Integrating container cleaning practices into a Zambian Community Health Club program – evidence from a pilot study

Communities relying on drinking-water storage routinely document containers as a reservoir for pathogens when they are not properly cleaned. Although lab-based research provides guidance on cleaning protocols, gaps remain in understanding: 1) what methods are practiced, and 2) method effectiveness at reducing biofilm growth. In partnership with AFMAC, this pilot explored biofilm contamination in household water storage containers of four Zambian communities engaged in WASH promoting community health clubs and health promoters. A mixed-methods design was used: 15 to 20 households per community completed a knowledge, attitudes, and practices survey and provided whole-container biofilm samples. Four focus group discussions with program members and four interviews with AFMAC staff explored container cleaning sensitizations. Findings revealed household awareness of container cleaning, inconsistent cleaning practices, and high levels of biofilm in 100% of storage containers. The absence of a standardized container cleaning module, reliance on visual cues as a proxy for microbial safety, and disproportionate burden placed on women underscore critical gaps in current programming and highlight container cleaning as a critical pathway to interrupt recontamination. This pilot highlights the need for locally adapted, practical protocols using accessible materials. Advancing container hygiene through integrated, adaptive, and scalable approaches is essential for reducing public health risks from unsafe water storage and improving point-of-use water quality.