IJERD – International Journal of Environmental and Rural Development (2013) 4-1

Research article
erdBehavioural Factor of Boiling Drinking Waterin Rural India
SATO MORIO*Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
Email: moriozisan@gmail.com

YAMAJI EIJI
Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
Received 15 December 2012

Accepted 27 March 2013(*Corresponding Author)

Abstract In India, 0.4 million children die from diarrhoea which is a particularly alarming
figure. There are several kinds of water sources in rural India, but most of them arecontaminated. Boiling is an effective way to purify water and improve its safety fordrinking. The objective of this study was to reveal the behavioural factor of boiling. Avillage near Sompeta city in Andhra Pradesh, India was selected as a survey site of thisstudy. On-site surveys were conducted from 14th to 29th April and from 23rd September
to 5th October in 2012. The surveys consisted of a water quality test of boiling andinterviews with all 53 households that had a child of 3 or 4 years old. The contents ofwater quality test were coliforms, iron and total hardness, and the interview questions wereabout habits and thoughts relating to boiling. The effect of boiling, the reduction ofinfection risks, could be observed by the test. However, the evaluation of the taste ofboiled-water was worse than non-boiled-water, even though iron could be removed.
Thirty-two per cent households always use boiled-water and 15% use it only in rainyseason. The main reason for boiling was to prevent infections. They knew boiling is aneffective way to reduce the risk of infection and thus use boiled-water daily. On the other
hand, 42% households use boiled-water only when they get sick and 11% of households
do not use it. The reason for not boiling was not the cost and trouble but a lack ofawareness of the necessity for it. In this area, doctors had given advice to boil water for thesake of children’s health. Some households followed the advice and used boiled-water;
however, there were a number of households that did not follow the advice and still usedwater without boiling.
Keywords drinking water, boiling, diarrhoea, child health, India

INTRODUCTION
About 1.5 million children aged five and below die from diarrhoea every year. This is the second
cause of death in children (WHO, 2008). The most seriously affected country is India, in which
about 0.39 million children die from diarrhoea (UNICEF and WHO, 2009). Pathogens which cause
diarrhoea are spread from excreta to new patients through hands, animals, water, etc. (Carr et al.,2001). Building toilets, developing water sources, improving water quality, and improving hygiene
habits can relatively reduce the risk of diarrhoea (Fewtrell et al., 2005). In order to preventchildren’s death from diarrhoea, the United Nations set a goal to “halve, by 2015, the proportion of
the population without sustainable access to safe drinking water and basic sanitation”   inMillennium Development Goals, and many kinds of activities were conducted all over the world.
Now 84% people have sustainable access to safe water in rural India (WHO and UNICEF,2010) but it is not always safe and many people do not use it because of wrong recognition about
the safety of the water source and bad taste (Sato and Yamaji, 2012). Furthermore, there is a highpossibility that water is not safe at the point of use, even if the water source is safe (Wright et al.,2004). Household water treatment and safe storage (HWTS), including boiling, chlorinating, andⒸ ISERD226

IJERD – International Journal of Environmental and Rural Development (2013) 4-1

filtering water at home, can be effective to improve the quality of drinking water and prevent
diarrhoea (Fewtrell et al., 2005). Boiling is the most common method of treating water at home andthe effect is evident in India (Clasen et al., 2008), but a number of households do not boil water fordrinking purposes. There are some studies concerning the promotion of boiling behaviour, forexample,   promotion   through   school   (Freeman   and   Clasen,   2010)   and   women’s   self-help groups(Freeman et al., 2012), but the behavioural factor of boiling drinking water is not made explicit.
OBJECTIVE
The objective of this study was to reveal the behavioural factor of boiling drinking water, that is,
the reason why a number of people don’t boil it, in rural India. In order to discuss the most feasible
method there, the effect of boiling at the site was presented first. Subsequently, the behaviouralfactor was examined.
METHODOLOGY
A village near Sompeta, in the city of Srikakulam district in Andhra Pradesh state, India wasselected as the survey site of this study (Fig. 1). People in this village use three kinds of drinking
water sources: (i) temple well that it is in the temple and has been used for a long time; (ii) bore
well, of which there were 11 in this village and they were built by the state government about 10years ago; and (iii) private well that was built in a house lot, of which the number are increasing.
About 80% of households do not have a toilet thus surface water and ground water of unconfined
aquifer are contaminated.
On-site surveys were conducted from 14th to 29th April 2012 and from 23rd September to 5thOctober in 2012. The survey consisted of a water quality test of boiling and an interview survey inhouseholds. All 53 households in this village that had a child of 3 or 4 years old were interviewed
about their way of thinking regarding boiling. The boiling test was conducted on the temple well, abore well in an elementary school, and a private well, by using a pot and gas stove in a  household’s  kitchen. One litre of water was put into the pot and heated on the gas stove. Water was taken tomeasure water quality four times: before heating; 0 minutes after start of boiling; 5 minutes after
start of boiling; and 10 minutes after start of boiling. The contents of the measurement werecoliforms, Fe (iron) and TH (total hardness). The Sun Chemical Co. Ltd. detection paper was used
for coliforms, and the Kyoritsu Chemical-Check Lab. Corp. test kit was used for Fe and TH.

