Upgrading a piped water supply from intermittent to continuous delivery and association with waterborne illness: a matched cohort study in urban India
Intermittent delivery of piped water can lead to waterborne illness through contamination in the pipelines or during household storage, use of unsafe water sources during intermittencies, and limited water availability for hygiene. We assessed the association between continuous versus intermittent w...
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| creator | Ercumen, Ayse Arnold, Benjamin F Kumpel, Emily Burt, Zachary Ray, Isha Nelson, Kara Colford, Jr, John M |
| description | Intermittent delivery of piped water can lead to waterborne illness through contamination in the pipelines or during household storage, use of unsafe water sources during intermittencies, and limited water availability for hygiene. We assessed the association between continuous versus intermittent water supply and waterborne diseases, child mortality, and weight for age in Hubli-Dharwad, India.
We conducted a matched cohort study with multivariate matching to identify intermittent and continuous supply areas with comparable characteristics in Hubli-Dharwad. We followed 3,922 households in 16 neighborhoods with children |
| doi_str_mv | 10.1371/journal.pmed.1001892 |
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We conducted a matched cohort study with multivariate matching to identify intermittent and continuous supply areas with comparable characteristics in Hubli-Dharwad. We followed 3,922 households in 16 neighborhoods with children <5 y old, with four longitudinal visits over 15 mo (Nov 2010-Feb 2012) to record caregiver-reported health outcomes (diarrhea, highly credible gastrointestinal illness, bloody diarrhea, typhoid fever, cholera, hepatitis, and deaths of children <2 y old) and, at the final visit, to measure weight for age for children <5 y old. We also collected caregiver-reported data on negative control outcomes (cough/cold and scrapes/bruises) to assess potential bias from residual confounding or differential measurement error. Continuous supply had no significant overall association with diarrhea (prevalence ratio [PR] = 0.93, 95% confidence interval [CI]: 0.83-1.04, p = 0.19), bloody diarrhea (PR = 0.78, 95% CI: 0.60-1.01, p = 0.06), or weight-for-age z-scores (Δz = 0.01, 95% CI: -0.07-0.09, p = 0.79) in children <5 y old. In prespecified subgroup analyses by socioeconomic status, children <5 y old in lower-income continuous supply households had 37% lower prevalence of bloody diarrhea (PR = 0.63, 95% CI: 0.46-0.87, p-value for interaction = 0.03) than lower-income intermittent supply households; in higher-income households, there was no significant association between continuous versus intermittent supply and child diarrheal illnesses. Continuous supply areas also had 42% fewer households with ≥1 reported case of typhoid fever (cumulative incidence ratio [CIR] = 0.58, 95% CI: 0.41-0.78, p = 0.001) than intermittent supply areas. There was no significant association with hepatitis, cholera, or mortality of children <2 y old; however, our results were indicative of lower mortality of children <2 y old (CIR = 0.51, 95% CI: 0.22-1.07, p = 0.10) in continuous supply areas. The major limitations of our study were the potential for unmeasured confounding given the observational design and measurement bias from differential reporting of health symptoms given the nonblinded treatment. However, there was no significant difference in the prevalence of the negative control outcomes between study groups that would suggest undetected confounding or measurement bias.
