Safe water treatment practices: A qualitative study on point-of-use chlorination in Nigeria

Background: 25% of the world's population does not have access to safely managed drinking water. Point-of-use chlorination is a safe, inexpensive, and effective strategy to improve water quality and child health. We aimed to understand safe water treatment practices and the feasibility and acceptability of point-of-use chlorination in Nigeria. Methods: Between November 2022 and January 2023, six focus group discussions were conducted with pregnant women and mothers of children aged <5 years. Semi-structured, in-depth interviews were conducted with women, health facility workers, shopkeepers or pharmacy attendants, and water point owners. Data were collected and analysed using the socio-ecological model of health framework. Four themes were identified. Results: Theme 1: water culture – there was little knowledge about the need to treat drinking water since it was considered safe and high-quality, and there was low knowledge about point-of-use chlorination. Theme 2: improving the quality of life – there were reports of child diarrhoea and lost pregnancies. Yet, most respondents did not link maternal and child health to drinking water. Theme 3: getting support – stakeholders were interested in point-of-use chlorination and agreed to link the programme to health workers already providing care for pregnant women and children. Theme 4: advocating for safe water – educating communities on the importance of safe drinking water and integrating services within communities is key. Conclusions: Safe drinking water and interventions such as point-of-use chlorination improve the quality of life. Yet, given the perception that existing water is safe and the lack of knowledge about the value of chlorination, awareness is the priority for change. This study demonstrated the potential for point-of-use chlorination if well-integrated and supported by different stakeholder groups.