Deep Tubewell Use and Child Diarrhea in Rural Bangladesh: Results from a Prospective Community Surveillance Study

Area of Science:

• Public Health
• Environmental Health
• Pediatrics

Background:

• Diarrheal diseases are a major cause of mortality in children under five in South Asia.
• Deep tubewells were installed in rural Bangladesh to provide safe drinking water, but their distance may increase contamination risks.
• Concerns exist that microbial contamination during water handling could negate the benefits of deep tubewells.

Purpose of the Study:

• To examine the association between deep tubewell use and diarrheal disease risk in children under five.
• To investigate how social and environmental factors modify this association.

Main Methods:

• Community diarrheal disease surveillance was conducted in Matlab, Bangladesh, from March 2018 to October 2019.
• Households with children under five using deep and shallow tubewells were included.
• Generalized Estimating Equations (GEE) were used to estimate the association between tubewell type and diarrhea prevalence.

Main Results:

• Children using deep tubewells had 17% lower diarrheal disease prevalence compared to those using shallow tubewells (RR=0.83, CI: 0.71-0.96).
• Protective effects were stronger for households with on-compound wells, in flood-prone areas, and using unimproved latrines.
• Deep tubewell use showed greater protection during the dry season.

Conclusions:

• Deep tubewell use does not appear to increase diarrhea risk in under-five children in rural Bangladesh.
• Deep tubewells may reduce diarrhea risk, particularly in contexts with higher microbial contamination risks.
• The findings highlight the potential public health benefits of deep tubewells, considering social and environmental factors.