The Effects of Climate Variability, Seasonal

Variations and Environmental Events on Drinking

Water Quality, Diarrhea Prevalence and Wash
Behaviour in Bangladesh

Standard Operating Procedures &

Data Collection Tools

IEDCR August 2016

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 Table of Contents
1. BACKGROUND................................................................................................................................................................ 4
2. OBJECTIVES .................................................................................................................................................................... 4
3. TARGET POPULATION................................................................................................................................................. 4
4. SOP FOR STUDY SITES AND CLUSTER SELECTION ............................................................................................... 5
5. FORM FOR INITIAL COMMUNITY (TSU) SURVEY ................................................................................................. 9
6. SOP FOR QUANTITATIVE DATA COLLECTION ................................................................................................... 15
7. SOP FOR QUALITATIVE DATA COLLECTION ....................................................................................................... 16
7.1 PHOTOGRAPHS FOR IDENTICATION OF IMPROVED WATER SOURCES................................................................................................... 18
7.2 PHOTOGRAPHS FOR IDENTICATION OF UNIMPROVED WATER SOURCE ............................................................................................... 19
8. SOP FOR CHILD ANTHROPOMETRY ASSESSMENT............................................................................................ 20
8.1 PURPOSE............................................................................................................................................................................................................ 20
8.2 DEFINITION ....................................................................................................................................................................................................... 20
8.3 MEASUREMENTS .............................................................................................................................................................................................. 20
8.4 MEASUREMENT TIMELINE ............................................................................................................................................................................. 21
8.5 EQUIPMENT AND SUPPLIES............................................................................................................................................................................ 21
Equipment ........................................................................................................................................................................................................ 21
Supplies.............................................................................................................................................................................................................. 22
8.6 EQUIPMENT MALFUNCTIONS ......................................................................................................................................................................... 23
8.7 REGULAR QUALITY CONTROL PROCEDURES .............................................................................................................................................. 23
Digital scales ................................................................................................................................................................................................... 23
Stadiometer ..................................................................................................................................................................................................... 23
MUAC tapes ...................................................................................................................................................................................................... 23
8.8 FIELD ACTIVITIES ............................................................................................................................................................................................ 23
Pre examination procedures .................................................................................................................................................................... 23
Reminders for Measuring and Recording ........................................................................................................................................... 24
Standing weights ........................................................................................................................................................................................... 24
Weighing the Infant in Mother’s Arms................................................................................................................................................. 25
Taking Mid-Upper Arm Circumference ............................................................................................................................................... 26
Taking Length for infants and children 0-23 months ................................................................................................................... 28
Taking Height for children 24 months and older ............................................................................................................................ 30
Taking Child’s Head Circumference ...................................................................................................................................................... 32
9. SOP FOR WATER SAMPLE COLLECTION AND TRANSPORTATION ............................................................... 33
9.1 FIELD BLANK/DUPLICATE SAMPLE COLLECTION...................................................................................................................................... 34
9.2 REQUIRED SUPPLIES ....................................................................................................................................................................................... 34
9.3 COMPOSITION OF FIELD IMPLEMENTATION TEAM ................................................................................................................................... 35
10. ROLES AND RESPONSIBILITIES OF THE FIELD IMPLEMENTATION TEAM .............................................. 36
10.1 Field Coordinator ................................................................................................................................................................................ 36
10.2 Monitoring Tools/ Methods ............................................................................................................................................................ 36
10.3 Interviewer (Quantitative) ............................................................................................................................................................. 36
10.4 Interviewer (Qualitative)................................................................................................................................................................. 36
10.5 Medical Technologist......................................................................................................................................................................... 36
10.6 Data enterer .......................................................................................................................................................................................... 36
11. DATA COLLECTIONS TOOLS ................................................................................................................................. 37
1(A): INFORMED CONSENT FORM FOR ADULT RESPONDENTS (ENGLISH) ................................................................................................ 37
1(C): INFORMED CONSENT FORM FOR PARENT/GUARDIAN OF MINOR CHILDREN AGED BETWEEN 0-17 YEARS......................... 40
APPENDIX 1(G): ENGLISH INFORMED CONSENT FORM FOR HOUSEHOLD ENROLMENT .......................................................................... 42
SOP FOR ID SELECTION FOR CLIMATE CHANGE PROJECT ............................................................................................................................... 44
STRUCTURED QUESTIONNAIRES (FORMATS A-L) ........................................................................................................................................... 45
Format A: Household Socio-Demographic Questionnaire (English) ...................................................................................... 45

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 Format B: Child anthropometry assessment questionnaire ....................................................................................................... 48
Format C: Child Vaccination History Questionnaire ...................................................................................................................... 49
Format D: Household Water Usage Questionnaire ........................................................................................................................ 51
Format E: Household Water, Sanitation And Hygiene Behaviour Questionnaire ............................................................. 55
Format F (A) : Household Health Outcome Assessment Tool..................................................................................................... 59
Format F (b): Household Health Outcome Assessment Tool ...................................................................................................... 63
Format G: Household Sanitation Assessment Form ....................................................................................................................... 65
Format H: Household POU Water Sample Collection Form ........................................................................................................ 68
Format I: Sanitary Inspection and Sample Collection Form For Focal Improved Water Source(s) ......................... 69
Source water sample collection form ................................................................................................................................................... 71
Format J: Water Specimen Collection, testing and analysis Procedure................................................................................. 75
SOP for Water Sample Collection ........................................................................................................................................................... 75
Field Blank/Duplicate sample collection ............................................................................................................................................ 76
SOP for Water Sample Collection for Determination of Arsenic Content ............................................................................. 76
SOP for pH Measurement ........................................................................................................................................................................... 76
SOP for Turbidity Measurement ............................................................................................................................................................. 77
SOP for Transportation of Water Samples in the Environmental Microbiology Lab of icddr,b .................................. 77
LAB SOP for Water Sample Analysis ..................................................................................................................................................... 77
Preparation of Media .................................................................................................................................................................................. 77
Preparation of MI Media............................................................................................................................................................................ 78
Media QA/QC................................................................................................................................................................................................... 78
Processing Samples ...................................................................................................................................................................................... 79
Processing with Membrane Filtration Unit ....................................................................................................................................... 79
Counting Plates .............................................................................................................................................................................................. 80
DATA ENTRY ............................................................................................................................................................................................................ 81
Hand Entry of Data into Lab Sheet........................................................................................................................................................ 81
LAB SOP FOR THE DETERMINATION OF ARSENIC USING HYDRIDE GENERATION ATOMIC ABSORPTION
SPECTROPHOTOMETER (HGAAS) ............................................................................................................................. 82
Format K: Meteorological Information Collection Format......................................................................................................... 83
Format L: Community Level Health Information Collection Format ..................................................................................... 84

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1. Background
Bangladesh is at the highest risk of facing the adverse impact of climate change, which will lead to an
increase in many climate-sensitive diseases. Climate change is predicted to increase intensity and
frequencies of natural hazards including water scarcity and flooding events thereby further contributing to
water stress. Climate change can also contribute to higher pathogen load, lower host immunity, and hamper
WASH accessibility thereby hindering WASH effectiveness on providing sustainable safe water and
promoting human health. However, measurements of climate change impacts would require long-term data
collection period of a few decades. Given that, 30 years of data collection is beyond the scope of one
research protocol, this study aims to assess the effects of climate variability, seasonality, and environmental
events (flooding/water scarcity) causing water stress that are assumed to be indicative of climate change
impacts, using these as proxy indicators as the length of the study is too short to address long-term changes
in climate on the effectiveness of WASH interventions.

2. Objectives
The general objectiveof this project is to measure the effects of climate variability, seasonal variations and
environmental events on the microbial quality of drinking water at point-of-use and at source in households
with access to an improved focal drinking water source(s). This SOP will help to manage the project,
development of data collection tools, train the field team members

The purpose of this Standard Operating Procedure (SOP) is as follows:

 To guide the field implemention team to select the study sites and clusters (urban,peri-urban and rural)
 To guide the field implementers in initial field setup, identification of study population and enrolment
of clusters & households
 To conduct the field data collection at the enrolled households within the selected clusters
 To guide the field implementation for troubleshooting
 To ensure timely collection, storage, transportation and analyses of the collected water samples from
selected improved water sources and from the enrolled HHs' point-of-use (POU)
 To guide and ensure timely collection, compilation and analysis of quantitative, qualitative, laboratory
and meteorological data as per the protocol
 To ensure quality of the collevcted data and samples by guiding the field coordinators to adequately
monitor and evaluate field data and sample collectioin teams

3. Target Population
Our target audience for this SOP: Field implemention team which includes field coordinators, quantitative,
qualitative interviewers and water sample collectors.

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4. SOP for Study Sites and Cluster Selection
We have 35 functional weather stations of Bangladesh Meteorological Department (BMD) across the
country with validated data. Among these 35 districts, we randomly selected one flood-prone and one
drought-prone district.

We selected one flood-prone and one drought-prone district where diarrheal disease prevalence had been
high using data from the Control Room of Directorate General of Health Services and satisfied the following
additional criteria:
 The districts were predicted to face higher severity in flooding or water scarcity - As identified by the
published literature and by the experts from the Bangladesh Meteorological Department (BMD), Flood
Forecasting and Monitoring Unit, and International Water Modeling (IWM).
 The environmental event under concern have been known to occur annually based on past data in the
selected districts (from the local meteorological office and Flood forecasting and monitoring unit)
 The districts were among those that had faced the highest temperature increase from the past decadal
mean temperature based on long-term temperature deviation. Not affected by multiple climate concerns
– salinity and floods. Therefore, specifically avoiding hoar areas, hill tracts and the coastal belts

 Using this method, Faridpur district was selected as the flood-prone sub-district and Rajshahi as the
drought-prone sub-district.
 We then listed all the sub-districts within each district. In the next stage, we selected all the sub-
districts within 20 kilometres radial distance of the weather station. Since Bangladesh is a triangular
delta plain, the mean temperature may be expected not to vary within 25 Kilometres. However,
cumulative rainfall, which is also an important determinant of diarrhea, may be expected to vary
frequently at a much smaller grid area, so we assumed a 10 Kilometre radial distance acceptable for
the purpose of the protocol. In this way, two sub-districts are selected in each district

Procedure for selection of Primary and Secondary Sampling Units (PSUs and SSUs):
 In order to get the primary sampling unit (PSUs), at first we used the population database to stratify the
four selected sub-districts into urban, peri-urban and rural thanas/paurashavas/ unions. These were
considered as the PSUs. We used PPS to select the necessary number of clusters from each primary
sampling unit. We then identified the city wards (for urban area) in municipalities or paurashavas, wards
within the union of the upazila as peri-urban and the unions of the upazila (for rural areas) of both
selected districts. We found out the distribution of the urban city wards within the four thanas of the
Rajshahi city corporation and Faridpur municipality/paurashava, peri-urban (wards within the unions of
Sadar upazila) and rural unions within the two selected sub-districts. We used the database from
Bangladesh Bureau of Statistics (BBS) 2011 and also from the Geo Location Registry of Directorate
General of Health Services (DGHS). The number of clusters per Thana and paurashava and union were
selected by probability proportionate to size (PPS).

Rajshahi District (Annex: 3):

 In Rajshahi municipality, there are four thanas: Boalia, Rajpara, Matihar and Shahmakhdum. We selected
urban and peri-urban clusters from each of the four thanas and Noahata Paurashava respectively.
 There are several city wards within each Thana. By using random number sampling, we selected the city
wards from each Thana and Noahata Paurashava.
 Peri urban clusters are located in Noahata Pourashova. There are 9 wards in the Pouroshova. We will

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 randomly selected 1 cluster from each ward.
 We need 80 rural clusters from rural Paba upazilla to reach the sample size. There are 8 unions in Paba
Upazilla.
 So we selected the number of clusters per unions using PPS from the eight unions of Paba Upazilla. We
randomly selected 11 city wards from Boalia thana ( city ward# 9,11,13,15,16,19,20,21,23,25,26), seven
city wards from Rajpara Thana (1,3,5,7,8,10,14), three city wards from Matihar thana (28,29,30) and two
city wards from Shahmakhdum thana (17,18) Annex 3.

In each selected city wards/wards/unions/Paura wards):

 We selected landmark identification from each randomized selected city ward of Rajshahi sadar and
Noahata Paurashava wards.
 We will list all the water sources around approximately 01 km radial distance of that selected landmark.
 Then we will select the eligible water source according to our protocol. Among the eligible water sources
we will randomly select the required number of clusters.
 In urban area (Rajshahi Sadar and Noahata Paurashava), we identified an eligible cluster in which 5 or
more households shared drinking water from the same improved source (piped networks) and in rural
areas (Unions of Paba upazilla) we identified the eligible clusters as those where 3 or more households
shared drinking water from the same improved source (Bore hole/modified bore hole).
 We will select total 55 urban and peri-urban clusters and 80 rural clusters. Total 515 households will be
enrolled from Rajshahi site.

Distribution of Urban and rural clusters in Rajshahi:

Rajshahi Sadar (Urban): Piped/Tap water network
Thana Ward Number Required number of cluster per ward Number of households
Rajpara 1 2 2*5=10
Rajpara 3 2 2*5=10
Rajpara 5 2 2*5=10
Rajpara 7 2 2*5=10
Rajpara 8 2 2*5=10
Boalia 9 2 2*5=10
Rajpara 10 2 2*5=10
Boalia 11 2 2*5=10
Boalia 13 2 2*5=10
Rajpara 14 2 2*5=10
Boalia 15 2 2*5=10
Boalia 16 2 2*5=10
Shahmakhdum 17 2 2*5=10
Shahmakhdum 18 2 2*5=10
Boalia 19 2 2*5=10
Boalia 20 2 2*5=10
Boalia 21 2 2*5=10
Boalia 23 2 2*5=10
Boalia 25 2 2*5=10
Boalia 26 2 2*5=10
Matihar 28 2 2*5=10
Matihar 29 2 2*5=10
Matihar 30 2 2*5=10
Total 46 230

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Paba Pourashava Peri-urban: Piped/Tap water network
Name of the ward Ward No Required number of cluster per ward Number of households
Naohata 1 1 1*5=5
Uttar pillapara 2 1 1*5=5
Maddho Putiapara 3 1 1*5=5
Bagdani 4 1 1*5=5
Duari 5 1 1*5=5
Thalta 6 1 1*5=5
Sontoshpur 7 1 1*5=5
Baroipara 8 1 1*5=5
Sotopaikpara 9 1 1*5=5
Total 9 45
Paba Upazilla (Rural): Borehole water source
Name of Unions Required number of cluster per ward per union Number of households
Parila 10 10*3=30
Borogachi 10 10*3=30
Horiaon 10 10*3=30
Hujuripara 10 10*3=30
Dorshona 10 10*3=30
Damkura 10 10*3=30
Horipur 10 10*3=30
Horogram 10 10*3=30
Total 80 240
Faridpur District (Annex: 3):
 In Faridpur paurashava, there are 9 available wards. We selected 5 urban clusters from each paurashava
ward from 9 available wards.
 Char Vadrashan Upazila HQ, 10 peri-urban clusters were randomly selected from union HQ.
 In Faridpur Sadar, there are 11 available unions. Eight rural clusters per union from 9 unions out of 11
available unions were selected randomly.
 From Char Vadrason, 2 urban clusters per union were selected from 4 available unions
 We will select total 55 urban and peri-urban clusters and 80 rural clusters. Total 515 households will be
enrolled from Faridpur site.
Distribution of urban, peri-urban and rural clusters in Faridpur:
1. Urban:
Faridpur Paurashava: Piped/Tap water network
Ward Number Required number of cluster per ward Number of households
1 5 5*5=25
2 5 5*5=25
3 5 5*5=25
4 5 5*5=25
5 5 5*5=25
6 5 5*5=25
7 5 5*5=25
8 5 5*5=25
9 5 5*5=25
Total 45 225

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2. Peri-urban:
Char Vadrashan Upazila HQ: Piped/Tap water network
Name of the Upazila Required number of cluster Number of households
Char Vadrashan Upazila HQ 10 10*5=50
Total 10 50

3. Rural:
A. Faridpur Sadar- Upazilla unions: Borehole water source
Name of Unions Required number of cluster per union Number of households
Aliabad 8 8*3=24
Ambikapur 8 8*3=24
Decreer Char 8 8*3=24
Greda Union 8 8*3=24
Ishan Union 8 8*3=24
Kaijuri 8 8*3=24
Kanaipur 8 8*3=24
Krishna Nagar 8 8*3=24
Uttar Channel 8 8*3=24
Total 72 216

B.Char Bhadrasan Upazilla unions: Borehole water source

Name of Unions Required number of cluster per union Number of households

Char Bhadrasan 4 4*3=12
Gazirtek 4 4*3=12
Total 8 24

Procedure for selection of Tertiary Sampling Unit (TSU)

We identified and listed the source pumps (municipal/community level submersible pumps) in each selected
SSU. We selected one source pumps randomly in each selected SSU as the landmark. We defined the
tertiary sampling unit as the area within 1-kilometre radial distance taking the landmark as the centre.

