Notes from the field

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Relationship between diarrhea risk and community-scale water treatment and refill kiosks

In a  study that was conducted by GWP researcher, Dr. Laura Sima, and coauthors at Yale University, Prof Menachem Elimelech, Prof Mayur Desai and Dr. Katie McCarty, this study investigates the association between diarrhea risk and community-scale water treatment and refill kiosks. We present data from a longitudinal study of 1,000 randomly selected low-income households in urban and peri-urban Jakarta. We monitored daily diarrhea status and water source for 1,000 children aged one to four years in Jakarta, Indonesia, for up to five months.

In developing countries, safe piped drinking water is generally unavailable, and bottled water is unaffordable for most people. Purchasing drinking water from community-scale decentralized water treatment and refill kiosks is becoming a common alternative in Indonesia. Within the past ten years this industry has become the primary drinking water source for 25 to 50 percent of low-income families in urban and peri-urban Jakarta, and continues to grow. Concurrently, nonprofit organizations in India and sub-Saharan Africa have devoted themselves to developing similar kiosks. Understanding the link between kiosks and diarrheal disease is an essential first step in determining whether or not to support this industry and how to regulate it. Considering its potential health implications, research and regulation in this sector has thus far been minimal.

Some of the children from the study

Among children in an urban slum, rate of diarrhea per 1,000 child-days varied significantly by primary water source: 8.13 for tap water, 3.60 for bottled water, and 3.97 for water kiosks. In multivariable Poisson regression analysis, diarrhea risk remained significantly lower among water kiosk users (adjusted rate ratio [RR] = 0.49, 95 percent confidence interval [CI] = 0.29--0.83) and bottled water users (adjusted RR = 0.45, 95 percent CI = 0.21--0.97), compared with tap water users. In a peri-urban area, where few people purchased from water kiosk (n=28, 6 percent of total population), diarrhea rates were lower overall: 2.44 for well water, 1.90 for bottled water and 2.54 for water kiosks. There were no significant differences in diarrhea risk for water kiosk users or bottled water users compared to well water users. The diarrhea rates may have been too low for us to notice a statistically significant difference or the well water may have been of high enough quality that a change to bottled or refill water did not impact diarrhea risk.

Purchasing water from low-cost water kiosks is associated with a reduction in diarrhea risk similar to that found for bottled water. Additional studies in other areas of Indonesian or other Southeast Asian countries is recommended to better understand. For additional information and details, please see the entire, published study.

Keywords: refill kiosks, Jakarta, childhood diarrhea, water treatment


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Laura Sima

JHU Researcher
Postdoc Fellow

Environmental Health Sciences

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