ArticleBMJ global health2025
Proof-of-concept evaluation at Cox's Bazar of the Safe Water Optimization Tool: water quality modelling for safe water supply in humanitarian emergencies.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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8 authors.
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Abstract
introductionWaterborne diseases are leading concerns in emergencies. Humanitarian guidelines stipulate universal water chlorination targets, but these fail to reliably protect water as postdistribution chlorine decay can leave water vulnerable to pathogenic recontamination. The Safe Water Optimization Tool (SWOT) models chlorine decay to generate context-specific chlorination targets that ensure water remains protected up to point-of-consumption. The SWOT has not been tested in an active humanitarian response, so we conducted a proof-of-concept evaluation at a Cox's Bazar refugee settlement to validate its modelling and assess its efficacy and effectiveness.
methodsWe trained the SWOT using data collected from July to September 2019 and evaluated using data from October to December 2019 (n=2221). We validated the SWOT's modelling by comparing performance using training and testing data sets. We assessed efficacy using binary logistic regression comparing household free residual chlorine (FRC) when the SWOT target was delivered at tapstands versus the status quo target, and effectiveness using interrupted time series analysis of the proportion of households with protective FRC before and after SWOT implementation.
resultsThe SWOT generated a context-specific FRC target of 0.85-1.05 mg/L for 15-hours protection. Validation of the SWOT's process-based model showed R
conclusionThe SWOT can generate context-specific chlorination targets that protect water against pathogenic recontamination. Improving feedback between monitoring and treatment would help system operators unlock the SWOT's full water safety potential.
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