Community survey for identification of eligible clusters within each TSU

Starting from the landmark, data collectors surveyed the TSU. Using the community survey form, they
visited each household within the TSU to identify and list the community and household level drinking
water sources. (Community Survey form)

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5. Form for Initial Community (TSU) Survey
TO IDENTIFY ELIGIBLE CLUSTERS WITH IMPROVED DRINKING WATER
SOURCES AND ENROLMENT OF CLUSTERS

Name of the interviewer:................................. ID of the Interviewer:.............................................

Date:................................ District:................................................ Upazila/Thana:.......................
Union/City Ward/Paurashava:.........................................
Landmark Identification:.....................................
GPS of the landmark:............................................

TO BE COMPLETED
TO BE COMPLETED BY SURVEYOR BY FIELD
COORDINATOR
Cell Distance Number of Remarks:
Type of Mark and
Name of number of of the water Direction households Type of 1=Eligible
water number the
Sl number owner of owner of source in from (HH) share facility* water source
source*: eligible
source the water Foot from Landmark the water * 2=Ineligible
household
source landmark source 3=Unknown

1. Type of water source: (Cross Check with photographs and FC/DPHE if confused)
Municipal Piped/Tap water (with Overhead Reservoir Tank) =1
Municipal Piped/Tap water (without Overhead Reservoir Tank)=2
Municipal Piped/Tap water with Shared Water Point= 3
Municipal Piped/Tap water from Stand pipe fitted with tap=4
Municipal Piped/Tap water from Stand pipe fitted with soft pipe=5
Municipal Piped/Tap water from Stand pipe fitted without tap=6
Municipal/DPHE/NGO Deep tube well with mechanized pump/Submersible pump=7
Municipal/DPHE/NGO/Community Deep tube well without mechanized pump/Submersible pump=8
Independent Submersible pump or Deep tube well with mechanized pump/Submersible pump connect to
piped network=9
Independent Submersible pump or Deep tube well with mechanized pump/Submersible pump not connect to
piped network=10
Source pump connected with a Tap=11 **Type of facility:
Municipal Stand pipe with tap=12 Individual HH=1
Municipal Stand Pipe without Tap=13 HH with shared water source=2
Municipal Stand pipe fitted with soft pipe=14 Institution (other than school)=3
Independent Bore Hole/Tube well=15 Mosque/Temple etc=4
Modified bore hole (TARA/Raised/Fitted with School =5
College=6
protected/unprotected chlorinator/ionizer/reservoir)=16 Others=7 (Please specify)
Rain water Harvesting=17 _________________________
Protected Dug well=18
Canal/River/Ditch =19
Others (SPECIFY)= 20

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Table A: Cluster selection from Rajshahi (Rajshahi Sadar, Noahata Paurashava and Paba)
Number of clusters per
Clusters Number of
Rural/Urban city wards/
District Upazila/Thana necessary to be Wards/Unions/Ci
/Peri-urban unions/wards/paura
enrolled per PPS tywards available
wards
2 urban clusters per
Rajshahi Boalia Urban 22 18 city ward from 11 city
wards
2 urban clusters per
Rajshahi Matihar Urban 6 3
city ward
2 urban clusters per
Rajshahi Rajpara Urban 14 10 city ward from 7 city
wards
Urban/City 2 urban clusters per
Rajshahi Shahmakhdum 4 2
wards city ward
Paba Peri-urban/ 1 urban cluster per
Rajshahi Paurashava - Paurashava 9 9 ward
Noahata wards
Rural clusters per
Rajshahi Paba upazila Rural/Union -------- 8 union according to
PPS
Total clusters 135
Total Households 515
Additional source pumps
10
in urban areas
Total water samples from
660
rajshahi

Table B: Cluster selection from Faridpur (Faridpur Sadar, Paurashava and Char Vadrashan)
Clusters Number of Number of clusters per city
Rural/Urban necessary to Wards/Unions/ wards/unions/wards/paura
District Upazila /Thana
/Peri-urban be enrolled per City wards wards
PPS available
5 urban clusters per
Faridpur Paurashava Urban 45 9 paurashava ward from 9
available wards
8 rural clusters per union from
Sadar Upazila -
Faridpur Rural 72 11 9 unions out of 11 available
Unions
unions
2 urban cluster per union
Faridpur Char Vadrashan Rural 8 4
from 4 unions
Char Vadrashan 10 urban clusters per union
Faridpur Peri-urban 10 1
Upazila HQ HQ

Total clusters 135

Total Households 515
Additional source pumps
10
in urban areas
Total water samples from
660
Faridpur

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 Annex: 3

For Picture Below (CLUSTERS SELECTED):

 Yellow = Urban cluster
 Green underline = Peri-urban
 Rectangle selection= Rural cluster

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Procedure for enrolment of clusters and households within each TSU:
 After Community Survey at each TSU and Water Source identification (Using photographic Aid) and
listing by Surveyor, Field Coordinator identified and gave random numbers to all eligible clusters with
improved water sources within the TSU
 Then, the necessary number of clusters were selected by lottery method from among the eligible clusters
within each Tertiary Sampling Unit
 The field team approached each selected cluster and sought Informed Consent from the owner of the
improved sources and Heads of households to be enrolled
 Took GPS reading of all enrolled sources and households if owner and household heads gave consent to
participate.
 If a cluster or household did not give consent, the next nearest cluster source and households were
approached

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6. SOP for Quantitative Data Collection
 A number of tools and techniques developed considering Bangladesh Perspective for quantitative data
collection by following the general guideline and appendixes and showed in the box. It need to noted
that the research will work in geographic location namely flood and drought area. Each of the
geographic location will be consisted of 135 clusters (55 piped water and 80 tube well user) using PPS.
 All data will be collected on papers. The field team will undergo at least two weeks of rigorous training
to become familiar with the survey instruments and to learn sterile technique for collecting water
samples.
 Interviews will be conducted with the primary drinking water collector of the household and/or the
female caretaker of the youngest child in the household.
 Diarrhea among children under-five (and all household members) will be assessed during each of the
18 short survey rounds according to the World Health Organization case definition of diarrhea (3 or
more loose/watery stools in 24 hours).
 We will use a 7-day recall period to measure diarrheal at each month household visit. At each
household, we will also determine 7-day period prevalence of diarrheal among all age groups as a
secondary outcome.
 All enrolled households will be visited on Format A: HH Socio-demographic Survey at Initial/Last visit
a monthly basis and at each visit, trained Format B: HH Child Anthropometry at Initial/Last visit
field data collectors will use structured Format C: HH Child Vaccination Survey at Initial/Last visit
questionnaire (Format D-H) to collect Format D: HH Water Usage Questionnaire
Format E: HH Water, Sanitation and Hygiene Behaviour Survey
WASH practice, health outcome, Format F1: HH Diarrheal Diseases Assessment Questionnaire
sanitation inspection, and water usage Format F2: HH Additional Gastro-intestinal Syndrome
form to explore total amount of water Assessment Questionnaire
Format G: HH Sanitation Assessment Form
available for drinking, cooking, washing, Format H: HH POU Water Sampling Form
bathing and sanitation purposes. Format I: Sanitary Inspection & Source Water Sampling
 Approximately 25% of the households in Format J: Water Sample Collection Procedure
Format K: Daily temperature, rainfall and humidity from BMD
low-income urban communities may be
data repository
expected to relocate per year, so there is
Format L: Local health data collection form
some risk of attrition in urban areas.
However households that are vacated are
usually soon filled with new tenants. To account for this, we will follow the disease experience of all
households with children under five served by selected water points, even if it may be a different
family than was present at the initiation of the study.
 We will measure socioeconomic, demographic, and educational attainment of household heads and
respondents at the initial research visit as well as at the end of the study to understand if there are any
differential compositional changes among households present at baseline versus those that move into
the study population.
 As a secondary analysis we will compare the disease experience of people who stayed in their
households throughout the duration of the evaluation and so control for any impact this might have on
our assessment. Since nutritional status is an important determinant of any childhood disease including
diarrheal.
 At the first and last survey round, trained data collectors in anthropometric assessments will collect the
child's weight, height and mid-upper arm circumference (MUAC) to calculate weight-for age at initial
visit and at end line (last visit) using WHO recommended equipments (digital scales and arm bands).
All measurements will be taken three times to reduce human error. Trained data collectors in
anthropometric assessments will be standardized during extensive training and field practice (at least
two weeks).
 We will also track mortality related to diarrhoea if any. Caretakers will be asked if they have sought
treatment or advice at a health care facility for their children in the past one month, and in the past
month (since the field team’s previous visit). Follow up questions will be asked regarding symptoms
and diagnosis to classify illnesses as gastrointestinal.

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7. SOP for Qualitative Data Collection
We will purposively select one household per enrolled cluster for qualitative exploration. A total of 45
households in 45 clusters will be selected for qualitative investigations per month from the enrolled 1030
households in 270 clusters for the qualitative study to complete the total 270 household qualitative study in
one round within 6 months time.
 From the preliminary field exploration, we assume that we will find different categories of households
based on different sources of water in the community- e.g municipal water supply (WASA), individual
submersible pump, communal submersible pump, shallow tube well or hand pumps with borehole,
TARA pumps and surface water (river, pond and well).
 We will categorize the study population based on different sources to cover differences in community
residents’ perception and practices that may attribute to differences in water sources and availability as
well as health outcomes in the households.
 We will purposively select five households and clusters per category in each district.We will also
conduct in-depth interviews to explore respondent's perceptions if the amount of water available could
meet household demand and if water stress had led them to seek alternative sources. We will also ask
specifically if availability and water stress varied with any flooding or environmental events.
 After building a good rapport with the community and study households and gaining their trust, the
researchers will roam in the entire community for the first few days and conduct several small group
and individual informal discussions to become acquainted with the community and gain an
understanding of the existing water usage and management structure and practices.
 They will spend as much time as possible every day in the community for the first one to two weeks
and visit study households to collect information through participant observation and informal
conversation.
 These information will inform and shape the guidelines. The researchers will carry a small notebook all
the time to jot down the field notes instantly on the spot, especially during observation and informal
conversations. They will also carry a digital recorder to record informal conversations, but may not use
it every time, since it might disrupt the natural flow of conversation. In each field, one of the
researchers will capture interesting moments relevant for the research in their camera.
 We will deploy in-depth interviews (Appendix-5) and direct observations (Appendix-6) guidelines to
collect qualitative data. We will conduct in-depth interviews at three time points during the 18 month
duration of data collection from each household. In this way, we will be able to understand perception
and perceived practices on individual and domestic water use as well as water stress and coping
strategies at the beginning, middle and end of the study to compare across seasons. Moreover, one
additional round will be made in the event of any flood.
 During in-depth interview, we will also collect information about changes in practices across and
within different seasons.
 We will also conduct observation in the households in every six months over the course of 18 months
to measure the quantity of water use for each type of household and personal purposes. We will
observation to understand the difference in availability of water and change in reported hygiene
practices at different seasons.

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 The general objectives is to assess the effects of climate variability, seasonal variations and
environmental events on the microbial quality of drinking water at point-of-use and at source in
households with access to an improved focal drinking water source(s).
(With months, with seasons and with environmental events (floods/water scarcity)

Observational Study Using

Mixed Research Methods

Prospective cohort/longitudinal study Water sample collection to Qualitative study

Monthly visits to 1030 households enrolled test for microbial quality Monthly visits to 45 HHs for
within 270 clusters and 20 source pumps Monthly household visits for 6-hour structured observation
Socio-demographic survey collecting POU drinking water of water use & WASH
Water availability measure samples from 1030 HHs, 20 practices
WASH accessibility source pumps and 270 In-depth interviewing of HH
WASH behaviour improved sources water collector to explore
Sanitary risk assessment additional contexts
HH resident's heath outcome

Repeated collection of
meteorological data
(mean temperature/
precipitation/humidity)

Adjust confounders: Identify root cause

Socio-demographic Contextual factors
Water availability Identify bias and improve reliability:
WASH access Social desirability
WASH behaviour Recall
Sanitary risk Measure water availability
Compare reported & actual behaviour

Quality of drinking water at the point-of-use in 1030 households and 290 improved source(s)

Assessment of health status (water-borne disease) of residents in the enrolled 1030 households vary

A schematic flow diagram is inserted in the following to reflect the whole research

17
 7.1 PHOTOGRAPHS FOR IDENTICATION OF IMPROVED WATER SOURCES


Borehole-Tube Well Modified Boreholw Tube Well Raised Tube well in flood Area

Boreholw with Protected Chlorinator

Modified Borehole Tara Pump Stand Pipe with Tap
Ionizer

Tap Water Stand Pipe without Tap Stand pipe fitted with Soft Pipe

Filtered Tap Water without Piped Community filtered water without piped
Common Community Water Source
Network network

Rainwater Harvesting Unit Piped Networkm from independent

submercible pump

18
 7.2 PHOTOGRAPHS FOR IDENTICATION OF UNIMPROVED WATER SOURCE



Deep Tube Well with Unprotected

Un-protected Dug Well POU Water
reserviour

Dheki Call Pond/ditch

19
8. SOP for Child Anthropometry Assessment
8.1 PURPOSE
This document is intended to serve as a guide and training manual for climate change field staff who will be
measuring maternal and child anthropometric data, including length/height, weight mid-upper arm
circumference (MUAC) and head circumference measurements. As to be detailed below, measurements will
be recorded on the study index children and their mothers at selected time points. Therefore, anthropometry
is a critical measurement for the project.

Anthropometry Overview
8.2 DEFINITION
ANTHROPOMETRY is the science that defines physical measures of a person's size, form, and functional
capacities. The field of anthropometry encompasses a variety of human body measurements. Several
indexes and ratios can be derived from anthropometric measurements that are used to predict health,
survival, and physical performance of individuals and populations. Anthropometry is a key component of
nutrition status assessment in children and adults. Anthropometric measurements also provide an indication
of child growth and development. Anthropometric data for infants and children reflect general health status
and dietary adequacy and are used to track trends in growth and development over time. 1

8.3 MEASUREMENTS
For our project, we will be measuring four primary indicators: length/height, weight, mid-upper arm
circumference (MUAC), and head circumference. The specific measurements vary somewhat by age of the
target individual and are listed below in Table 1.

Table 1. Body measurements by age category

Birth to 2 yr > 2 yr Mothers
-Weight -Weight - Weight
-Recumbent length -Standing height - Standing height
-Head circumference -Head circumference - MUAC
-MUAC -MUAC

Collection of anthropometry data requires two or more active trained data collectors: the examiner and the
recorder. Typically, the examiner will position the participant and take all measurements and the recorder
will assist and write or enter these values. Some measurements (ex: child recumbent length) require two
staff trained in anthropometry to collect the measurement – one to position the child’s head and the other to
keep the body straight, and focus on the feet where the measurement is captured.

Another important duty of the recorder is to help the examiner position the participants during their
examination. In this role the recorder also alerts the examiner if the respondent needs to be repositioned.
Also, the recorder participates in taking recumbent length measurements on infants and young children.
Lastly, the recorder marks body sites that are measured by the examiner and hands equipment and supplies
to the examiner when needed.

1Cogill B., Anthropometric Indicators Measurement Guide. Food and Nutrition Technical Assistance (FANTA) Project, USAID. March 2003.
Available online: http://www.fantaproject.org/sites/default/files/resources/anthropometry-2003-ENG.pdf

20
 8.4 MEASUREMENT TIMELINE
The anthropometric measurements will be collected at two time-points during the study: At each of these
visits, the weight, length/height, MUAC and head circumference of the index child will be recorded.

8.5 EQUIPMENT AND SUPPLIES

EQUIPMENT
MEASURING TAPE
Purpose: For measurement of MUAC and head circumference
Model: Shorr Tape measuring tape 65 cm
Description: Accurate, high quality, durable, flexible, non-stretch, non-tear, weather-resistant, synthetic
tape. Measuring range: Metric Units: 6 - 65 cm x 1 mm White tape with black numerals.
Special care instructions: Store tapes in a protective case. Old film canisters or small plastic bottles work
well. Inspect tapes regularly for cracks, kinks, or worn/faded ink. Damaged tapes should be discarded.

DIGITAL STANDING SCALE

Purpose: For measurement of maternal weight and index child weight
Model: SECA 874; Digital Floor Scale with Mother/Child Function
Description: This lightweight digital floor scale is extremely versatile since
it weighs infants, children and adults. With its special Mother/Child Tare
Feature, a mother/adult steps on the scale and she can be weighed (or not),
then after pressing a button, the display goes to zero, the mother takes the
child in her arms and only the weight of the child appears in the display
panel. The side-by-side, opposite facing dual display makes it easy reading
for the professional and the subject.
Capacity: 200 kg
Graduation: 0 - 150 kg : 50 g
150 - 200 kg : 100 g
Power: 6 AA batteries included
Display: LCD
Weight: 8 lb / 3.6 kg
Features: Tip-on Automatic switch-on, Automatic switch-off, Auto-HOLD, mother/child tare, lbs/kg
switch-over

Special care instructions:

Handle the scale carefully:
 Store and transport scale in carrying case.
 Do not drop or bump the scale.
 Do not weigh loads with a total weight of more than 150 kg.
 Do not store the scale in direct sunlight or other hot places.
 Protect the scale against excess humidity or wetness.
 Do not use the scale at temperatures below 0 degrees C or above 45 degrees C.
Cleaning the scale: To clean the scale, wipe surfaces with a damp cloth. Never put the scale into
water.

