title: Comparison of the burden of diarrhoeal illness among individuals with and without household cisterns in northeast Brazil.
abstract: BACKGROUND
  Lack of access to safe and secure water is an international issue recognized by the United Nations. To address this problem, the One Million Cisterns Project was initiated in 2001 in Brazil's semi-arid region to provide a sustainable source of water to households. The objectives of this study were to determine the 30-day period prevalence of diarrhoea in individuals with and without cisterns and determine symptomology, duration of illness and type of health care sought among those with diarrhoea. A subgroup analysis was also conducted among children less than five years old.
  
  
  METHODS
  A face-to-face survey was conducted between August 20th and September 20th, 2007 in the Agreste Central Region of Pernambuco State, Brazil. Households with and without a cistern that had at least one child under the age of five years were selected using systematic convenient sampling. Differences in health outcomes between groups were assessed using Pearson's Chi-squared and two-way t-tests. Demographic variables were tested for univariable associations with diarrhoea using logistic regression with random effects. P-values of 0.05 or less were considered statistically significant.
  
  
  RESULTS
  A total of 3679 people from 774 households were included in the analysis (1863 people from 377 households with cisterns and 1816 people from 397 households without cisterns). People from households with a cistern had a significantly lower 30-day period prevalence of diarrhoea (prevalence = 11.0%; 95% CI 9.5-12.4) than people from households without a cistern (prevalence = 18.2%; 95% CI 16.4-20.0). This significant difference was also found in a subgroup analysis of children under five years old; those children with a cistern had a 30-day period prevalence of 15.6% (95% CI 12.3-18.9) versus 26.7% (95% CI 22.8-30.6) in children without a cistern. There were no significant differences between those people with and without cisterns in terms of the types of symptoms, duration of illness and health care sought for diarrhoea.
  
  
  CONCLUSIONS
  Our results indicate that the use of cisterns for drinking water is associated with a decreased occurrence of diarrhoea in this study population. Further research accounting for additional risk factors and preventative factors should be conducted.
authors: Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada. pasha.marcynuk@phac-aspc.gc.ca
authors: Pasha B
authors: PB
authors: Marcynuk
authors: James A
authors: JA
authors: Flint
authors: Jan M
authors: JM
authors: Sargeant
authors: Andria
authors: A
authors: Jones-Bitton
authors: Ana M
authors: AM
authors: Brito
authors: Carlos F
authors: CF
authors: Luna
authors: Elizabeth
authors: E
authors: Szilassy
authors: M Kate
authors: MK
authors: Thomas
authors: Tiago M
authors: TM
authors: Lapa
authors: Enrique
authors: E
authors: Perez
authors: André M
authors: AM
authors: Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012498:Sanitary Engineering / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
references: Arch Dis Child. 1999 Oct;81(4):337-8
references: 10490440
references: J Infect Dis. 1999 Jul;180(1):167-75
references: 10353875
references: Int J Environ Health Res. 2006 Jun;16(3):231-9
references: 16611567
references: Epidemiol Infect. 2011 Apr;139(4):560-71
references: 20492746
references: Arch Dis Child. 2006 Feb;91(2):139-41
references: 16403847
references: Am J Trop Med Hyg. 2008 Nov;79(5):696-701
references: 18981506
references: Int J Epidemiol. 2006 Aug;35(4):1051-8
references: 16723368
references: J Health Popul Nutr. 2010 Apr;28(2):149-58
references: 20411678
references: Water Sci Technol. 2007;56(9):21-8
references: 18025727
references: Epidemiol Infect. 2008 Apr;136(4):451-60
references: 17565767
references: Epidemiol Infect. 2004 Aug;132(4):607-17
references: 15310162
references: BMC Public Health. 2006 Dec 19;6:307
references: 17178001
references: Appl Environ Microbiol. 2008 Sep;74(17):5490-6
references: 18621865
references: Am J Trop Med Hyg. 2008 Mar;78(3):382-7
references: 18337330
references: J Health Popul Nutr. 2009 Jun;27(3):345-57
references: 19507750
references: Water Res. 2006 Jan;40(1):37-44
references: 16343588
references: Lancet. 1996 Dec 21-28;348(9043):1695-7
references: 8973432
references: Can J Microbiol. 2008 Jun;54(6):495-500
references: 18535637
references: Lancet Infect Dis. 2005 Jan;5(1):42-52
references: 15620560
references: Am J Trop Med Hyg. 2007 Feb;76(2):354-64
references: 17297049
references: Epidemiol Infect. 2008 Nov;136(11):1463-71
references: 18205977
references: Am J Trop Med Hyg. 2008 Sep;79(3):394-400
references: 18784232
references: BMJ. 2005 Sep 3;331(7515):478
references: 16046440
references: Am J Trop Med Hyg. 2009 Feb;80(2):286-93
references: 19190228
references: Bull World Health Organ. 2003;81(3):197-204
references: 12764516
references: Health Educ Behav. 2008 Apr;35(2):207-20
references: 17114333