title: "Improved" But Not Necessarily Safe: An Assessment of Fecal Contamination of Household Drinking Water in Rural Peru.
abstract: The indicator used to measure progress toward the Millennium Development Goal (MDG) for water is access to an improved water supply. However, improved supplies are frequently fecally contaminated in developing countries. We examined factors associated with Escherichia coli contamination of improved water supplies in rural Pisco province, Peru. A random sample of 207 households with at least one child less than 5 years old was surveyed, and water samples from the source and storage container were tested for E. coli contamination. Although over 90% of households used an improved water source, 47% of source and 43% of stored water samples were contaminated with E. coli. Pouring or using a spigot to obtain water from the storage container instead of dipping a hand or object was associated with decreased risk of contamination of stored water (adjusted prevalence ratio [aPR] = 0.58, 95% confidence interval [CI] = 0.42, 0.80). Container cleanliness (aPR = 0.67, 95% CI = 0.45, 1.00) and correct handwashing technique (aPR = 0.62, 95% CI = 0.42, 0.90) were also associated with decreased contamination risk. These findings highlighted the limitations of improved water supplies as an indicator of safe water access. To ensure water safety in the home, household water treatment and improved hygiene, water handling, and storage practices should be promoted.
authors.affiliation: Department of Epidemiology, University Of Washington, Seattle, Washington; Bacteriology Department, U.S. Naval Medical Research Unit No. 6, Callao, Peru; Waterborne Diseases Prevention Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Hospital San Juan de Dios, Ica Regional Ministry of Health, Pisco, Peru heitzk@uw.edu.
authors.forename: Kristen
authors.initials: K
authors.lastname: Heitzinger
authors.affiliation: Department of Epidemiology, University Of Washington, Seattle, Washington; Bacteriology Department, U.S. Naval Medical Research Unit No. 6, Callao, Peru; Waterborne Diseases Prevention Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Hospital San Juan de Dios, Ica Regional Ministry of Health, Pisco, Peru.
authors.forename: Claudio A
authors.initials: CA
authors.lastname: Rocha
authors.affiliation: Department of Epidemiology, University Of Washington, Seattle, Washington; Bacteriology Department, U.S. Naval Medical Research Unit No. 6, Callao, Peru; Waterborne Diseases Prevention Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Hospital San Juan de Dios, Ica Regional Ministry of Health, Pisco, Peru.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Quick
authors.affiliation: Department of Epidemiology, University Of Washington, Seattle, Washington; Bacteriology Department, U.S. Naval Medical Research Unit No. 6, Callao, Peru; Waterborne Diseases Prevention Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Hospital San Juan de Dios, Ica Regional Ministry of Health, Pisco, Peru.
authors.forename: Silvia M
authors.initials: SM
authors.lastname: Montano
authors.affiliation: Department of Epidemiology, University Of Washington, Seattle, Washington; Bacteriology Department, U.S. Naval Medical Research Unit No. 6, Callao, Peru; Waterborne Diseases Prevention Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Hospital San Juan de Dios, Ica Regional Ministry of Health, Pisco, Peru.
authors.forename: Drake H
authors.initials: DH
authors.lastname: Tilley
authors.affiliation: Department of Epidemiology, University Of Washington, Seattle, Washington; Bacteriology Department, U.S. Naval Medical Research Unit No. 6, Callao, Peru; Waterborne Diseases Prevention Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Hospital San Juan de Dios, Ica Regional Ministry of Health, Pisco, Peru.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Mock
authors.affiliation: Department of Epidemiology, University Of Washington, Seattle, Washington; Bacteriology Department, U.S. Naval Medical Research Unit No. 6, Callao, Peru; Waterborne Diseases Prevention Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Hospital San Juan de Dios, Ica Regional Ministry of Health, Pisco, Peru.
authors.forename: A Jannet
authors.initials: AJ
authors.lastname: Carrasco
authors.affiliation: Department of Epidemiology, University Of Washington, Seattle, Washington; Bacteriology Department, U.S. Naval Medical Research Unit No. 6, Callao, Peru; Waterborne Diseases Prevention Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Hospital San Juan de Dios, Ica Regional Ministry of Health, Pisco, Peru.
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Cabrera
authors.affiliation: Department of Epidemiology, University Of Washington, Seattle, Washington; Bacteriology Department, U.S. Naval Medical Research Unit No. 6, Callao, Peru; Waterborne Diseases Prevention Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Hospital San Juan de Dios, Ica Regional Ministry of Health, Pisco, Peru.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Hawes
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D060766:Drinking Water / Q000382:microbiology* / Q000592:standards; D004926:Escherichia coli; D005191:Family Characteristics; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010568:Peru; D012424:Rural Population; D018508:Water Purification / Q000379:methods / Q000706:statistics & numerical data; D060753:Water Quality / Q000592:standards; D014881:Water Supply / Q000592:standards; D055815:Young Adult
chemical_list: D060766:Drinking Water