21
 HEIGHT/LENGTH BOARD (STADIOMETERS)
Purpose: For measurement of infant length, young child height, or maternal height
Model: ShorrBoard® Infant/Child/Adult Portable Height-Length Measuring Board
Description: Made of high quality hardwoods with a weather-resistant finish. The versatile
Infant/Child/Adult ShorrBoard (0-200 cm X 0.1 cm) is convertible since the same board is used to measure
the recumbent length of infants less than 2 years of age laying down and the
standing height of children 2 years of age, older children and adults. This is a
three-piece measuring board that collapses and is secured to a compact unit of
75 cm (29.5 in) where the three panels are held together with self-contained
spring-loaded hand-turned bolts.
They are portable, lightweight (6.7 kg), extremely strong and durable,
accurate, easy to assemble and use, and have an adjustable, removable two-
inch wide, very strong braided nylon shoulder strap for easy carrying.
The Auto-Lock ShorrBoards have a moveable head/footpiece that slides
smoothly up and down the measuring board and instantly locks automatically
in position where it is placed on the board above the subject’s head for
standing height (there are no knobs to turn) or at the child’s feet when taking
recumbent length measurements, leaving the user’s hands free to position the
subject.
Special care instructions: Store and transport stadiometer in the carrying case.
Clean with water and mild detergent. Do not immerse length board in water.
Be sure the stadiometer is placed on a stable, level surface to avoid tipping
over and cracking the wood. Inspect the stadiometer between each use. If wood is cracked or broken, if
measuring tape is worn or illegible, or if the head/footpiece becomes unstable discontinue use and request
repair or replacement.

CALIBRATION WEIGHTS AND MEASURES

Purpose: To ensure that the scales and stadiometers are functioning properly and providing accurate and
reliable data.
Model: . Avery 2013-5 kg calibration weight (Locally Purchased)
Description: Standard weights are to be used daily to check the calibration of scales. The weights are
stored together with the equipment.
A standard length metal pole should be used to calibrate the stadiometers weekly.
SUPPLIES
 Pencils: The recorder will use water based markers to make markings that are clearly visible on the
subjects’ skin
 Alkaline AA batteries (spares): The digital scales are battery powered. Each team should carry
spare batteries with them to the field daily.
 Bleach disinfectant spray: Bleach is provided for cleaning the surfaces of instruments that require
disinfection in case of a significant soiling.
 Lubrication oil: Is used to lubricate the aluminium track of the height board when sliding the
head/foot piece becomes difficult
 Screw drivers: Used to open the digital measuring devices when changing the batteries, the screws
are stored in the cabinet drawers.

22
 8.6 EQUIPMENT MALFUNCTIONS
-All equipment or repair needs must be reported to the technologists or logistics manager immediately.
-All equipment issues should be documented in the unusual occurrences field log
- Under no circumstances should scales be opened by field staff if they malfunction

8.7 REGULAR QUALITY CONTROL PROCEDURES

Before leaving the office each morning, the field teams should do a series of inventory and equipment
checks using the anthropometry equipment checklist (checklists are specific to the teams that do anthro
measurement).
For each piece of anthropometric equipment, the following checks should be made daily:

DIGITAL SCALES
 Remove the cover from the scale
 Check that all four feet of the scale base lie on the metal platform adjust if needed
 Check that batteries are operational and that spare batteries are enclosed in carrying case.
 Calibrate the scale daily using the calibration weights in 5 kg, 10 kg, and 15 kg increments. Record
data on the Seca Scale calibration log that is unique to each scale.
 Return cover on the scale
STADIOMETER
 Check that the adjustment knobs are secure and firm.
 Check that the stadiometer is in good condition. If wood is cracked or broken, if measuring tape is
worn or illegible, or if the head/footpiece becomes unstable discontinue use and request repair or
replacement.
MUAC TAPES
Have the correct type of measuring tapes and ruler.
If the measuring tape is stretched, cracked, or damaged in any way it should be replaced.

OTHER SUPPLIES
Ensure that supplies are packed the anthropometric bag using the anthropometry equipment
checklist provided for each team.

8.8 FIELD ACTIVITIES

PRE EXAMINATION PROCEDURES

These are a few preparatory procedures and decisions that the anthropometrists should address prior to
obtaining measurements to make the experience easier:
o If possible, prepare the room or designated measurement site in the community for the examination
before the participant enters the room/measurement site.
o Confirm that all supplies needed for the exercise are available and accessible: marker pens for
marking mid-upper arm, measuring tape for mid-upper arm circumference (MUAC), head
circumference tape, length board, weight trays, scales, data collection sheets and absorbent
pads/baby wipes, etc.
o There will usually be several choices on where to place the measuring board or scale, but the choice
should be made carefully. Be sure that you have a sturdy, flat surface for measuring boards, a flat
place to set the scales and adequate light so the measurements can be read accurately. When the
stadiometer is used in the upright position (for adults or children >2 y), be sure that it is set-up
against a wall, post, or tree to prevent it from accidently tipping over and falling.

23
 o When the participant enters the room, introduce yourself and your assistant (recorder)
o The recorder will open the anthropometry component in the electronic data entry system, or will
have the appropriate form available
o The measurer should provide a brief introduction to the exercise such as: What measurements are
going to be conducted e.g. weight and height etc., what is expected of the participant before taking
the measurements e.g. minimising the clothing on subject’s body, to ensure that the procedures are
as comfortable as possible.

REMINDERS FOR MEASURING AND RECORDING

ETHICALLY HANDLING ANTHROPOMETRIC DATA IN SURVEYS
Informed consent from the primary caregiver is necessary. Confidentiality of the information collected must
be assured and maintained. Sharing results and referral in situations where measurements indicate severe
acute malnutrition of the child is also protocol.

REQUIRED TRAINING
All interviewers' anthropometrists will go through a rigorous training, which includes a standardization
activity before each new data collection
.
ONE CHILD AT A TIME
You should complete the questions and measurements for one child at a time. This avoids potential problems
with mix-ups that might occur if you have several children to measure. Always start with the target child.

CONTROL THE CHILD

When you are taking weight and length/height measurements, the child needs to be as calm as possible. A
child who is excited or scared can make it difficult to get an accurate measurement. Work with the mother
to get her to try to soothe an upset child.

SETTING UP SCALE AT THE EXAMINATION SITE

The scale should be placed on a hard-floor surface. It should not be placed on a floor which is carpeted or
otherwise covered with soft material. If there is no such floor available, a hard wooden platform should be
placed under the scale. A carpenter's level should be used to verify that the surface on which the scale is
placed is horizontal.

STANDING WEIGHTS

Job aid: Checklist for weighing mothers and infants

Weighing the Mother
1. Prepare mother for weighing:
o Mothers should be asked to remove any heavy outer clothing, sweater, etc.
o Mothers should also be asked to remove shoes before they step on the scale.
o If mother has any hair ornaments these should also be removed
2. Prepare the scale:
o Ensure that the scale is still on level ground.
o Check that the scale is reading “zero” before the mother steps on the scale.
3. Weigh the mother:
o Assess the mother’s clothing and record on the form.
o Ask the mother to step on the scale and hold still.

24
 o The anthropometrist reads the weight out loud, exactly as shown on the electronic scale.
o The assistant repeats the weight out loud and records weight on the form.
o Ask the mother to step off the scale.
4. Repeat the measurement process two more times; be sure the scale reads “zero” each time before the
mother steps back on the scale.

WEIGHING THE INFANT IN MOTHER’S ARMS

The 2 in 1 function of the Seca 874 scale enables the body weight of babies and small children to be
measured. The child is held in the adult’s arms
1. Prepare infant and mother for weighing:
o Infants should be weighed naked.
o The mother should be weighed in the same clothing as used to measure her weight alone.
o Infants should be kept warm by holding them wrapped in a blanket or cloth until they are measured.
o After 18 months, infants can be weighed in light weight underpants if the mother prefers.
o Never weigh an infant of any age with a wet or full diaper.
o If length will be measured after weight (suggested), undo braids and remove hair ornaments before
weighing, to avoid delays while the child is naked/ undressed.
2. Prepare the scale:
o Ensure that the scale is still on level ground.
o Check that the scale is reading “zero” before the mother steps on the scale.
3. Weigh the infant and mother:
o Assess the infant’s clothing and record on the form.
o Ask the mother to step on the scale without the child (if she has not been measured previously) and
hold still.
o The anthropometrist reads the weight out loud, exactly as shown on the electronic scale.
o The assistant repeats the weight out loud and records weight on the form.
o The measurer can press the 2 in 1 key to activate the function. The scale will store the weight of the
mother and display “zero” and “NET” below
o The child can now be given to the mother while she is still standing on the scale and record the
weight on display.
o If the mothers elects to get off the scale to pick the child, the display will show “-----” She should
step on the scale again with child in had to record the weight of the child
o The scale will display the weight of the child. The display will show HOLD and NET in addition to
weight
o Ask the mother to step off the scale.
4. Repeat the measurement process 2 more times; be sure the scale reads “zero” each time before the mother
steps back on the scale.
NB: If several children are to be weight consecutively, it is important that it is always the same adult who
performs the measurement and that this person’s weight does not change (e.g. due to a piece of cloth being
removed)
NOTE; only the biologic mother’s weight is recorded. However, any caretaker can stand on the scale and
hold the baby for the baby’s weight measurement.

25
 FIGURE 1: TAKING CHILD WEIGHT USING MOTHER/CHILD SCALE
Source: How to Weigh and Measure Children: Assessing the Nutritional Status of Young Children,
United Nations

TAKING MID-UPPER ARM CIRCUMFERENCE

Job aid: Checklist for MUAC of mothers or children

1. Preparing subject for measuring Mid Upper Arm Circumference:
o Keep your work at eye level. Sit down when possible. Very young children can be held by their
mother during this procedure.
o Ask the mother to remove clothing that may cover the child’s left arm.

2. Measuring the child:

o Calculate the midpoint of the child’s left upper arm which is between the tip of the child’s shoulder
and the elbow and mark the midpoint with a pen on the arm s point. Ensure that the arm is bent at
right angle with palm facing up when identifying the midpoint.
o Mark the midpoint with a pen/marker
o Straighten the child’s arm and wrap the tape around the arm at the midpoint.
o Make sure the numbers are right side up and that the tape is flat around the skin.
o Inspect the tension of the tape on the child’s arm. Make sure the tape has the proper tension so that it’s
neither too tight nor too loose. Ask the assistant to verify on the side that is away from the measurer.
o When the tape is in the correct position on the arm with the correct tension, record the measurement to
the nearest 0.1 cm.
o Remove the tape from the child’s arm.

26
 3. Repeat the measurement process a total of three times

FIGURE 2: TAKING CHILD'S MID-UPPER ARM CIRCUMFERENCE (MUAC)

Source: How to Weigh and Measure Children: Assessing the Nutritional Status of Young Children,
United Nations

27
 TAKING LENGTH FOR INFANTS AND CHILDREN 0-23 MONTHS

Job aid: Checklist for length of infants/children

1. Prepare the infant for measuring length:
 Undo braids and remove hair ornaments.
 Infants should be measured without shoes or socks.
 Remove clothing except for underwear or other very light clothing. If possible, infants should be
measured right after they are weighed, and without clothing.
 Remove any diaper; diapers can interfere with straightening the legs.
 Infants should be kept warm by holding wrapped in a blanket or cloth until they are placed on the
length board.

2. Prepare the length board:

 Place the measuring board on a hard flat surface, i.e., ground, floor, or steady table.
 Place a clean soft cloth on the board.
 Place data collection form nearby within easy reach

3. Measure the child:

 It is important to work quickly but calmly, so that the child remains as calm as possible.
 The mother or the assistant can place the infant on the board, with his/her head against the
headboard. Then ask the mother to move aside.
 The assistant:
o Moves into position above the infant’s head, at the “top” (head end) of the length board.
o Positions of head. Position the head so that the infant’s eyes are looking straight up. The crown
of the head is touching the head board, with hair compressed. The imaginary vertical line from
the ear canal to the lower boarder of the eye socket is perpendicular to the board. (Position 4 in
the figure below)
o Holds the infant’s head in position with both hands. Hands are over the ears. With some infants
it may be possible for the assistant to stabilize the shoulders with thumbs.
 The anthropometrist:
o Checks that the assistant is holding the head in the correct position before working with
legs/feet.
o Stands to one side of the board, on the side where he/she can read the measurement.
o Checks that the infant is lying straight along the board (Arrow 7), with shoulders and hips on the
board and at right angles to the length of the body.
o Applies gentle but firm pressure to straighten the legs with one hand (Arrow 8)
o Moves the footboard against the infant’s feet with the other hand (Arrow 9). The soles of the
infant’s feet must be flat on the board and the toes pointing upwards. If the infant bends toes or
arches feet, softly scratch the soles and slide the footboard when the toes/feet straighten.
 The anthropometrist reads the length to the last completed unit (last visible line on the tape). Do not
attempt to round to the nearest line.
 The anthropometrist reads the length out loud.
 The assistant repeats the length out loud and records on the form.
 Either the anthropometrist or the mother can lift the infant off the board and comfort him/her.
4. Repeat the measurement process a total of 3 times.
If the child is very upset and active and you cannot hold both legs in position, you can take the measurement
with only one leg (and foot) in good position.

28
NOTE; If the child has skeletal deformity, don't take this measurement. Children with physical disabilities
require specialized measurements.

FIGURE 3: TAKING LENGTH OF CHILDREN 0-23 MONTHS OR BELOW 85 CM.

Source: How to Weigh and Measure Children: Assessing the Nutritional Status of Young Children,
United Nations

29
 TAKING HEIGHT FOR CHILDREN 24 MONTHS AND OLDER

Job aid: Checklist for height of children

NOTE: This job aid is only relevant for the final visit when children may be older than 24 months old.
Children < 24 months should be measured in a reclined position.
1. Prepare the child for measuring standing height:
 Undo braids and remove hair ornaments.
 The child should be measured without shoes or socks.
 Remove any heavy clothing that may make it difficult to position child against the stadiometer.
 If children are undressed for weighing (before measuring height) be sure they are kept warm and
comfortable until height is measured.
2. Prepare the stadiometer:
 Check set-up of stadiometer per set-up checklist (on flat surface near wall; use the spacer against the
wall to stabilize the board).
3. Measure the child:
 It is important to work quickly but calmly, so that the child remains as calm as possible.
 The mother or the assistant can ask the child to stand against the stadiometer with feet slightly apart.
Then ask the mother to move aside.
 The assistant:
o Kneels on the child’s right-hand side and helps position the child so that the child’s head,
shoulder blades, buttocks, calves and heels are touching the stadiometer (see picture below).
o Holds the child’s knees and ankles to keep the legs straight and the feet flat.
 The anthropometrist:
o Kneels on the child’s left-hand side, at face-to-face level with the child and in good position to
see the measuring tape.
o Positions the child’s head so that an imaginary horizontal line from the child’s ear canal to the
lower edge of the eye socket runs parallel to the floor (see picture below).
o Pushes gently on the tummy to get the child to stand to full height.
o With left hand, holds the child’s chin to hold head in position.
o With right hand, pulls the headpiece of the stadiometer down to rest on the child’s head,
compressing the hair.
 The anthropometrist reads the height to the last completed unit (last visible line on the tape). Do not
attempt to round to the nearest line.
 The anthropometrist reads the height out loud.
 The assistant repeats the height out loud and records on the form.
 Release the child briefly before repositioning.
4. Repeat the measurement process a total of three times and average the three readings.

