Point-of-Use Water Treatment in Cholera Response: Choosing Between Aquatabs and P&G Purifier of Water

South Sudan's cholera outbreak — now in its second year and spanning 46 of 48 targeted counties — is still generating active transmission even as oral rehydration campaigns and vaccination drives have pushed weekly case counts down from a peak of around 1,000 in December 2024 to roughly 114 by late September 2025, according to WHO's Africa Regional Office. That reduction is real, but it is not a signal to stand down.

Cholera case fatality rates spike when household water treatment coverage drops, and field coordinators managing the transition from acute response to sustained control face a practical procurement question: which point-of-use product do you reach for, when, and for whom?

Two products dominate NGO procurement across East Africa for household-level disinfection: Aquatabs 67mg sodium dichloroisocyanurate tablets and P&G Purifier of Water sachets. Both are authorised for humanitarian use by the WHO and stocked in the WASH Cluster pipeline. Both deliver free residual chlorine (FRC) to treated water. But they are not interchangeable. Turbidity levels, household water container sizes, programme duration, and cold chain conditions all push field teams toward one product or the other — and choosing wrong costs money, time, and sometimes lives.

This guide sets out the operational logic for that decision, grounded in Sphere Handbook thresholds, WHO cholera guidance, and the realities of operating in South Sudan, Uganda, and DRC.

Quick answers for field teams:

• Aquatabs 67mg treat 20 litres per tablet to achieve approximately 0.5 mg/L FRC in clear water (turbidity below 5 NTU); P&G Purifier of Water sachets treat 10 litres and include coagulant action for turbid water up to 30 NTU.

• The Sphere Handbook minimum FRC at point of delivery is 0.2–0.5 mg/L; during a confirmed cholera outbreak, WHO recommends maintaining 0.5 mg/L throughout the distribution system and at the household level.

• Covered household storage containers statistically preserve chlorine residual longer than uncovered containers — field studies in South Sudan confirm UV exposure and temperature fluctuation accelerate residual loss.

• Both Aquatabs and P&G Purifier of Water are stocked pre-positioned by Specialized Logistics Solutions (SLS) in Juba and Kampala for same-week dispatch across East and Central Africa.

Why Turbidity Changes Everything

The single largest variable determining which product field teams should procure is source water turbidity. Turbidity is measured in nephelometric turbidity units (NTU) and represents the cloudiness of water caused by suspended particles — silt, organic matter, bacteria-laden sediment. In flood conditions, which have affected South Sudan, Kenya, and northern Uganda in successive rainy seasons since 2024, source water turbidity can spike above 100 NTU with little warning.

Chlorine reacts with suspended organic particles before it can inactivate pathogens. In highly turbid water, a standard dose of Aquatabs 67mg — designed to treat 20 litres of clear water — will exhaust its active chlorine against sediment, leaving FRC at point of delivery below the Sphere threshold of 0.2 mg/L. This is not a product failure; it is chemistry. The WHO Drinking Water Quality Guidelines state that turbidity above 5 NTU significantly compromises chlorine disinfection efficiency, and treatment should not proceed with chlorine alone without prior coagulation-flocculation.

P&G Purifier of Water sachets contain both ferric sulphate (a coagulant) and sodium dichloroisocyanurate. Field instructions specify a two-stage process: stir vigorously for five minutes to allow coagulation, allow floc to settle for five minutes, pour through a clean cloth into the second container, then wait 20 minutes before drinking. This process reduces turbidity to below 0.5 NTU and delivers FRC within the Sphere target range in water with initial turbidity up to 30 NTU, according to P&G's field efficacy data supported by laboratory validation studies cited by the Global WASH Cluster.

The operational implication is direct: when field teams are operating in flood-affected areas or drawing from unprotected surface sources with visual turbidity, P&G Purifier of Water is the correct primary product. When water sources are piped, treated at a central point, or have turbidity consistently below 5 NTU, Aquatabs 67mg offer lower cost per litre, simpler instructions, and a smaller logistics footprint. Visit the Specialized Logistics Solutions WASH products page for current stock availability and pricing on both product lines.

