Evaluation of water quality and domestic water treatment practices as risk factors for diarrhea in the Kimana Group Ranch
Tanner, Thomas E
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Diarrheal diseases kills an estimated 1.8 million people per year, of which, 1.6 million are children under the age of five years old. Diarrheal diseases as a result of contaminated drinking water remain a major public health concern in developing countries. Worldwide, about 1.1 billion people lack access to sustainable and safe drinking water sources. Contamination from pesticides, poor sanitation, unsafe waste disposal, and animal and human excrement are detrimental to a community's drinking water quality. The Kimana Group Ranch, a 6,000 square mile Maasai group ranch within the Amboseli Region of the Southern Kajiado District in Southwest Kenya, is a community that has seen drastic changes in its water quality and quantity in recent decades. The Maasai, a traditionally pastoralist tribe, is moving more towards agriculture due to the outside influence of encroaching tribes and the prospect of a better economic future. This shift towards agriculture, increased population growth and the rapidly melting ice caps of Mt. Kilimanjaro have had harmful effects on the ranch's water quality. The purpose of this study was to examine the effects on the Kimana Group Ranch's water quality on diarrheal illness within the ranch. Our goal was to identify those contaminants most likely to cause illness, the types of sources most likely to be contaminated, and the effects of domestic water treatment on the prevalence of diarrheal disease within this community. We hypothesized that open water sources are most likely to be contaminated, that human and animal excrement was causing most of the contamination, and those individuals who treated their water were less likely to report diarrheal illness. Open and closed water sources were identified throughout the community through non-random convenience snowball sampling. Altogether 30 sites were identified, nineteen closed sources and eleven open sources. All sites were sampled and tested for concentrations of ammonia, nitrates, nitrites, pH, presence of fecal coliform, and temperature and conductivity. Surveys were administered at 29 of the sites to 526 participants where we asked individuals questions about their water collection habits, water uses, diarrhea in the household, and domestic water treatment behaviors. Ethical considerations were taken and the study was approved by the Kenyan Institutional Review Board with a waiver of approval from Boston University School of Public Health. Univariate, bivariate, and multivariate analysis was performed using SAS v 9.1. The proportion of individuals reporting diarrhea within their household within the last two weeks was 12% (63/526). There was a two-fold increase in the proportion of individuals who reported illness at open sources versus closed sources, 14.6% and 7.4% respectively. Bivariate analysis shows that individuals who collect water from open sources have 2.15 (95% CI:1.15, 4.00) times the odds of reporting illness in their household as compared to individuals who collect their water from a closed source. Multivariate analysis shows that in this population, treating your water every time you collect reduces your odds of diarrhea by 51%. Fecal coliform was the only water quality predictor that was not within acceptable drinking water standards. All open water sources where illness was reported tested positive for coliform. Illness at open water sources made up 98% of the total illnesses at water sources with coliform contamination. Altogether, 77.8% of all who reported illness were at open water sources. Open water sources are the most contaminated and cause the most illness within the Kimana Group Ranch. Our analysis shows domestic water treatment practices provide a protective effect against diarrhea. Further studies must address other types of microbial contaminants in the ranch's water sources and their association with diarrheal illness. Open water sources and water treatment education must be the focus of interventional research within this community.
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