30
 FIGURE 4: TAKING HEIGHT OF CHILDREN ABOVE 24 MONTHS
Source: How to Weigh and Measure Children: Assessing the Nutritional Status of Young Children,
United Nations

31
 TAKING CHILD’S HEAD CIRCUMFERENCE

Job aid: Checklist for head circumference for infants/children

1. Preparing child for measuring head circumference:
o Ask mother to remove any cloth covering on the child’s head.
o Undo braids and remove hair ornaments
o Older children can stand; infants under 24 months should be held in the mother’s lap

2. Measuring the child:

o Sit or kneel on the left side of the child, to keep your work at eye level
o Pass the tape around the head and anchors it just above the eyebrows and over the fullest protuberance
of the skull at the back of the head.
o Position the tape correctly on the side of the head, them tighten the tape to compress the hair and skin
o Read the circumference to the last completed unit (last visible line on the tape). Do not attempt to
round to the nearest line.
o Records the measurement on the form
o Remove the tape briefly before repositioning

3. Repeat the measurement process 3 times.

FIGURE 5: TAKING CHILD'S HEAD CIRCUMFERENCE

32
9. SOP for Water Sample Collection and Transportation
1. Collect sterile container from the Environmental Microbiology Laboratory of icddr,b.
2. Do not open/mishandle the sterile container before sample collection.
Tube well:
1. Wear gloves.
2. Clean the tube well outlet with fresh tissue paper to remove dirt/debris/rust.
3. Discard water for 1 min to remove remaining dirt/debris/rust.
4. Use a piece of clean tissue paper to dry the tube well outlet.
5. Soak a piece of tissue paper/cotton with 100% alcohol holding with big forceps.
6. Set fire on the soaked tissue paper.
7. Sterilize the tube well outlet using the flame.
8. Wait until smoke comes out of the upper open end of the tube well.
9. Discard water from the tube well for 1-2 mins.
10. Label the water collection bottle as stated in the procedure.
11. Open the container cap and collect the water into the container up to the brim. Remember not to
touch the container mouth with the tube well outlet.
12. Do not touch inside of the container with hands.
13. Close the container tightly.
14. Place the container in a cool box containing sufficient number of ice packs to keep the temperature
inside the container between 4-10°C.
Distribution tap/faucet:
1. Wear gloves.
2. Remove hose/strain (if any) attached to the faucet.
3. Clean the faucet with tissue paper to remove dirt/debris/rust.
4. Discard water for 1 min to remove remaining dirt/debris/rust.
5. Use a piece of clean tissue paper to dry the tap/faucet. If the tap/faucet is made with plastic then
clean it with 70% alcohol, do not flame.
6. If the tap is made with metal then soak a piece of tissue paper/cotton with 100% alcohol holding
with big forceps.
7. Set fire on the soaked tissue paper.
8. Sterilize the faucet using the flame.
9. Discard water from the faucet for 1-2 mins.
10. Label the water collection bottle as stated in the procedure.
11. Open the container cap and collect the water into the container up to the brim. Remember not to
touch the container mouth with the tap outlet.
12. Do not touch inside of the container with hands.
13. Close the container tightly.
14. Place the container in a cool box containing sufficient number of ice packs to keep the temperature
inside the container between 4-10°C.
Point of Use Water:
1. Label the water collection bottle as stated in the procedure.
2. Ask the respondent to provide water sample as if s/he is serving water to a family member.
3. Open the container cap and collect the water into the container up to the brim. Remember not to
touch the container mouth with the water holding pot from where you will pour the water.
4. Do not touch inside of the container with hands.
5. Close the container tightly.
6. Place the container in a cool box containing sufficient number of ice packs to keep the
temperature inside the container between 4-10°C.

33
 9.1 FIELD BLANK/DUPLICATE SAMPLE COLLECTION

1. Each day one of the sample collector will carry a ‘field blank’ to control for field sampling conditions.
The field blank will have lab water in the sterile container. The selected sample collector will just carry
the blank container in their cooler box and open the cap of the blank container once in the field and then
close the cap of the container tightly and then send back the blank sample together with other samples in
the Environmental Microbiology Laboratory.
2. Each day the sample collector will collect a duplicate sample from one of every ten households. This
sample will be collected along with the source as well as point of use water sample at the same time. The
procedure should be the same, and the sample collector will write ‘duplicate’ on the label in addition to
the normal household code.

9.2 REQUIRED SUPPLIES

1. pH Meter: 6 piece
2. Turbidity Meter: 6 piece
3. Gloves: 30 box (Medium size)
4. Cool Box: 4 small coolbox and 4 large size cool box
5. Ice packs: 50 piece
6. Forceps: 12 piece
7. Tissue paper-toilet tissue, facial/Kimwipe tissue: Kimwipe: 30 packets and Toilet Tissue: 60 piece
8. Cotton: 12 rolls
9. Alcohol-100%, 70%:
10. Squeeze bottles: 16 piece
11. Clear tape: 12
12. Marker pen: 12 (slim)
13. Pen: 12 piece
14. Writing pad: 12 piece
15. Data record sheet:
16. Gas lighter: 8 piece
17. Masking tape: 20
18. Hand sanitizer: 30

34
 9.3 COMPOSITION OF FIELD IMPLEMENTATION TEAM

SL Name Designation
1 Dr. Sadia Afreen Central Project Coordinator (CPC)
2 Lutfun Nahar Field Coordinator
3 Shuchata Hasin Field Coordinator
4 Md.Ferdous Hossain Field Coordinator
5 Md. Akteruzzaman Qualitative Interviewer
6 Md. Shahinur Alam Qualitative Interviewer
7 Arzina Khatun Shimu Qualitative Interviewer
8 AQM Abdullah Al Baker Qualitative Interviewer
9 Mostafa Ahmed Quantitative Interviewer
10 Md. Abdul Quddus Howlader Quantitative Interviewer
11 Md.Shamim Mia Quantitative Interviewer
12 Ashik Ilahi Sefat Quantitative Interviewer
13 Md. Humayun Kabir Quantitative Interviewer
14 S.M. Hasan Al Mahmud Quantitative Interviewer
15 Md. Shohel Rana Quantitative Interviewer
16 Sakib Mahmud Quantitative Interviewer
17 Sarwar Alam Khan Quantitative Interviewer
18 Mohammed Eusuf (Rashed) Quantitative Interviewer
19 Md. Sazzad Hossain Khan Quantitative Interviewer
20 Md. Altafur Rahman Quantitative Interviewer
21 Md. Nazrul Islam Medical Technologist
22 Md.Masud Rana Medical Technologist
23 Md.Masudur Rahman Medical Technologist
24 Md. Rashedul Islam Medical Technologist
25 Md. Touhidur Rahman Data Enterer( Qualitative)
26 Auju Ara Khan Data Enterer( Qualitative)
27 Md.Shahadat Hossian Data Enterer (Quantitative)
28 Arman Sarkar Data Enterer(Quantitative)
29 Abul Bashar Sample Transporter
30 Md.Humayun kabir Local Sample Transporter
31 Md. Siddiqur Rahman Local Sample Transporter

35
10. Roles and Responsibilities of the Field Implementation Team
10.1 FIELD COORDINATOR
 Implement the specific field activities according to the Standard Operating Procedures.
 Liaise with the Central Project Coordinator, Local stakeholders both respondents site and other
government agencies.
 Supervise the field staffs and data collection procedures.
 Field data and sample management eg, data rechecking, storing and sample rechecking, packaging,
transport processing and timely transferring to IEDCR or ICDDR,B
 Manage field staff and resources, monitor quality.
 Encourage staff to report frankly on fieldwork, highlighting problems and possible solutions plus
lessons learned. Reward innovation in critical reflection and learning.
10.2 MONITORING TOOLS/ METHODS
 Spot Check.
 Field visit (planned and/or surprise)
 Re-Interview.
 Cross check.
 Questionnaire review.
 Frequent team meeting about (filed problems and field update).
10.3 INTERVIEWER (QUANTITATIVE)
 Preparation of field visit plan
 Collect quantitative field data
 Interviewing the HH
 Collect data from the respondent.
 In each site there will be 6 Interviewers they will visit 515 HH in every month.
 They will fill-up Form- A, Form- B, and Form- C in the 1st (initial visit) and 18th (last visit) visit.
 They will fill up Form- D, Form- E, Form- F(A), Form- F(B), Form- G in every month
10.4 INTERVIEWER (QUALITATIVE)
 Preparation of field visit plan
 Collect qualitative field data
 Interviewing and observing the HH
 In-depth interview
 6-hours structured observation
 There are two interviewers in each field site they will have 45 in-depth interviews and 45 6hrs
structured observation in each month.

10.5 MEDICAL TECHNOLOGIST

 Collect water samples from water source of 135 and 515 HH POU in every month.
 Testing different water quality physical parameters.
 Planning for timely sample collection.
 Collection of microbiological samples, storage and transferring to the IEDCR/ICDDR,B laboratory
10.6 DATA ENTERER
 Entry of quantitative data, and transcription of qualitative data

36
11. Data Collections Tools
1(A): INFORMED CONSENT FORM FOR ADULT RESPONDENTS (ENGLISH)
English version
Protocol Title: The effect of climate variability, seasonal variations and environmental events on drinking
water quality, diarrhea prevalence and WASH practices in Bangladesh.
Principal Investigator’s name: Professor Dr. Meerjady Sabrina Flora
Purpose of the research

(Assalamualaikum/Nomoshkar/Greetings)
My name is_________________________________________________ and I work with the institute of
Epidemiology, Disease Control and Research (IEDCR), Mohakhali, Dhaka. We are interested in conducting
a research to see the effect of climate variability, seasonal variations and environmental events on drinking
water quality, diarrhea prevalence and WASH practices in Bangladesh.
Background:
Climate change have a significant influence on health via different pathways, including through changes in
the distribution of diseases, direct health impacts, water scarcity, and reduced access to water supply and
sanitation facilities.
Why are we inviting you to participate in the study?
We have selected our study sites randomly from the unions vulnerable to climate change. Your household
has been selected randomly for data collection. Because you are residing in an area where we expect climate
conditions will affect your livelihood and surrounding and thus affect health. So, we would like to invite you
to participate in this study.
Methods and procedures
What is expected from the participants of the research study?
The study will last for eighteen months. Following your permission we will enroll your household into the
study. We will monitor your household on certain health conditions to obtain information on specific
diseases, your water supply and use of hand hygiene practices in this household and collect samples from
your source of water supply. If your household is selected, then we will monitor your daily activities and use
of WASH facility over 8 hours. We will visit once in every month for the next eighteen months and collect
information for this study.
Qualitative data: methods and course of action
If you agree to participate in our current study, we will talk to you approximately for 30-45 minutes about
water use, your understanding of water stress, coping strategies, your exposure to Water, Sanitation and
Hygiene (WASH) intervention and how WASH intervention change your behaviour and practices. We will
take notes on your responses. We will also tape record these sessions to ensure that we do not miss any
important information from this session. This tape recording will not be shared with anyone outside of our
study group.
With your permission, I would also like to take photographs from your household. The audiotapes and
photographs, as well as the transcriptions will be stored securely at the Institute of Epidemiology, Disease
Control and Research. The photographs will be used to present our research at various conferences and
scientific meetings.
Risks & Benefits
There are no major risks involved in this study. We will not interfere your daily household chores and will
occupy a limited time each month for collecting data. We will not provide you any payment for taking part

37
in this study. We cannot and do not guarantee or promise that you will receive any direct benefit from this
study. However, by participating in our study you could help us in generating information.
Privacy, anonymity and confidentiality
Confidentiality of the data and test results will be strictly maintained. All the interview data will be kept
confidential even after the completion of data analysis. We will use the information only for the purpose of
the study, and we will not use your name in sharing and publishing the results of this study. All data and
tests results of the water samples collected will be kept confidential as allowed by the law of this country.
The samples and the test results will be coded without your name or personal information, and stored
separately for analysis by the researchers. None of these researchers will be able to identify you. Other
persons who may have access to your test results include research groups that oversee the safety of the study
including institutes such as the Institutional Review Board.
If you sign this form, you permit us to release information to authorized researchers and the safety
committee. There is no expiration date to this permission. This information will be coded and it is unlikely
that anyone will be able to trace it to you, protecting your privacy.
We assure that the privacy, anonymity and confidentiality of data/information identifying you, or your
family, will be strictly maintained. We will keep all information and results of the laboratory tests performed
on your water confidential, under lock and key. None other than the investigators of this research; possible
study monitor; the Ethical Committee; and any law-enforcing agency in the event of necessity would have
any access to the information. We will not use your name in sharing and publishing the results of this study.
Future use of information
The information collected from this study may be shared with other researchers if needed, but we will
strictly maintain your confidentiality and privacy. In the future during the implementation of the study, the
relevant research team members may wish to perform additional tests (including testing for faecal
cooliforms, heavy metals etc) on the water samples on the samples that will have been already collected. No
further consent will be taken from you. If you change your mind about having your water sample tested, you
may contact us and the sample will be discarded immediately.
Right not to participate and withdraw
Taking part in the study is completely voluntary. The enrolled members of the households may choose not
to answer any or all of the questions asked. We request to complete the study. However, you can drop
yourself from the study any time, even in the middle of an interview. In that case, we will delist you and
your household's water samples will be destroyed.
Principle of compensation
You need not to pay us take part in this study, and similarly we will not pay you money for attending in the
study. Participation in this study is free and we will not offer any kind of compensation for your
participation in this study.
Persons to contact:
If you have additional questions about the survey, or if you have questions about your rights as a participant
of a research study, or if you think some harm has been done to you because of the survey, you may contact
or meet her personally at following address: Dr. Farhana Haque, IEDCR, Mohakhali, Dhaka. Phone:
9898691, 9898796; Ext 219
If you have questions about being part of a research study or you think some harm has been done to you
because of the study, you may contact: Dr Md Sohel Samad, IRB Co-ordinator, IEDCR. Tel: +880-2-
9898796, Ext. 219.

38
If you agree to our proposal of enrolling your household in our study, please indicate that by putting your
signature or your left thumb impression at the specified space below:

Thank you for your cooperation.

_______________________________________ ____________________
Signature or left thumb impression of respondent Date

_______________________________________ ____________________
Signature or left thumb impression of Date
Parent/ Guardian/ Attendant

_______________________________________ ____________________
Signature or left thumb impression of the witness Date
_______________________________________ ___________________

Signature of the PI or his/her representative

39
 1(B): INFORMED CONSENT FORM FOR PARENT/GUARDIAN OF MINOR CHILDREN
AGED BETWEEN 0-17 YEARS

Protocol Title: The effect of climate variability, seasonal variations and environmental events on drinking
water quality, diarrhea prevalence and WASH practices in Bangladesh.
Principal Investigator’s name: Professor Dr. Meerjady Sabrina Flora
Purpose of the research
(Assalamualaikum/Nomoshkar/Greetings)
My name is ______________________________ and I work with the institute of Epidemiology, Disease
Control and Research (IEDCR), Mohakhali, Dhaka. We are interested in conducting a research to see the
effect of climate variability, seasonal variations and environmental events on drinking water quality,
diarrhea prevalence and WASH practices in Bangladesh.
Background:
Climate change have a significant influence on health via different pathways, including through changes in
the distribution of diseases, direct health impacts, water scarcity, and reduced access to water supply and
sanitation facilities.
Why are we inviting you to participate in the study?
We have selected our study sites randomly from the unions vulnerable to climate change. Your household
has been selected randomly for data collection. Because you are residing in an area where we expect climate
conditions will affect you and your family's livelihood and the surrounding and thus affect health outcome.
So, we would like to invite your child to participate in this study.
Methods and procedures
What is expected from the participants of the research study?
The study will last for eighteen months. Following your permission we will enroll your household into the
study. We will monitor your household on certain health conditions to obtain information on specific
diseases, your water supply and use of hand hygiene practices in this household and collect samples from
your source of water supply. If your household is selected, then we will monitor your daily activities and use
of WASH facility over 8 hours. We will visit once in every month for the next eighteen months and collect
information for this study and also talk to you and your.
Qualitative data: methods and course of action
If you agree to participate in our current study, we will talk to you regarding your child's health conditions
approximately for 30-45 minutes about water use, your understanding of water stress, coping strategies, your
exposure to Water, Sanitation and Hygiene (WASH) intervention and how WASH intervention change your
behaviour and practices. We will take notes on your responses. We will also tape record these sessions to
ensure that we do not miss any important information from this session. This tape recording will not be
shared with anyone outside of our study group.
With your permission, I would also like to take photographs from your household. The audiotapes and
photographs, as well as the transcriptions will be stored securely at the Institute of Epidemiology, Disease
Control and Research. The photographs will be used to present our research at various conferences and
scientific meetings.
Risks & Benefits
There are no major risks involved in this study. We will not interfere your daily household chores and will
occupy a limited time each month for collecting data. We will not provide you any payment for taking part
in this study. We cannot and do not guarantee or promise that you will receive any direct benefit from this
study. However, by participating in our study you could help us in generating information.
Privacy, anonymity and confidentiality
Confidentiality of the data and test results will be strictly maintained. All the interview data will be kept
confidential even after the completion of data analysis. We will use the information only for the purpose of
the study, and we will not use your name in sharing and publishing the results of this study. All data and
tests results of the water samples collected will be kept confidential as allowed by the law of this country.
The samples and the test results will be coded without your name or personal information, and stored
separately for analysis by the researchers. None of these researchers will be able to identify you. Other

40
persons who may have access to your test results include research groups that oversee the safety of the study
including institutes such as the Institutional Review Board.
If you sign this form, you permit us to release information to authorized researchers and the safety
committee. There is no expiration date to this permission. This information will be coded and it is unlikely
that anyone will be able to trace it to you, protecting your privacy.
We assure that the privacy, anonymity and confidentiality of data/information identifying you, or your
family, will be strictly maintained. We will keep all information and results of the laboratory tests performed
on your water confidential, under lock and key. None other than the investigators of this research; possible
study monitor; the Ethical Committee; and any law-enforcing agency in the event of necessity would have
any access to the information. We will not use your name in sharing and publishing the results of this study.
Future use of information
The information collected from this study may be shared with other researchers if needed, but we will
strictly maintain your confidentiality and privacy. In the future during the implementation of the study, the
relevant research team members may wish to perform additional tests (including testing for faecal
cooliforms, heavy metals etc) on the water samples on the samples that will have been already collected. No
further consent will be taken from you. If you change your mind about having your water sample tested, you
may contact us and the sample will be discarded immediately.
Right not to participate and withdraw
Taking part in the study is completely voluntary. The enrolled members of the households may choose not
to answer any or all of the questions asked. We request to complete the study. However, you can drop
yourself from the study any time, even in the middle of an interview. In that case, we will delist you and
your household's water samples will be destroyed.
Principle of compensation
You need not to pay us take part in this study, and similarly we will not pay you money for attending in the
study. Participation in this study is free and we will not offer any kind of compensation for your
participation in this study.
Persons to contact:
If you have additional questions about the survey, or if you have questions about your rights as a
participant of a research study, or if you think some harm has been done to you because of the survey, you
may contact or meet her personally at following address: Dr. Farhana Haque, IEDCR, Mohakhali, Dhaka.
Phone: 9898691, 9898796; Ext 219
If you have questions about being part of a research study or you think some harm has been done to
you because of the study, you may contact: Dr Md Sohel Samad, IRB Co-ordinator, IEDCR. Tel: +880-2-
9898796, Ext. 219.
If you agree to our proposal of enrolling your household in our study, please indicate that by putting
your signature or your left thumb impression at the specified space below:
Thank you for your cooperation.

