Guidelines

Please take into account that the assignments can only be submitted in English, and try
to give short and structured answers (descriptive text and/or a set of bullet points).
Please submit your assignment by April 27, 11.59 pm CEST. It should not take you
longer than 1-2 hours to complete the assignment, which counts 30% towards your final
grade. You can submit and re-submit your work for evaluation as many times as you
want before the submission deadline, without any penalty.

In week 4, your solution will be evaluated by your peers while you concurrently
evaluate five solutions of your peers. It is important that you submit your peer
evaluations before the peer evaluation deadline (May 5, 11.59pm CEST). We will
provide the evaluation criterion for all questions. The aim of this assignment is to apply
your knowledge in a concrete situation. It is acceptable if participants report numbers in
different ways (e.g. 2003 OR 2002.7 OR 2002.712345678).
Extra point
Your peers can give you an extra point if your responses are well structured, logically
ordered and easy to understand.

You are approached by a head teacher from a primary school in Bolivia, who is
worried about the high level of student absences. He assumes that poor drinking water
quality is one of the main causes of the absences, because the students often complain
about stomach problems and diarrhea. He invites you to visit his school to discuss the
situation in Bolivia and in the school.

1. The head teacher wonders if diarrheal diseases are a major problem in Bolivia
compared to neighboring countries, such as Peru or Chile. He would also like to know if
the deaths caused by diarrheal diseases for children (0-14 years) are higher in Bolivia
compared to your home country.
Please answer the question using the resources from the course.

2. A water quality test of the drinking water at his school measuring Escherichia
coli indicates a faecal contamination concentration of 63 CFU/100mL.
The head teacher would like to have safe drinking water and asks if there is good
solution, which can be applied directly at the school.
To demonstrate to him the efficacy of different HWTS methods, you treat a sample of
water with SODIS and another sample with chlorine. The results of the samples after
treatment are as follows: 2 CFU/100 mL for the SODIS sample and <1 CFU/100 mL for
the chlorine sample. What are the log reduction values (LRV) for both?
Please round both answers to one decimal place (e.g. 2.3).

3. The school has 30 teachers and 940 pupils, is located in a peri-urban area and has
access to water from a piped system.
The water is usually clear, but regularly is turbid for short periods, especially during the
rainy season. Electricity is not reliable.
The head teacher also says that the teachers dont want to boil the water, because they
dont like the flat taste of boiled water. A major challenge is the absence of hygienic
water storage containers.
The head teacher would like to treat the water at the school with a HWTS method and
would like to have your recommendation. What are other important factors that you
should know before giving him your recommendation? Please name 3 factors.

4. What combination of HWTS methods do you propose?

Please choose a combination of two methods and explain your choice, by naming three
advantages and two potential drawbacks.

RESPUESTA 1
The IHME GBD Visualization Tool and the WHO spreadsheet Disease and injury country estimates:
Burden of disease are potential information sources which were presented in the course. We present
model answers for both options. There are different ways to make the comparisons: with deaths or
DALYs due to diarrheal diseases. Both are valid, if calculated correctly. We show for example the
mortality figures.
Model Answer Option A: IHME
Source: IHME GBD Visualization Tool
www: http://viz.healthmetricsandevaluation.org/gbd-compare/

Comparison 1: The IHME GBD Tool indicates that there were 2404 (2403.78) deaths due to
diarrheal diseases in Bolivia in 2010. A comparison with Chile and Peru shows that diarrheal disease
mortality was higher in Bolivia (2403.78 = 4.39% of total deaths; 24.17 deaths/100,000), than in
Peru (1061.86 = 0.82% of total deaths, 3.65 deaths/100,000) or Chile (237.23 = 0.24% of total
deaths; 1.45 deaths/100,000).

Comparison 2: The deaths caused by diarrheal diseases for children (0-14 years) in 2010 were
higher in Bolivia (2138.77 deaths) than in Switzerland (5.51 deaths). [The home country of course
depends on the student.]

Note that since IHME doesnt report disease burden for the 0-14 age groups, this second comparison
required adding together the Under-5 deaths (2090.88 for Bolivia in 2010) and the 5-14 death (47.89 in
Bolivia). The number of deaths can be added directly, but the proportion of deaths (e.g. per 100000, or
percentage of deaths) cannot be added, since the denominators are different. For example, while it is
correct that in Bolivia, in 2010, 14.93% of under-5 deaths were caused by diarrhea, and 3.12% of the age
5-14 deaths were also caused by diarrhea, it would be incorrect to say that 14.93+3.12 = 18.05% of age 014 deaths were caused by diarrhea.
Model Answer - Option B: WHO
Source: WHO-file By sex and age on the website Disease and injury country estimates: Burden of
disease
www: http://www.who.int/healthinfo/global_burden_disease/estimates_country/en (In the section Death
estimates for 2008 by cause for WHO member states download the "By sex" spreadsheet for the first
comparison and the By sex and age spreadsheet for the second comparison).
Note that in the spreadsheet cells, figures are rounded to the nearest 0.1. Since the spreadsheet data show
populations in thousands, this means that figures are rounded to the nearest hundred. However, by
looking in the formula window, you can see the unrounded data. For example, the number of diarrheal
deaths in 2008 in Chile was 0.180509 thousand, or 180.509, but this is rounded to the nearest hundred and
displays as 0.2 in the table. Either rounded or unrounded answers should be accepted as correct for the
assignment.