Fig. 1 Survey site
RESULTS AND DISCUSSION
Boiling habit for child is showed in Fig. 2. Thirty-two per cent of households always used boiled water
for their child and 15% of households only used boiled water in rainy season. They use boiled water
before the child becomes sick to prevent disease. On the other hand, 42% households used boiled waterto relieve disease only when the child becomes sick. Furthermore, 11% of households never boiled
water for their child.
The results of the boiling test for density of coliforms are shown in Fig. 3. According to theWHO’s   guidelines for drinking water quality, coliforms should not be detected in 1mL of sampledⒸ ISERD

227

IJERD – International Journal of Environmental and Rural Development (2013) 4-1water. Water from all sources had coliforms before boiling and this means all sources contained risks ofdiarrhoea. In particular, the temple well and private well had more coliforms as their depth is shallower
than the bore well. However, water from all sources contained no coliforms after 10 minutes of boiling.
Coliforms were killed by boiling therefore it can reduce risk of diarrhoea.
Table 1 shows the numbers and ratios for the frequencies of infection with cholera and typhoid thatwere added up by households' boiling habit. The households that did not have a habit of boiling water
for their child before becoming sick tended to be infected with cholera and typhoid more often than thehouseholds that regularly boiled water. These results also suggest that boiling can reduce the risk ofdiarrhoea.
Figure 4 shows the results of the boiling test for the density of Fe, and Fig. 5 shows the same
results for TH. A bore well with an iron pipe often makes the Fe density of its water high and makes its
taste worse. According to the WHO’s guidelines on drinking water quality, there is a reference value
about Fe from a viewpoint of taste and colouring, though not from a viewpoint of safety. It specifies thatthe density of Fe should be under 0.3 mg/L. After boiling, Fe cannot be detected: the density was0mg/mL. At that time, there was some white powder at the bottom of the pot which may have contained
Fe. Boiling makes it possible to remove Fe from water. TH was often used as an indicator to check thetaste of water, but it is not specified in the WHO’s  guidelines because the preference toward it depends
on the person and region. TH tended to decrease by boiling, as Fig. 5 indicates.

Fig. 2 Boiling habit for childFig. 3 Results of boiling test for coliforms

Fig. 4 Results of boiling test for Fe

Fig. 5 Results of boiling test for TH

Table 1 Frequency of infection with Cholera and Typhoid by households' boiling habits

Occasionally
Once
Never
I don't know
Total

Always / Seasonnally
CholeraTyphoid
14%
14%
00%
4 16%
23 96%
20 80%
102525

Only when sick / Never
CholeraTyphoid
3 13%
28%
14%
8 33%
19 83%
14 58%
542828Ⓒ ISERD

228

Total
CholeraTyphoid49%
36%
12%
12 24%
42 89%
34 69%
6453
53 100%IJERD – International Journal of Environmental and Rural Development (2013) 4-1