_______________________________________ ____________________
Signature or left thumb impression of respondent Date

_______________________________________ ____________________
Signature or left thumb impression of Date
Parent/ Guardian/ Attendant

_______________________________________ ____________________
Signature or left thumb impression of the witness Date

_______________________________________ ___________________
Signature of the PI or his/her representative Date

41
 APPENDIX 1(C): ENGLISH INFORMED CONSENT FORM FOR HOUSEHOLD ENROLMENT
PRIMARY RESPONDENT: HOUSEHOLD HEAD AT ENROLMENT
Protocol Title: The effect of climate variability, seasonal variations and environmental events on drinking
water quality, diarrhea prevalence and WASH practices in Bangladesh.
Principal Investigator’s name: Professor Dr. Meerjady Sabrina Flora
Purpose of the research
(Assalamualaikum/Nomoshkar/Greetings)
My name is ______________________________ and I work with the institute of Epidemiology, Disease
Control and Research (IEDCR), Mohakhali, Dhaka. We are interested in conducting a research to see the
effect of climate variability , seasonal variations and environmental events on drinking water quality,
diarrhea prevalence and WASH practices in Bangladesh.
Background:
Climate change have a significant influence on health via different pathways, including through changes in
the distribution of diseases, direct health impacts, water scarcity, and reduced access to water supply and
sanitation facilities.
Why are we inviting you to participate in the study?
We have selected our study sites randomly from the unions vulnerable to climate change. Your household
has been selected randomly for data collection. Because you are residing in an area where we expect climate
conditions will affect your livelihood and surrounding and thus affect health. So, we would like to invite you
to participate in this study.
Methods and procedures
What is expected from the participants of the research study?
The study will last for eighteen months. Following your permission we will enroll your household into the
study. We will monitor your household on certain health conditions to obtain information on specific
diseases, your water supply and use of hand hygiene practices in this household and collect samples from
your source of water supply. If your household is selected, then we will monitor your daily activities and use
of WASH facility over 8 hours. We will visit once in every month for the next eighteen months and collect
information for this study.
Child anthropometry
If your household decides to join the study, trained field research assistants (FRAs) will initially visit your
household to collect some information through interviews with the family members, observations and by
taking some measurements of the children aged less than 5 years, if applicable. This will include
demographic information and questions about everyday hygiene, water treatment and sanitation practices
related information. With your permission, they will inspect your sanitation facilities as well. The team will
also ask questions about each child regarding vaccination status, child development and weigh and measure
the child if they are present or after they are born.They will also ask mothers or caregivers about their infant
feeding practices, and whether the infant has been sick. This will be done 3 times during the 18-month study
period (at visit #1, 10 and 18).
Additonal qualitative data : methods and course of action
If you agree to participate in our current study, we will talk to you approximately for 30-45 minutes about
water use, your understanding of water stress, coping strategies, your exposure to Water, Sanitation and
Hygiene (WASH) intervention and how WASH intervention change your behaviour and practices. We will
take notes on your responses. We will also tape record these sessions to ensure that we do not miss any
important information from this session. This tape recording will not be shared with anyone outside of our
study group.
With your permission, I would also like to take photographs from your household. The audiotapes and
photographs, as well as the transcriptions will be stored securely at the Institute of Epidemiology, Disease
Control and Research. The photographs will be used to present our research at various conferences and
scientific meetings.
Risks & Benefits
There are no major risks involved in this study. We will not interfere your daily household chores and will
occupy a limited time each month for collecting data. We will not provide you any payment for taking part

42
in this study. We cannot and do not guarantee or promise that you will receive any direct benefit from this
study. However, by participating in our study you could help us in generating information.
Privacy, anonymity and confidentiality
Confidentiality of the data and test results will be strictly maintained. All the interview data will be kept
confidential even after the completion of data analysis. We will use the information only for the purpose of
the study, and we will not use your name in sharing and publishing the results of this study. All data and
tests results of the water samples collected will be kept confidential as allowed by the law of this country.
The samples and the test results will be coded without your name or personal information, and stored
separately for analysis by the researchers. None of these researchers will be able to identify you. Other
persons who may have access to your test results include research groups that oversee the safety of the study
including institutes such as the Institutional Review Board.
If you sign this form, you permit us to release information to authorized researchers and the safety
committee. There is no expiration date to this permission. This information will be coded and it is unlikely
that anyone will be able to trace it to you, protecting your privacy.
We assure that the privacy, anonymity and confidentiality of data/information identifying you, or your
family, will be strictly maintained. We will keep all information and results of the laboratory tests performed
on your water confidential, under lock and key. None other than the investigators of this research; possible
study monitor; the Ethical Committee; and any law-enforcing agency in the event of necessity would have
any access to the information. We will not use your name in sharing and publishing the results of this study.
Future use of information
The information collected from this study may be shared with other researchers if needed, but we will
strictly maintain your confidentiality and privacy. In the future during the implementation of the study, the
relevant research team members may wish to perform additional tests (including testing for faecal
cooliforms, heavy metals etc) on the water samples on the samples that will have been already collected. No
further consent will be taken from you. If you change your mind about having your water sample tested, you
may contact us and the sample will be discarded immediately.
Right not to participate and withdraw
Taking part in the study is completely voluntary. The enrolled members of the households may choose not
to answer any or all of the questions asked. We request to complete the study. However, you can drop
yourself from the study any time, even in the middle of an interview. In that case, we will delist you and
your household's water samples will be destroyed.
Principle of compensation
You need not to pay us take part in this study, and similarly we will not pay you money for attending in the
study. Participation in this study is free and we will not offer any kind of compensation for your
participation in this study.
Persons to contact:
If you have additional questions about the survey, or if you have questions about your rights as a
participant of a research study, or if you think some harm has been done to you because of the survey, you
may contact or meet her personally at following address: Dr. Farhana Haque, IEDCR, Mohakhali, Dhaka.
Phone: 9898691, 9898796; Ext 214
If you have questions about being part of a research study or you think some harm has been done to
you because of the study, you may contact: Dr. Sohel Samad, IRB Co-ordinator, IEDCR. Tel: +880-2-
9898796, Ext. 219.
If you agree to our proposal of enrolling your household in our study, please indicate that by putting
your signature or your left thumb impression at the specified space below:
Thank you for your cooperation.
_______________________________________ ____________________
Signature or left thumb impression of respondent Date

_______________________________________ ____________________
Signature or left thumb impression of Date
Parent/ Guardian/ Attendant
_______________________________________ ____________________
Signature or left thumb impression of the witness Date

43
 SOP FOR ID SELECTION FOR CLIMATE CHANGE PROJECT

ID must be 14 digits.
 Type the two digit site code such as Rajshahi-01, and Faridpur-02
 Type one digit area code such as: 1=Urban, 2= Peri-urban, 3= Rural.
 Type the two digit ward’s number such as City Ward No-28.
 Type the three digit cluster number. The number is 001 t0 135.
 Type the three digit HH number. The number is 001 to 515.
 Type two digit questionnaire format number. The number is 01 for format A
 Type two digit for survey round or visit. The number is 01 for visit number 1.

For an example:

Site Area Ward Cluster Household (HH) Format No Survey round

1 1 2 8 0 0 1 0 0 1 0 1 0 1

44
 STRUCTURED QUESTIONNAIRES (FORMATS A-L)
FORMAT A: HOUSEHOLD SOCIO-DEMOGRAPHIC QUESTIONNAIRE (ENGLISH)

TO BE ADMINISTERED AT FIRST AND LAST VISIT ONLY

ADMINISTERED TO HOUSEHOLD HEAD AND/OR ADULT RESPONDENT

Note Time
Start of the interview: End of the interview:
Name of the FRA
Date d d / m m / y y
/ /
HH Identification Area Cluster Site Household
No
GPS Location Lattitude Longitude
District
Upazila
Union
Village
Para
Respondent's Name
Telephone number
Notes

Signature of the
Signature of Checked By Signature of Field
Field Data Data Entry by
the Respondent Supervisor Team Coordinator
Collector

Name

Signature

A1: How many members are living in this

household?

45
 A2: Please collect the details of the respondent and all household members
Diarrhea is defined as 3 or more loose stools in 24
How old What is hour periodor in any single day during the last 7
What is days
is his/her Status in
this
he/she? relationship Did he or she Did he or she Did he or she have the Study
person’s
(years/m with the have diarrhea in have diarrhea diarrhea in the past
sex?
onths) respondent? any one day in in the past 48 48 hours?
SL. the past 7 days? hours?
Name
No. Yes =1 Yes =1
Yes =1
Father = 1 No = 2 No = 2 Respondent
No = 2
Male = 1 Mother = 2 Unknown =3 Unknown =3 =1
Unknown =3
Female=2 Brother = 3 Decline = 4 Decline = 4 If yes Non-
Decline = 4
Sister = 4 If yes note the note the exact date: Respondent
If yes note the
Other = 5 exact date: ____ =2
exact date: ____
____
1
2
3
4
5
6
7
8
9
10

A3: What is the education of the respondent?

Class 1- Class 8 = 1 SSC = 2 HSC = 3 Degree = 4
Masters = 5 Other = 6
Please Specify "other":

A4: What is the occupation of the respondent?

Farmer = 1 Business = 2 Service = 3 Day Labor = 4 Transport Worker = 5 Other =
6
Please Specify "other" :

A5: What is the total income of the household?

The total income of the house hold will the sum of all income of the members of
the household if the household do not want answer please write 99999

A6: What is the total expenditure of the household?

The total income of the house hold will the sum of all income of the members of
the household if the household do not want answer please write 99999

A7: What is the housing pattern of the household

Pucka = 1 Semi Pucka = 2 Tin = 3 Kutcha = 4 Jhupri = 5 Other 6
Please Specify "other"
A8: What is the Number of living rooms in your household?

46
A9: What is the main material of wall of your principal dwelling room?
Mud = 1 Bamboo Straw = 2 Wood = 3 Tin = 4 Cement + Brick = 5
Other = 6
Please Specify "other"
A10: What is the main material of floor of your principal dwelling room?
Mud = 1 Bamboo Straw = 2 Wood = 3 Tin = 4 Cement + Brick = 5
Other = 6
Please Specify "other"
A11: What type of fuel does your household mainly use for cooking?
Crop residue/grass = 1 Dung cakes = 2 Coal/charcoal = 3 Wood = 4 Kerosene = 5
Electricity = 6 Gas = 7 Other = 8
Please Specify "other"
A12: Does your household (or any member of your household) have any of the following?
Yes = 1 No = 2 (Multiple responses acceptable)
 Almirah or wardrobe,  Table, Chair/bench,  Watch/clock,  Cot/khat,  Radio (working), 
Television (working),  Refrigerator,  Motorcycle,  Bicycle  Telephone,  mobile phone, 
Fan,  Lep/toshak (mattress)

Signature of Interviewer (Quantitative) Checked by (Research Officer Signature)

Date: Date:

47
 FORMAT B: CHILD ANTHROPOMETRY ASSESSMENT QUESTIONNAIRE
TO BE ADMINISTERED TO CHILDREN AGED 0-5 YEARS OF AGE IF AVAILABLE IN THE
HOUSEHOLD AT INITIAL AND LAST SURVEY ROUND

Note Time
Start of the interview: End of the interview:
Name of the FRA
Date d d / m m / y y
/ /
HH Identification No. Area Cluster Site Household

Child ID
Notes

Signature of Signature of the Checked By Signature of Field Team

Data Entry by
the Respondent Interviewer Supervisor Coordinator
Name

Signature

Child's Name:

Mother’s/Father's Name:

Child's Age (month) :

H1: Weight of mother measurement. Weight

(Kg)

H2: Is child wearing clothing during weight No Clothes=1
measurement? Only Shirt/Dress=2
Only Pants=3 
Both Shirt/Dress &
Pants=4
H3: Weight of mother + child
Measurement
Weight
(Kg)
.
H4: Length of Child
Measurement
Length
(cm)
.
H5: Length Measurement Method Child was:
1= lying (recumbent)

2=standing
H6: Head Circumference Measurement Circumference
(cm)
.
H7: Child Mid Upper Arm Circumference
Measurement (MUAC)
MUAC
(cm)
.

Signature of Interviewer (Quantitative) Checked by (Research Officer Signature)

Date: Date:

48
 FORMAT C: CHILD VACCINATION HISTORY QUESTIONNAIRE
ADMINISTERED TO ALL CHILDREN, AGED 0-5 YEARS IN THE HOUSEHOLD AT FIRST AND LAST VISIT
Additional instructions: Use a separate sheet for each child

Note Time
Start of the interview: End of the interview:
Name of the FRA
Date d d / m m / y y
/ /
HH Identification No Area Cluster Site Household

Child ID
Notes

Signature of Signature of the Checked By Signature of Field Team

Data Entry by
the Respondent Social Surveyor Supervisor Coordinator
Name

Signature


G1: Did [CHILD] ever receive any vaccinations to prevent Yes=1
him/her from getting diseases, including vaccinations received No =2
in a national immunization campaign? Don’t know/not sure=9


G2: Do you have a card where [CHILD] vaccinations are Card Present [Observed by
written down? [If Yes: May I see it please?] interviewer]=1
Card Present [No observed by
interviewer]==2
No card =3
IF G2 is 1 then Go TO G4 and
IF G2 is 2 then GO TO G3
G3: For children without a vaccination card
[please tell me if NAME received any of the following
vaccination:


1. BCG vaccination against tuberculosis, this is an Yes=1
injection in the arm or shoulder that usually causes a No =2
scar? Don’t know=9


2. Polio vaccine that is (pink) drop in the mouth? Yes=1
No =2
Don’t know=9


3. How many times was the polio vaccine received? Don’t know=9


4. A DPT vaccination that is an injection given in the Yes=1
thigh or buttocks, sometimes at the same time as the No =2
polio drops? Don’t know=9


5. How many times was the DPT vaccine received? Don’t know=9

49
 
6. A measles injection or an MMR injection that is a shot Yes=1
in the arm at the age of 9 months or order to prevent No =2
him/her from getting measles? Don’t know=9


7. A pneumococcal (PCV) vaccination that is a shot in the Yes=1
thigh sometimes at the same time as the polio drops to No =2
help prevent some kinds of pneumonia? Don’t know=9


8. How many times was the PCV vaccine received? Don’t know=9


9. Rotavirus vaccine, that is, drops in the mouth to Yes=1
prevent some kinds of diarrhea? No =2
Don’t know=9


10. How many times was the Rotavirus vaccine received Don’t know=9


11. Within the last six months, has [NAME] received a Yes=1
vitamin A dose(like this/any of these) No =2
SHOW COMMON TYPES OF Don’t know=9
AMPULES/CAPSULES/SYRUPS

G4: For children with a vaccination card:

Copy the vaccination date for each vaccine from the card.
Recode “99” in the DAY column if card shows that a vaccination was given, but no date is recorded.
Recode “88” in the DAY column if vaccination not given.
DAY MONTH YEAR Country’s Schedule (Age)
1 BCG 
2 POLIO 0 
3 POLIO 1 
4 POLIO 2 
5 POLIO 3 
6 DPT 1 
7 DPT 2 
8 DPT 3 
9 MEASLES 
10 VITAMIN A 
11 PCV 1 
12 PCV 2 
G5: Vaccination Status 
Complete=1
Incomplete=2

Signature of Interviewer (Quantitative) Checked by (Research Officer Signature)

Date: Date:

50
 FORMAT D: HOUSEHOLD WATER USAGE QUESTIONNAIRE

ADMINISTERED TO THE HOUSEHOLD RESIDENT PRIMARILY RESPONSIBLE FOR WATER COLLECTION AT EACH
MONTHLY SURVEY ROUND
Note Time
Start of the interview: End of the interview:
Name of the FRA
Date d d / m m / y y
/ /

HH Identification No Area Cluster Site Household

Notes

Signature of the Signature of the Checked By Signature of Field

Data Entry by
Respondent Interviewer Supervisor Team Coordinator
Name

Signature

B1: From where/which of the technologies you have been collecting this water?
(Please marks the focal water supply options by providing identification number as per the instruction in
the first visit and mark it in any location of the household. The focal water supply point may one or two
of many list all in the following)
Focal Water Point (FWP) Focal Water
FWP Area Cluster Site Type
Identification No Point No
1

Focal Water Point (FWP) Focal Water

FWP Area Cluster Site Type
Identification No Point No
2

Focal Water Point (FWP) Focal Water

FWP Area Cluster Site Type
Identification No Point No
3

B1.1: If the respondent of house hold has not been collecting

water from the focal water supply options in the area then _______________________________
where else the respondent has been collecting water? (Please
Specify) _______________________________

B2 Breakdown/explore the total amount of water used in last 24 hours into the following
categories in a family by discussing with the respondent
If possible
Insert picture Issues at least to be considered Amount
Using pattern Breakdon of
here during calculation (lit)
water usage (lit)
Plain water
B31 Drinking Juice
Saline

51
 Sherbet
Tea
Bathing
Washing hands
B32 Personal Face
hygiene/cleanin Legs
g Washing genital and anus after
urination and defecation
Ablution
Washing or wiping living/bed room
Washing toilet and bathroom
Washing water source point
B33 Household
hygiene/cleanin Washing cloths
g Washing kitchen and vegetable and
meat cutting place
Washing rooms after defecation of
child
Washing meat, fish, vegetable
B34 Food and Washing lentil, rice, fruit, betel leaf
food Washing cooking utensil like glass,
preparation plate, etc
Adding water in leftover food
Bathing
Washing hand after excretion
B35 Child Cleaning face leg
Washing genital and anus after
urination and defecation
Bathing and cleaning
B36 Domestic Leaning of the domestic animal
animal shed
Drinking
B37 Others
(Specify) _____________________________
Total

Lit
B 3: How much water you need for your daily life? (Cooking, bath,
wash, drink etc.)
er

B4: What is the distance of the focal water supply water Codes are from question B2
points from your house (ft) FWP 1 FWP 2 FWP 3

B5: Do you get sufficient water round the year? 

