ganizations having national outreach
• Contributions to the integration of HWTS in the activities of other
• Make sure that the promoted methods and the promotion activi- organizations: e.g., during the formulation of a strategy and or of
ties conform with the applicable legal and regulatory frameworks. regulations, capacity building, coordination among different institu-
• Establish a solid evidence base and documentation to justify the tions, design and co-funding of HWTS programs, and integration
promotion of HWTS. This includes information on water quality and of a HWTS component in existing programs.
diarrheal disease - including water quality tests from local water • Establishment of partnerships with like-minded organizations to
sources and household storage containers. enhance the scope and scale of HWTS projects
• Establish contacts with local authorities, political, and health pro- • Share the experience of the project through media channels to
fessionals, and religious and informal leaders, and convince them generate broad awareness
of the benefits of HWTS for the local population. Gain their formal • Seek or facilitate collaboration with academic institutions to broad-
or informal endorsement and/or active support. Relevant govern- en the evidence base of HWTS
ment agencies should be consulted at the appropriate level (local,
district, province, national) before starting a project. This may in- In order to pro-actively foster the activities of an enabling environ-
clude the agencies responsible for water supply and sanitation, ment, sufficient resources in terms of budget and personnel need
health, development, housing, poverty alleviation, and education. to be earmarked in the planning phase. Successful activities may
• Identify potential opposition to the promotion of HWTS, e.g., pri- require the active and continuous involvement of high level repre-
vate entrepreneurs selling bottled water or other HWTS products sentative of the organization, as lower level project staff may not
who may fear lower profits, or public water suppliers who react de- have the necessary access to key stakeholders.

SODIS bottles in Togo

42
 Promotion of the SODIS method

3.3 Addressing behaviour In contrast, it is difficult to communicate information about infec-

tion risk for different reasons. Firstly, it is typically not possible to
change factors assess the infection risk due to drinking water contamination for
the target population in absolute terms, nor relative to other trans-
SODIS and HWTS campaigns are considered to be most effective mission routes. Secondly, personal experiences may seemingly
if they address the behaviour change process holistically and em- contradict objective risks: a person can consume untreated water
ploy a combination of promotion tools addressing the following for months without any health problems, but suffer from diarrhoea
factors: risk, attitude, norm, ability and self-regulation. This – e.g., from pathogens being transmitted through contaminated
subchapter shows how these factors can be addressed. Tools that food - shortly after adopting the practice of drinking water treat-
have been effective in past SODIS projects are highlighted in the ment. A SODIS campaign should, therefore, avoid raising unrealis-
next subchapter. tic expectations by suggesting that diarrhoea infections can be
completely prevented by HWTS, but instead transmit the message
that infection risks can be significantly reduced if the practice is
3.3.1 Addressing risk factors consistently applied.
Despite the heavy toll in terms of mortality and morbidity, diar-
rhoea is often not recognized as a preventable disease among the The consumption of treated water can effectively prevent infection
most vulnerable populations of low-income countries. Without the from diarrhoea disease, but only if the level of safe water con-
knowledge about disease vectors and infection routes, and with- sumption is consistently high. Brown and Clasen (2012) concluded
out the means to adopt preventive measures, communities have that a reduction from 100% to 90% in safe water consumption
learned to accept diarrhoea as a part of life, or as fate. WASH pro- would decrease its protection from infection by up to 96% based
grams and the promotion of boiling by health authorities have in- on a theoretical model of infection risks. Therefore, it is extremely
creased people’s understanding about the causes and effects of important to stress the importance of consistent safe water con-
diarrheal disease, but low awareness continues to be a limiting fac- sumption in promotion campaigns and to integrate this point
tor to behaviour change in many places. The insight that HWTS use among the key promotion messages, e.g., in training curricula and
is typically highest among the more educated people confirms the on IEC materials. Especially for the most vulnerable household
critical importance of awareness. As the with the results of many members, i.e. young children or people with compromised im-
health programs (e.g., anti-smoking campaigns) show, disseminat- mune systems, zero-tolerance of the consumption of unsafe drinks
ing information about health risks is often not sufficient to trigger (including untreated water) should be propagated. The level of con-
a rapid and far-reaching behaviour change. sistent safe water consumption should also be integrated as a
monitoring parameter.
As a driver of behaviour change, the fear of the harmful health ef-
fects from a certain behaviour is most effective if these effects are
grave, likely, immediate, and linked to the behaviour through sim-
ple cause-effect relationships (e.g., drunk driving or ingestion of
poisonous substances). Health threats are less deterring if the
health effects are mild, uncertain, occur in the far future, or if the
link between behaviour and effect is complex or stochastic (e.g.,
cancer). As diarrhoea is mostly non-fatal for adults, fear of patho-
gens in drinking water may not be powerful enough to change peo-
ple’s behaviour – while for families with small children, the fear of
infection from potentially fatal diseases can act as a very potent
motivation.

Although the fear of diarrheal disease may not be the most impor-
tant driver of behaviour change in many cases, information about
diarrhoea causing pathogens and the different transmission routes Box 18: Addressing risk factors
should feature as one element of a SODIS promotion campaign.
Target behaviour
Practices to block pathogen transmission routes other than HWTS
• People drink exclusively safe water.
– i.e., personal and environmental hygiene or improved sanitation
- should at least be mentioned, or can be promoted prominently as Promotion target

integral parts of the campaign, depending on the defined scope of • The targeted population should know that the consumption of contami-
nated water puts them at risk of infection from diarrheal disease (per-
the project and available resources.
ceived vulnerability), should know that diarrheal disease can have severe
consequences, such as suffering, absence from school or work, medical
The concept of the preventability of diarrheal disease is compara- expenses and may cause death (perceived severity), and should know
tively easy to understand, when based on the information about that diarrheal disease is transmitted by germs of faecal origin (factual
germs and transmission routes. This is even the case with people knowledge).
who have the long standing perception that diarrhoea is a normal Potential promotion components
part of life. The same is true for the severity of diarrhoea disease. • Household visits by promoters (e.g., with information flyers)
Most people have experienced diarrhoea first hand, and can under- • Training event for the community (e.g., through street theatre)
• Mass media campaign via local radio or national TV (e.g., interviews with
stand the serious health effects that the disease can have, espe-
experts, statements of celebrities, etc.)
cially on infants.