Comparison 1: In the WHO spreadsheet Deaths estimates for 2008 by cause for WHO Member
States the Deaths worksheet indicates 2800 deaths due to diarrheal diseases in Bolivia (2758.939
if unrounded numbers are used). A comparison with Chile and Peru shows that the number of deaths
due to diarrheal diseases was higher in Bolivia than in Peru (1500 deaths) or Chile (200 deaths). The
worksheet Death rates shows the 2008 diarrheal death rates per 100,000 of Bolivia, Peru, and
Chile. If the diarrheal disease deaths are normalized by population (this is a better way to compare
different countries) Bolivia still has the highest disease burden, at 28.5 per 100,000, compared to 5.4
per 100,000 in Peru and 1.1 per 100,000 in Chile.

Comparison 2: The deaths caused by diarrheal diseases for children (0-14 years) in 2010 were
higher in Bolivia (2300 deaths; 2259.483 if unrounded numbers are used) than in Switzerland (0
deaths). [The home country of course depends on the student.] Since country populations vary
greatly, it would be best if the answer were normalized to population. So, for example, Brazil has
very nearly the same number of diarrheal disease deaths in the 0-14 age group as Bolivia (2300), but
since its population is more than 14 times larger, the disease burden is much smaller there.
Normalization to the number of total deaths would also give a more comparable figure than simply
using the number of deaths.

SCORING:
Two comparisons should be made: first, among countries in the region, and second, against the home
country of the student responding. The model answer for the first comparison looks at the total diarrheal
disease burden, from all ages. It would also be possible to make a similar analysis using only the burden
of disease among children, and if a student does this correctly they should get full points. However, the
second question (about the students home country) explicitly asked about the disease burden in the 0-14
age group, so only this answer would be considered correct. Ideally the answers were normalized to
population, but this is not required to get the points.
Award one point for each correct answer. Give credit if a correct response is given, even if it is different
from the model answer. For example, a student may report disease burden in DALYs instead of deaths, or
may report under 5 or 0-14 disease burden instead of total burden for the regional comparison. This is
fine. As long as the student has accessed either the IHME or WHO resources correctly, and the numbers
they present correspond to the question posed, a point should be awarded.

RESPUESTA 2
Model Answer:
The log reduction value for the SODIS sample is 1.5. This is calculated as the log10 of (63/2) =
1.4983105537896004, which is then rounded to 1.5.
The log reduction value for the chlorine sample is greater than 1.8. This is calculated by considering that
since the final concentration is below 1, the reduction is therefore greater than from 63 to 1. So the LRV
must be greater than log10 (63/1), or greater than 1.7993405494535817. This value is rounded to 1.8, so
to achieve a concentration <1 CFU/100 mL, the LRV must be greater than 1.8.
SCORING:
Give one point for each correct answer (1.5 for SODIS, >1.8 for chlorination). Do not award points if
answers are not rounded, as this was clearly required in the question. For the chlorination question, the

correct answer is >1.8. However, we will also accept the answer 1.8, because 1.8 is greater than
1.7993405494535817 and therefore technically also correct. Answers such as 2, >2, and are not
correc

RESPUESTA 3
Model Answer
Further important factors that you should know before giving him your recommendation are the

Budget of the school for HWTS (e.g., does the school have the budget to buy a filter?)

Access to consumables (e.g., can the school buy chlorine tablets?)

Personal preferences (e.g., is the taste of the water important?)

Required drinking water volume per day

HWTS skills of school personnel

Other factors may be valid, if they are presented with a convincing argument.
SCORING:
Award two points if three or more valid factors are mentioned. If one or two valid factors are mentioned,
award one point. Use your judgment to assess if the factors presented are valid or not.

RESPUESTA 4
Please evaluate if the recommended combination of HWTS processes is appropriate and if the advantages
and drawbacks are correct. There are different potential combinations, all of them with advantages and
drawbacks. We provide three examples. Other combinations may be valid, if they are presented with a
convincing argument. Of course, also more specific recommendations (e.g. membrane filtration followed
by pasteurization) are valid, if they are presented with a convincing argument. Please include to your
feedback , if you consider the recommended combination of HWTS processes as appropriate and if the
named advantages and drawbacks are correct or not.

Filtration followed by chlorination

Advantages: effective for treating turbid water, provides residual protection for recontamination, easy to
apply.
Drawbacks: need for supply chains for chlorine products, need for replacement of broken filters, change
in the taste of the water

Coagulation followed by UV treatment

Advantages:

effective

for

treating

turbid

water,

cheap,

easy

Drawbacks: no residual protection, logistically challenging to treat large volumes of water

to

apply

Filtration followed by pasteurization

Advantages:

effective

for

treating

turbid

water,

easy

to

apply

Drawbacks: need for replacement of broken filters, no residual protection

SCORING:
Award two points if the response presents a combination of HWTS processes, with three correct
advantages and two correct drawbacks. Award one point if a recommendation is made, but without three
correct advantages and two correct drawbacks. Use your best judgment in case a different combination
from the model answer is presented. If a single HWTS process is presented, a maximum of one point
should be awarded, since single processes cannot effectively treat turbid water (even membrane filtration
would require some pre-treatment for turbid water).

Overall evaluation/feedback
Is the student's response well structured, logically ordered and easy to understand in your opinion?
SCORING:
Select the option Yes, if you consider the assignment as well structured, logically ordered and easy to
understand. This will give an extra point to the student.