Home based interventions are advocated in rural areas against a variety of diseases. The combination of different interventions might have synergistic effects in terms of health improvement and cost effectiveness. However, it is crucial to ensure cultural acceptance. The aim of the study was to develop an effective and culturally accepted home-based intervention package to reduce diarrhoea and lower respiratory illnesses in children. In two rural Peruvian communities we evaluated the performance and acceptance of cooking devices, household water treatments (HWT) and home–hygiene interventions, with qualitative and quantitative methods. New ventilated stove designs reduced wood consumption by 16%. The majority of participants selected solar water disinfection as HWT in a blind tasting. In-depth interviews on hygiene improvement further revealed a high demand for kitchen sinks. After one year of installation the improved chimney stoves and kitchen sinks were all in use. The intervention package was successfully adapted to local customs, kitchen-, home–and hygiene management. High user satisfaction was primarily driven by convenience gains due to the technical improvements and only secondarily by perceived health benefits. / Revisión por pares.

abstract: Diarrheal diseases caused by poor water, sanitation and hygiene continue to kill more children in Sub-Saharan Africa's burgeoning informal urban settlements than in any other part of the world. In recent years, Delegated Management Model (DMM), a partnership in which a utility delegates service management to slum residents have been promoted as new models to improve services. This dissertation examines the benefits of DMM by comparing water services in three informal settlements in Kisumu city, Kenya: two slums where DMM has been implemented, and one, a control, where it has not. In addition, the research examined how school-based hygiene interventions could be designed to improve safe water and hygiene knowledge in urban informal settlements. This study compared outcomes of two approaches to hygiene education, one which combined messages with participatory water testing; the second used hygiene messages alone. Results of the DMM study showed that DMM implementation had lowered water cost and improved provider accountability. However, unhygienic water collection and handling practices on the part of the service users could contaminate drinking water that was clean at the delivery point, thus preventing the intended health outcomes of DMM from being realized. Results of the hygiene education intervention showed that one week after the inventions, hygiene knowledge among students who received the intervention that combined hygiene messages with participatory water testing was significantly improved. Evaluation of the intervention 12 months after implementation showed that the hygiene knowledge gained was sustained. The research findings suggest that: i) regular monitoring of water quality at the kiosks is essential to ensure that the DMM model achieves intended health outcomes, ii) sanitation conditions at kiosk sites need to be regulated to meet minimum hygiene standards, and iii) customers need to be educated on safe water collection and storage practices. Finally, school-based hygiene education could be made more effective by including hands-on water testing by students. Making sustainable impact on health and wellbeing of slum residents requires not only building effective partnerships for water delivery, but also paying close attention to the other points of intervention within the water system. / Dissertation/Thesis / Doctoral Dissertation Sustainability 2014