Yes = 1
Intermediate = 2
No = 3
Do not know = 4

52
B521: What is the respondent's explanation for not getting enough water? 
The water point becomes non-functional due to unavailability of ground water = 1
The water point becomes non-functional due to unavailability of surface water = 2
The water point becomes non-functional due to unavailability of rain water = 3
The water point becomes hard to purge = 4
The water of the water point have bad physical odor/smell/taste = 5
The water of the water point has arsenic problem = 6
The water point become non-functional due to extreme events (flood or drought) = 7
The water point becomes non-functional due to man made reasons = 8
Others=9
Others (Please specify) ____________________________ __

B522: What activities of your house hold is affected due to not getting 
sufficient water?
Drinking = 1
Personal hygiene/cleaning = 2
Household hygiene/cleaning = 3
Food and food preparation = 4
Child = 5
Domestic animal = 6
Others =7
Others (Please specify) ____________________________ ____

B5221: How you are managing the activity with less water
Doing the activities with inadequate water = 1
Doing the activities by reducing the frequency of the activity =2 
Doing the activities by reusing the water which is bad quality for the intended use = 3
Doing the activities by colleting water from long distances (more than 10m) = 4
Others = 5
Others (Please specify) _________________________
B5222: If the answer is 4 then measure the distance of water point from
the respondent’s house.
 ft

B523: Who makes the decision of water management during not getting
sufficient water?

Head of the household (usually father) = 1
Mother =2
Others = 3
Others (specify) _______________________________
B524: From the affected activities due to not getting water what kind of
losses you are experiencing?

Financial = 1
Health = 2
Time = 3
Labor = 4
Others =5
Others (specify) ________________________________
B5241: Are you getting any support from anywhere including your family
members regarding water management during not getting water?


53
Government = 1
NGOs = 2
Project = 3
Family = 4
Other =5
Others (specify) ________________________________
B6: Do you spend any money for getting available safe water considering a year?

Yes = 1
No = 2
Not sure = 9

Signature of Interviewer (Quantitative) Checked by (Research Officer Signature)

Date: Date:

54
 FORMAT E: HOUSEHOLD WATER, SANITATION AND HYGIENE BEHAVIOUR QUESTIONNAIRE

ADMINISTERED TO THE RESPONDENT (HOUSEHOLD RESIDENT PRIMARILY INVOLVED IN

HOUSEHOLD WATER COLLECTION AND USAGE) AT EACH MONTHLY HOUSEHOLD VISIT

Note Time
Start of the interview: End of the interview:
Name of the Interviewer
Date d d / m m / y y
/ /
HH Identification No Area Cluster Site Household

Notes

Signature of Signature of the Checked By Signature of Field

Data Entry by
the Respondent Interviewer Supervisor Team Coordinator
Name
Signature

C1: In which type of container you have been collecting drinking water in
last 7 days?
Earthen pitcher = 1 Metallic pitcher = 2 Bucket Other (specify
=3 Jug = 4
A vessel with tap = 5 Plastic bottle = 6 Other = 7

C11: Do you clean the container before collecting the drinking water?
Yes = 1 No = 2 Occasionally = 3 If I think for cleaning = 4

C11a: How does the respondent clean it?

Circling water inside the container with hand = 1
Circling water with soap or ash inside the container with hand = 2
Using a brush for cleaning the container = 3

C11a: Observe if container is easily cleanable?

Cleanable = 1 Un-cleanable = 2 Hard to Clean = 3

C2: When do you collect drinking water?

Every Morning = 1 Every Afternoon = 2 Every Evening = Other (specify)
3
Any time as required = 4 Other =5

C21: Do you store the water?

Yes = 1 No = 2

C22: Where and how do you store the water?

Storage container covered and placed in a high location in a room = 1 Other (specify)
Storage container un-covered and placed in a high location in a room = 2
Storage container un-covered and placed in a normal location in a room = 3
Storage container un-covered and placed in a high location outside a room = 4
Storage container covered and placed in a unhygienic location anywhere = 5
Storage container un-covered and placed in a unhygienic location anywhere = 6
Other = 7

55
C221: Can you show me where you would go to fill a glass of drinking
water or if you store drinking water, where you would fill the storage
vessel?
Hand pump from supply water = 1
Hand pump from ground water = 2
Household tap = 3
Household cistern = 4
Unable to determine = 5
Decline = 6
C3: What is physical quality of the collected drinking water?
Good Smell + Good Color = 1 Bad Smell + Bad Color = 2
Good Smell + Bad Color = 3 Bad Smell + Good Color = 4

C31: What is your idea why this is happening?

Temperature increase =1 Erratic rainfall = 2 Other (specify)
Drying of surface water = 3 Due to flood and drought = 4
Bad Management of the system = 5 Other (please specify) = 6

C4: After collecting drinking water do you use any purification system?
Yes = 1 No = 2

C41: What kinds of drinking water purification system you are following?
Boiling = 1 Chlorination = 2 Filtering = 3 Fitkiri = 4 Other (specify
Combination of these = 5 Other = 6

C41a: If the purification system is filtering device then what is the

frequency of cleaning the filter?
Clean regularly as per the instruction = 1 Never Cleans = 2 Other (specify
Occasionally Clean = 3 Clean when the water have bad taste, color or
odor = 4 Other = 5

C41b: If the purification system is filtering device then what is the type of
the filter?
Ceramic Filter = 1 Bio-sand filter = 2 Other = 3 Other (specify

C42: What is frequency of purification?

Everyday = 1 Other (specify
Each time after collecting water = 2
Occasionally = 3
Other = 4

C43: Why you are using purification system?

The collected water have bad smell and color = 1 Other (specify)
The collected water have arsenic contamination = 2
The collected water have iron contamination = 3
You know that purification of water will improve quality of any
contaminated water = 4
Other = 5

56
C44: How much money you spent in a month for water purification? Taka (BDT)
(including filter, bills, management etc.)

C5: From where you are collecting cooking water?

Focal water supply technology = 1 Other water supply technology =
2
Pond = 3 River = 4 Rainwater = 5 Mixing
of all = 5

C51: Do you reuse the vegetable and other materials cleaning water?
Yes = 1 No = 2

C52: If yes, then for what purposes?

Hand washing = 1 Domestic animal feeding = 2 Vegetable plants Other (specify)
=3
Other = 4

C6: What water you generally use during flooding or drought?

Collect water from other safe sources and use = 1
Collect water from other safe source and chlorinating before use =2
Collect water from other safe source and filtering before use = 3
Use the water from the existing source what I used before without
treatment = 4
Use the water from the existing source what I used before with
(chlorination or filtering treatment = 5 Other (specify)
Other = 6

C7: Do you wash your hands?

Yes = 1 No = 2

C71: Water material you usually use for washing hands?

Soap = 1 Ash = 2 Soil = 3 Only water = 4 Other = 5 Other (specify)

C72: if the answer of the C6 is 1 then ask can you show me where did
you kept the hand washing materials? (go and see)
Toilet/Bathroom = 1 In a case anywhere = 2 Other (specify)
No specific location but material existed = 3
Not available during the survey time = 4
Other = 5
C73: When do you generally wash your hands?
Yes = 1 No = 2
C83a: Before preparing food
C83b: Before eating
C83c: After eating
C83d: Before feeding a child
C83e: After cleaning child’s anus Other (specify)
C83f: After disposal of child feces
C83g: After defecation
C83h: After handling cow-dung

57
C83i: After returning from outside compound
C83j: Other

C74: Please show me how do you wash your hands?

Washed hands correctly as per procedure of standard hand washing = 1
Washed hands incorrectly as per procedure of standard hand washing = 2

C741: Please show me generally where how do you wash your hands?
Inside toilet = 1 Inside kitchen = 2 Within 3 steps of toilet = 3 Other (specify)
More than 3 steps but less than 3 meters from toilet = 4
More than 3 meters from toilet = 5
In front of the tube well = 6 No specific place = 6
Other = 7 Decline = 7

C8: Will it become possible to do hand washing during flooding or

drought?
Yes = 1 No = 2

C9: Do you think hand washing is costly?

Yes = 1 No = 2

C10: How much money you spent for hand washing in a month?
(soap, water etc.)

Thank you.

Signature of Interviewer (Quantitative) Checked by (Research Officer Signature)

Date: Date:

58
 FORMAT F (A): HOUSEHOLD HEALTH OUTCOME ASSESSMENT TOOL
ADMINISTERED AT EACH MONTHLY HOUSEHOLD VISIT TO THE ELIGIBLE CONSENTING CAREGIVER OF THE
CHILD UNDER 5 YEARS WITH CARE-GIVER REPORTED DIARRHEA DURING THE PAST 7 DAYS
AND/OR
ADMINISTERED TO EACH ELIGIBLE CONSENTING MEMBER OF HOUSEHOLD WHO HAS ALREADY REPORTED
DIARRHEA DURING THE PAST 7 DAYS

Additional instructions: Use a separate sheet for each diarrhea case

Note Time
Start of the interview: End of the interview:
Name of
subject
ID prim.
match person visit FRA
hh
Date day month year
Notes

For Office Use Only

Field Checked by: Office Edited by:
Computer Entry by 1: Computer Entry by 2:

NOTE: All text in bold should be read, and all text in italics are notes to the interviewer.
S EC T IO N 1 : I LL NES S H IS T O R Y

1. Have you had any diarrhea during the last 7 days? 

(Defined by 3 or more loose stools in a single day)
Yes=1 No=2
Don’t Know=9

Skip Note: If no, go to 32

2. Have you had any diarrhea during the last 48 hours? 

(Defined by 3 or more loose stools in a single day)
Yes=1 No=2
Don’t Know=9
Skip Note: If no, go to 32

3. How many days did the passage of loose stool lasted (during this episode)? 
(Defined by 3 or more loose stools in a single day)
_____ days unknown ☐decline ☐

4. What time of day did the first loose stool started? 

(Defined by 3 or more loose stools in a single day)
Morning=1 Afternoon=2 Evening=3 Don’t Know=9

5. Do you still have loose stools? 

Yes=1 No=2
Don’t Know=9

 Skip Note: If no, go to 6

 Skip Note: Only answer if 4is no
6. How many days ago did you last have diarrhea 
(defined by 3 or more loose stools in a single day)
_____ days decline ☐

59
 7. Since your diarrhea started, were any stools clear or water-like? 
Yes=1 No=2 Don’t Know=9

8. Since your diarrhea started, were any stools blood-colored or black? 

Yes=1 No=2 Don’t Know=9

9. Since your diarrhea started, were any stools green or yellow colored? 
Yes=1 No=2 Don’t Know=9

10. Since your diarrhea started, have you experienced any of the following? 
(Check all that apply)
Fever=1 Vomiting=2 Fatigue=3
Fainting=4 Abdominal pain=5 Others=9
Others (Specify) ....................................................................................

11. Since the last time we interviewed you, how many times, if any, have you 
visited a Govt./Private Health facility in response to this diarrhea?
_____ times decline ☐

12. Since the last time we interviewed you, how many times, if any, have you 
visited a NGO/private practitioner (MBBS) in response to this diarrhea?
_____ times decline ☐

13. Since the last time we interviewed you, how many times, if any, have you 
visited a traditional healer/village doctor in response to this diarrhea?
_____ times decline ☐

14. Since the last time we interviewed you, how many times, if any, have you 
visited an Upazila health complex in response to this diarrhea?
_____ times decline ☐

15. Since the last time we interviewed you, how many times, if any, have you 
visited a General government hospital in response to this diarrhea?
_____ times decline ☐

16. Since the last time we interviewed you, how many times, if any, have you 
visited a pharmacy or drug seller in response to this diarrhea?
_____ times decline ☐

17. Did you take any ORS since our last interview with you? 
Yes=1 No=2 ( skip to 22)
Don’t Know=9
 Skip Note: Only answer the following if 17 was “yes”
18. Was this ORS purchased or homemade? 
Purchased=1
Homemade=2 ( skip to 22)
Both=3
Don’t Know=9
 Skip Note: Only answer the following if 18 is “purchased” or “ both”
19. How many packets of ORS did you take during since our last 
interview with you?

_________ packets unknown☐decline☐

60
 20. Did you get any intravenous rehydration therapy (Iv fluid) since our 
last interview with you?
(Intravenous rehydration is where a solution is injected into the patient’s blood stream)
Yes=1 No=2 Don’t Know=9
 Skip Note: If no, go to 24

 Skip Note: Only answer the following if 23 was “yes”

21. Where did you receive this treatment?(choose all that apply) 
Pharmacy/drug seller=1
Hospital/clinic=2
Self-administered at home=3
Other (specify) _______________

22. Did you take any drug as treatment for diarrhea since our last 
interview with you?
Yes=1 No=2 Don’t Know=9
 Skip Note: If no, go to 28

 Skip Note: Only answer if 24was “yes”

23. Were any of these drugs purchased after you were sick? 
Yes=1 No=2 Don’t Know=9

24. Can you show me the drugs box, bottle, or other packaging? 
Yes=1 No=2 Don’t Know=9
25. Write the name of the medicine below
(Write medicine generic drug name if possible)
Sl Name of medicine
1.
2.
2.
4.
5.
..

26. Since our last interview with you, as a result of your diarrhea, were you 
unable to perform your daily activities such as school or work?
Yes=1 No=2 Don’t Know=9
 Skip Note: If no, go to 30

 Skip Note: Only answer if 28 is “yes”

27. On how many days were you unable to perform your daily activities? 
_____ days unknown ☐ decline☐

28. Since our last interview with you, how often did you defecate in a 
bedpan or bucket?
Never=1
1 to 2 times=2
Less than once a day but 3 or more times=3
At least once per day=4
Don’t Know=9

61
 29. Since our last interview with you, how often did you defecate in the open? 
Never=1 1 to 2 times=2
Less than once a day but 3 or more times=3 At least once per day=4
Don’t Know=9

S E CT I O N 2 : E X PO S U RE H I S T O RY

30. Since our last interview with you, how often did you prepare 
food for your household?
Did not do this=1 One to two days=2
Three or more days but not every day=3 Everyday=4
Don’t know=9

31. Since our last interview with you, how often did you feed a 
child with your hand?
Did not do this=1 One to two days=2
Three or more days but not every day=3 Everyday=4
Don’t know=9

32. Since our last interview with you, did how often did you eat a meal 
that was prepared more than 2 hours before you ate it?
Did not do this=1
One to two days=2
Three or more days but not every day=3
Everyday=4
Don’t know=9
 Skip Note: If “did not do this”, go to 36
 Skip Note: Only answer if 34 is NOT “did not do this”
33. Since our last interview with you, did you eat a meal that was 
prepared more than 6 hours before you ate it?
Did not do this=1
One to two days=2
Three or more days but not every day=3
Everyday=4
Don’t know=9

34. Since our last interview with you, on how many days did you drink water at the following
locations?

Home

Did not do this=1 One to two days=2
Three or more days but not every day=3 Everyday=4
Don’t know=9
Work/School

Did not do this=1 One to two days=2
Three or more days but not every day=3 Everyday=4
Don’t know=9
Elsewhere

Did not do this=1 One to two days=2
Three or more days but not every day=3 Everyday=4
Don’t know=9

62
 FORMAT F (B): HOUSEHOLD HEALTH OUTCOME ASSESSMENT TOOL

SECTION THREE: ADDITIONAL GASTRO-INTESTINAL ILLNESS SYNDROMIC

INFORMATION

Read questions exactly as written below. Circle Y for “yes,” N for “no” and DK for “don’t know,
can’t remember, not sure” etc.
1. Did you or any of your household members have:
 Nausea Y N DK
 Vomiting Y N DK
 Bloody diarrhea Y N DK
 Abdominal cramps Y N DK
 Fever Y N DK
 Chills Y N DK
 Headache Y N DK
 Body aches Y N DK
 Fatigue Y N DK
 Constipation Y N DK
 Jaundice (Yellow coloration of eyes or sclera) Y N DK
 Other: Y N _____DK__________

2. Did you or your family member see a healthcare professional, such as a doctor or a nurse?
Y N
When? ____ /____/ ____

3. Were you or your family member hospitalized overnight?

Y N Where? __________________________________

4. Did the healthcare provider tell you the diagnosis?

Y N DK If yes, mention the diagnosis:________________ _

5. Did anyone in your household have a similar illness?

Y N DK

6. Do you know of anyone else with a similar illness during the past week?
Y N DK
If yes, who? ______________________________________
When? ____ / ____ / ____

7. Did you attend a large gathering the week before your illness? (e.g., wedding reception,
showers, church events, clubs, school events, athletic events, office parties or banquets, parties,
festivals, fairs)
Y N If yes, what events?
Event 1: ________________location:___________When? ____ / ____ / _
Event 2: ________________location:____________When? ____ / ____ / ____

8. Do you know anyone else in your neighborhood/school/office/business/health club etc. with the
same illness?
Y N If yes: Where?_________________
How many people?______

63
9. Did you travel anywhere during the seven days before your illness? Y N
If yes, where? ____________________________
When? ____ / ____ / ____ to ____ / ____ / ____

10. Have you had contact with children in a childcare setting during the seven days before illness?

Y N If yes, when: ____ / ____ / ____

Are you aware of any other illness in the daycare? Y N DK

11. During the seven days before your illness, did you have any pets at home, have contact with
household pets elsewhere, or visit a household with pets?
Y N
If yes, what type of pets animals?

