Drinking water improvements and rates of urinary and gastrointestinal infections in Galápagos, Ecuador: Assessing household and community factors

• Published in: American journal of human biology 2020-01, Vol.32 (1), p.e23358-n/a
• Main Authors: Houck, Kelly M., Terán, Enrique, Ochoa, Juan, Zapata, Gyssell N., Gomez, Ana M., Parra, Rafael, Dvorquez, Denise, Stewart, Jill R., Bentley, Margaret E., Thompson, Amanda L.
• Format: Article
• Language: English
• Subjects: Adult; Bottled water; Child; Child, Preschool; Contamination; Cooking; Drinking water; Drinking Water - analysis; Ecuador - epidemiology; Family Characteristics; Fecal coliforms; Feces; Feces - chemistry; Female; Gastrointestinal Diseases - epidemiology; Health Knowledge, Attitudes, Practice; Households; Humans; Hygiene; Infections; Infectious diseases; Infrastructure; Levels; Male; Public health; Residence Characteristics - statistics & numerical data; Urinary tract infections; Urinary Tract Infections - epidemiology; Water analysis; Water pollution; Water Quality; Water sampling; Water supply systems; Water treatment; Water treatment plants; Water use; Young Adult
• ISSN: 1042-0533; 1520-6300
• DOI: 10.1002/ajhb.23358

Objectives The Galápagos provides an important setting to investigate the health impacts of a new drinking water treatment plant (DWTP) in a limited resource environment. We examine how household perceptions and practices affect the relationship between water quality and infections before and after DWTP. Methods Ethnographic data and self‐reported infections were collected from 121 mothers and 168 children ages 2 to 10 from Isla San Cristóbal. Household tap water samples were tested for levels of fecal contamination. Community level infection rates were estimated using discharge records from the Ministry of Public Health. The effects of the new DWTP and fecal contamination levels on infections were tested using logistic and Poisson models. Results Perceptions of water quality and household practices influenced exposures to contaminated tap water. We found minimal change in drinking water sources with 85% of mothers sampled before the DWTP and 83% sampled after using bottled water, while >85% from the pooled sample used tap water for cooking and hygiene practices. The DWTP opening was associated with lower odds of fecal contamination in tap water, reported urinary infections, and community level rates of urinary and gastrointestinal infections. The household practice of recently washing the cistern contributed to higher contamination levels after the DWTP opened. Conclusions To ensure access to clean water, public health works need to consider how household perceptions and practices influence tap water use and quality, in addition to infrastructure improvements. Exposures to contaminated tap water contribute to the burden of infectious disease in environments with inadequate water infrastructure.