Exposure and Health

, Volume 10, Issue 3, pp 145–153 | Cite as

Designing a Mixed-Methods Approach for Collaborative Local Water Security: Findings from a Kenyan Case Study

  • Hilary Barber
  • Sarah E. Dickson-Anderson
  • Corinne J. Schuster-Wallace
  • Susan J. Elliott
  • Saaya Tema
Original Paper


The purpose of this research was to develop and pilot a mixed-methods-coupled systems (human and physical) approach to understand strengths, challenges and health impacts associated with water, sanitation and hygiene (WaSH) in a rural Kenyan community. The pilot was undertaken in partnership with three of eight geographically separate neighbourhoods in a rural Maasai community. Qualitative and quantitative data represented the condition of physical infrastructure, water quality, WaSH-related practices, perceived health and incidents of waterborne disease. As evidenced through this case study, sanitary inspections are necessary but insufficient to identify potable water supplies, although they are good indicators of non-potable supplies. Furthermore, results underscored that even within a single community, differences in location and access to resources can lead to very different WaSH-related practices and perceptions. While focus on clinical health records and water quality and infrastructure are standard methods, the integration of these with community practices and perceptions provides a more complete foundation on which to build infrastructure and behaviour-change interventions. In melding community and scientific knowledge, intervention options can be more appropriately, and therefore sustainably, designed to reflect the social and cultural, as well as the physical, needs of the community.


Community Health Kenya Mixed-methods WaSH Water security 



The authors are grateful to Dr. Diana Karanja and the Kenya Medical Research Institute and the Il Ngwesi Group Ranch for their support and insights.


This study was funded by the United Nations University Institute for Water, Environment and Health (UNU-INWEH) core research funds (Schuster-Wallace, former Programme Officer [Water-Health], UNU-INWEH) and the Natural Sciences and Engineering Research Council Discovery Grant program (Dickson; RGPIN/250121-2013).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the McMaster Research Ethics Board (Cert. # 2011148) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

12403_2017_251_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 kb)


  1. APHA, Awwa, WEF (2012) Standard methods for the examination of water and wastewater, 22nd edn. American Public Health Association/American WaterWorks Association/Water Environment Federation, Washington, DCGoogle Scholar
  2. Dickson SE, Schuster-Wallace CJ, Newton JJ (2016) Water security assessment indicators: the rural context. Water Resour Manag 30(5):1567–1604CrossRefGoogle Scholar
  3. Drinking Water Quality and Effluent Monitoring Guideline (2009) Kenya Water Services Regulatory Board (KWRSB), KenyaGoogle Scholar
  4. Dufour A, Bartram J, Bos R, Gannon V (2012) Animal waste, water quality and human health. WHO: International Water Association, LondonGoogle Scholar
  5. Howard G, Bartram J (2003) Domestic water quantity, service level, and health. Report. WHO/SDE/WSH/03.02. Water, Sanitation and Health Programme, WHO, GenevaGoogle Scholar
  6. Howard G, Ince M, Schmoll O, Smith M (2012) Rapid assessment of drinking water quality, report. WHO and UNICEF, GenevaGoogle Scholar
  7. IGR (2010) Il Ngwesi Group Ranch strategic plan 2010–2014, report. Il Ngwesi Group Ranch, KenyaGoogle Scholar
  8. Keller S (2012) Problem and preference ranking. Sustainable sanitation and water management. Accessed 8 Dec 2016
  9. Manja KS, Maurya MS, Rao KM (1982) A simple field test for the detection of faecal pollution. Bull WHO 60(5):797–801Google Scholar
  10. Maroyi A (2017) Lippia javanica (Burm. f.) Spreng. traditional and commercial uses and phytochemical and pharmacological significance in the African and Indian subcontinent. Evid Based Complement Altern Med. doi: 10.1155/2017/6746071 CrossRefGoogle Scholar
  11. Micrology Laboratories (2011) Detection of waterborne coliforms and fecal coliforms with Coliscan easygel. Micrology Laboratories LLC, IndianaGoogle Scholar
  12. Minkler M, Wallerstein N (2011) Improving health through Community Organization and community building. In: Minkler M (ed) Community organizing and community building for health, 2nd edn. Rutgers University Press, New Brunswick, NJGoogle Scholar
  13. Ottoson J, Stenstrom TA (2003) Faecal contamination of greywater and associated microbial risks. Water Res 37(3):645–655CrossRefGoogle Scholar
  14. Prüss-Ustün A, Bartram J, Clasen T, Colford JM, Cumming O, Curtis V, Bonjour S, Dangour AD, De France J, Fewtrell L, Freeman MC (2014) Burden of disease from inadequate water, sanitation and hygiene in low-and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health 19(8):894–905CrossRefGoogle Scholar
  15. Schuster-Wallace CJ, Dickson S (2017) Pathways to a Water Secure Community. In: Adeel Z, Sandford R, Devlaeminck D (eds) Individuals and Communities: The Human Face of Water in the Water Security in a New World book series. Springer, New York, pp 197–216Google Scholar
  16. Schuster-Wallace CJ, Watt S (2015) Women and the water-health nexus. In: Chamberlain Froese J, Elit L (eds) Women’s health in the majority world, 2nd edn. Nova Sciences Publishers, New York, pp 131–154Google Scholar
  17. Schuster-Wallace CJ, Cave K, Bouman-Dentener A, Holle F (2015a) Women, WaSH, and the water for life decade. Report. United Nations University Institute for Water, Environment and Health and the women for water partnership. DOI: 10.13140/RG.2.2.22205.26089Google Scholar
  18. Schuster-Wallace CJ, Cave K, McCormick H, Watt S, Karanja D, Dickson S (2015b) WaSH: integrated social empowerment toolkit for community WaSH and Wellbeing—W:ISE Toolkit Handbook. Report. United Nations University Institute for Water, Environment and Health, CanadaGoogle Scholar
  19. van de Mortel TF (2008) Faking it: social desirability response bias in self-report research. Aust J Adv Nurs 25(4):40–48Google Scholar
  20. Viljoen AM, Subramoney S, van Vuuren SF, Başer KHC, Demirci B (2005) The composition, geographical variation and antimicrobial activity of Lippia Javanica (Verbenaceae) leaf essential oils. J Ethnopharmacol 96(1–2):271–277CrossRefGoogle Scholar
  21. WHO (2005) Water safety plans. Report. WHO, GenevaGoogle Scholar
  22. WHO (2011) Guidelines for drinking-water quality, 4th edn. WHO, GenevaGoogle Scholar
  23. WHO and UNICEF (2015) Progress on sanitation and drinking water—2015 update and MDG assessment. Report. WHO and UNICEF, GenevaGoogle Scholar
  24. Wright J, Gundry S, Conroy RM (2004) Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use. Trop Med Int Health 9(1):106–117CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.CalgaryCanada
  2. 2.McMaster UniversityHamiltonCanada
  3. 3.DundasCanada
  4. 4.University of WaterlooWaterlooCanada
  5. 5.Il Ngwesi Group RanchTimauKenya

Personalised recommendations