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Water supply, sanitation and diarrhoeal disease in Nicaragua: results from a case-control study
A C Gorter1, P Sandiford, G D Smith
1División de Ingenería Ambiental, Universidad Nacional de Ingenería, Managua, Nicaragua.
Insights
Water availability, not quality, significantly impacts child diarrhea risk in Nicaragua. Increased distance to water sources and household crowding elevate illness rates, highlighting the importance of accessible water for child health.
Area of Science:
- Environmental Health
- Pediatrics
- Epidemiology
Background:
- Childhood diarrhea remains a significant global health concern, particularly in low-income settings.
- Understanding risk factors is crucial for developing effective prevention strategies.
- Previous research has explored water quality and sanitation, but accessibility's role needs further investigation.
Purpose of the Study:
- To identify key risk factors associated with childhood diarrheal disease in rural Nicaragua.
- To investigate the relationship between water quality, water availability, sanitation, and diarrhea morbidity.
- To examine the influence of socioeconomic factors, such as maternal education and household crowding, on diarrhea incidence.
Main Methods:
- A case-control study involving 1229 children under five with diarrhea, matched with an equal number of controls with other illnesses.
- Microbiological testing of water supplies for fecal coliforms to assess water quality.
- Statistical analysis, including conditional logistic regression, to identify significant risk factors and control for confounding variables.
Main Results:
- No significant association was found between microbiological water quality and diarrhea morbidity.
- Water availability demonstrated a statistically significant association with diarrhea; children with water sources >500m away had 34% higher incidence rates.
- Maternal education level was inversely correlated with diarrhea frequency, and a higher number of young children in the household increased diarrhea incidence.
Conclusions:
- Water availability and accessibility are critical determinants of childhood diarrhea, outweighing water quality in this rural Nicaraguan setting.
- Socioeconomic factors, including maternal education and household crowding, play a significant role in diarrhea risk.
- Interventions should focus on improving water accessibility and addressing household conditions to reduce childhood diarrhea burden.
Abstract:
A case-control study of risk factors for child diarrhoeal disease was undertaken in a rural area of Nicaragua. Some 1229 children under the age of five were matched with an equal number of children of the same age presenting with other illnesses unrelated to water and sanitation. The main types of water supply were sampled at monthly intervals and tested for the presence of faecal coliforms in order to characterize their microbiological quality. In spite of marked differences in water quality between the different types of water supply, no relationship was found with diarrhoea morbidity. In contrast, there was a statistically significant association between water availability and diarrhoea morbidity. Children from homes with water supplies over 500 meters from the house had incidence rates of diarrhoea 34% higher than those of children from houses with their own water supply. Owning a latrine was not found to be significantly related to diarrhoea morbidity. A mother's level of schooling was inversely correlated with the frequency of diarrhoea in her children. A significant association was also found between the number of children under the age of five living in the house and the incidence of diarrhoea. These effects remained significant after controlling for confounding variables by conditional logistic regression.
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