Please note: Content last updated January, 2019

Evaluating the Potential of Electric Kettle Promotion for Safer Water & Cleaner Air: NEARING COMPLETION

The findings from our 2013-2014 project in Guangxi (see below) indicated that if rural Chinese households currently boiling their drinking water in pots heated with solid-fuels (which produce hazardous air pollution) switched to using electric kettles, there could be significant gains in access to microbiologically safe drinking water, and accompanying reductions in household air pollution (HAP). Exposure to HAP is linked to a number of negative health impacts, and rural HAP contributes significantly to China’s overall air pollution burden. Households currently purchasing bottled water (which we found to be frequently contaminated), or not treating their water at all, could also benefit from a switch to electric kettles.

Because the majority of rural Chinese households boil their drinking water every day, increased electric kettle use could have a significant impact on improving the health, livelihoods, and environmental health, of hundreds of millions of rural Chinese. To promote such a change in water treatment practices, the NCRWSTG and UCB developed a simple and scalable strategy for promoting the use electric kettles in poor rural areas. However, before this or a similar program might be recommended for use at a wider scale, we sought to evaluate whether a Rural Electric Kettle Promotion Program would increases electric kettle adoption and provide concomitant improvements to drinking water quality, reduced air pollution, and other benefits. The NCRWST invited Dr. Alasdair Cohen and the Berkeley team to work with them and their China CDC partners to rigorously evaluate and quantify the potential benefits, and understand the feasibility, of such a program.

Our Guangxi research revealed that households in the lowest incomes groups (and female-headed households in particular) tend to be more likely to boil with metal pots and hazardous fuels. For such households then, the cost of an electric kettle and/or the associated increase in electricity consumption, may be a barrier to would-be adoption. Taking this into consideration, we designed a cluster-randomized impact evaluation design to measure rates of electric kettle adoption in a group that received promotional messaging and free electric kettles (450 poverty-classified households) and in a control group (450 poverty-classified households).

After extensive enumerator training, the project began at the end of 2017 and will be completed later this year (2019). We collected a range of data in order to compare rates of electric kettle adoption and use (based on observed data and data from electricity use meters), drinking water quality, and exposure to HAP (using real-time PM2.5 monitoring in a subset of households), as well as other outcomes related to health. At this writing, the primary phase of data collection is essentially completed and we are preparing to use qualitative methods to better understand HWT preferences and related behaviors and beliefs in the two groups.

Our study was pre-registered on the Chinese Clinical Trials Register (ChiCTR-IOR-17013373) and ClinicalTrials.gov (Identifier: NCT03376152).

The photo above is in rural Anhui near our project field sites: a poor household's current home can be seen (right side) next to their new home which is under construction thanks to subsidies from a government poverty alleviation program.

 

Systematic Review of Bottled Water Quality in China: MANUSCRIPT PREPARATION

China is now the world’s largest market for bottled water [Rodwan, 2014].

Chinese researchers have found various microbial and chemical contaminants in a variety of bottled water brands across China. We suspect bottled water contamination may be a more substantial issue in rural areas as compared to urban ones.

Bottled water contamination is a problem across the world, in low-, middle-, and even high-income countries, but China is one of the few countries with a wealth of publically available data on the subject (mostly from peer-reviewed publications).

To better understand these issues and other issues, UCB conducted a systematic review of all the China-based bottled water quality literature and studies. By collecting and synthesizing these data we hope to shed light onto which policy measures might improve safe water access in China and – by extension - other countries as well.

 

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Improving small-scale water utility operation under conditions of intermittent water supply in rural areas: PILOT STUDIES COMPLETED

In China, millions of small-scale water utilities provide rural households and schools the convenience of piped water. However, many small-scale utilities struggle to consistently provide users with safe drinking water, and some are unable to provide drinking water 24 hours a day, seven days a week. This intermittent water supply (IWS) has a number of negative implications for drinking water quality and water supply infrastructure.

This project was intended to help such utilities improve their management and operations by identifying ways to: optimize the timing of water supply, improve the use of dose-appropriate chlorination, and expand the use of Water Safety Plans (to further strengthen quality assurance and quality control). Extensive scoping work was conducted in two provinces in China in 2017 and 2018.

 

In late 2017, Dr. Li Hongxing and Dr. Alasdair Cohen met with Shandong provincial and local CDC officials and staff to visit participating villages and discuss the project.

Lessons learned from this work are being used by NCRWSTG to inform the design of larger scale studies on IWS which are expected to begin in 2019 or 2020.

IWS is a global problem; we hope this research will provide insights for improving water supply management under conditions of IWS in other countries as well.
 
Collaborative Research on Household Water Treatment in Guangxi: COMPLETED

In 2013-2014, we collaborated with the NCRWSTG and the Guangxi Province China CDC to conduct the first study focused on household water treatment in rural China.

Working together, we developed, tested, and refined new survey questions focused on people’s water-related behaviors and beliefs. These questions were then included in comprehensive household surveys. In the summer of 2013, we trained Guangxi Province China CDC staff and surveyed 450 households in 15 villages across two rural counties – pictures from the county-level training sessions are shown below.

Drinking water samples were collected from each household and tested for indicators of microbial and fecal contamination. Because we understand that boiling would be relatively widespread, we also collected samples from village drinking water sources and analyzed them for indicators of agricultural or industrial contamination. In order to understand potential seasonal variation, in the winter we returned to four of the summer study.

In addition to once again collecting and analyzing water samples, we also placed small remote temperature sensors on kettles and pots in households who boiled in order to better understand boiling behaviors and corroborate the reported boiling data from our surveys.

After initial data analyses, we returned to Guangxi in the Fall of 2014 to meet with Provincial and County China CDC staff to share our preliminary results with them and get their valuable thoughts and feedback on various aspects of the data and our results. 

We found that 47.5% of households in the area boiled locally sourced water for drinking, 18.2% did not treat their drinking water, and 34.4% purchased bottled water - the majority of whom also boiled their bottled water before drinking it.

Among other findings, our analyses revealed that households using electric kettles to boil their water had the safest drinking water as compared to households boiling water with pots, or to those households using bottled water. This was, as far as we are aware, the first study to analyze boiling in this way.

Based on this research, we believe that electric kettles offer a number of comparative advantages over boiling with pots, such as:

  • Reliable pathogen inactivation (because the water is automatically brought to 100°C before the kettle shuts off)
  • Limited opportunity for secondary-contamination (because the kettles have built-in lids, and cannot be operated when the lid is open – which is essentially a method of safe water storage, making recontamination of the boiled water very unlikely)
  • High energy efficiency as compared to solid-fuel combustion,
  • and – importantly – electric kettles do not produce hazardous indoor air pollution.

(see our 2015 PLoS ONE publication for more details).

Additional analyses showed that female-headed households were most likely to boil overall, and among boilers those using electric kettles rather than pots had higher income proxies. Higher-income households with younger, literate, and male heads were also more likely to purchase (frequently contaminated) bottled water, or to use electric kettles if they boiled. We also found substantial contamination in the bottled water samples, but no association between bottled water cost and microbial quality. Looking at the bottled water users overall, the perception that bottled water was convenient appeared to be the primary driver of bottled water use, rather than concerns about safety, or health, for example.

Overall, these findings illustrate that boiling is not an undifferentiated practice, but one with different methods of varying effectiveness, environmental impact, and adoption across socioeconomic strata.

(see our 2017 Environmental Science & Technology publication for more details).