Continuous water supply had no significant overall association with diarrheal disease or ponderal growth in children <5 y old in Hubli-Dharwad; this might be due to point-of-use water contamination from continuing household storage and exposure to diarrheagenic pathogens through nonwaterborne routes. Continuous supply was associated with lower prevalence of dysentery in children in low-income households and lower typhoid fever incidence, suggesting that intermittently operated piped water systems are a significant transmission mechanism for Salmonella typhi and dysentery-causing pathogens in this urban population, despite centralized water treatment. Continuous supply was associated with reduced transmission, especially in the poorer higher-risk segments of the population.]]></description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1001892</identifier><identifier>PMID: 26505897</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Care and treatment ; Child Mortality ; Child, Preschool ; Cholera ; Complications and side effects ; Development and progression ; Drinking water ; Drinking Water - microbiology ; Female ; Hepatitis ; Households ; Humans ; Illnesses ; India - epidemiology ; Infant ; Infant, Newborn ; Low income groups ; Male ; Patient outcomes ; Prevalence ; Risk factors ; Socioeconomic factors ; Studies ; Urban Health ; Water Microbiology ; Water Quality ; Water supply ; Water Supply - standards ; Waterborne Diseases - epidemiology ; Waterborne Diseases - mortality ; Waterborne infections</subject><ispartof>PLoS medicine, 2015-10, Vol.12 (10), p.e1001892-e1001892</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Ercumen et al 2015 Ercumen et al</rights><rights>2015 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Ercumen A, Arnold BF, Kumpel E, Burt Z, Ray I, Nelson K, et al. (2015) Upgrading a Piped Water Supply from Intermittent to Continuous Delivery and Association with Waterborne Illness: A Matched Cohort Study in Urban India. PLoS Med 12(10): e1001892. doi:10.1371/journal.pmed.1001892</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c736t-fe41ce85bb68fc6c444e1590a6396c5a03e057900f988e478e782c2009efd55d3</citedby><cites>FETCH-LOGICAL-c736t-fe41ce85bb68fc6c444e1590a6396c5a03e057900f988e478e782c2009efd55d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624240/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624240/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26505897$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Brocklehurst, Clarissa</contributor><creatorcontrib>Ercumen, Ayse</creatorcontrib><creatorcontrib>Arnold, Benjamin F</creatorcontrib><creatorcontrib>Kumpel, Emily</creatorcontrib><creatorcontrib>Burt, Zachary</creatorcontrib><creatorcontrib>Ray, Isha</creatorcontrib><creatorcontrib>Nelson, Kara</creatorcontrib><creatorcontrib>Colford, Jr, John M</creatorcontrib><title>Upgrading a piped water supply from intermittent to continuous delivery and association with waterborne illness: a matched cohort study in urban India</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description><![CDATA[Intermittent delivery of piped water can lead to waterborne illness through contamination in the pipelines or during household storage, use of unsafe water sources during intermittencies, and limited water availability for hygiene. We assessed the association between continuous versus intermittent water supply and waterborne diseases, child mortality, and weight for age in Hubli-Dharwad, India.
We conducted a matched cohort study with multivariate matching to identify intermittent and continuous supply areas with comparable characteristics in Hubli-Dharwad. We followed 3,922 households in 16 neighborhoods with children <5 y old, with four longitudinal visits over 15 mo (Nov 2010-Feb 2012) to record caregiver-reported health outcomes (diarrhea, highly credible gastrointestinal illness, bloody diarrhea, typhoid fever, cholera, hepatitis, and deaths of children <2 y old) and, at the final visit, to measure weight for age for children <5 y old. We also collected caregiver-reported data on negative control outcomes (cough/cold and scrapes/bruises) to assess potential bias from residual confounding or differential measurement error. Continuous supply had no significant overall association with diarrhea (prevalence ratio [PR] = 0.93, 95% confidence interval [CI]: 0.83-1.04, p = 0.19), bloody diarrhea (PR = 0.78, 95% CI: 0.60-1.01, p = 0.06), or weight-for-age z-scores (Δz = 0.01, 95% CI: -0.07-0.09, p = 0.79) in children <5 y old. In prespecified subgroup analyses by socioeconomic status, children <5 y old in lower-income continuous supply households had 37% lower prevalence of bloody diarrhea (PR = 0.63, 95% CI: 0.46-0.87, p-value for interaction = 0.03) than lower-income intermittent supply households; in higher-income households, there was no significant association between continuous versus intermittent supply and child diarrheal illnesses. Continuous supply areas also had 42% fewer households with ≥1 reported case of typhoid fever (cumulative incidence ratio [CIR] = 0.58, 95% CI: 0.41-0.78, p = 0.001) than intermittent supply areas. There was no significant association with hepatitis, cholera, or mortality of children <2 y old; however, our results were indicative of lower mortality of children <2 y old (CIR = 0.51, 95% CI: 0.22-1.07, p = 0.10) in continuous supply areas. The major limitations of our study were the potential for unmeasured confounding given the observational design and measurement bias from differential reporting of health symptoms given the nonblinded treatment. However, there was no significant difference in the prevalence of the negative control outcomes between study groups that would suggest undetected confounding or measurement bias.