Each household evaluated which water was tastier: before boiling or after boiling. Table 2 presents
the results that were added by households' boiling habits. Most of the households evaluated that waterthat was not boiled did not taste better than boiled water, regardless of the habit of boiling. Table 3
shows the results of the evaluation of the taste of boiled water. Households with a daily boiling habit
tended to set a high value on the taste of boiled water compared to those without this habit. The taste ofwater may improve after boiling because Fe can  be  removed  by  boiling,  but  people’s  evaluations  did notcorrespond with this. During the survey, some households said that boiled water was not tasty because itis warm. This suggested the possibility that boiling makes water taste worse by raising the watertemperature. Indeed, most of households in this area do not have a refrigerator thus it is difficult forthem to have cold water at home.
Table 4 shows the numbers and ratios of the reasons for not boiling that were added by households'boiling habits. Some households without a boiling   habit   answered   “Bad   Taste”   as   the   reason.   But  according to this information alone, it is not clear why the mothers were not willing to give boiled water
to their child, despite the fact that boiling  water  is  safer.  Two  households  answered  “Cost”  as  the  reason  for not boiling. During the survey, they said that they want to boil but they do not have enough moneyfor it. Figure 6 is a boxplot about household income that was added by boiling habits. The exchange ratewas Rs 1 equals about USD 0.02 on 14th Dec 2012. The average income of all households was Rs
23,000. The households with high income tended to have a habit of boiling. However, the number ofhouseholds with boiling habits that have a smaller income than the median income of households
without boiling habits was not a few. It is possible for households with a small income to boil water
daily. Boiling habit may also depend on whether they have a gas stove or not because it is related toincome, costs, and labour. In this village, 62% of households had a gas stove for cooking and 38% did
not have a gas stove. Figure 7 illustrates a comparison of boiling habits between households with gas
stove and those without. There were small differences between them therefore the ownership of a gas
stove does not have a significant effect. According to Table 4, all households that boil water in rainyseason alone think boiling is not needed except in this season, and most of households that boil water
only when their child is sick think that it is unnecessary to boil water before sickness occurs. The maincause of not boiling water for their child is a lack of awareness of its importance and necessity.

Table 2 Preference taste of water between before boiling and after boiling
BeforeAfter
No answer
Total

Always
1482%
318%
017

Seasonally
Only when sick
8100%
1990%
00%
210%
01822

Never
4100%
00%
26Total
4590%
510%
353
100%

Never
00%
00%
120%
480%
16Total
24%
1529%
1325%
2242%
1
53100%

Never
375%
00%
125%
26100%

Total
314%
29%
1777%
1436100%

Table 3 Evaluation about the taste of boiled water
Very GoodGoodNot Bad
Bad
No answer
Total

Always
00%
847%
529%
424%
017

Seasonally
Only when sick
00%
29%
338%
418%
113%
627%
450%
1045%
00822

Table 4 Reason for not boiling water
Bad taste
Cost money
No needNo answer
Total

Seasonally
00%
00%
8100%
08100%

Only when sick
00%
213%
1488%
622100%Ⓒ ISERD229

IJERD – International Journal of Environmental and Rural Development (2013) 4-1

Table 5 shows the numbers and ratios of the reason for boiling that were added by households'
boiling habits. Most of the households with a habit to boil water always or seasonally answered"Prevention from disease" as the reason. On the other hand, half of the households that boil water only
when their child is sick answered "Relieve disease," while the remaining half answered "Doctor'sadvice”  as  the  reason. They boil water only for the treatment of disease, not for the prevention.
Each household evaluated which water is safer, before boiling or after boiling. Table 6 shows theresults that were added by households' boiling habits. The option of "No answer" was not shown as all
households answered this question. All of the households with a boiling habit who stated that they boil
water for the prevention from disease evaluated that boiled water is safer than non-boiled water. On theother hand, some of the households without daily boiling habits evaluated that non-boiled water is safer
than boiled water. Furthermore, 23% of households that boil water only when the child is sick follow
the  doctor’s  advice  and boil water for the treatment of disease in spite of the fact that they think nonboiled water is safer than boiled water.
Numbers and ratios of households that have been advised by a doctor to boil water were added byhouseholds’  boiling  habits, as shown in Table 7. Almost all households have been advised by a doctor;
however there were still households without a boiling habit, regardless of the fact that they were advised
by a doctor to do it. Doctors can influence people to enhance their awareness of child health, but not allpeople.

