Effectiveness of Traditional Water Purification Methods in Preventing Waterborne Diseases such as Cholera in Kassala State

Abstract

Zinab Abdellatef Othman Blal, Albaraa Abdelrahman Ali Adam, Majdolin Alhassan Mohamed Omer, Tasneem Abdalaziz Hamed Alhaj, Yasmeen Ahmad Bushara Mohamed 5-Marwa Alssir Bashir Alkhidir, Faal Abdalmonem Boshra Abdallah and Mosab Altaj Mohamed Awida

Background: Access to safe drinking water is a fundamental determinant of public health, yet it remains a critical challenge in conflict-affected regions like Sudan. In rural and semi-urban communities, households often rely on Indigenous Traditional Knowledge (ITK) for water treatment. Common methods include sedimentation using clay pots (Zirs), boiling, and coagulation using natural plant derivatives such as Moringa oleifera seeds (locally known as Rauwa) to clarify turbid water. While these methods are historically rooted, they are often labor-intensive and inconsistent. For instance, boiling is frequently abandoned due to the high cost of fuel, while simple sedimentation fails to eliminate microscopic pathogens like Vibrio cholerae effectively.

The urgency of effective water purification has escalated dramatically since the onset of the conflict. The collapse of the national water infrastructure has forced millions to rely on unregulated water trucking vendors. Consequently, Sudan declared a severe cholera outbreak in August 2024, which began in Kassala State and rapidly spread across the country. By early 2025, the Federal Ministry of Health reported over 50,000 confirmed cases and 1,350 associated deaths, with Kassala remaining a major hotspot due to the high influx of Internally Displaced Persons (IDPs).

In East/West Al-Qash, the primary challenge is not merely the source of water, but its storage. Residents heavily depend on household storage cisterns (Tanakir) to store water purchased from mobile tankers. Research indicates that even if water is sourced safely, secondary contamination often occurs within these cisterns due to biofilm formation and lack of residual chlorination. This study posits that the "Knowledge-Practice Gap" where families are aware of cholera but trust their storage tanks blindly is a leading driver of the continued epidemic in the region.

Methods: A cross-sectional descriptive study was conducted in East/West Al-Qash, Kassala State. Data was collected from 100 participants using a structured questionnaire covering demographics, water handling practices, and disease awareness.

Results: The analysis revealed that 63 households rely on water tankers as their primary source. Despite a high level of educational attainment, represented by 78 university graduates, a significant 59 respondents reported not practicing any form of water purification. Among the methods utilized, boiling was cited by 41 participants, while solar disinfection was used by 29 others. The study identified critical barriers; specifically, 71 individuals believe their water is already safe, and 62 perceive traditional methods as too time-consuming. Furthermore, while cholera awareness is high among 96 residents, 67 confirmed witnessing cases within East/West Al-Qash.

Conclusion: This study establishes that a critical "knowledge-practice gap" exists in East/West Al-Qash, where high health literacy is undermined by a misplaced trust in household cisterns (Tanakir) and the operational burden of traditional purification methods. The persistence of cholera in the region is likely fueled by secondary contamination within these storage units rather than a lack of awareness. Therefore, to effectively dismantle the transmission cycle, public health strategies must pivot from general education to capability enablement. It is strongly recommended to prioritize the distribution of household water filters and chlorine tablets, a solution endorsed by 77% of the community, and to implement systematic chlorination campaigns targeting residential Tanakir. These measures address the community's demand for time-efficient solutions and are essential for securing water safety at the point of use.

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