43
 Promotion of the SODIS method

3.3.2 Addressing attitude factors tive beliefs in the target population. This relates to the tone of in-
ter-personal communication, the formulation of the campaign
Numerous examples show that health programs that focus only on slogan (“SODIS for happy families” instead of “SODIS to prevent
risks and adverse health effects may be less effective than cam- disease”), the design of posters, etc. Generally, it is easier to cre-
paigns that portray the target behaviour as a desirable and overall ate positive emotional associations for a modern looking high-tech
beneficial practice. Examples of health campaigns in which posi- water treatment device than for a low-tech system like SODIS, boil-
tive persuasive messages were employed – instead of or along ing or chlorination. Low-cost technologies are even at risk of being
with deterring messages focusing on health threats - include non- perceived negatively if their use is associated with poverty and
smoking, healthy diet, physical exercise, dental hygiene, or hand with the inability to purchase a more sophisticated technology. For
washing. SODIS, the use of a waste product (empty bottles) may be a stig-
ma in some locations and may have to be actively countered with
Generally, promotion tools for SODIS should focus not only on pre- messages to improve the method’s reputation . If water users ex-
vention of the adverse effects of diarrheal disease, but should pect to lose rather than gain social status from adopting SODIS,
frame safe water consumption as part of a happier, modern, more they might decide against it even if they believe in its positive ef-
healthy lifestyle. If a campaign can associate safe water consump- fects in terms of water quality and health.
tion – or the use of SODIS - with positive notions, such as happi-
ness, empowerment, financial savings, and gain of social status, The most important advantages of SODIS– the simplicity and use
positive attitudes are created that are conducive to behaviour of a widely available inexpensive ‘waste’ product – can also work
change. The availability and consumption of safe drinking water be- as a disadvantage unless a positive emotional association with SO-
comes desirable in its own right, with health benefits being only DIS use is established. If several HWTS methods are promoted in
one of several underlying motivations. parallel, it may be necessary to put special emphasis on creating
Positive attitudes can be constituted both at the rational (instru- positive attitudes for each individual technology. Failing that, only
mental beliefs) and emotional (affective beliefs) level. At the ration- the most attractive option(s) may be considered viable by the tar-
al level, a SODIS promotion project should create awareness about get households even though they may not be affordable or locally
the tangible benefits of SODIS, including: available, leaving the potential of other methods untapped.
• Improved water quality and health
• Empowerment of mothers to control factors that impact family
health
• Reduced absence from school and work
3.3.3 Addressing norm factors
• Financial savings (increased productivity, reduced treatment costs, Very few people base their intentions to adopt a new behaviour
and reduced treatment costs compared to the boiling or purchase solely on the rational weighing of costs and benefits, or due to
of bottled water) their affective beliefs. Most people look to other members in their
• Time savings (relative to boiling) community and are influenced by their example, advice, and by
• Social status gain from having safe water in the household for what they think others expect them to do. A water user may be
themselves and visitors more easily convinced to adopt a HWTS method if it is already
• The better taste of water (compared to boiled and chlorinated wa- widely practiced in the community (descriptive norm) and recom-
ter) mended/endorsed by local authorities and important peers (injunc-
tive norm). In addition, most people have a sense of what is ‘the
The conclusion that the benefits outweigh the investment, despite right thing to do’ (personal norm) that may or may not differ from
the investment required to collect bottles and daily labour input, societal norms.
constitutes the rational component in the intentions of water us-
ers to try out this new practice. For projects introducing a new HWTS technology, it is crucial to in-
form and persuade local leaders and influential figures in order to
Instead of simply focusing on rational arguments, promotional secure their endorsement, and possibly their active involvement in
tools can also be designed specifically to strengthen positive affec- the promotion. The same is true for practices that are already
known but not widely adopted, such as boiling water or hand wash-
ing. Influential figures can include political and religious leaders,
teachers, local doctors, nurses, or community health workers.
Box 19: Addressing attitude factors
With the support of these opinion leaders, a project is more likely
Target behaviour
to trigger a favourable social dynamic, resulting in universal adop-
• People drink exclusively safe water.
tion and sustained use of the practice. Local opinion leaders should
Promotion target
be involved in the early preparatory steps, i.e. before the start of
• The targeted population should believe that water treatment will result
in the improved health of family members and that the costs and labour the promotion at the household level. Note that it is often easier to
inputs are worthwhile (instrumental beliefs), and should feel positive secure the endorsement and support of health professionals than
about consuming treated water and providing treated water to family of the authorities in charge of water supply, because for them the
members (affective beliefs).
promotion of HWTS means admitting that the public supply is not
Potential promotional components safe. The promotion of SODIS through schools or mass media
• Involvement of celebrities in the promotion campaign
channels also contributes to strengthening norms and a common
• Painting of murals in the community
• Distribution of IEC materials and key messages via social media
perception of SODIS as a mainstream practice.

44
 Promotion of the SODIS method

Once promotion is ongoing and the first households have started 3.3.4 Addressing ability factors
using SODIS, the project should aim at increasing the visibility of
the early adopters and capitalize on their experience to convince Educating the people on how to apply the SODIS method correct-
other households to change their behaviour. Visibility can be en- ly and sustainably, i.e., the transfer of action knowledge, is a key
hanced, e.g., by asking SODIS user households to display stickers component of every SODIS promotion campaign. Although the ap-
outside of their homes. Interactions between users and non-users plication procedures for SODIS - as for most other HWTS meth-
can be actively supported to trigger a self-reinforcing social dynam- ods - are relatively simple, there is still considerable room for
ic towards widespread SODIS use. If the promotion fails to estab- misunderstanding that can result in incorrect use. Targeted water
lish a solid base of SODIS users relatively fast, and if early adopters users must be able to correctly perform all the steps of the SODIS
are seen relapsing towards raw water consumption, it can become method. Furthermore, they must be aware of the conditions that
very difficult to convince the more hesitant water users to adopt potentially limit the effectiveness of SODIS (e.g., cloudy or rainy
SODIS use. weather, high water turbidity, and scratched bottles), and must
know how to mitigate these challenges in order to achieve satis-
People’s perception of whether SODIS is – or could become - a factory results. The promotion must also assist targeted water us-
mainstream practice also depends on the extent to which these ers in developing strategies on how to deal with the potential
practices are promoted at a larger scale, e.g., through national lev- challenges to the long term application of SODIS (see chapter
el policy campaigns or as part of the curriculum in schools and 3.3.5).
health programs. If SODIS is promoted only in small pilot areas,
the fact that friends and relatives in neighbouring areas are not Successful transfer of know-how regarding the correct application
aware of the method can potentially limit the trust of people in the of SODIS is more likely if communication employs different promo-
method. Promotion through mass media also strengthen the per- tion tools (oral, visual, hands-on training, etc.), and is repeated at
ception of SODIS/HWTS as a trustworthy practice. National poli- different points in time. SODIS communication channels are simi-
cies and programs are often beyond the control of organizations lar to those promoting sensitization about diarrheal disease and
implementing SODIS projects, however, and the integration of transmission routes: group trainings, household visits, street the-
HWTS promotion at the national level is commonly a long term atre, written materials, and/or mass media. Practical demonstra-
goal. In some cases, it may be possible to leverage the support of tions of the SODIS methods should be part of group or household
national authorities for pilot projects that establish norms, e.g., by trainings. Household visits offer the opportunity for promoters to
asking permission to conduct promotional activities through health answer queries, correct mistakes, provide advice on specific chal-
centres or schools, and/or to use government logos on IEC mate- lenges, and to discuss strategies on how to sustain the practice
rials. and avoid relapses (see also chapter 3.3.5) For the sustained use
of SODIS, it is important that the promotion strengthens people’s
self-efficacy, i.e., their confidence and ability to overcome chal-
lenges that may prevent them from applying SODIS. These chal-
lenges may apply to entire communities (e.g., bottle supply), in
which case they should be addressed during community trainings.
Challenges that are very specific to individual households (e.g., ac-
cess to suitable places for bottle exposure) are best addressed dur-
ing household visits.

Box 20: Addressing norm factors Box 21: Addressing ability factors
Target behaviour Target behaviour
• People drink exclusively safe water. • People drink exclusively safe water.
Promotion target Promotion target
• The targeted population should perceive water treatment as a main- • The targeted population should know the correct application for water
stream practice (descriptive norms), should perceive water treatment as treatment (action knowledge), should know how they can successfully
a practice that is approved and viewed favourably (injunctive norms) and deal with barriers that arise during the maintenance of the behaviour
think of water treatment as the right thing to do (personal norm). (maintenance self-efficacy) and should know how they can successfully
recover from setbacks and failure (recovery self-efficacy).
Potential promotion components
• SODIS-stickers placed outside of the homes of SODIS-users Potential promotion components
• Training events at schools • Community or group trainings, including practical demonstrations
• Endorsement of respected opinion leaders • Household visits by promoters, including practical demonstrations
• Establishing a ‘safe water zone’, i.e., declaring an area a safe water zone • Written IEC materials with application guidelines, e.g., for distribution to
once a threshold of safe water households are recorded (e.g., 80%). households or for display in the community

