In low-resource contexts, household-level point-of-use water treatment (POUWT) techniques are the final, and sometimes only, barrier against waterborne illnesses, and in these and other water-related applications, health risks can be quantified using one of two methods. Firstly, Escherichia coli (or other indicator organism) counts can be used to monitor water and determine adherence to a health-based limit (i.e. compliance monitoring). Secondly, E. coli can be used to conduct a quantitative microbial risk assessment (QMRA), indicating the level of protection conferred by a given POUWT device by spiking test water with E. coli to ascertain a reduction efficacy relative to that target organism, a process referred to as challenge testing, which is typically carried out in a laboratory context. Although both methods are well established, both have scope for improvement for effective field application in low-resource contexts. Regarding compliance monitoring, I assessed the performance of a new low-cost field kit for E. coli enumeration, which was designed by others. I also assessed the feasibility of re-using some disposable materials, in terms of sterility and mechanical wear. The use of the new low-cost field kit was successful during the fieldwork campaign; however, re-using disposable materials introduced a relatively high occurrence of false positive results during E. coli enumeration. Use of the new low-cost field kit can reduce financial barriers, thus enabling greater water quality testing coverage. Regarding challenge testing, the aim of this study was to adapt current protocols to assess the household performance (as opposed to laboratory performance) of POUWT techniques. I developed a conceptual framework to conduct Field Challenge Tests (FCT’s) on POUWT techniques, using a probiotic health supplement containing E. coli as the challenge organism. I successfully carried out a FCT in Malawi with limited resources, verifying FCT viability. Applications of such FCT’s include quality control practices for manufactured devices, guiding QMRA and recommendations by public health organizations regarding POU device selection, and assessing the impact of user training programmes regarding POUWT techniques. / Graduate

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