title: The Relationship Between Distance to Water Source and Moderate-to-Severe Diarrhea in the Global Enterics Multi-Center Study in Kenya, 2008-2011.
abstract: In the developing world, fetching water for drinking and other household uses is a substantial burden that affects water quantity and quality in the household. We used logistic regression to examine whether reported household water fetching times were a risk factor for moderate-to-severe diarrhea (MSD) using case-control data of 3,359 households from the Global Enterics Multi-Center Study in Kenya in 2009-2011. We collected additional global positioning system (GPS) data for a subset of 254 randomly selected households and compared GPS-based straight line and actual travel path distances to fetching times reported by respondents. GPS-based data were highly correlated with respondent-provided times (Spearman correlation coefficient = 0.81, P < 0.0001). The median estimated one-way distance to water source was 200 m for cases and 171 for controls (Wilcoxon rank sums/Mann-Whitney P = 0.21). A round-trip fetching time of > 30 minutes was reported by 25% of cases versus 15% of controls and was significantly associated with MSD where rainwater was not used in the last 2 weeks (odds ratio = 1.97, 95% confidence interval = 1.56-2.49). These data support the United Nations definition of access to an improved water source being within 30 minutes total round-trip travel time.
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya bnygren@cdc.gov.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Nygren
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Ciara E
authors.initials: CE
authors.lastname: O'Reilly
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Anangu
authors.initials: A
authors.lastname: Rajasingham
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Richard
authors.initials: R
authors.lastname: Omore
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Maurice
authors.initials: M
authors.lastname: Ombok
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Alex O
authors.initials: AO
authors.lastname: Awuor
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Jaron
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Fenny
authors.initials: F
authors.lastname: Moke
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Vulule
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Kayla
authors.initials: K
authors.lastname: Laserson
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Tamer H
authors.initials: TH
authors.lastname: Farag
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Dilruba
authors.initials: D
authors.lastname: Nasrin
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: James P
authors.initials: JP
authors.lastname: Nataro
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Kotloff
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Myron M
authors.initials: MM
authors.lastname: Levine
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Gordana
authors.initials: G
authors.lastname: Derado
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Ayers
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: R Ryan
authors.initials: RR
authors.lastname: Lash
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland; Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Mintz
mesh_terms: D016022:Case-Control Studies; D003906:Developing Countries; D003967:Diarrhea / Q000453:epidemiology*; D004751:Enteritis / Q000453:epidemiology* / Q000209:etiology; D040362:Geographic Information Systems; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D013997:Time Factors; D014195:Travel; D014881:Water Supply