45
 Promotion of the SODIS method

3.3.5 Addressing self-regulation Remembering and reminders

factors In order for a practice to become a routine habit, it is important
Addressing people’s awareness, motivation, and ability to use SO- that people remember the behaviour, particularly at the specific
DIS is expected to translate into an initial uptake of the practice in time when it has to be performed. Remembering is especially
a community. This does not mean, however, that the project has important in the early stages of the habit formation process, and
already succeeded in establishing sustainable behaviour change. when the practice is interrupted for some reason, e.g., during
New habits are formed through regular practice over several weeks rainy periods in the case of SODIS.
or months, and the risk of relapsing to old habits persists even af-
ter that. The following subchapters describe approaches and tools Different strategies can be employed to support remembering in
that help to transform the new practice of water treatment into a the target households. One key task for promoters during follow-
sustainable habit and prevent relapsing to the consumption of raw up visits to households is to remind people to apply and to practice
water. the water treatment and/or safe storage. Printed materials distrib-
uted to households as prompts - e.g., stickers or posters put on
display in the place where water treatment is done – can positive-
Planning routine and coping ly impact the habit formation process. Such prompts are more like-
ly to be used and to remain visible in households if they are
activities integrated around other useful things, i.e., a calendar. Reminders
Many people are quick to make room in their daily routines for a such as banner or posters can also be distributed for display in the
newly advertised technology or practice in the short term. This ap- community at strategic locations. Another channel to disseminate
plies to the use of a new household water treatment method or to reminders is mass media, i.e. radio and TV programs. School pro-
putting new running shoes to the test. However, as the practice motion can support remembering if children learn about SODIS/
loses novelty and excitement, it risks being marginalized in relation HWTS and remind their parents back home about the practice.
to the former older routine activities. Relapse is all the more likely
if the new practice is time-consuming and tedious. For this reason, Commitment
forming the habit of regular SODIS use may be even more chal-
People are more likely to follow through with a behaviour change
lenging than achieving the sustained use of a filter, considering the
if they consciously commit to do so. This can be a private commit-
multiple routine tasks that are required (periodic collection of bot-
ment, a declaration made to friends or family members, or a pub-
tles, daily filling and exposure at least six hours waiting period,
lic pledge. The promotion can try to motivate the people to make a
possibly cooling of water, etc.).
commitment and to communicate it to others. Promoters can ask
people directly if they are willing to treat their drinking water (ap-
In order to prevent relapsing from the consistent application of SO-
plying caution not to pressure them into making false commit-
DIS, potential priority conflicts with other activities should be per-
ments), and invite them to share their commitment with others,
manently resolved. While some households find it easy to integrate
either bilaterally or during group meetings. This declaration can be
SODIS in their daily activities, others may need external support
formalized as a public pledge or by signing a written declaration of
and advice. SODIS/HWTS promotion programs should be prepared
intent. Stickers or posters put up outside the house or compound
to provide this kind of support. Concretely, this means discussing
also represent the commitment of the household and can, as such,
the daily household routine with the person in charge of drinking
reinforce their motivation to keep up the behaviour.
water, and assigning responsibilities and time slots for each task.
Advice on how to integrate SODIS/HWTS into household routines
must relate to the individual situations of each household, and pro-
Institutionalization
moting a participatory approach is essential. General suggestions
can be provided during community and group trainings. Stimulat- The experience from SODIS promotion as with other health-relat-
ing interactions between households to share experiences and ed behaviour change, campaigns is that sustainable habit forma-
best practices is another approach. It can be useful to write down tion depends on a long-term promotion effort. Any SODIS or HWTS
the outcomes of these discussions, i.e., the individual solutions in project should, thus, adopt strategies aimed at institutionalising
each household, to help water users better remember the plan. the promotion activities (both in terms of education and product
availability) beyond the actual project period. In the long term, cen-
Ideally, routine activities and coping strategies can be implement- tral governments are expected to play a large role in HWTS promo-
ed by household members themselves without relying on external tion through national programs. In individual projects,
support. Collective solutions, e.g., households supporting each institutionalisation mainly relies on local institutions. Local health
other with bottle supply or surveillance of exposed bottles can be centres or community health workers, schools, self-help groups,
considered to mitigate certain challenges, but such arrangements etc., can continue education activities if they have been properly
are often fragile and prone to failure if one of the involved parties trained and equipped with the necessary materials (e.g., manuals
does not do his/her assigned role for some reason. and promotion guidelines). Newly formed local groups for the spe-
cific purpose of HWTS promotion, e.g., HWTS committees, are at
a high risk of disintegrating without project support compared to
pre-existing institutions. Supply chains for required HWTS prod-
ucts (including consumables and spare parts) are preferably trans-
ferred to private entrepreneurs on a commercial basis. For the

46
 Promotion of the SODIS method

Pupil in Bolivia explaining different water treatment methods

successful institutionalisation of subsidised business models, the Box 21: Questions to address self-regulating factors for SODIS
long-term availability of funds for subsidies must secured. application
The following issues should be addressed:
Efforts to achieve institutionalization can be started early in the pro- • When and how do we collect bottles? Who is responsible?
ject cycle, though the local institutions may want to see that HWTS • Which person is in charge of filling, placing, and – if necessary - watch-
promotion is effective before they commit to engaging in such pro- ing over the bottles?
• At what time, after and before what other activities, do we fill and ex-
jects in the long run. Institutionalization should be a main focus of
pose the bottles?
phasing-out activities towards the end of a project. • Which water do we use for SODIS? Water from a source, or household
storage?
• Where in the household do we fill the bottles, using what equipment?
• Where do we expose the bottles to the sun? Is there a risk that the bot-
tles could be tampered with while we are away, and how can this be pre-
vented?
• Do bottles need to be moved during the day to receive enough sunlight?
Who is responsible?
• How do I ensure that the required exposure time is adhered to, i.e., that
water is not consumed too early in the day by some family members?
• Where do I store the treated water? In the bottles themselves? Do I
Box: 22 Addressing self-regulation factors need a second set of bottles for exposure for the next day? Or in a stor-
Target behaviour age container? How do I keep it clean and prevent re-contamination?
• People drink exclusively safe water.
Furthermore, potential challenges and barriers to the application of SODIS
Promotion target
that may arise should be discussed, e.g.:
• The targeted population should have a clear understanding of where,
when and how to treat water (action control/planning), should be aware • What other activities could conflict with the application of SODIS? What
about potential barriers to the application and know strategies to over- can be done to resolve these conflicts?
come them (coping planning), should regularly be reminded to treat wa- • Who applies SODIS when the person in charge is (temporarily) unavail-
ter before consumption (remembering) and should commit publicly or able?
privately to treat water consistently (commitment). • What adaptations are needed when the weather is cloudy and the bot-
tles need to be exposed for two consecutive days (e.g., use of another
Potential promotion components
HWTS method)?
• Household visits with structured discussions to plan routine activities
• What alternative methods can I use if SODIS is not applicable for some
and protocols of the coping strategies
reason, or if the volume of safe water is insufficient to meet the de-
• Follow-up community trainings
mand?
• Prompts for the households or for display in the community (e.g.,: stick-
• What options do I have in case the regular source of new bottles be-
er, poster, calendar)
comes inaccessible?
• Statements of intent made in front of promoters or friends/neighbours