Fig. 6 Household income by boiling habit

Fig. 7 Comparison of boiling habit between
households with gas stove and without it

Table 5 Reason for boiling water
Prevention from disease
Relieve disease
Doctor's advise
Warm body
No answer
Total

Always
15100%
00%
00%
00%
2
17100%

Seasonally
686%
00%
00%
114%
1
8100%

Only when sick
00%
850%
850%
00%
6
22
100%

Total
2155%
821%
821%
13%
9
47
100%

Table 6 Comparative evaluation of the water safety between before boiling and after boiling
BeforeAfterAlways
00%17100%

Seasonally
Only when sick
00%
523%
8100%
1777%

Never
233%
467%

Total
713%
4687%

Table 7 Numbers and ratios of households that have been advised by a doctor to boil waterYes
NoAlways
17100%
00%

Seasonally
8100%
00%

Only when sick
2195%
15%Ⓒ ISERD

230

Never
6100%
00%

Total
5298%
12%

IJERD – International Journal of Environmental and Rural Development (2013) 4-1CONCLUSIONThe  effect  of  boiling  water  was  observed  and  people’s  behavioural  factor  of  boiling  was  examined  in rural India. The risk of diarrhoea could be reduced by boiling. Water from a bore well with aniron pipe has a high level of iron which worsened its taste; however boiling could remove it.
Nevertheless, evaluation of its taste was not good because the water temperature may increase after
boiling. The main reason for boiling was the prevention of infection. Households with boiling
habits knew that boiling was an effective way to reduce the risk of infection and consequently
boiled water for their child daily. On the other hand, the reason for not boiling was not the cost andtrouble, but a lack of awareness of necessity for it. This lack of awareness made difference inpeople’s boiling behaviour.
In this survey site, doctors had advised mothers not to use water without boiling. Somehouseholds followed it and started boiling water, but a number of households ignored it. Doctors
have contacts with almost all households and thus have the opportunity to enlighten them about thecorrect knowledge and habit of children’s   health,   but   some households doesn’t follow   doctors’  advice.  The  type  of  households  that  tend  to  follow  doctors’  advice  and  the  ways  in  which  doctors  can enlighten all households on the necessity of boiling water should be examined after this study.
Furthermore, there are other ways besides the doctor to enlighten households on the benefits ofboiling  water  for  children’s  health  and  these  methods  also  require  further  investigation.
ACKNOWLEDGEMENTS
The authors thank Indian NGO, Green Basics, for assisting in the conduction of the on-site survey.

REFERENCES
Carr, R. and Strauss, M. 2001. Water quality: guidelines, standards and health. Assessment of risk and risk
management for water-related infectious disease. International Water Association on behalf of WHO, 89113.
Clasen, T., McLaughlin, C., Nayaar, N., Boisson, S., Gupta, R., Desai, D., and Shah, N. 2008.
Microbiological effectiveness and cost of disinfecting water by boiling in semi-urban India. Am J Trop
Med Hyg, 79, 407-413.
Fewtrell, L., Kaufman, R.B., Kay, D., Enanoria, W., Haller, L., and Colford, J.M.Jr. 2005. Water, sanitation,and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and metaanalysis. The Lancet Infectious Disease, 5, 42-52.
Freeman, M. and Clasen, T. 2010. A cluster-randomized trial to assess the impact of a school-based safe
water intervention on household adoption of point-of-use water treatment practices in Southern India. AmJ Trop Med Hyg, 84, 370-378.
Freeman, M., Trinies, V., Boisson, S., Gregory, M., and Clasen, T. 2012. Promoting household watertreatment  through  women’s  self  help  groups  in  rural India: assessing impact on drinking water quality andequity. PLoS ONE, 7, e44068.
Sato, M. and Yamaji, E. 2012. Safety of drinking water  source  and  people’s  choice  behavior  in  rural  India.
International Journal of Environmental and Rural development, 3, 43-48.
UNICEF and WHO. 2009. Diarrhoea: Why children are still dying and what can be done.
WHO. 2008. The Global Burden of Disease: 2004 update.
WHO and UNICEF. 2010. Progress on sanitation and drinking-water: 2010 update. Joint Monitoring
Programme for Water Supply and Sanitation.
Wright, J., Gundry, S., and Conroy, R., 2004. Household drinking water in developing countries: asystematic review of microbiological contamination between source and point-of-use. Trop Med Int
Health, 9, 106-117.

Ⓒ ISERD231