Dosing, Contact Time, and the FRC Threshold During Cholera Response

Standard Sphere Handbook guidance calls for 0.2–0.5 mg/L FRC at point of delivery. During confirmed cholera outbreaks, the WHO emergency WASH guidance tightens this: maintain at least 0.5 mg/L FRC throughout the distribution chain, and consider targeting 1.0 mg/L at the filling point to account for residual decay during household storage. MSF's Medical Guidelines for cholera response specify 0.5 mg/L at the household level as a minimum, recommending regular testing with a pool-type comparator chlorimeter or a portable photometer.

For Aquatabs 67mg, the dosing is straightforward: one tablet per 20 litres, wait 30 minutes before drinking. The tablet releases approximately 67mg of available chlorine, yielding roughly 3.35 mg/L at dosing — well above target — which then decays during the contact period. Research published in Environmental Science & Technology on passive chlorination confirms that decay rates in covered containers in East Africa field conditions typically land FRC in the 0.5–1.0 mg/L range at 30 minutes, assuming clear water and a covered container.

For P&G Purifier of Water, one sachet treats exactly 10 litres via the two-stage process described above. Field programmes distributing to families using 10-litre jerrican pairs (common in South Sudan and Uganda) find the product integrates naturally into household practice. However, the two-stage protocol — coagulate, settle, filter through cloth, wait — takes approximately 30 minutes total and requires two clean containers, a clean cloth, and adequate household time. In acute emergency contexts with mobile displaced populations, compliance drops relative to Aquatabs' single-step use. IOM field teams in Bentiu and Malakal have documented both products in use simultaneously across different population groups, calibrated to their source water and household conditions.

The Global WASH Cluster's guidance on chlorine tablet selection emphasises that compliance with the full protocol is as important as product efficacy: a technically superior product used incorrectly delivers worse outcomes than a simpler product used consistently.

South Sudan Outbreak Context and the Procurement Cycle Right Now

South Sudan's Ministry of Health confirmed the current outbreak in September 2024. By May 2026, 8.6 million oral cholera vaccine doses have been administered across 46 targeted counties, according to WHO, with coverage at 87% of the target population. Case counts have fallen significantly from peak, but WHO's Africa Regional Office is explicit that WASH coverage gaps — not vaccine coverage alone — determine whether transmission continues.

UNICEF South Sudan is still actively procuring and transporting emergency water treatment chemicals in-country. IOM reports water purification tablet distribution as an active component of its Renk transit centre, Bentiu IDP camp, and Malakal site operations. The OCHA April 2026 humanitarian access snapshot for South Sudan documents convoy suspensions on the Malakal–Longochuk corridor due to illegal payment demands — a reminder that pre-positioned in-country stock is not a planning convenience but an operational necessity when road corridors close without notice.

Programmes that relied on Kampala or Nairobi forward stocking in 2025 were able to respond to access disruptions faster than those dependent on international procurement. Specialized Logistics Solutions (SLS) holds pre-positioned stock of both Aquatabs 67mg and P&G Purifier of Water in Juba, with replenishment links through Kampala, specifically to serve programmes facing exactly these access dynamics. SLS holds exclusive distribution rights for P&G Purifier of Water in South Sudan and is an authorised distributor of Aquatabs 67mg across the region. See the full WASH product catalogue for current lot availability and delivery timelines.

For programme planners looking at Q3 and Q4 2026 procurement, the South Sudan rainy season (May through October) brings flooding that consistently pushes source water turbidity above 5 NTU across the Greater Upper Nile, Jonglei, and Unity states — precisely the conditions that shift the product decision toward P&G Purifier of Water for household-level distribution.

Calcium Hypochlorite for Community-Scale Treatment

Point-of-use tablets address household-level treatment. Community water points — storage tanks, trucked water distribution, rehabilitated boreholes — require a different approach. HTH Calcium Hypochlorite (65–70% available chlorine) is the standard product for bulk disinfection at tank, trucking, and distribution point scale.

Dosing for community chlorination with HTH at 70% available chlorine: to achieve 0.5 mg/L FRC in a 10,000-litre storage tank, add approximately 7.1 grams of HTH granules, premixed as a stock solution before addition. For cholera response targeting 1.0 mg/L FRC at the filling point, double this dose. Always verify FRC with a comparator or photometer 30 minutes post-dosing before releasing water for distribution.