47
 Promotion of the SODIS method

3.4 Recommendations for 3.4.3 Integrate water quality

the promotion tests to the promotion campaign
This manual does not prescribe a specific one-size-fits-all approach Water quality tests to demonstrate the contamination of drinking
for the promotion of SODIS but rather provides a series of recom- water before and after treatment are a powerful persuasive promo-
mendations that have been effective in past SODIS projects. tional tool. Tests at source or at the household storage level raise
awareness about the presence of germs in the water and can in-
form about related health risks. Test results showing zero contam-
3.4.1 Use multiple promotion ination after SODIS treatment strengthen beliefs that the method
channels works effectively and yields the benefits associated with safe
drinking water consumption. Water quality tests as a tool to influ-
The use of multiple promotion channels will reach more members ence attitudes (instrumental as well as affective beliefs) are most
of the target population, and allow the promoted messages to be effective if they are performed and interpreted in the presence of
conveyed from different angles. the water users so that they can see the results with their own
eyes.
The promotion channels used in previous SODIS projects can be
grouped into the following four categories: The number and frequency of water quality tests in a SODIS/
• Individual visit or meeting: This promotion channel is mainly used HWTS promotion project is typically limited by cost and the de-
during household visits and during meetings with local opinion mand for skilled labour. Water quality tests can be conducted ei-
leaders, such as doctors, political leaders, religious leaders or en- ther through field test methods or at a local lab. There are two
trepreneurs in the health sector. different types of faecal pathogen tests:
• Training or information events: This channel is ideal to reach a spe- • quantitative methods indicating the concentration of either patho-
cific group within a community, such as women groups, teachers gens or indicator organisms in the water
or members of an association. • presence/absence tests showing a positive result if any number of
• Traditional mass medias: Television, radio and print media are pathogens or indicator organisms above a (very low) threshold con-
mostly used to complement the personal promotion channel and centration are present in the water.
reach a wide range of users.
• Internet: The Internet is mainly used to provide information on the The most common example of presence/absence tests are H2S vi-
web and to interact with target groups via social media. als that are filled with water and indicate contamination through a
colour change. Presence/absence tests are less expensive and
Implementing agencies are encouraged to evaluate and select a easier to process than quantitative tests, but cannot show differ-
suitable set of channels according to the target groups, the local ences in contamination levels. Presence/absence tests also do not
context, the duration of the intervention, as well the financial and evaluate and prioritize sources with different contamination levels.
personal capacity. Furthermore, they fail to demonstrate a substantial improvement
in water quality if a few indicator organisms survive the treatment
process and produce a positive result. Water quality tests that in-
3.4.2 Engage community dicate contamination for both untreated and treated water – even
promoters if pathogen concentrations were in fact substantially reduced – will
negatively affect people’s belief in the treatment method and their
In most SODIS promotion projects supported by Eawag, commu- motivation to adopt it. Quantitative tests provide a more differen-
nity promoters played a crucial role in the training and follow up of tiated picture of varying contamination levels. Quantitative test
water users. They can address all key factors influencing behaviour methods include membrane filtration for coliform counts and most
change by organizing trainings, engaging local authorities, and reg- probable number methods and typically require more costly mate-
ularly visiting individual households. Effective promoters enjoy re- rials and labour inputs (including possibly a filtration step to detect
spect and credibility in the community and can get easy access to pathogens in low concentrations) compared to presence/absence
the people in charge of drinking water inside households (usually tests.
women). The level of motivation and enthusiasm to serve the com-
munity is a key criterion in the recruitment of promoters. These cri- Most common field testing methods require an incubation period
teria often apply to people who had been previously enrolled in of at least 24 hours. The gap between sampling and results some-
community training or outreach projects, or people who occupy in- what limits the persuasive effect of water quality testing, and pro-
fluential positions in the target area (community health workers, ject staff may need to go to the field site twice to conduct the test
staff of health centres, and self-help group leaders). and present the results. Field test materials, including vials and
plates, can remain with the water users during the incubation pe-
Studies show that inter-personal communication is often the most riod. However, qualified personnel is needed to interpret and dis-
effective promotion tool, and that the effectiveness critically de- cuss the results and to safely dispose of the materials.
pends on the rapport between the promoters and the target popu-
lation. The volume of water used in different analytical methods deter-
mines the reliability of test results. Test methods using small sam-
ple volumes (e.g., 1ml) cannot produce reliable results in the low
concentration range, especially for concentrations below 100

48
 Promotion of the SODIS method

CFU/100ml) . Processing larger water samples - e.g., filtering Examples of water quality test methods are:
100ml samples for the subsequent detection of coliforms on the • Local lab: mostly membrane filtration or most probable number
filter paper - is often a time-demanding and error-prone step, and method, multi-parameter analysis if required, usually expensive (>
requires additional material and skilled labour. 5USD per test)
• Field test kits for quantitative tests (e.g., Delaqua, Hach): prices
Due to their costs and demand for skilled labour, water quality typically > 1000 USD, heavy if including a battery powered incuba-
tests are usually employed at specific times - e.g., to establish an tor
evidence base to persuade local opinion makers before the start of • Disposable plates and trays for quantitative tests: e.g., 3M Petri-
a promotion campaign, at community trainings, or at a limited num- films, Compact Dry plates, IDDEXX Quanty-Tray : cost typically 1-2
ber of households - rather than as a regular activity in all house- USD per test, and may require additional materials that complicate
holds. field testing (filtration unit of 100ml samples, and an incubator if
ambient temperature is not high enough)
• Vials for presence/absence tests: e.g., H2S vials - their cost can be
<1 USD per test

Water quality tests in Guinea

49
 Promotion of the SODIS method

3.4.4 Develop comprehensive

and attractive IEC materials
Information, Education and Communication (IEC) materials used in
behaviour change programs should be attractive, adapted to the lo-
cal context, designed specifically to influence one or several spe-
cific behaviour change factors.

There is a wide range of IEC materials that can be used in a promo-

tion campaign, such print-materials (e.g., stickers, leaflets, post- Box 25: Parameters and design features of IEC materials

ers, handbooks, manuals), paintings (e.g., murals), audio-material For all IEC materials, the following parameters should be defined:
(e.g., radio ads) or video-material (e.g., TV ads). • Type (poster, leaflet, sticker, radio spot, puppet theatre, etc.)
• Purpose, i.e., which behaviour change factor will be addressed (multiple
purposes possible)
A comprehensive IEC strategy defines a series of parameters and
• Target audience
design features for all the materials. Materials used in the training • Main message
of trainers or distributed to promoters for their own reference are • Content
typically more detailed and technical, while materials distributed • Format
to target households or displayed in public places typically concen- • Distribution channel
• Number of copies
trate on simple, clear, factual or emotional messages. Examples
for promotion materials used in SODIS promotion projects are To maximize the effectiveness of IEC materials, the following design fea-
tures should be applied:
available on the SODIS webpage: www.sodis.ch.
• Adapted to the purpose
• Adapted for the target audience (e.g., adults, children, illiterates, deci-
sion makers, etc.)
• Adapted to local contexts (i.e., in terms of language, appearance of peo-
Box 24:: Examples of key messages addressing different risk ple in illustrations, and cultural sensitivities)
factors: • Clear and catchy key message
• Aesthetic and attractive design
• “Diarrhoea is severe, but is a preventable disease!” (risk factor)
• Simple where possible (not too much text), comprehensive where nec-
• “Safe water is good for you!” (attitudinal factor)
essary (e.g., user instructions must be complete)
• “Everyone in the community drinks safe water!” (norm factor)

Wall painting in India

50
 Promotion of the SODIS method

• Make sure that people can easily access detailed information about
3.4.5 Promote an integrated the different technologies after the promotion, both to support their
HWTS approach selection among the different HWTS methods, and to resolve
An integrated HWTS approach enables water users to make in- questions regarding the application of their chosen method. Easy
formed choices among a range of technology options about what access to relevant information can be achieved through training
more effectively addresses the diverse needs, capacities, and pref- and capacity building of local resource persons (health workers and
erences of water users. group leaders), household visits after the initial training, or IEC ma-
terials displayed in the community or distributed to each house-
Therefore, promoting several methods is challenging and may hold.
overwhelm the target water users. The following strategies can be
applied:

• Avoid overloading target water users with technical details during

the first promotion event, focus on the importance of safe drinking
water and the existence of technological solutions.

