Health, wealth, and happiness : evidence from piped water and behavior change interventions in rural Zambia

The introduction of safe, accessible piped water has transformed human health and development. During the first half of the 19th century, American cities experienced large reductions in total mortality, most of which has been attributed to the introduction of filtered and chlorinated piped drinking water. Providing piped water, either on-premises or nearby, has other benefits as well. Research focusing on low- and middle-income countries has found that households living nearby their water source devote less time to fetching water, freeing up time to pursue work outside the home, caregiving, education, or leisure activities. As of 2017, nearly 800 million people still lack basic access to drinking water, relying on distant or unprotected sources of water that expose them to dangerous levels of pathogens. It is estimated that inadequate access to water, sanitation, and hygiene (WASH) is responsible for approximately 800,000 deaths from diarrheal disease alone, primarily affecting young children. This burden of disease is most prevalent in Sub-Saharan Africa, where 39% of households lack basic access to water. However, water scarcity impacts household well-being in ways beyond infectious disease burden. In 2007, just 6% of rural Zambian households had piped water access. This forces households, particularly women and girls, to devote substantial time to fetching water every day, leading to low household water consumption and time poverty. The first research chapter of this dissertation (Chapter 2) examines the impacts of a rural piped water system in southern Zambia on household time expenditures and productive uses of water. This quasi-experimental study of four villages used a combination of household surveys, Global Positioning System transponders, and water meters to measure time spent fetching water, water consumption, and how water was being utilized for domestic and productive activities. Households receiving the piped water intervention spent less time fetching water, savings that accrued primarily to women and girls. Household water consumption also increased, which was used for both domestic and productive uses such as gardening. These households reported being happier, healthier, and having more time to participate in work inside or outside the home. This work contributes to the expanding research on the time and economic impacts that piped water supply can have on rural households. Chapter 3 measures how the same piped water intervention affected environmental fecal contamination and child health. This study measures the effects of transitioning from distant, unimproved water sources to piped water supply on both microbiological contamination and child health. Providing households with shared and private piped water access at a conveniently close location was associated with significant reductions in water contamination. However, despite increases in water availability, there were no measured changes in self-reported handwashing frequency or microbiological indicators of hand contamination. This study contributes to the literature on the health impacts of piped water access, with a focus on the understudied transition from off-plot unimproved water sources to improved piped water supply. Recognizing that infrastructure alone is insufficient to change some household behaviors, Chapter 4 evaluates the impact of a school-based education intervention on the dissemination of WASH-related messages in rural communities. In low-income countries, rural areas have lower rates of access to WASH infrastructure and worse health outcomes than their urban counterparts. However, interventions in rural communities are more expensive on a per-capita basis, due to low population density and geographic isolation. Schools represent an opportunity to reach large numbers of students at once, making school-based programs cost-effective entry points. This study takes advantage of the piloting phase in Zambia of the WASH UP! program, a high-intensity, school-based WASH program developed by the creators of Sesame Street. The program was associated with significant increases in both student knowledge and transmitting WASH messages from the school to the home. However, considering the high-intensity nature of the program, the magnitude of these changes suggests that there is substantial scope for improvement. This study contributes to the behavior change literature by focusing on the impact that young children alone can have on message transmission and the factors that encourage or impede this process. This research combines tools and theory from microbiology, engineering, and social science to characterize the impacts of piped water provision and behavior change messaging on rural households in Zambia. The results of this dissertation provide evidence of the holistic benefits of piped water supply and measure the potential for young children to act as agents of change for positive WASH behaviors within their own families

Advisor: Davis Jenna (Professor)
Boehm Alexandria
Darmstadt Gary L.