HTH drums are heavy and require secure, dry, ventilated storage — calcium hypochlorite is a strong oxidiser and will degrade organic materials and react dangerously if stored near flammables. SLS supplies HTH Calcium Hypochlorite in 40kg and 45kg drums from Juba stock and can advise on storage configuration for field warehouses. The Pumps and Equipment page includes Multiquip and Aussie Pumps dewatering equipment commonly deployed alongside community water treatment systems in flood response.

Matching the right product to the right treatment level — HTH for bulk, P&G Purifier of Water or Aquatabs for household — is fundamental to running an efficient WASH programme. Programmes that deploy HTH at household level create dangerous dosing errors; programmes that attempt to scale Aquatabs to community tank disinfection generate unnecessary cost and inconsistent FRC.

What This Means for Your Programme

The decision between Aquatabs 67mg and P&G Purifier of Water is not a question of which product is better. It is a question of source water quality, household protocol compliance, programme duration, and the access conditions that determine how quickly you can resupply. In high-turbidity flood conditions, P&G Purifier of Water protects your FRC targets. In clear-water or piped-supply contexts with mobile populations, Aquatabs deliver better compliance and lower logistical overhead. In community tank and trucked-water programmes, HTH Calcium Hypochlorite is the correct tool.

Run both Aquatabs and P&G Purifier of Water in parallel where your programme spans both water quality contexts — which most South Sudan and Uganda operations do. Build your procurement to account for rainy season turbidity spikes before they arrive, not after. And ensure your in-country forward stock is positioned ahead of convoy disruptions, not dependent on them staying open.

Specialized Logistics Solutions (SLS) holds pre-positioned stock of Aquatabs 67mg, P&G Purifier of Water, and HTH Calcium Hypochlorite in Juba and Kampala, available for rapid dispatch. Contact the team at sales@maji-safi.org.

Frequently Asked Questions

What is the correct Aquatabs 67mg dose for cholera response?

One Aquatabs 67mg tablet treats 20 litres of clear water (turbidity below 5 NTU). Wait 30 minutes before drinking. During a confirmed cholera outbreak, WHO recommends targeting 0.5 mg/L FRC at the household level — verify with a chlorimeter after the contact period. In turbid water, Aquatabs alone are insufficient; use P&G Purifier of Water instead.

How does P&G Purifier of Water work differently from Aquatabs?

P&G Purifier of Water sachets combine a coagulant (ferric sulphate) with a chlorine disinfectant. The coagulant removes suspended particles first, reducing turbidity to near-zero before chlorination occurs. This makes the product effective in water up to 30 NTU — conditions where chlorine tablets alone would be consumed by organic particles before reaching pathogens. The two-stage process takes approximately 30 minutes and requires two containers and a clean cloth.

What FRC level should field teams target during South Sudan's cholera outbreak?

The Sphere Handbook minimum is 0.2–0.5 mg/L at point of delivery. During an active cholera outbreak, WHO guidance recommends maintaining at least 0.5 mg/L FRC at the household level. Many field protocols target 1.0 mg/L at the filling point to account for decay during household storage, particularly in uncovered containers under high UV and temperature conditions common across South Sudan and Uganda.

Can Aquatabs be used for bulk water trucking or tank disinfection?

Aquatabs are designed for household-scale use (10–20 litres per tablet). For bulk disinfection of water trucks, storage tanks, or community distribution points, use HTH Calcium Hypochlorite (65–70% available chlorine) premixed as a stock solution. SLS supplies HTH in 40kg and 45kg drums from pre-positioned Juba stock.

Where can NGOs procure Aquatabs and P&G Purifier of Water in South Sudan?

Specialized Logistics Solutions (SLS) is the exclusive distributor of P&G Purifier of Water in South Sudan and an authorised distributor of Aquatabs 67mg across East and Central Africa. Stock is pre-positioned in Juba with replenishment through Kampala. Contact the team at sales@maji-safi.org or visit the WASH products page to request availability and pricing. SLS is UNGM-registered (Vendor No. 380716) and has over 35 years of in-country operational history across South Sudan, Uganda, Kenya, and DRC.