Box 23: Essentials: What promoters need to know

SODIS promoters must have a solid understanding of the rationale
of household water treatment to prevent infections with diarrhoea, a
comprehensive knowledge of the application guidelines of SODIS and
possibly of other HWTS methods, and should be able to advise water
users on how to overcome challenges to the correct and sustained
application of SODIS. An initial training of promoters typically takes 1-3
days, depending on whether or not other HWTS methods are integrated
in the promotion, and the tasks which promoters are expected to do.
Refresher trainings during the promotion period are recommended.

A promoter should have knowledge of:

• Diarrhoea: pathogens, health effects, mortality risk, and productivity loss
• Transmission routes of pathogens through drinking water, hygiene, food,
and the environment
• Strategies to prevent transmission of pathogens: water treatment, im-
proved personal and environmental hygiene, and improved sanitation
• Drinking water contamination: possible source, and critical points for re-
contamination
• Importance of consistent safe water consumption for effective preven-
tion of infection
• Household water treatment: different options
• Solar disinfection: principle (UV radiation in sunlight)
• SODIS steps: exposure of water in clean PET bottles to direct sunlight,
and storage in bottles
• Weather dependence: 1 day (min. 6 hours) for sunny weather; 2 days
when the sky is more than 50% cloudy; not applicable on rainy days
• Limitations of the SODIS method: not effective for turbid water, not ef-
fective during rainy days, and does not remove chemical pollutants, such
as arsenic and fluoride.
• Bottle types: water and soda bottles made of PET, colourless, maximum
2 litres and labels removed
• Suitable places to expose bottles: no shade during the entire exposure
time (possibly: reflective surface)
• Quantity: sufficient to allow for consistent safe water consumption for all
family members
• Storage: ideally in the bottles, alternating 2 sets of bottles for daily expo-
sure and storage
• Replacement of bottles: when the outer surface becomes opaque from
scratches or solar radiation, which happens typically after a few months
• Bottle availability: points of access, and strategies to collect bottles
• Strategies to integrate water treatment into daily household routines
• Promotion skills: effective use of persuasion, communication, and moni-
toring tools
• Depending on scope of the project: application guidelines of other HWTS
methods, specific information and application guidelines for hygiene and
sanitation

Woman applying SODIS in Nepal

51
 Appendices

4 Appendices cherichia coli cells as signs of accelerated cellular senescence. En-

vironmental Microbiology 12(11), 2931-45.
• Boyle M., Sichel C., Fernandez-Ibanez P., Arias-Quiroz G. B., Iriarte-
Puna M., Mercado A., Ubomba-Jaswa E. and McGuigan K. G.
4.1 References (2008). Bactericidal effect of solar water disinfection under real
sunlight conditions. Applied and Environmental Microbiology
• AIDSTAR-One (2012). Session 3: Behaviour change for water, san-
74(10), 2997-3001.
itation, and hygiene in the home.
• Brown J. and Clasen T. (2012). High Adherence Is Necessary to Re-
• AL-Gheethi A. A. S., Norli I. and Kadir M. O. A. (2013). Elimination of
alize Health Gains from Water Quality Interventions. Plos One 7(5).
enteric indicators and pathogenic bacteria in secondary effluents
• Byrne J. A., Fernandez-Ibanez P. A., Dunlop P. S. M., Alrousan D. M.
and lake water by solar disinfection (SODIS). Journal of Water Re-
A. and Hamilton J. W. J. (2011). Photocatalytic Enhancement for So-
use and Desalination 3(1), 39-46.
lar Disinfection of Water: A Review. International Journal of Photo-
• Altherr A.-M., Mosler H.-J., Tobias R. and Butera F. (2008 ). Attitudi-
energy.
nal and Relational Factors Predicting the Use of Solar Water Disin-
• Christen A., Pacheco G. D., Hattendorf J., Arnold B. F., Cevallos M.,
fection: A Field Study in Nicaragua. Health Education & Behaviour
Indergand S., Colford J. M. and Mausezahl D. (2011). Factors asso-
35 (2), 207-20.
ciated with compliance among users of solar water disinfection in
• Amin M. T. and Han M. Y. (2009). Roof-harvested rainwater for po-
rural Bolivia. Bmc Public Health 11.
table purposes: Application of solar collector disinfection (SOCO-
• Conroy R. M., Elmore-Meegan M., Joyce T., McGuigan K. G. and
DIS). Water Research 43(20), 5225-35.
Barnes J. (1996). Solar disinfection of drinking water and diarrhoea
• Andra S. S., Makris K. C. and Shine J. P. (2011). Frequency of use
in Maasai children: A controlled field trial. The Lancet 348(9043),
controls chemical leaching from drinking-water containers subject
1695-7.
to disinfection. Water Research 45(20), 6677-87.
• Conroy R. M., Meegan M. E., Joyce T., McGuigan K. and Barnes J.
• Arnold B., Arana B., Mausezahl D., Hubbard A. and Colford J. M.
(1999). Solar disinfection of water reduces diarrhoeal disease: an
(2009). Evaluation of a pre-existing, 3-year household water treat-
update. Archives of Disease in Childhood 81(4), 337-8.
ment and handwashing intervention in rural Guatemala. Interna-
• Conroy R. M., Meegan M. E., Joyce T., McGuigan K. and Barnes J.
tional Journal of Epidemiology 38(6), 1651-61.
(2001). Solar disinfection of drinking water protects against cholera
• Asiimwe J. K., Quilty B., Muyanja C. K. and McGuigan K. G. (2013).
in children under 6 years of age. Archives of Disease in Childhood
Field comparison of solar water disinfection (SODIS) efficacy be-
85(4), 293-5.
tween glass and polyethylene terephalate (PET) plastic bottles un-
• Dejung S., Fuentes I., Almanza G., Jarro R., Navarro L., Arias G., Ur-
der sub-Saharan weather conditions. Journal of Water and Health
quieta E., Torrico A., Fenandez W., Iriarte M., Birrer C., Stahel W. A.
11(4), 729-37.
and Wegelin M. (2007). Effect of solar water disinfection (SODIS)
• Bach C., Dauchy X., Chagnon M. C. and Etienne S. (2012). Chemi-
on model microorganisms under improved and field SODIS condi-
cal compounds and toxicological assessments of drinking water
tions. Journal of Water Supply Research and Technology-Aqua
stored in polyethylene terephthalate (PET) bottles: A source of con-
56(4), 245-56.
troversy reviewed. Water Research 46(3), 571-83.
• Dessie A., Alemayehu E., Mekonen S., Legesse W., Kloos H. and
• Bach C., Dauchy X., Severin I., Munoz J. F., Etienne S. and Chagnon
Ambelu A. (2014). Solar disinfection: an approach for low-cost
M. C. (2013). Effect of temperature on the release of intentionally
household water treatment technology in Southwestern Ethiopia.
and non-intentionally added substances from polyethylene tereph-
Journal of Environmental Health Science and Engineering 12.
thalate (PET) bottles into water: Chemical analysis and potential
• Dionisio Calado A. (2013). Solar disinfection of viruses (SODIS): in-
toxicity. Food Chemistry 139(1-4), 672-80.
activation of coliphages MS2 and phiX174, human adenovirus and
• Bach C., Dauchy X., Severin I., Munoz J. F., Etienne S. and Chagnon
echovirus in water from Switzerland and India. M.Sc. Thesis, EPFL.
M. C. (2014). Effect of sunlight exposure on the release of inten-
• Du Preez M., Conroy R. M., Ligondo S., Hennessy J., Elmore-
tionally and/or non-intentionally added substances from polyethyl-
Meegan M., Soita A. and McGuigan K. G. (2011). Randomized In-
ene terephthalate (PET) bottles into water: Chemical analysis and
tervention Study of Solar Disinfection of Drinking Water in the
in vitro toxicity. Food Chemistry 162, 63-71.
Prevention of Dysentery in Kenyan Children Aged under 5 Years.
• Berney M., Weilenmann H. U., Simonetti A. and Egli T. (2006). Effi-
Envion. Sci. Technol. 45(21), 9315-23.
cacy of solar disinfection of Escherichia coli, Shigella flexneri, Sal-
• du Preez M., McGuigan K. G. and Conroy R. M. (2010). Solar Disin-
monella Typhimurium and Vibrio cholerae. Journal of Applied
fection of Drinking Water In the Prevention of Dysentery in South
Microbiology 101(4), 828-36.
African Children Aged under 5 Years: The Role of Participant Moti-
• Black R. E., Morris S. S. and Bryce J. (2003). Where and why are 10
vation. Environmental Science & Technology 44(22), 8744-9.
million children dying every year? Lancet 361(9376), 2226-34.
• Eawag-Sandec/WSSCC/UN-HABITAT (2011). Community-Led Ur-
• Bosshard F., Berney M., Scheifele M., Weilenmann H. U. and Egli T.
ban Environmental Sanitation Planning: CLUES.
(2009). Solar disinfection (SODIS) and subsequent dark storage of
• Fisher M. B., Iriarte M. and Nelson K. L. (2012). Solar water disin-
Salmonella typhimurium and Shigella flexneri monitored by flow
fection (SODIS) of Escherichia coli, Enterococcus spp., and MS2
cytometry. Microbiology-Sgm 155, 1310-7.
coliphage: Effects of additives and alternative container materials.
• Bosshard F., Bucheli M., Meur Y. and Egli T. (2010 ). The respiratory
Water Research 46(6), 1745-54.
chain is the cell's Achilles' heel during UVA inactivation in Escheri-
• Fisher M. B., Keenan C. R., Nelson K. L. and Voelker B. M. (2008).
chia coli. Microbiology 156(7), 2006-15.
Speeding up solar disinfection (SODIS): effects of hydrogen perox-
• Bosshard F., Riedel K., Schneider T., Geiser C., Bucheli M. and Egli
ide, temperature, pH, and copper plus ascorbate on the photoinac-
T. (2010). Protein oxidation and aggregation in UVA-irradiated Es-
tivation of E-coli. Journal of Water and Health 6(1), 35-51.

