Risk assessment of waterborne infections in Enugu State, Nigeria: Implications of household water choices, knowledge, and practices

Onyekachi Juliet Okpasuo; Ifeanyi Oscar Aguzie; Anunobi Toochukwu Joy; Fabian C Okafor; Onyekachi Juliet Okpasuo; Ifeanyi Oscar Aguzie; Anunobi Toochukwu Joy; Fabian C Okafor

doi:10.3934/publichealth.2020050

AIMS Public Health

2020, Volume 7, Issue 3: 634-649. doi: 10.3934/publichealth.2020050

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Research article

Risk assessment of waterborne infections in Enugu State, Nigeria: Implications of household water choices, knowledge, and practices

1.
Parasitology and Public Health Research Laboratory, University of Nigeria, Nsukka, Nigeria
2.
Science Laboratory Technology Department, Federal Polytechnic, Idah, Kogi State, Nigeria
3.
Ecology and Environmental Biology, University of Nigeria, Nsukka, Nigeria

Received: 05 July 2020 Accepted: 27 July 2020 Published: 06 August 2020

This research investigated the prevalence of waterborne infections (WBIs) and the risks associated with household drinking water choices, knowledge, and practices. A cross-sectional multi-stage sampling research design was employed. A well-structured questionnaire was used to sample 403 individuals representing 115 household; and stool samples collected and subjected to standard parasitic and bacterial diagnostic methods. From the 403 samples, 344 (85.4%) were positive for at least one waterborne pathogen of nine isolates: E. coli (38.0%), Giardia lamblia (35.2%), E. histolytica (33.0%), Salmonella typhi (19.9%), Proteus spp. (13.2%), Shigella dysentery (9.4%), Klebsiella spp. (7.4%), Enterobacter spp. (5.5%), and Cryptosporidium spp. (5.2%). Prevalence of WBIs was >75% in all age groups, but decreased with age. Prevalence of WBIs was >80% in all communities. Risk was not biased by gender. Odds of infection from public well (OR = 2.487; CI₉₅: 1.296–4.774) and borehole/vendor (OR = 2.175; CI₉₅: 1.231–3.843) users was over two times greater than non-users. Risk of WBDs was significantly reduced by 60% in sachet water drinkers (OR = 0.392; CI₉₅: 0.217–0.709; p < 0.05). Surprisingly, river/stream water users had a significant reduced risk of WBDs than non-users (OR = 0.335; CI₉₅: 0.150–0.749; p < 0.05). Poor hygiene was the most important determinant of WBIs; poor sanitary practice increased odds of WBIs by 400% (OR = 4.945; CI₉₅: 2.358–10.371; p < 0.05). This study shows that most household water choices are vulnerable to contamination at many points in their journey from source to mouth; and advocates adequate provision of safe water, “point of use” household water treatment, and good storage methods to effectively curb WBIs.
- water quality,
- safe drinking water,
- poor hygiene,
- waterborne diseases
Citation: Onyekachi Juliet Okpasuo, Ifeanyi Oscar Aguzie, Anunobi Toochukwu Joy, Fabian C Okafor. Risk assessment of waterborne infections in Enugu State, Nigeria: Implications of household water choices, knowledge, and practices[J]. AIMS Public Health, 2020, 7(3): 634-649. doi: 10.3934/publichealth.2020050

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Abstract

This research investigated the prevalence of waterborne infections (WBIs) and the risks associated with household drinking water choices, knowledge, and practices. A cross-sectional multi-stage sampling research design was employed. A well-structured questionnaire was used to sample 403 individuals representing 115 household; and stool samples collected and subjected to standard parasitic and bacterial diagnostic methods. From the 403 samples, 344 (85.4%) were positive for at least one waterborne pathogen of nine isolates: E. coli (38.0%), Giardia lamblia (35.2%), E. histolytica (33.0%), Salmonella typhi (19.9%), Proteus spp. (13.2%), Shigella dysentery (9.4%), Klebsiella spp. (7.4%), Enterobacter spp. (5.5%), and Cryptosporidium spp. (5.2%). Prevalence of WBIs was >75% in all age groups, but decreased with age. Prevalence of WBIs was >80% in all communities. Risk was not biased by gender. Odds of infection from public well (OR = 2.487; CI₉₅: 1.296–4.774) and borehole/vendor (OR = 2.175; CI₉₅: 1.231–3.843) users was over two times greater than non-users. Risk of WBDs was significantly reduced by 60% in sachet water drinkers (OR = 0.392; CI₉₅: 0.217–0.709; p < 0.05). Surprisingly, river/stream water users had a significant reduced risk of WBDs than non-users (OR = 0.335; CI₉₅: 0.150–0.749; p < 0.05). Poor hygiene was the most important determinant of WBIs; poor sanitary practice increased odds of WBIs by 400% (OR = 4.945; CI₉₅: 2.358–10.371; p < 0.05). This study shows that most household water choices are vulnerable to contamination at many points in their journey from source to mouth; and advocates adequate provision of safe water, “point of use” household water treatment, and good storage methods to effectively curb WBIs.

Acknowledgments

We acknowledge Mr Kenneth Ugwu of Classical Biomedicals and Diagnostic Centre for the resourceful assistance and guidance during microbial examination of samples. We thank Abergel Megan for English proofreading of the manuscript.

Study limitations

The authors note two important limitations of this study:
1. Symptomatic and asymptomatic carriers, which would have helped ascertain the risk asymptomatic infected people pose, was not reported. Symptomatic and asymptomatic individuals pose risk, but symptomatics are more likely to seek treatment, reducing the risk of transmission.
2. We did not distinguish stream water users based on the level of treatment they give to their water. Also, other impacts of stream water (e.g. presence of heavy metal, runoffs from agricultural farms, etc.) on users was not ascertained. We did not also verify whether stream users received more frequent treatment for WBDs due to the high probability of their constant exposure to WBDs arising from drinking stream water. This limitation was unanticipated and surprisingly due to reduced risk of WBDs among stream water users. Thus, this deficiency would hopefully be addressed from further studies in this regard.
These two limitations do not, however, reduce the relevance of our findings nor the generalizability of same.

Conflicts of interest

The authors declare that there was no conflict of interest.

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