12. Did you live on a farm, visit a farm, or visit a animal zoo in the seven days before your illness?
Y N If yes: what kind of animal(s) did you have contact with?____
When? ____ / ____ / ____ Where?__________________

13. From what sources of water did you drink during the seven days before your illness?
Municipal tap water Y N DK
Private well water Y N DK
Untreated surface water
(river, pond, lake) Y N DK
Bottled water Y N DK
Other ___________________

14. Did you drink any untreated/raw water during the seven days before your illness?
Y N If yes, where? _____________________________

15. Did you swim during the seven days before your illness?
Y N If yes, where?
Lake Y N
Pond Y N
River Y N
Ocean/sea Y N
Pool Y N
Other Y N

Thank you for helping us with our study

Signature of Interviewer (Quantitative) Checked by (Research Officer Signature)

Date: Date:

64
 FORMAT G: HOUSEHOLD SANITATION ASSESSMENT FORM

ADM IN ISTERED TO RESP ONDENT AT EACH MONTH LY HOUSEHOLD VISIT

Note Time
Start of the interview: End of the interview:
Name of the Sanitation
Surveyor

Date d d / m m / y y
/ /

HH Identification No Area Cluster Site Household

Notes

Signature of the Signature of the Checked By Data Entry Signature of Field

Respondent Interviewer Supervisor by Team Coordinator
Name

Signature


E1: Do you have any latrine?

Yes = 1 No = 2


E1.1: If answer of the question E1 is '2" then ask where you defecate?

Open Place = 1 Sharing with neighbor's latrine = 2


E111: If answer of the question E1.1 is "2" then observe the shared latrine and
categorize. [Observation]
Sanitary Latrine (Water Sealed or any other sealing mechanism) = 1
Unsanitary Latrine
(No Water Sealed or any other sealing mechanism)= 2
Hanging latrine = 3


E1.1.1: If answer of the question E1.1 is "1"then calculate by asking the
respondent about the total number of open defecation by the respondent’s
family in last week.


E1.2: If answer of the question E1 is "1" then categorize the latrine

65
Sanitary Latrine (Water Sealed or any other sealing mechanism) = 1
Unsanitary Latrine
(No Water Sealed or any other sealing mechanism) = 2


E1.2.1: What is the infrastructure of the sanitary latrine looked like

Bamboo works wall with latrine RCC slab = 1

Plastic works wall with latrine RCC slab = 2
Modern/septic tank = 3
Others = 9
Others (specify) ________________________________


E1.2.2: What is the infrastructure of the un sanitary latrine looked like

Bamboo works wall latrine RCC slab = 1

Plastic works wall latrine RCC slab = 2
Others = 9
Others (specify) ________________________________


E1.2.3: What is the location of the location of the infrastructure of the sanitary?

Attached with home = 1

Distant form home = 2


E2: What is the status of cleanliness of the surrounding environment sanitary
latrine?
Clean = 1
Unclean = 2


E3: How many water points including the focal water point existed within 30 m
distance of the latrine


E4: Do any other families share you latrine

Yes = 1 No = 2


E4.1: If the question E4 is "1" then how many other families share you latrine


E5: Do you have any children in your family

Yes = 1 No = 2


E5.1: If the answer of the Question E5 is "1" then where do they defecate

Latrine = 1 Inside house arena = 2 Outside house arena = 3

66
 
E5.2: If the answer of the Question E51 is "2 or 3" then what you usually do
with feces after deification of the child?
Collect and dispose into the latrine = 1
Collect and through into the surrounding environment = 2
Do not do anything the feces remain as it is = 1


E5.2.1: If the answer of the Question E5 is "1" then how many time your
child/Childs defecated in last week?


E6: Do you wash your hands after deification?

Yes = 1 No = 2


E6.1: If the answer of the question E6 is "2" then the reason for not hand
washing are?
Less water to hand wash = 1
No habit of hand washing after deification = 2


E6.2: If the answer of the question E6 is "1" then where you mostly wash your
hands after deification?
Inside toilet = 1
Inside kitchen = 2
Within 3 steps of toilet = 3
> 3 steps but < 10 feet of toilet = 4
> 10 feet of toilet = 4
No specific place = 5


E6.3: If the answer of the question E6 is "1" then what materials use you for
hand washing after deification?
Soap = 1
Ash = 2
Soil = 3
Pond water = 4
Tue well water = 5
Others = 6
Others (specify) ________________________________

Signature of Interviewer (Quantitative) Checked by (Research Officer Signature)

Date: Date:

67
 FORMAT H: HOUSEHOLD POU WATER SAMPLE COLLECTION FORM

ADM IN ISTERED TO THE RESPONDENT AT EACH M ONTHLY HOUSEHOLD VIS IT

After completion of the consent, please ask the respondent household to give you a glass of water from
where the respondents usually drinks/serves water

Information on water sample for storage and sending to Central icddr,b Information of Sample for Field
laboratory for testing Testing
Sent to
Amount
Sample ID Laboratory
of Sample Parameter Result** Parameter Result
No Mention time
(ml)
and date
Sample E. Coli Appearance
ID+EC (cfu/100 ml)
Sample Turbidity Turbidity
ID+Tu (NTU) (NTU)
Sample Arsenic* pH
ID+As (mg/l)
* In every 10th sample
** To be included later from laboratory and noted

Signature of Interviewer (Quantitative) Checked by (Research Officer Signature)

Date: Date:

68
 FORMAT I: SANITARY INSPECTION AND SAMPLE COLLECTION FORM FOR FOCAL IMPROVED
WATER SOURCE(S)
ADM IN I S T ER ED T O C AR E T A KER O F T HE F O C AL I M P R O V ED WAT ER S UP P LY S O U R C E IN T HE
AR EA , IF D IF F ER ENT F R O M T HE R ES I DE NT S O F T HE E NR O LL ED HO US E HO LD AT E AC H
M O NT HLY S UR V EY R O UN D

Name of the Sanitary

Inspector
Name of the Caretaker

Date d d / m m / y y
/ /

Focal Water
Focal Water Point (FWP) Area Cluster Site Type
Point No
Identification No

Notes

Signature of
Signature of the Checked By Signature of Field Team
the Data Entry by
Social Surveyor Supervisor Coordinator
Respondent
Name

Signature

[Before Proceeding Interviewer ask a few questions to the caretaker of the focal water supply system]
D1: When did this water point installed? d d / m m / y y y y
/ /


D2: Who installed this water point?

DPHE = 1 LGED = 2 NGO = 3 Private = 4


D2: Since installation has the water point became non functional.

Yes = 1 No = 2


D21: If D2 answer is Yes then what is maximum time it remained non- months
functional?


D22: If D2 answer is yes then how many times it remained non-functional?

69
 
D23: If D2 answer is yes then what is the reason for becoming non-functional?

Technical problem of the tube well head/bucket etc. = 1

Due to unavailability of the source water = 2
Due to flooding = 3
Due to drying of the surface water = 4
Due to unavailability or erratic rainfall = 5
Due to bad physical water quality = 6
Due to arsenic contamination = 7
Due to iron contamination = 8
Others = 9
Other (specify) _____________________________


D3: Do you have a maintenance tools? If yes show me

Yes = 1 No = 2


D4: Do you receive any caretaker training?

Yes = 1 No = 2


D5: Is there any contribution for installation of the water point from the user side?

Yes = 1 No = 2


D51: The answer of question D5 is Yes then what is the average amount of user
contribution?


D6: Measure the flow rate? ml/min
(use a graduated bucked and collect water for a minute and record the amount )


D7: Open the tube well head and measure the depth and leave the system as it ft
was after measurement or collect acceptable true information from the caretaker
and the community about the depth of the borehole


D8: If the people uses river water pond water as source water for the technology ft
measure the depth of the pond or river by appropriate method

70
 SOURCE WATER SAMPLE COLLECTION FORM

TYPE OF FACILITY: PIPED WATER

General Information
Focal Water Point (FWP) Area Cluster Site Point No Type
Identification No
GPS Location Lattitude Longitude
Date of Visit d d / m m / y y
/ /

Information on water sample for storage and sending to Central icddr,b Information of Sample for Field
laboratory for testing Testing
Sent to
Amount
Sample ID Laboratory
of Sample Parameter Result** Parameter Result
No Mention time
(ml)
and date
Sample E. Coli
Appearance
ID+EC (cfu/100 ml)
Sample Turbidity Turbidity
ID+Tu (NTU) (NTU)
Sample Arsenic*
pH
ID+As (mg/l)
* In every 10th sample
** To be included later from laboratory and noted

Specific Diagnostic Information for Assessment

No Diagnostic Items (Put  Mark) Yes No
1 Do any tap stands leak?
2 Does surface water collect around any tap stand?
3 Is the area uphill of any tap stand eroded?
4 Are pipes exposed close to any tap stand?
5 Is human excreta on the ground within 10m of any tap stand
6 Is there a sewer within 30m of any tap stand?
7 Has there been discontinuity in the last 10 days at any tap stand?
8 Are there signs of leaks in the mains pipes in the Parish?
9 Do the community report any pipe breaks in the last week
10 Is the main pipe exposed anywhere in the Parish?
Sum of Tick

Signature of the Sample collector

71
 TYPE OF FACILITY: PIPED WATER WITH SERVICE RESERVOIR

General Information
Focal Water Point (FWP) Area Cluster Site Point No Type
Identification No
GPS Location Lattitude Longitude
Date of Visit d d / m m / y y
/ /

Information on water sample for storage and sending to Central icddr,b Information of Sample for Field
laboratory for testing Testing
Sent to
Amount
Sample ID Laboratory
of Sample Parameter Result** Parameter Result
No Mention time
(ml)
and date
Sample E. Coli
Appearance
ID+EC (cfu/100 ml)
Sample Turbidity Turbidity
ID+Tu (NTU) (NTU)
Sample Arsenic*
pH
ID+As (mg/l)
* In every 10th sample
** To be included later from laboratory and noted
Specific Diagnostic Information for Assessment
No Diagnostic Items (Put  Mark) Yes No
1 Do any tap stands leak?
2 Does surface water collect around any tap stand?
3 Is the area uphill of any tap stand eroded?
4 Are pipes exposed close to any tap stand?
5 Is human excreta on the ground within 10m of any tap stand
6 Is there a sewer within 30m of any tap stand?
7 Has there been discontinuity in the last 10 days at any tap stand?
8 Are there signs of leaks in the mains pipes in the Parish?
9 Do the community report any pipe breaks in the last week
10 Is the main pipe exposed anywhere in the Parish?
Sum of Tick

Signature of the Sample collector

72
 TYPE OF FACILITY: DEEP BOREHOLE WITH MECHANIZED PUMPING

General Information
Focal Water Point (FWP) Area Cluster Site Point No Type
Identification No
GPS Location Lattitude Longitude
Date of Visit d d / m m / y y
/ /

Information on water sample for storage and sending to Central icddr,b Information of Sample for Field
laboratory for testing Testing
Sent to
Amount
Sample ID Laboratory
of Sample Parameter Result** Parameter Result
No Mention time
(ml)
and date
Sample E. Coli
Appearance
ID+EC (cfu/100 ml)
Sample Turbidity Turbidity
ID+Tu (NTU) (NTU)
Sample Arsenic*
pH
ID+As (mg/l)
* In every 10th sample
** To be included later from laboratory and noted

Specific Diagnostic Information for Assessment

No Diagnostic Items (Put  Mark) Yes No
1 Is there a latrine or sewer within 100m of pump house?
2 Is the nearest latrine un-skewered?
3 Is there any source of other pollution within 50m?
4 Is there an uncapped well within 100m?
5 Is the drainage around pump house faulty?
6 Is the fencing damaged allowing animal entry?
7 Is the floor of the pump house permeable to water?
8 Does water forms pools in the pump house?
9 Is the well seal insanitary?
Sum of Tick

Signature of the Sample collector

73
 TYPE OF FACILITY: BOREHOLE WITH HAND PUMP

General Information
Focal Water Point (FWP) Area Cluster Site Point No Type
Identification No
GPS Location Lattitude Longitude
Date of Visit D d / m m / y y
/ /

Information on water sample for storage and sending to Central icddr,b Information of Sample for Field
laboratory for testing Testing
Sent to
Amount
Sample ID Laboratory
of Sample Parameter Result Parameter Results
No Mention time
(ml)
and date
Sample E. Coli
Appearance
ID+EC (cfu/100 ml)
Sample Turbidity Turbidity
ID+Tu (NTU) (NTU)
Sample Arsenic
pH
ID+As (mg/l)*
* In every 10th sample
** To be included later from laboratory and noted

Specific Diagnostic Information for Assessment

No Diagnostic Items (Put  Mark) Yes No
1 Is there a latrine within 10m of the borehole?
2 Is there a latrine uphill of the borehole?
Are there any other sources of pollution within 10m of borehole?
3
(e.g. animal breeding, cultivation, roads, industry etc)
4 Is the drainage faulty allowing ponding within 2m of the borehole?
5 Is the drainage channel cracked, broken or need cleaning?
6 Is the fence missing or faulty?
7 Is the apron less than 1m in radius?
8 Does spilt water collect in the apron area?
9 Is the apron cracked or damaged?
10 Is the hand pump loose at the point of attachment to apron?
Sum of Tick

Signature of Interviewer (Quantitative) Checked by (Research Officer Signature)

Date: Date:

74
 FORMAT J: WATER SPECIMEN COLLECTION, TESTING AND ANALYSIS PROCEDURE

SOP FOR WATER SAMPLE COLLECTION

1. Collect sterile container from the Environmental Microbiology Laboratory of icddr,b.

2. Do not open/mishandle the sterile container before sample collection.

Tube well:
1. Wear gloves.
2. Clean the tube well outlet with fresh tissue paper to remove dirt/debris/rust.
3. Discard water for 1 min to remove remaining dirt/debris/rust.
4. Use a piece of clean tissue paper to dry the tube well outlet.
5. Soak a piece of tissue paper/cotton with 100% alcohol holding with big forceps.
6. Set fire on the soaked tissue paper.
7. Sterilize the tube well outlet using the flame.
8. Wait until smoke comes out of the upper open end of the tube well.
9. Discard water from the tube well for 1-2 mins.
10. Label the water collection bottle as stated in the procedure.
11. Open the container cap and collect the water into the container up to the brim. Remember not to
touch the container mouth with the tube well outlet.
12. Do not touch inside of the container with hands.
13. Close the container tightly.
14. Place the container in a cool box containing sufficient number of ice packs to keep the
temperature inside the container between 4-10°C.

Distribution tap/faucet:
1. Wear gloves.
2. Remove hose/strain (if any) attached to the faucet.
3. Clean the faucet with tissue paper to remove dirt/debris/rust.
4. Discard water for 1 min to remove remaining dirt/debris/rust.
5. Use a piece of clean tissue paper to dry the tap/faucet. If the tap/faucet is made with plastic then
clean it with 70% alcohol, do not flame.
6. If the tap is made with metal then soak a piece of tissue paper/cotton with 100% alcohol holding
with big forceps.
7. Set fire on the soaked tissue paper.
8. Sterilize the faucet using the flame.
9. Discard water from the faucet for 1-2 mins.
10. Label the water collection bottle as stated in the procedure.
11. Open the container cap and collect the water into the container up to the brim. Remember not to
touch the container mouth with the tap outlet.
12. Do not touch inside of the container with hands.
13. Close the container tightly.
14. Place the container in a cool box containing sufficient number of ice packs to keep the
temperature inside the container between 4-10°C.