52
 Appendices

• Franz R. and Welle F. (2009). Can Migration of Endocrine Disruptors • Heri S. and Mosler H. J. (2008). Factors affecting the diffusion of
from Plastic Bottles be the Cause of Estrogenic Burden Recently solar water disinfection: A field study in Bolivia. Health Education
Determined in Bottled Mineral Water? Deutsche Lebensmittel- & Behaviour 35(4), 541-60.
Rundschau 105(5), 315-+. • Huda T. M. N., Unicomb L., Johnston R. B., Halder A. K., Sharker M.
• Fujioka R. S. and Yoneyama B. S. (2002). Sunlight inactivation of hu- A. Y. and Luby S. P. (2012). Interim evaluation of a large scale sani-
man enteric viruses and fecal bacteria. Water Science and Technol- tation, hygiene and water improvement programme on childhood
ogy 46(11-12), 291-5. diarrhea and respiratory disease in rural Bangladesh. Social Sci-
• Gall A. (2010). Bacteriophage prd1 as a potential surrogate for ad- ence & Medicine 75(4), 604-11.
enovirus in drinking water disinfection with free chlorine, low pres- • Hunter P. R. (2009). Household Water Treatment in Developing
sure ultraviolet light, and sunlight. M.Sc., University of Illinois. Countries: Comparing Different Intervention Types Using Meta-Re-
• Gelover S., Gómez L. A., Reyes K. and Teresa Leal M. (2006 ). A gression. Environmental Science & Technology 43(23), 8991-7.
practical demonstration of water disinfection using TiO2 films and • INFO Project (2008). Tools for Behaviour Change Communication.
sunlight.. Water Research 40(17), 3274-80. • Jagger J. (1985). Solar-UV actions on living cells. Praeger, Westport
• Gill L. W. and Price C. (2010). Preliminary observations of a contin- - Conn.
uous flow solar disinfection system for a rural community in Kenya. • K4Health (2014). Toolkits: Behaviour Change Communication. htt-
Energy 35(12), 4607-11. ps://www.k4health.org/toolkits/pc-bcc/behaviour-change-commu-
• Gomez-Couso H., Fontan-Sainz M., McGuigan K. G. and Ares- nication (accessed 22.09.2014.
Mazas E. (2009). Effect of the radiation intensity, water turbidity • Kalt P., Birzer C., Evans H., Liew A., Padovan M. and Watchman M.
and exposure time on the survival of Cryptosporidium during sim- (2014). A Solar Disinfection Water Treatment System for Remote
ulated solar disinfection of drinking water. Acta Tropica 112(1), 43- Communities. Procedia Engineering 78, 250 - 8.
8. • Kehoe S. C., Barer M. R., Devlin L. O. and McGuigan K. G. (2004).
• Graf J., Meierhofer R., Wegelin M. and Mosler H. J. (2008). Water Batch process solar disinfection is an efficient means of disinfect-
disinfection and hygiene behaviour in an urban slum in Kenya: im- ing drinking water contaminated with Shigella dysenteriae type I.
pact on childhood diarrhoea and influence of beliefs. International Letters in Applied Microbiology 38(5), 410-4.
Journal of Environmental Health Research 18(5), 335-55. • Kehoe S. C., Joyce T. M., Ibrahim P., Gillespie J. B., Shahar R. A. and
• Graf J., Togouet S. Z., Kemka N., Niyitegeka D., Meierhofer R. and McGuigan K. G. (2001). Effect of agitation, turbidity, aluminium foil
Pieboji J. G. (2010). Health gains from solar water disinfection (SO- reflectors and container volume on the inactivation efficiency of
DIS): evaluation of a water quality intervention in Yaounde, Came- batch-process solar disinfectors. Water Research 35(4), 1061-5.
roon. Journal of Water and Health 8(4), 779-96. • Keresztes S., Tatar E., Mihucz V. G., Virag I., Majdik C. and Zaray G.
• Guart A., Bono-Blay F., Borrell A. and Lacorte S. (2011). Migration of (2009). Leaching of antimony from polyethylene terephthalate
plasticizers phthalates, bisphenol A and alkylphenols from plastic (PET) bottles into mineral water. Science of the Total Environment
containers and evaluation of risk. Food Additives and Contaminants 407(16), 4731-5.
Part a-Chemistry Analysis Control Exposure & Risk Assessment • Khaengraeng R. and Reed R. H. (2005). Oxygen and photoinactiva-
28(5), 676-85. tion of Escherichia coli in UVA and sunlight. Journal of Applied Mi-
• Gurung P., Grimm B. and Autenrieth M. (2009). Disseminating the crobiology 99(1), 39-50.
SODIS method: Which approach is most effective? . Waterlines • King B. J., Hoefel D., Daminato D. P., Fanok S. and Monis P. T. (2008).
28(2). Solar UV reduces Cryptosporidium parvum oocyst infectivity in en-
• Halperin M., Paz-Soldan V. A., Quispe V., Paxton A. and Gilman R. vironmental waters. Journal of Applied Microbiology 104(5), 1311-
H. (2011). Student Column SUSTAINABILITY OF SOLAR DISIN- 23.
FECTION TO PROVIDE SAFE DRINKING WATER IN RURAL PERU. • Kraemer S. M. and Mosler H. J. (2010). Persuasion factors influenc-
Public Health Reports 126(5), 762-8. ing the decision to use sustainable household water treatment. In-
• Harding A. S. and Schwab K. J. (2012). Using Limes and Synthetic ternational Journal of Environmental Health Research 20(1), 61-79.
Psoralens to Enhance Solar Disinfection of Water (SODIS): A Labo- • Kruti J. and Shilpa D. (2012). Solar water disinfection under real con-
ratory Evaluation with Norovirus, Escherichia coli, and MS2. Amer- ditions with or without solar collector. Journal of Environmental Re-
ican Journal of Tropical Medicine and Hygiene 86(4), 566-72. search And Development 7(2A), 1085-98.
• Heaselgrave W. and Kilvington S. (2010). Antimicrobial Activity of • Lantagne D. and Clasen T. (2012). Point-of-use water treatment in
Simulated Solar Disinfection against Bacterial, Fungal, and Proto- emergency response Waterlines 31 (1&2), 30-52.
zoan Pathogens and Its Enhancement by Riboflavin. Applied and • Lonnen J., Kilvington S., Kehoe S. C., Al-Touati F. and McGuigan K.
Environmental Microbiology 76(17), 6010-2. G. (2005). Solar and photocatalytic disinfection of protozoan, fun-
• Heaselgrave W. and Kilvington S. (2011). The efficacy of simulated gal and bacterial microbes in drinking water. Water Research 39(5),
solar disinfection (SODIS) against Ascaris, Giardia, Acanthamoeba, 877-83.
Naegleria, Entamoeba and Cryptosporidium. Acta Tropica 119(2-3), • Mani S. K., Kanjur R., Singh I. S. B. and Reed R. H. (2006). Compar-
138-43. ative effectiveness of solar disinfection using small-scale batch re-
• Heaselgrave W. and Kilvington S. (2012). The efficacy of simulated actors with reflective, absorptive and transmissive rear surfaces.
solar disinfection (SODIS) against coxsackievirus, poliovirus and Water Research 40(4), 721-7.
hepatitis A virus. Journal of Water and Health 10(4), 531-8.
• Heaselgrave W., Patel N., Kilvington S., Kehoe S. C. and McGuigan
K. G. (2006). Solar disinfection of poliovirus and Acanthamoeba pol-
yphaga cysts in water - a laboratory study using simulated sunlight.
Letters in Applied Microbiology 43(2), 125-30.

