Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Water Res. 2020 Mar 1;170:115269. doi: 10.1016/j.watres.2019.115269. Epub 2019 Nov 7.
The Sustainable Development Goals recognize that the availability and quality of improved water sources affect how households use and benefit from these sources. Although unreliability in piped water supplies in low- and middle-income countries (LMICs) has been described, few studies have assessed household coping strategies in response to unreliable water supplies and associated health outcomes. We characterized unreliability in the piped water supply of the town of Borbón, Ecuador over the twelve years following a major upgrade, as well as household coping strategies and associations with diarrhea. We examined trends in primary and secondary drinking water sources, water storage, and water treatment using longitudinal data collected from 2005 to 2012. In 2017, a follow-up survey was administered (N = 202) and a subset of 84 household water samples were tested for chlorine residual levels and microbial contamination. From 2005 to 2017, access to a household water connection increased from 19.4% to 90.3%. However, reliability decreased over time, as in the latter half of 2009, households had access to piped water 79% of the time, compared to 63% by 2017. Piped water samples were highly contaminated with total coliforms (100% of samples) and Escherichia coli (89% of samples). From 2005 to 2017, households less likely to report drinking water treatment (50.6%-5.0%). And from 2009 to 2017, bottled water was increasingly consumed as the primary drinking water source (18.8%-62.4%). From 2005 to 2012, having a household connection was not statistically significantly associated with diarrhea case status (OR: 0.86 95%CI: 0.53, 1.39). Neither household water treatment nor bottled water consumption were negatively associated with diarrhea. Increased water storage was associated with diarrhea (OR: 1.33 per 10L of water stored, 95%CI: 1.05, 1.69). Household water treatment, and consumption of purchased bottled water, two coping strategies that households may have undertaken in response to an unreliable water supply, were not associated with a reduced likelihood of diarrhea. These data suggest a need to understand how impoverished rural households in LMICs respond to unreliable water supplies, and to develop heath messaging appropriate for this context.
可持续发展目标认识到，改善水源的供应和质量会影响家庭对这些水源的使用和受益程度。尽管低中收入国家（LMICs）的管道供水不可靠已经得到了描述，但很少有研究评估家庭应对不可靠供水的策略以及与健康结果的关联。我们描述了厄瓜多尔博尔博恩镇在一次重大升级后的 12 年中，管道供水的不可靠性，以及家庭应对策略及其与腹泻的关联。我们使用 2005 年至 2012 年收集的纵向数据，研究了主要饮用水源、储水和水处理的变化趋势。2017 年，进行了一次后续调查（N=202），并对 84 户家庭水样的氯残留水平和微生物污染进行了检测。2005 年至 2017 年，家庭用水连接的比例从 19.4%增加到 90.3%。然而，可靠性随着时间的推移而下降，因为在 2009 年下半年，家庭有 79%的时间可以获得管道水，而到 2017 年这一比例下降到 63%。管道水样中总大肠菌群（100%的样本）和大肠杆菌（89%的样本）污染严重。2005 年至 2017 年，家庭中报告饮用水处理（50.6%-5.0%）的比例呈下降趋势。而且，从 2009 年到 2017 年，瓶装水作为主要饮用水源的比例逐渐增加（18.8%-62.4%）。2005 年至 2012 年，家庭用水连接与腹泻病例状况之间没有统计学显著关联（OR：0.86，95%CI：0.53，1.39）。家庭饮用水处理和瓶装水消费均与腹泻无关。储水增加与腹泻有关（每储存 10 升水，OR：1.33，95%CI：1.05，1.69）。家庭水的处理，以及购买瓶装水的消费，这两个家庭可能采取的应对不可靠供水的策略，与腹泻的可能性降低无关。这些数据表明，有必要了解 LMIC 中贫困农村家庭对不可靠供水的反应，并制定适合这一背景的健康信息传递策略。
