The Safe Water Optimization Tool (SWOT) generates evidence-based point-of-distribution free residual chlorine (FRC) targets to adjust chlorine dosing by operators and ensure water quality at point-of-consumption. To investigate SWOT effectiveness in surface waters, we conducted two before-and-after mixed-method evaluations in a Uganda refugee settlement served by piped and trucked surface water systems. We surveyed 888 users on water knowledge, attitudes, and practices; collected 2768 water samples to evaluate FRC,Escherichia coli, and disinfection by-products (DBPs) concentrations; and conducted nine key-informant interviews with system operators about SWOT implementation. After baseline data collection, SWOT chlorination targets were generated, increasing point-of-distribution FRC targets from 0.2 to 0.7-0.8 mg/L and from 0.3 to 0.9 mg/L for piped and trucked systems, respectively. At endline, household point-of-consumption FRC ≥ 0.2 mg/L increased from 23 to 35% and from 8 to 42% in the two systems. With these increases, we did not observe increased chlorinated water rejection or DBPs concentrations exceeding international guidelines. Informants reported that SWOT implementation increased knowledge and capacity and improved operations. Overall, SWOT-generated chlorination targets increased chlorine dosage, which improved household water quality in surface waters although less than previously documented with groundwater sources. Additional operator support on prechlorination water treatment processes is needed to ensure maximally effective SWOT implementation for surface water sources.
Journal Article > CommentaryFull Text
Lancet Global Health. 2016 October 4; Volume 4 (Issue 10); e680-681.; DOI:10.1016/S2214-109X(16)30173-5
Stoett P, Daszak P, Romanelli C, Machalaba C, Behringer R, et al.
Lancet Global Health. 2016 October 4; Volume 4 (Issue 10); e680-681.; DOI:10.1016/S2214-109X(16)30173-5
Conference Material > Slide Presentation
Kiddell-Monroe R, Farber J, Devine C, Orbinski J
MSF Scientific Days International 2021: Innovation. 2021 May 20; DOI:10.1016/S2542-5196(21)00177-7
Journal Article > ResearchFull Text
Environ Health Perspect. 2024 October 9; Volume 58 (Issue 42); 18531-18540.; DOI:10.1021/acs.est.4c04240
Heylen C, String G, Naliyongo D, Ali SI, Brown J, et al.
Environ Health Perspect. 2024 October 9; Volume 58 (Issue 42); 18531-18540.; DOI:10.1021/acs.est.4c04240
Journal Article > ResearchFull Text
Lancet. 2002 June 22; Volume 359 (Issue 9324); DOI:10.1016/S0140-6736(02)09096-7
Trouiller P, Olliaro PL, Torreele E, Orbinski J, Laing R, et al.
Lancet. 2002 June 22; Volume 359 (Issue 9324); DOI:10.1016/S0140-6736(02)09096-7
There is a lack of effective, safe, and affordable pharmaceuticals to control infectious diseases that cause high mortality and morbidity among poor people in the developing world. We analysed outcomes of pharmaceutical research and development over the past 25 years, and reviewed current public and private initiatives aimed at correcting the imbalance in research and development that leaves diseases that occur predominantly in the developing world largely unaddressed. We compiled data by searches of Medline and databases of the US Food and Drug Administration and the European Agency for the Evaluation of Medicinal Products, and reviewed current public and private initiatives through an analysis of recently published studies. We found that, of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis. There is a 13-fold greater chance of a drug being brought to market for central-nervous-system disorders or cancer than for a neglected disease. The pharmaceutical industry argues that research and development is too costly and risky to invest in low-return neglected diseases, and public and private initiatives have tried to overcome this market limitation through incentive packages and public-private partnerships. The lack of drug research and development for "non-profitable" infectious diseases will require new strategies. No sustainable solution will result for diseases that predominantly affect poor people in the South without the establishment of an international pharmaceutical policy for all neglected diseases. Private-sector research obligations should be explored, and a public-sector not-for-profit research and development capacity promoted.
Conference Material > Video (keynote)
Orbinski J
MSF Scientific Days UK 2019: Research. 2019 May 9