53
 Appendices

• Martin-Dominguez A., Alarcon-Herrera M. T., Martin-Dominguez I. moeba histolytica/dispar at a point-of-use water treatment. Journal
R. and Gonzalez-Herrera A. (2005). Efficiency in the disinfection of of Applied Microbiology 106(3), 847-52.
water for human consumption in rural communities using solar ra- • Mustafa A., Scholz M., Khan S. and Ghaffar A. (2013). Application
diation. Solar Energy 78(1), 31-40. of solar disinfection for treatment of contaminated public water
• Mausezahl D., Christen A., Pacheco G. D., Tellez F. A., Iriarte M., Za- supply in a developing country: field observations. Journal of Wa-
pata M. E., Cevallos M., Hattendorf J., Cattaneo M. D., Arnold B., ter and Health 11(1), 135-45.
Smith T. A. and Colford J. M. (2009). Solar Drinking Water Disinfec- • Percival S., Chalmers R., Embrey M., Hunter P. and Sellwood J.
tion (SODIS) to Reduce Childhood Diarrhoea in Rural Bolivia: A (2004). Rotavirus. In: Microbiology of Waterborne Diseases Per-
Cluster-Randomized, Controlled Trial. Plos Medicine 6(8). cival S, Chalmers R, Embrey M, Hunter P, Sellwood J and Wyn-
• McGuigan K. G., Conroy R. M., Mosler H. J., du Preez M., Ubom- Jones P (eds), Elsevier Academic Press, pp. 445-52.
ba-Jaswa E. and Fernandez-Ibanez P. (2012). Solar water disinfec- • Rainey R. C. and Harding A. K. (2005). Acceptability of solar disin-
tion (SODIS): A review from bench-top to roof-top. Journal of fection of drinking water treatment in Kathmandu Valley, Nepal. In-
Hazardous Materials 235, 29-46. ternational Journal of Environmental Health Research 15(5),
• McGuigan K. G., Joyce T. M., Conroy R. M., Gillespie J. B. and El- 361-72.
more-Meegan M. (1998). Solar disinfection of drinking water con- • Reed R. H. (1997). Solar inactivation of faecal bacteria in water: The
tained in transparent plastic bottles: characterizing the bacterial critical role of oxygen. Letters in Applied Microbiology 24(4), 276-
inactivation process. Journal of Applied Microbiology 84(6), 1138- 80.
48. • Reed R. H. (2004). The inactivation of microbes by sunlight: Solar
• McGuigan K. G., Mendez-Hermida F., Castro-Hermida J. A., Ares- disinfection as a water treatment process. Advances in Applied Mi-
Mazas E., Kehoe S. C., Boyle M., Sichel C., Fernandez-Ibanez P., crobiology, Vol 54 54, 333-65.
Meyer B. P., Ramalingham S. and Meyer A. (2006). Batch solar dis- • Rincon A. G. and Pulgarin C. (2004a). Bactericidal action of illumi-
infection inactivates oocysts of Cryptosporidium parvum and cysts nated TiO2 on pure Escherichia coli and natural bacterial consortia:
of Giardia muris in drinking water. Journal of Applied Microbiology post-irradiation events in the dark and assessment of the effective
101(2), 453-63. disinfection time. Applied Catalysis B-Environmental 49(2), 99-112.
• McGuigan K. G., Samaiyar P., du Preez M. and Conroy R. M. (2011). • Rincon A. G. and Pulgarin C. (2004b). Effect of pH, inorganic ions,
High Compliance Randomized Controlled Field Trial of Solar Disin- organic matter and H2O2 on E-coli K12 photocatalytic inactivation
fection of Drinking Water and Its Impact on Childhood Diarrhea in by TiO2 - Implications in solar water disinfection. Applied Catalysis
Rural Cambodia. Environmental Science & Technology 45(18), B-Environmental 51(4), 283-302.
7862-7. • Rincon A. G. and Pulgarin C. (2004c). Field solar E-coli inactivation
• Meierhofer R. and Landolt G. (2009). Factors supporting the sus- in the absence and presence of TiO2: is UV solar dose an appropri-
tained use of solar water disinfection - Experiences from a global ate parameter for standardization of water solar disinfection? Solar
promotion and dissemination programme. Desalination 248(1-3), Energy 77(5), 635-48.
144-51. • Romero-Maraccini O. C., Sadik N. J., Rosado-Lausell S. L., Pugh C.
• Mendez-Hermida F., Ares-Mazas E., McGuigan K. G., Boyle M., Si- R., Niu X. Z., Croue J. P. and Nguyen T. H. (2013). Sunlight-Induced
chel C. and Fernandez-Ibanez P. (2007). Disinfection of drinking wa- Inactivation of Human Wa and Porcine OSU Rotaviruses in the
ter contaminated with Cryptosporidium parvum oocysts under Presence of Exogenous Photosensitizers. Environmental Science
natural sunlight and using the photocatalyst TiO2. Journal of Pho- & Technology 47(19), 11004-12.
tochemistry and Photobiology B-Biology 88(2-3), 105-11. • Romero O. C., Straub A. P., Kohn T. and Nguyen T. H. (2011). Role of
• Mendez-Hermida F., Castro-Hermida J. A., Ares-Mazas E., Kehoe Temperature and Suwannee River Natural Organic Matter on Inac-
S. C. and McGuigan K. G. (2005). Effect of batch-process solar dis- tivation Kinetics of Rotavirus and Bacteriophage MS2 by Solar Irra-
infection on survival of Cryptosporidium parvum oocysts in drink- diation. Environmental Science & Technology 45(24), 10385-93.
ing water. Applied and Environmental Microbiology 71(3), 1653-4. • Rose A., Roy S., Abraham V., Holmgren G., George K., Balraj V.,
• Moser S. and Mosler H.-J. (2008). Differences in influence patterns Abraham S., Muliyil J., Joseph A. and Kang G. (2006). Solar disin-
between groups predicting the adoption of a solar disinfection fection of water for diarrhoeal prevention in southern India. Ar-
technology for drinking water in Bolivia. Social Science & Medicine chives of Disease in Childhood 91(2), 139-41.
67(4), 497-504. • Rungchang S., Numthuam S., Qiu X. L., Li Y. J. and Satake T. (2013).
• Mosler H.-J. and Kraemer S. (2012). Which psychological factors Diffusion coefficient of antimony leaching from polyethylene tere-
change when habitual water treatment practices alter? Journal of phthalate bottles into beverages. Journal of Food Engineering
Public Health 20 (1), 71 ff. 115(3), 322-9.
• Mosler H. J. (2012). A systematic approach to behaviour change in- • Sanchez-Martinez M., Perez-Corona T., Camara C. and Madrid Y.
terventions for the water and sanitation sector in developing coun- (2013). Migration of antimony from PET containers into regulated
tries: a conceptual model, a review, and a guideline. International EU food simulants. Food Chemistry 141(2), 816-22.
Journal of Environmental Health Research 22(5), 431-49. • Schmid P., Kohler M., Meierhofer R., Luzi S. and Wegelin M. (2008).
• Mosler H. J., Kraemer S. M. and Johnston R. B. (2013). Achieving Does the reuse of PET bottles during solar water disinfection pose
long-term use of solar water disinfection in Zimbabwe. Public a health risk due to the migration of plasticisers and other chemi-
Health 127(1), 92-8. cals into the water? Water Research 42(20), 5054-60.
• Mtapuri-Zinyowera S., Midzi N., Muchaneta-Kubara C. E., Simbini • Sciacca F., Rengifo-Herrera J. A., Wethe J. and Pulgarin C. (2010).
T. and Mduluza T. (2009). Impact of solar radiation in disinfecting Dramatic enhancement of solar disinfection (SODIS) of wild Salmo-
drinking water contaminated with Giardia duodenalis and Enta- nella sp in PET bottles by H2O2 addition on natural water of Burki-
na Faso containing dissolved iron. Chemosphere 78(9), 1186-91.

