title: Is drinking water in Abidjan, Côte d'Ivoire, safe for infant formula?
abstract: OBJECTIVE
  To survey knowledge, attitudes, and practices regarding water use and infant feeding in the Koumassi District of Abidjan, Côte d'Ivoire, and to evaluate the microbiologic quality of source and stored drinking water.
  
  
  METHODS
  Random-cluster household survey.
  
  
  METHODS
  We randomly selected 20 clusters, each comprising six households with at least 1 child aged < or =3 years. In each household, we administered a questionnaire and collected source and stored drinking water samples and tested these for chlorine levels and for total coliform and fecal bacteria count ( Escherichia coli ).
  
  
  RESULTS
  Municipal water was used for drinking in 112 (93%) of 120 households, and in 99 (83%), it was stored for later use. By 1 month of age, 97 (90%) of 108 infants given drinking water were given stored water for drinking. In 8 (66%) of 12 households where children were receiving artificial feeding, formula was prepared from municipal water without additional treatment. Stored water had lower levels of free chlorine than source water (median of 0.05 versus 0.2 mg/dl; p <.001), and E. coli was detected in 36 (41%) of 87 stored water samples and 1 (1%) of 108 source water samples ( p <.001).
  
  
  CONCLUSIONS
  In the Koumassi District of Abidjan, where municipal water is widely available and of good quality, drinking water is stored in most households, is often contaminated with E. coli, and is given to children at a young age. If replacement feeding is to be more widely used to prevent postnatal transmission of HIV-1, communities using stored water need interventions to make stored water safer.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: E F
authors.initials: EF
authors.lastname: Dunne
authors.forename: H
authors.initials: H
authors.lastname: Angoran-Bénié
authors.forename: A
authors.initials: A
authors.lastname: Kamelan-Tano
authors.forename: T S
authors.initials: TS
authors.lastname: Sibailly
authors.forename: B B
authors.initials: BB
authors.lastname: Monga
authors.forename: L
authors.initials: L
authors.lastname: Kouadio
authors.forename: T H
authors.initials: TH
authors.lastname: Roels
authors.forename: S Z
authors.initials: SZ
authors.lastname: Wiktor
authors.forename: E M
authors.initials: EM
authors.lastname: Lackritz
authors.forename: E D
authors.initials: ED
authors.lastname: Mintz
authors.forename: S
authors.initials: S
authors.lastname: Luby
mesh_terms: D002713:Chlorine / Q000032:analysis; D015169:Colony Count, Microbial; D007560:Cote d'Ivoire / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D004926:Escherichia coli / Q000302:isolation & purification; D005191:Family Characteristics; D015658:HIV Infections / Q000517:prevention & control; D006306:Health Surveys; D006801:Humans; D007225:Infant Food / Q000592:standards*; D007231:Infant, Newborn; D011795:Surveys and Questionnaires; D014871:Water Microbiology / Q000592:standards*; D014881:Water Supply / Q000592:standards*
chemical_list: D002713:Chlorine