Point of Use Water:

7. Label the water collection bottle as stated in the procedure.
8. Ask the respondent to provide water sample as if s/he is serving water to a family member.

75
 9. Open the container cap and collect the water into the container up to the brim. Remember not to
touch the container mouth with the water holding pot from where water will be poured.
10. Do not touch inside of the container with hands.
11. Close the container tightly.
12. Place the container in a cool box containing sufficient number of ice packs to keep the
temperature inside the container between 4-10°C.

FIELD BLANK/DUPLICATE SAMPLE COLLECTION

1. Each day one of the sample collector will carry a ‘field blank’ to control for field sampling
conditions. The field blank will have lab water in the sterile container. The selected sample collector
will just carry the blank container in their cooler box and open the cap of the blank container once in
the field and then close the cap of the container tightly and then send back the blank sample together
with other samples in the Environmental Microbiology Laboratory.
2. Each day the sample collector will collect a duplicate sample from one of every ten households. This
sample will be collected along with the source as well as point of use water sample at the same time.
The sample procedure should be the same, and the sample collector will write ‘duplicate’ on the
label in addition to the normal household code.

SOP FOR WATER SAMPLE COLLECTION FOR DETERMINATION OF ARSENIC CONTENT

Both source water and point of use water will be collected for determination of arsenic content. Separate
bottles containing concentrated nitric acid will be used.
1. Collect special sample collection bottles (with 200µl of concentrated nitric acid) from the
Environmental Microbiology Laboratory of icddr,b.
2. Care must be taken to prevent any leakage from the bottles containing concentrated nitric acid.
3. Label the bottles properly.
4. Follow the collection procedure described for collection of water samples for microbiological
analysis.
5. During sample collection pay attention not to overflow water as it will reduce the concentration of
nitric acid.
6. Water sample for determination of arsenic should be collected from every 10 th household.
7. The bottles can be kept at room temperature.

SOP FOR PH MEASUREMENT

1. Samples should be tested as soon as possible after collecting the sample.
2. Rinse the probe (electrode) with distilled or deionised (DI) water if possible and then wipe with lint
free tissue paper.
3. Thoroughly rinse probe once or twice with the sample water.
4. Press the power button to open the meter display.
5. Insert the electrode (probe) into the sample.
6. Press measure button.
7. The pH icon will flash until the reading is stable. Then it will stabilize and show the result on the
digital display.
8. Record the result in the worksheet.

76
 SOP FOR TURBIDITY MEASUREMENT
1. Sample should be tested as soon as possible after collecting the sample.
2. Clean the sample cell/vial.
3. Rinse the sample vial with approximately 10 ml of the sample water.
4. Place the turbidity meter on a flat and level surface.
5. Pour the sample into the rinsed sample vial up to the mark.
6. Wipe outside of the vial with soft, lint-free cloth/tissue. Ensure that the outside of the vial is dry,
clean and free from smudges.
7. Place the sample vial inside the sample well and align the vial’s index mark with the meter’s index
mark.
8. Push the vial until it is fully snapped in.
9. Cover the vial with the light shield cap.
10. Turn on the meter by pressing the ON/OFF key.
11. After the power-up sequence the meter goes to measurement mode.
12. The measured reading will then appear in the display.
13. Record the result in log-book.

SOP FOR TRANSPORTATION OF WATER SAMPLES IN THE ENVIRONMENTAL MICROBIOLOGY

LAB OF ICDDR,B
 The water samples for microbiological analysis (source water, point of use water, duplicate sample,
blank sample) will be sent to the Environmental Microbiology Laboratory (EML) of icddr,b.
 Take a clean and dry cool box.
 Place sufficient amount of ice packs inside the box.
 Keep a thermometer inside the box to measure temperature.
 Then place the samples inside the box. Recheck whether the caps of the bottles were tightened
properly to avoid leakage of water.
 Close the cool box properly, avoid overloading and place masking tape around the neck of the box,
so that air can’t enter inside the box.
 Ensure the box is properly air tight.
 Label the box properly (mobile number of the contact person and address)
 Now the box is ready for transportation.
 It is absolutely essential to maintain cold chain (to keep the temperature inside the cool box from
4°C to 10°C) during transportation of the samples. The samples need to be reached in the
Environmental Microbiology Lab early in the morning of the following day. It should be kept in
mind that the samples must be processed within 24 hrs after collecting the samples.

LAB SOP FOR WATER SAMPLE ANALYSIS

This SOP describes the procedures for the analysis of water samples

PREPARATION OF MEDIA
MI media will be used for analyzing samples. For analysis of water samples, MI media will be used for
enumeration of E. coli and total coliforms by incubation at 35°C ± 0.5°C.

Materials Needed
MI Agar media
Cefsulodin sodium salt (stored in -20˚C freezer)
Distilled water
1 L flask

77
1000 mL graduated cylinder
Sterile petri dishes (approximately 60 petri dishes per 1000 ml media)
15 mL falcon tubes (2x)
10 mL syringe
0.2 um filter
Scale, weighing paper and weighing spatula
Stirring hot plate
Thermometer
Water bath
Sterile serological pipette for dispensing media
Pipettor (with 1-5 mL sterile tips) for dispensing cefsulodin solution
Gas burner
Autoclave machine
Autoclave tape
Aluminum foil
70% ethanol
Gloves
PREPARATION OF MI MEDIA
- Measure 1000 mL of distilled water in graduated cylinder
- Add 36.5 g MI Agar and 1000 mL of sterile distilled water to 2L flask
- Cover flask with sterile aluminum foil and place on stirring hot plate
- Heat on stirring hot plate until media boils (it will become transparent)
- Boil for 1 minute to completely dissolve, make sure it does not boil over
- Autoclave at 121°C and 15 psi for 15 minutes
- Let agar cool down to ~50˚C in a water bath
- Prepare 1 mg/1 mL Cefsulodin solution
o Add 10 mg Cefsulodin and 10 mL of distilled water to sterile test tube
o Shake to dissolve
o Remove plunger from syringe and attach 0.2 um filter to tip of syringe
o Filter solution into fresh sterile test tube
- Add 5 mL of fresh Cefsulodin solution to 1000 mL of media (final concentration 5 mg/L)
- Place remainder of solution in 4˚C fridge wrapped in aluminum foil. Discard if unused after 2 days.
- Place media on stirring hot plate for 30 seconds
- Cover work bench with aluminum foil and wipe with ethanol
- Put on gloves and wipe hands with ethanol
- Light gas burner
- Open and create stacks of 5 plates for pipetting.
- With sterile pipette and bulb pipettor and sterile technique, dispense 15 – 20ml per plate of media.
- Let stand on workbench for 2 hours for agar to solidify (minimize light exposure and be careful not to
move plates while cooling)
- When all plates are poured, select two plates for QA/QC from each batch of media prepared that day.
- Select a plate for negative QA/QC and incubate for 24 hours.
- Select a plate for positive QA/QC. Place a positive control on the plate and incubate for 24 hours.
- Keep remaining plates in poly bag, write date, initials and batch number on the wrapping and place in
refrigerator (4˚ C). Make sure to refrigerate plates in inverted position. This ensures that any
condensation that forms will remain on the lid of the plate instead of falling on the media.
- Fill data sheet for the QA/QC plates for all media batches. If no growth is observed on negative QA/QC
plate, and growth is observed on positive QA/QC plate, the media is good to use.
-
MEDIA QA/QC
Run one positive and one negative control for every new batch of media as follows (this should be done at
least one day before any samples are processed with the new batch of media).

78
1. Label one plate of fresh media as positive control (PC) with date and batch number
2. Use preserved ATCC strains of E. coli as positive control
3. Process 100 mL volume of sample and place into plate
4. Label one plate of fresh media as negative control (NC) with date and batch number
5. Incubate PC and NC plates at 35°C ± 0.5°C (MI plates) for 24 hours
6. If the positive control does not show colonies or the negative control shows colonies, discard the batch of
media and prepare a new batch
7.
PROCESSING SAMPLES
Samples should be processed in order of collection time. The goal is to process samples within 24 hours of
collection. Membrane filtration can be performed using membrane filtration unit.

Materials Needed
Membrane filtration unit
Vacuum pump
47 mm membrane filter with 0.2 um pore size
90 mm petri dish with pre-poured media
Incubator (set at 35 °C ± 0.5°)
Longwave UV lamp (366 nm), handheld, 4-watt preferred or 6-watt
Forceps
10 mL sterile pipette
Gas burner
70% ethanol
Gloves (nitrile, latex or vinyle)
Aluminum foil

PROCESSING WITH MEMBRANE FILTRATION UNIT

1. Remove petri dishes from fridge and allow to warm up to room temperature
2. Put on gloves and wipe hands with ethanol
3. Light Gas burner
4. Remove one bottle from cooler (remove in the order they have been collected)
5. Wipe down bottle with ethanol soaked tissue before placing on testing surface
6. Label Petri dishes with sample ID, unique ID, initials and volume processed
7. Place sterile funnel on filter apparatus (do not touch or set down filter funnel on any other surface)
8. Ensure that filter apparatus is disconnected from vacuum (valve in horizontal position)
9. Sterilize forceps by dipping in ethanol and flaming in burner, let them cool before use
10. Open membrane package, pull away package and yellow paper without touching membrane
11. Using sterile forceps, remove membrane from package (hold membrane by the edge only)
12. With forceps in other hand, place membrane (grid-side up) onto sterile filter holder
13. Place funnel immediately (do not touch or set down filter funnel on any other surface)
14. Shake bottle vigorously to distribute the bacteria uniformly
15. Carefully add 100 mL of sample from bottle into funnel (Bottle should not touch funnel)
16. Connect filtration apparatus to vacuum by bringing valve into vertical position
17. When sample is filtered, use a sterile squeeze bottle to rinse sides of filter funnel with sterile water
18. Disconnect from vacuum when the filter is dry
19. Lift the filter funnel
20. Using sterile forceps, hold the membrane by the edge and gently lift from the filter unit
21. Transfer the membrane (grid-side up) to petri dish containing MI media
22. Run forceps around outside edge of membrane to ensure it makes contact with media, reseat if needed
23. Replace the lid of the Petri Dish
24. Invert plate and place in a stack on lab bench
25. Preserve contents of rest of the samples in the refrigerator

79
26. Set aside the filter funnel for sterilization
27. Repeat steps 7 through 26 until all samples have been processed
28. Empty glass flask attached to vacuum pump before it fills up, do not allow the water to reach the level of
the flask outlet – this would allow water into the pump and break the pump
29. Place all plates in incubator and fill out incubator sheet
30. Incubate the plates at 35° C ± 0.5° for 24 hours

COUNTING PLATES
Plates should be counted as soon as they are removed from the incubator. If it is not possible to read them
immediately or if the reading has to be interrupted, plates should be placed in a 4° C fridge until they can be
read. Ideally there should be 20-80 colonies per plate after incubation for optimal reading but up to 200 is
acceptable. E. coli target colonies are blue / indigo of all sizes. Total coliform are fluorescent under UV
light.

1. If number of colonies exceeds 200, record result as “TNTC” and process the preserved sample with
appropriate dilution to get countable colonies.
2. Otherwise, count the colonies on the plate using a clicker and write the count on the back of plate
a. Read all blue and blue/green colonies as E. coli regardless of size
b. Create a dark environment and shine longwave UV light (366 nm) on plate
c. Read all fluorescent colonies as total coliforms regardless of size
d. Add any non-fluorescent blue colonies to total coliform count (color can mask fluorescence)
e. Exclude any fluorescent bright green colonies from total coliform count (an increase in the
number of bright green colonies may indicate breakdown of the Cefsulodin in the media)
3. If there are a lot of colonies (>100) evenly distributed across the plate, the plate can be divided in ½ or ¼
and only count colonies on a fraction of the plate. If plate is split in half or in quarters, record count (25)
x multiplier (2) = real count (50) so it will be obvious for people transferring data (should also be
obvious from markings on plate from counting).
4. Count any bacterial growth on blanks (even if they are not E. coli or total coliforms) and record the
number and appearance of the colonies.

MI plate with E. coli and total MI plate with E. coli and

coliforms under 366 nm UV confluent total coliforms under
light 366 nm UV light

80
 DATA ENTRY
HAND ENTRY OF DATA INTO LAB SHEET
1. Microbiologist #1 (the plate counter): Copy number of MI colonies from plate to the data sheet.
2. Microbiologist #2: Take original plates with counts on back and compare to the filled out sheet. For
quality check, recount every 10th plate. If recount is significantly different (off by ~5%) discuss with
lab supervisor why difference occurred.

4.2 ELECTRONIC ENTRY OF LAB DATA

1. Lab microbiologists will be responsible for electronic data entry on a regular basis.
2. Data will be entered into excel using there “MF Results” data entry template; all data will be entered
within 10-12 days after the data is generated by the lab.

5. QA/QC PROCEDURES
The following blanks, duplicates and replicates should be processed for quality control.
 Field blanks as per field schedule
 1 lab blank per microbiologist per day
 5% lab replicates (two aliquots from the same bottle)

5.1 FIELD BLANKS

1. Label plate with sample ID, unique ID, volume and initials
2.Water blanks will be labeled as “WB.SAMPLE COLLECTOR ID.DAY.MONTH”
3.Process 100 mL of the field blank.
4.Incubate with the rest of day’s samples.
5.If field blank shows bacteria, contamination has occurred during sample collection and the contamination
should be noted for analysis. Inform Supervisor to talk to sample collector about improving their
performance.
Note: Field blanks will have a unique numerical ID.

5.2 LAB BLANKS

1. Label plate with sample ID
2. For sample ID, use “LB.LAB MICROBIOLOGIST INITIALS.DAY.MONTH”
3. Process 100 mL of autoclaved distilled water
4. Incubate with the rest of day’s samples.
5. If the laboratory blank shows bacteria, contamination may have occurred during sample processing and
the contamination should be noted for analysis. Inform Supervisor to assess contamination of distiller.

Note: Lab blanks will NOT have a unique numerical ID, only sample ID.

5.3 LAB REPLICATES

Lab replicates should be run for 5%
1. Use the unique IDs to select the sample for replicates according to the following rule:
2. Label plate with sample ID, unique ID, volume and initials
3. For sample ID, use “REP.TYPE.ID.DAY.MONTH” (i.e., put “REP” before the sample ID)
4. Incubate with the rest of day’s samples.

81
Lab SOP for the Determination of Arsenic Using Hydride Generation
Atomic Absorption Spectrophotometer (HGAAS)

1.0 Scope and application

This method is applicable for the determination of arsenic in water. The detection limit of this
method is 0.3 to 0.5 μg/L.

2.0 Safety
Personal protective equipments (PPE) will be used during the laboratory analysis. For individual
materials safety we will follow the material safety data sheets (MSDS).

3.0 Sample Storage

Collected samples can be stored up to six months at room temperature.

4.0 Accuracy Check and Quality control

4.1 Laboratory quality control standard will be analyzed as reference material to ensure
the quality of the experiment.

4.2 All quality control data should be maintained and available for easy reference or
inspection.

5.0 Method Performance

Standard reference material; SRM 1643e (trace elements in water) from NIST is used for
checking the precision and accuracy of the analysis, which is found to be excellent with CV%=±5. Internal
quality-control (QC) samples (pooled water samples) and spiked internal QC samples throughout the study
showed good accuracy and precision. To validate the precision and accuracy of the method, recovery and
duplicate samples is also analyzed (recovery=97%, CV%=±5).

6.0 Waste Management

ICDDR,B waste management policy will be followed.

82
 FORMAT K: METEOROLOGICAL INFORMATION COLLECTION FORMAT

Administered every month to the BMD Data Repository Officer/District/Upazila Meteorological Officer

Signature of Signature of the Checked By Signature of Field Team

Data Entry by
the Respondent FRA Supervisor Coordinator

Name

Signature

Instruction
1. Use the same format as shown for the collection of information on temperature (maximum and minimum),
rainfall, humidity and extreme events in two different locations namely, Rajshahi and Faridpur district.
Metrological Item Sub Item
Temperature
Mean
Maximum
Minimum
Rainfall
Humidity
2. If any extreme event occurs during the research period please record its duration and follow instruction 1
for the days of extreme events.

83
 FORMAT L: COMMUNITY LEVEL HEALTH INFORMATION COLLECTION FORMAT

ADM IN I S T ER ED T O T HE U N IO N H EA LT H AS S IS T A NT / NE AR ES T G O VER NM E N T H O S P IT AL
Name of the FRA

Date of Collection D d / m M / y y
/ /

Notes

Signature of
Signature of the Checked By Signature of Field Team
the Data Entry by
Social Surveyor Supervisor Coordinator
Respondent

Name

Signature

Instruction
1. Site specific union data of diarrhoeal incidence need to collect by using the same format as shown form
the union health clinic registers of the for all sites of all clusters.
2. If any extreme events occurred during the research period the same for need to be used during the extreme
events days
District Name: Upazila: Union:
Cluster No: Site No: Name of the Month:

Date Union (no of diarrhoeal incidence)

No
(dd/mm/yyyy)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21

84
 Date Union (no of diarrhoeal incidence)
No
(dd/mm/yyyy)
22
23
24
25
26
27
28
29
30
31

85
86