Continuous water supply had no significant overall association with diarrheal disease or ponderal growth in children <5 y old in Hubli-Dharwad; this might be due to point-of-use water contamination from continuing household storage and exposure to diarrheagenic pathogens through nonwaterborne routes. Continuous supply was associated with lower prevalence of dysentery in children in low-income households and lower typhoid fever incidence, suggesting that intermittently operated piped water systems are a significant transmission mechanism for Salmonella typhi and dysentery-causing pathogens in this urban population, despite centralized water treatment. Continuous supply was associated with reduced transmission, especially in the poorer higher-risk segments of the population.]]></description><subject>Care and treatment</subject><subject>Child Mortality</subject><subject>Child, Preschool</subject><subject>Cholera</subject><subject>Complications and side effects</subject><subject>Development and progression</subject><subject>Drinking water</subject><subject>Drinking Water - microbiology</subject><subject>Female</subject><subject>Hepatitis</subject><subject>Households</subject><subject>Humans</subject><subject>Illnesses</subject><subject>India - epidemiology</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Low income groups</subject><subject>Male</subject><subject>Patient outcomes</subject><subject>Prevalence</subject><subject>Risk factors</subject><subject>Socioeconomic factors</subject><subject>Studies</subject><subject>Urban Health</subject><subject>Water Microbiology</subject><subject>Water Quality</subject><subject>Water supply</subject><subject>Water Supply - standards</subject><subject>Waterborne Diseases - epidemiology</subject><subject>Waterborne Diseases - mortality</subject><subject>Waterborne infections</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>DOA</sourceid><recordid>eNqVk99qFDEUxgdRbK2-gWhAEL3YNZlJJokXQin-WSgW1HobspkzsykzyTTJtO6L-Lxm3W3pQi-UXCSc_M73hZxziuI5wXNScfLuwk_B6X4-DtDMCcZEyPJBcUgYlTNS8_rhnfNB8STGC4xLiSV-XByUNcNMSH5Y_D4fu6Ab6zqk0WhHaNC1ThBQnMaxX6M2-AFZlyODTQlcQskj412ybvJTRA309grCGmnXIB2jN1Yn6x26tmm1lVr64ADZvncQ4_tsM-hkVtnI-JUPCcU0Nevsgaaw1A4tXGP10-JRq_sIz3b7UXH-6eOPky-z07PPi5Pj05nhVZ1mLVBiQLDlshatqQ2lFAiTWNeVrA3TuALMuMS4lUIA5QK4KE2JsYS2YaypjoqXW92x91HtvjQqwquKZh1BMrHYEo3XF2oMdtBhrby26m_Ah07pkKzpQWlBGdfQkgYLKpiWohKkbTnHjWSlZFnrw85tWuaqmfydQfd7ovs3zq5U568UrUtaUpwF3uwEgr-cICY12Gig77WDXI387lKUjHPJM_pqi3Y6P8261mdFs8HVMa0oJZTUZaZm91AdOMj23kFrc3iPn9_D59XAYM29CW_3EjatA79Sp6cY1eL7t_9gv_47e_Zzn319h12B7tMq-n7a9GncB-kWNMHHGKC9LQ3BajN0Nx2iNkOndkOX017cLett0s2UVX8AesYong</recordid><startdate>20151001</startdate><enddate>20151001</enddate><creator>Ercumen, Ayse</creator><creator>Arnold, Benjamin F</creator><creator>Kumpel, Emily</creator><creator>Burt, Zachary</creator><creator>Ray, Isha</creator><creator>Nelson, Kara</creator><creator>Colford, Jr, John M</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope></search><sort><creationdate>20151001</creationdate><title>Upgrading a piped water supply from intermittent to continuous delivery and association with waterborne illness: a matched cohort study in urban India</title><author>Ercumen, Ayse ; Arnold, Benjamin F ; Kumpel, Emily ; Burt, Zachary ; Ray, Isha ; Nelson, Kara ; Colford, Jr, John M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c736t-fe41ce85bb68fc6c444e1590a6396c5a03e057900f988e478e782c2009efd55d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Care and treatment</topic><topic>Child Mortality</topic><topic>Child, Preschool</topic><topic>Cholera</topic><topic>Complications and side effects</topic><topic>Development and progression</topic><topic>Drinking water</topic><topic>Drinking Water - microbiology</topic><topic>Female</topic><topic>Hepatitis</topic><topic>Households</topic><topic>Humans</topic><topic>Illnesses</topic><topic>India - epidemiology</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Low income groups</topic><topic>Male</topic><topic>Patient outcomes</topic><topic>Prevalence</topic><topic>Risk factors</topic><topic>Socioeconomic factors</topic><topic>Studies</topic><topic>Urban Health</topic><topic>Water Microbiology</topic><topic>Water Quality</topic><topic>Water supply</topic><topic>Water Supply - standards</topic><topic>Waterborne Diseases - epidemiology</topic><topic>Waterborne Diseases - mortality</topic><topic>Waterborne infections</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ercumen, Ayse</creatorcontrib><creatorcontrib>Arnold, Benjamin F</creatorcontrib><creatorcontrib>Kumpel, Emily</creatorcontrib><creatorcontrib>Burt, Zachary</creatorcontrib><creatorcontrib>Ray, Isha</creatorcontrib><creatorcontrib>Nelson, Kara</creatorcontrib><creatorcontrib>Colford, Jr, John M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ercumen, Ayse</au><au>Arnold, Benjamin F</au><au>Kumpel, Emily</au><au>Burt, Zachary</au><au>Ray, Isha</au><au>Nelson, Kara</au><au>Colford, Jr, John M</au><au>Brocklehurst, Clarissa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Upgrading a piped water supply from intermittent to continuous delivery and association with waterborne illness: a matched cohort study in urban India</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2015-10-01</date><risdate>2015</risdate><volume>12</volume><issue>10</issue><spage>e1001892</spage><epage>e1001892</epage><pages>e1001892-e1001892</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract><![CDATA[Intermittent delivery of piped water can lead to waterborne illness through contamination in the pipelines or during household storage, use of unsafe water sources during intermittencies, and limited water availability for hygiene. We assessed the association between continuous versus intermittent water supply and waterborne diseases, child mortality, and weight for age in Hubli-Dharwad, India.
