1. Point-of-Use Water Treatment & LifeStraw® Christian Connections for International Health (CCIH) 24 May 2008

2. Attribution  Tom Clasen, London School of Hygiene and Tropical Medicine (LSHTM), presentation Washington DC, February 2008  University of North Carolina (M. Sobsey, J. Brown)  LSHTM (S. Cairncross, V. Curtis, I. Roberts, T. Rabie, L. Smith, W. Schmidt, S. Thomas)  WHO

3. Leading Causes of Deaths from Infectious Diseases 2004 World Health Report

4. Childhood Mortality by Cause Black RE, Morris SS & Bryce J (2003). Where and why are 10 million children dying every year? Lancet 361:2226-34.

5. 1990s: Reduction in Diarrhea from Improvements in Water Quality Expected reduction in diarrheal disease morbidity from improvements in one or more components of water and sanitation (Esrey, 1991) All Studies Rigorous Studies No. Studies Reduction Reduction Water and Sanitation 720%230% Sanitation1122%536% Water Quality and Quantity 2216%217% Water Quality 717%415% Water Quantity 727%520% Hygiene633%633%

6. Interventions at Source

7. Effectiveness Data: Cochrane Review Clasen T, Roberts I, Rabie T, Schmidt W, Cairncross S. Interventions to improve water quality for preventing diarrhoea (A Cochrane Review). In: The Cochrane Library, Issue 3, 2006.

8. Summary of Effectiveness—Under 5s Intervention Type (no. trials) Effect(random) % Δ (1-RR) 95% CI of Estimate Source (4) 0.8515% 0.71 to 1.02 Household (25) 0.5644% 0.39 to 0.81 Filtration (5) Filtration (5)0.3664% 0.24 to 0.53 Chlorination (12) Chlorination (12)0.7624% 0.67 to 0.86 Solar Disinfection (0) Solar Disinfection (0)nanana Flocc/Disinfection (7) Flocc/Disinfection (7)0.5248% 0.20 to 1.37 Flocc/Disinf (6)( ex Doocy*) Flocc/Disinf (6)( ex Doocy*)0.7129% 0.61 to 0.84 Impr. Storage (1) Impr. Storage (1)0.6931% 0.47 to 0.81

9. Interventions at the Household

10. Continuing Challenges in Point-of-Use  No successful large-scale models  Little evidence that purely commercial strategies reach the most vulnerable populations  Questions about whether any HWTS product or implementation strategy has achieved consistent, correct and sustained use among the most vulnerable populations  Little success in attracting significant donor funding (compared, e.g., to HIV/AIDS, TB, malaria)

11. Scaling Up: 2005-2007

12. 100% Coverage of 1.1B without access to improved water supplies Coverage Gap

13. Different Needs / Different Drivers TIME Development of Commercial Market Subsidy / Time- limited Intervention Equity

14. Different Needs / Different Drivers TIME SOUTH SUDAN CONGO (DRC) PNG ZAMBIA CAMBODIA NIGERIA GHANA SENEGAL INDIA CHINA MEXICO BRAZIL 1 2 3 4

15. LifeStraw Family  Highly effective against all categories of microbial pathogens  High output (150ml/min)  High capacity (>18,000 L)  Operates in high and variable turbidity (15 NTU)  Low cost  Easy to deploy, learn, use, maintain  Portable, robust  Improves water aesthetics  No chemicals  No replacement parts  Protects against recontamination

16. Lab Testing

17. LifeStraw Family: Congo