Diarrhoeal diseases accounted for the death of over 500,000 children under-five globally in 2017 (1) and are the third leading cause of mortality in this age group (2). Approximately 88% of those deaths result from unsafe water, inadequate sanitation, and insufficient hygiene (3), making effective WASH interventions crucial for the health and survival not only of children but also youths and adults. Until centrally treated, piped water can be delivered to every family, the initial critical need is the provision of microbiologically safe drinking water to reduce the incidence of diarrhoea and other waterborne diseases. UNICEF’s global chlorine tablet programme distributes tablets and trains recipients on how to use them, with a focus on emergency or humanitarian situations.

The research brief below summarises the results of a study which covered a reproducible random sample of 40 sites (villages, camps, and towns) in five countries that have been targeted by UNICEF programmes. All sites had received chlorine tablets at least six months prior to the study.

Purposes of the study:

1. To document the actual use of chlorine tablets by end-users and primary stakeholders in contexts of emergencies;
2. To assess the correct use of chlorine tablets by recipients and compare their use with other HWTS (household water treatment and safe storage) technologies for supporting public health in humanitarian settings;
3. To assess UNICEF’s global chlorine tablet programme, specifically in terms of areas for improvement related to distribution, monitoring, and effectiveness from a user perspective.

Methodology:

Data were collected between September and December 2021 and included a range of variables, such as measurement of water parameters (pH, turbidity, and free chlorine residual – FCR), from the following sources:

• Document review.
• Observations via transect walks and measurement of water-source parameters in a sample of 40 sites.
• Household survey and measurements of water parameters from 493 households in the observed sites.
• 163 key-informant individual and group interviews.
• Online surveys with 34 staff from governments, WASH partners, and UNICEF.

The study provided forward-looking recommendations that aimed at improving the UNICEF’s global chlorine tablet programme, as well as actions by WASH actors at all levels. 

The research brief is available for download below. Please contact UNICEF Supply Division (supply@unicef.org) for further questions or to access the full report.

1. UNICEF (2021): Diarrhoea. Available at https://data.unicef.org.
2. Our World in Data: Causes of death in children under five year old. Available at: https://ourworldindata.org.
3. CDC: Global Diarrhea Burden. Available at: https://www.cdc.gov.