We conducted a matched cohort study with multivariate matching to identify intermittent and continuous supply areas with comparable characteristics in Hubli-Dharwad. We followed 3,922 households in 16 neighborhoods with children <5 y old, with four longitudinal visits over 15 mo (Nov 2010-Feb 2012) to record caregiver-reported health outcomes (diarrhea, highly credible gastrointestinal illness, bloody diarrhea, typhoid fever, cholera, hepatitis, and deaths of children <2 y old) and, at the final visit, to measure weight for age for children <5 y old. We also collected caregiver-reported data on negative control outcomes (cough/cold and scrapes/bruises) to assess potential bias from residual confounding or differential measurement error. Continuous supply had no significant overall association with diarrhea (prevalence ratio [PR] = 0.93, 95% confidence interval [CI]: 0.83-1.04, p = 0.19), bloody diarrhea (PR = 0.78, 95% CI: 0.60-1.01, p = 0.06), or weight-for-age z-scores (Δz = 0.01, 95% CI: -0.07-0.09, p = 0.79) in children <5 y old. In prespecified subgroup analyses by socioeconomic status, children <5 y old in lower-income continuous supply households had 37% lower prevalence of bloody diarrhea (PR = 0.63, 95% CI: 0.46-0.87, p-value for interaction = 0.03) than lower-income intermittent supply households; in higher-income households, there was no significant association between continuous versus intermittent supply and child diarrheal illnesses. Continuous supply areas also had 42% fewer households with ≥1 reported case of typhoid fever (cumulative incidence ratio [CIR] = 0.58, 95% CI: 0.41-0.78, p = 0.001) than intermittent supply areas. There was no significant association with hepatitis, cholera, or mortality of children <2 y old; however, our results were indicative of lower mortality of children <2 y old (CIR = 0.51, 95% CI: 0.22-1.07, p = 0.10) in continuous supply areas. The major limitations of our study were the potential for unmeasured confounding given the observational design and measurement bias from differential reporting of health symptoms given the nonblinded treatment. However, there was no significant difference in the prevalence of the negative control outcomes between study groups that would suggest undetected confounding or measurement bias.
Continuous water supply had no significant overall association with diarrheal disease or ponderal growth in children <5 y old in Hubli-Dharwad; this might be due to point-of-use water contamination from continuing household storage and exposure to diarrheagenic pathogens through nonwaterborne routes. Continuous supply was associated with lower prevalence of dysentery in children in low-income households and lower typhoid fever incidence, suggesting that intermittently operated piped water systems are a significant transmission mechanism for Salmonella typhi and dysentery-causing pathogens in this urban population, despite centralized water treatment. Continuous supply was associated with reduced transmission, especially in the poorer higher-risk segments of the population.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26505897</pmid><doi>10.1371/journal.pmed.1001892</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Care and treatment Child Mortality Child, Preschool Cholera Complications and side effects Development and progression Drinking water Drinking Water - microbiology Female Hepatitis Households Humans Illnesses India - epidemiology Infant Infant, Newborn Low income groups Male Patient outcomes Prevalence Risk factors Socioeconomic factors Studies Urban Health Water Microbiology Water Quality Water supply Water Supply - standards Waterborne Diseases - epidemiology Waterborne Diseases - mortality Waterborne infections |
| title | Upgrading a piped water supply from intermittent to continuous delivery and association with waterborne illness: a matched cohort study in urban India |
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