Impact of Intermittent Piped Water Supply on Health Outcomes among Children under five in Angola, Ethiopia, Tanzania, and Zimbabwe Open Access

Abstract

Background: In many countries throughout the world, piped water is delivered intermittently. In Africa, it is estimated that over one-third of the urban piped water supplies deliver water intermittently. When the pipes deliver water intermittently, the water that is delivered is more likely to be contaminated because the positive pressure within the pipes cannot be maintained and as a result, pathogens may enter the distribution system. Drinking contaminated water can cause pathogens to enter the body and cause diarrhea. Children under five are especially vulnerable. Diarrhea is the second-leading cause of death among children under five years old and can lead to malnutrition, which can cause stunting and low weight.  

Methods: This study used Demographic and Health Surveys (DHS) data to estimate the association between intermittent piped water supply and diarrhea, death, height-for-age (HAZ) and weight-for-age (WAZ) among children under five who live in urban areas. The DHS are nationally representative cross-sectional surveys, which collect health data from populations in low and middle-income countries. The country surveys included were: Angola (2015- 16), Ethiopia (2016), Tanzania (2015- 16), and Zimbabwe (2015). Multiple logistic regression models were fit to examine the relationship between intermittent piped water supply and diarrhea and death. Multiple linear regression models were fit to examine the relationship between intermittent piped water supply and HAZ and WAZ. 

Results: Across all four countries (N= 6,288), 65% of children under five lived in households with an intermittent piped water supply. Overall, for all countries combined, there was a trend that intermittent piped water supply was associated with diarrhea among children under five (OR= 1.16, 95% CI: 0.87—1.54). Although, this result was not statistically significant. No associations were found between intermittent piped water supply and child death, HAZ, or WAZ.

Conclusion: Intermittent piped water supply may be associated with diarrhea among children under five. Further research on the association between intermittent piped water supply and diarrhea is warranted.

Table of Contents

Introduction........................................................................1

    Background on Diarrheal Disease..................................1

    Etiology of Diarrheal Disease........................................1

    Malnutrition and Stunting..................................................2

    Water....................................................................................4

    Piped Water.............................................................................5

    Study Region...........................................................................8

    Water supply in the sub-Sahara African countries.................9

Methods............................................................................11

    Data..............................................................................11

    Participants and Settings..................................................11

    Measurements and Variables.............................................12

    Data Analysis..................................................................14

    Data Cleaning.................................................................14

   Bivariate Analysis............................................................15

   Multivariate Analysis........................................................15

Results.............................................................................18

   Descriptive Statistics.......................................................18

   Diarrhea among children under five...................................19

   Mortality among children under five.................................21

   Height-for-Age Z-score..................................................21

   Weight-for-Age Z-score....................................................22

Discussion.............................................................................24

   Limitations.....................................................................26

   Future directions and conclusion.......................................27

Tables and Figures.............................................................29

References.......................................................................38

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	piped water WASH diarrhea
Committee Chair / Thesis Advisor	Levy, Karen, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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