I think it's great you are doing this research and coming to your own judgements on charities. Sorry you didn't get the feedback you were hoping for previously.

I'm not an expert in this - but I think the risk of post-source contamination is a major driver behind why people think chlorination is the most effective intervention. The chlorine stays in the water so continues be protective whereas unchlorinated water can easily be contaminated from storage/dipping cups/hands before it is drunk.

E.g. https://www.academia.edu/816567/Household_drinking_water_in_developing_countries_a_systematic_review_of_microbiological_contamination_between_source_and_point_of_use

It's also worth noting that you can't assume the water coming out of those boreholes is free from bacteriological contamination in the first place. Often the groundwater can be contaminated, particularly if there are livestock or latrines nearby. Possibly Wells4wellness have data on this, it isn't that complicated or expensive to do field tests for bacteriological quality. Contaminants like heavy metals are trickier and probably less common.

This survey in Niger (if my French is still up to scratch) suggested that most waterpoints' water tested positive for coliforms so this could be a major factor.
https://www.pseau.org/outils/ouvrages/winrock_international_resume_des_etudes_sur_les_eaux_souterraines_de_15_communes_de_la_region_de_zinder_2022.pdf 
 

You might be interested in this project - https://grid3.org/ using micro censuses, and satellite images to get more accurate population projections.

Best of luck with the intervention!

One thing I would suggest is that since this is a genetic disease, once you have found a case - it is worth advising the family to get cousins/siblings tested as they are much more likely than the general population to have the disease. The first sickling crisis can be fatal so early diagnosis is really important. 

Thanks for writing this post, and the others, on your experience with Alvea - really interesting reading.

I think the thing that is most impressive to me is that you stopped before you ran out of money and returned money to investors. 

That, in my experience, is extremely unusual in the charitable/not for profit sector... where people often keep going with projects that in their heart of hearts they know are not having much or any impact.

Do you see a realistic prospect for any state with nuclear weapons giving them up? 

Either unilaterally or as part of some kind of agreement?

Thanks for writing this - I really enjoyed reading through it, and definitely value hearing from someone with clinical experience of treating patients with mental illnesses.

Speaking for myself, I find the DALY framework helpful in thinking about estimating the health burden of diseases, but definitely don't see it as the be all and end all. 

Likewise Nigeria: https://www.reuters.com/world/africa/nigeria-regulator-grants-approval-oxfords-malaria-vaccine-2023-04-17/

Thanks for the explanation, definitely agree that there are some big limitations on looking at careseeking behaviour in that way. No perfect solution but possibly excluding malaria cases as they are so seasonal would be appropriate, or if you can collect baseline data for a year then you can compare month to month. 

I think existing cost-effectiveness studies might be something you can mine to get to DALY/case... for instance, this study here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8757489/#!po=51.5625 

suggests that in their intervention, treating an additional 124 cases of diarrhoea = saving almost 5 DALYs (if my quick skim of table 3 is right). That's modelled I think, but might be a good additional datapoint.