Impact of tubewell access and tubewell depth on childhood diarrhea in Matlab, Bangladesh

Van, Wu Jianyong, Yunus Mohammad, Streatfield Peter, Escamilla Veronica, Akita Yasuyuki, Serre Marc, Emch, Emch Michael

Description

During the past three decades in Bangladesh, millions of tubewells have been installed to reduce the prevalence of diarrheal disease. This study evaluates the impacts of tubewell access and tubewell depth on childhood diarrhea in rural Bangladesh. Methods A total of 59,796 cases of diarrhea in children under 5 were recorded in 142 villages of Matlab, Bangladesh during monthly community health surveys between 2000 and 2006. The location and depth of 12,018 tubewells were surveyed in 2002-04 and integrated with diarrhea and other data in a geographic information system. A proxy for tubewell access was developed by calculating the local density of tubewells around households. Logistic regression models were built to examine the relationship between childhood diarrhea, tubewell density and tubewell depth. Wealth, adult female education, flood control, population density and the child's age were considered as potential confounders. Results Baris (patrilineally-related clusters of households) with greater tubewell density were associated with significantly less diarrhea (OR (odds ratio) = 0.87, 95% confidence interval (CI): 0.85-0.89). Tubewell density had a greater influence on childhood diarrhea in areas that were not protected from flooding. Baris using intermediate depth tubewells (140-300 feet) were associated with more childhood diarrhea (OR = 1.24, 95% CI: 1.19-1.29) than those using shallow wells (10-140 feet). Baris using deep wells (300-990 feet) had less diarrheal disease than those using shallow wells, however, the difference was significant only when population density was low (< 1000 person/km 2 ) or children were at the age of 13-24 months. Conclusions Increased access to tubewells is associated with a lower risk of childhood diarrhea. Intermediate- depth wells are associated with more childhood diarrhea compared to shallower or deeper wells. These findings may have implications for on-going efforts to reduce exposure to elevated levels of arsenic contained in groundwater that is pumped in this study area primarily from shallow tubewells.

Sujets

• Tube well
• Groundwater
• Arsenic

Informations

• Publié par: biomed
• Publié le: 01 janvier 2011
• Nombre de lectures: 5
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Wu et al . Environmental Health 2011, 10 :109 http://www.ehjournal.net/content/10/1/109

R E S E A R C H Open Access Impact of tubewell access and tubewell depth on childhood diarrhea in Matlab, Bangladesh Jianyong Wu 1 , Mohammad Yunus 2 , Peter Kim Streatfield 2 , Alexander van Geen 3 , Veronica Escamilla 4,5 , Yasuyuki Akita 1 , Marc Serre 1 and Michael Emch 4,5*

Abstract Background: During the past three decades in Bangladesh, millions of tubewells have been installed to reduce the prevalence of diarrheal disease. This study evaluates the impacts of tubewell access and tubewell depth on childhood diarrhea in rural Bangladesh. Methods: A total of 59,796 cases of diarrhea in children under 5 were recorded in 142 villages of Matlab, Bangladesh during monthly community health surveys between 2000 and 2006. The location and depth of 12,018 tubewells were surveyed in 2002-04 and integrated with diarrhea and other data in a geographic information system. A proxy for tubewell access was developed by calculating the local density of tubewells around households. Logistic regression models were built to examine the relationship between childhood diarrhea, tubewell density and tubewell depth. Wealth, adult female education, flood control, population density and the child ’ s age were considered as potential confounders. Results: Baris (patrilineally-related clusters of households) with greater tubewell density were associated with significantly less diarrhea (OR (odds ratio) = 0.87, 95% confidence interval (CI): 0.85-0.89). Tubewell density had a greater influence on childhood diarrhea in areas that were not protected from flooding. Baris using intermediate depth tubewells (140-300 feet) were associated with more childhood diarrhea (OR = 1.24, 95% CI: 1.19-1.29) than those using shallow wells (10-140 feet). Baris using deep wells (300-990 feet) had less diarrheal disease than those using shallow wells, however, the difference was significant only when population density was low (< 1000 person/km 2 ) or children were at the age of 13-24 months. Conclusions: Increased access to tubewells is associated with a lower risk of childhood diarrhea. Intermediate- depth wells are associated with more childhood diarrhea compared to shallower or deeper wells. These findings may have implications for on-going efforts to reduce exposure to elevated levels of arsenic contained in groundwater that is pumped in this study area primarily from shallow tubewells. Keywords: Diarrheal disease, tubewell, groundwater, arsenic

Background In Bangladesh, diarrheal diseases are one of the leading Diarrheal diseases are a major public health problem in causes of death in children under 5, accounting for 20% the developing world. Approximately 1.5 million chil- of all infant deaths [4]. In an effort to reduce diarrheal dren die from diarrheal diseases each year globally, diseases, during the past 30 years Bangladesh has under- which makes it the second most common cause of mor- taken an almost universal shift from drinking surface tality in children under five [1]. Diarrheal diseases can water to drinking groundwater. The concentration of be attributed to contaminated drinking water, poor sani- fecal indicator bacteria is typically orders of magnitude tation and hygiene, and more broadly to poverty [2,3]. lower in groundwater compared to surface water in den- sely populated villages of Bangladesh [5]. Millions of tubewells have been installed and now provide drinking * Correspondence: [e-mail] 4 Department of Geography, University of North Carolina at Chapel Hill, NC water for more than 95% of rural residents [6]. Diarrhea USA mortality has declined in the past four decades in rural Full list of author information is available at the end of the article © 2011 Wu et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.