54
 Appendices

• Silverman A. I., Peterson B. M., Boehm A. B., McNeill K. and Nel- fusion and migration modelling compared with literature data. Food
son K. L. (2013). Sunlight Inactivation of Human Viruses and Bacte- Additives and Contaminants Part a-Chemistry Analysis Control Ex-
riophages in Coastal Waters Containing Natural Photosensitizers. posure & Risk Assessment 28(1), 115-26.
Environmental Science & Technology 47(4), 1870-8. • Westerhoff P., Prapaipong P., Shock E. and Hillaireau A. (2008). An-
• Smith R. J., Kehoe S. C., McGuigan K. G. and Barer M. R. (2000). timony leaching from polyethylene terephthalate (PET) plastic used
Effects of simulated solar disinfection of water on infectivity of Sal- for bottled drinking water. Water Research 42(3), 551-6.
monella typhimurium. Letters in Applied Microbiology 31(4), 284- • Whitlam G. C. and Codd G. A. (1986). Damage to micro-organisms
8. by light. Special Publication of the Society of General Microbiology
• Sommer B., Marino A., Solarte Y., Salas M. L., Dierolf C., Valiente 17, 129-69.
C., Mora D., Rechsteiner R., Setter P., Wirojanagud W., Ajarmeh H., • WHO (1998). PHAST Step-by-step Guide.
AlHassan A. and Wegelin M. (1997). SODIS - An emerging water • WHO (2009). Scaling Up Household Water Treatment Among Low-
treatment process. Journal of Water Supply Research and Technol- Income Populations
ogy-Aqua 46(3), 127-37. • WHO (2011). Evaluating household water treatment options:
• SuSanA (2009). Introduction to Viruses http://waterbornepatho- Heath-based targets and microbiological performance specifica-
gens.susana.org/menuviruses/virusintro (accessed 21.09.2014. tions.
• Tamas A. (2009). 1st Report of the SODIS Sustainability Study - Ne- • WHO (2013). Household water treatment and safe storage: manu-
pal. Eawag. al for the participants.
• Tamas A. and Hans-Joachim M. (2011 ). Why do people stop treat- • WHO/UNICEF (2012). Toolkit for monitoring and evaluating house-
ing contaminated drinking water with Solar Water Disinfection (SO- hold water treatment and safe storage.
DIS)? Health Education & Behaviour 38(4), 357-66. • WHO/UNICEF (2014). Progress on Drinking Water and Sanitation -
• Tamas A. and Kraemer S. (2009). Promoting Sodis effectively. In: 2014 Update WHO/UNICEF Joint Monitoring Programme for Water
Eawag News. Supply and Sanitation.
• Tamas A. and Mosler H.-J. (2009). SODIS Promotion - Investigating • Wilson S. A. and Andrews S. A. (2011). Impact of a natural coagu-
the behaviour change process. In: (Eawag) SFIoASaT (ed.). lant pretreatment for colour removal on solar water disinfection
• Tamas A. and Mosler H.-J. (2011). Why do people stop treating con- (SODIS). Journal of Water Sanitation and Hygiene for Development
taminated drinking water with solar water disinfection (SODIS)? 1(1), 57-67.
Health Education & Behaviour 38(4), 357-66. • Zafar N. S., Luby S. and Mendoza C. (2010). Recall errors in a week-
• Tamas A., Tobias R. and Mosler H.-J. (2009). Promotion of Solar Wa- ly survey of diarrhoea in Guatemala: determining the optimal length
ter Disinfection: Comparing the Effectiveness of Different Strate- of recall. Epidemiol. Infect 138(2), 264-9.
gies in a Longitudinal Field Study in Bolivia. Health Communication
24, 711–22.
• Tamas A., Wehrle F., Wojtalla K. and Meierhofer R. (2011). Assess-
ing Long-Term Sustainability of former Eawag HWTS Projects. In:
Sandec News, pp. 8-9.
• Theitler D. J., Nasser A., Gerchman Y., Kribus A. and Mamane H.
(2012). Synergistic effect of heat and solar UV on DNA damage and
water disinfection of E. coli and bacteriophage MS2. Journal of Wa-
ter and Health 10(4), 605-18.
• Ubomba-Jaswa E., Fernandez-Ibanez P. and McGuigan K. G. (2010).
A preliminary Ames fluctuation assay assessment of the genotox-
icity of drinking water that has been solar disinfected in polyethyl-
ene terephthalate (PET) bottles. Journal of Water and Health 8(4),
712-9.
• Ubomba-Jaswa E., Navntoft C., Polo-Lopez M. I., Fernandez-Ibanez
P. and McGuigan K. G. (2009). Solar disinfection of drinking water
(SODIS): an investigation of the effect of UV-A dose on inactivation
efficiency. Photochemical & Photobiological Sciences 8(5), 587-95.
• Unicef (2006). BEHAVIOUR CHANGE COMMUNICATION IN
EMERGENCIES: A TOOLKIT.
• UNICEF (2013). Handwashing Promotion: Monitoring and Evalua-
tion Module.
• Waddington H. and Snilstveit B. (2009). Effectiveness and sustain-
ability of water, sanitation, and hygiene interventions in combating
diarrhoea. Journal of Development Effectiveness 1(3), 295-335.
• Wegelin M., Canonica S., Mechsner K., Fleischmann T., Pesaro F.
and Metzler A. (1994). Solar water disinfection: Scope of the pro-
cess and analysis of radiation experiments. Journal of Water Sup-
ply: Research and Technology - Aqua 43(4), 154-69.
• Welle F. and Franz R. (2011). Migration of antimony from PET bot-
tles into beverages: determination of the activation energy of dif-

55
 Eawag
Überlandstrasse 133
P.O. Box 611
8600 Dübendorf
Switzerland
Phone: +41 (0)58 765 52 86
Fax: +41 (0)58 765 53 99
info@sandec.ch
www.eawag.ch, www.sandec.ch, www.sodis.ch

ISBN: 978-3-906484-59-4

56