title: Faecal contamination of household drinking water in Rwanda: A national cross-sectional study.
abstract: Unsafe drinking water is a leading cause of morbidity and mortality, especially among young children in low-income settings. We conducted a national survey in Rwanda to determine the level of faecal contamination of household drinking water and risk factors associated therewith. Drinking water samples were collected from a nationally representative sample of 870 households and assessed for thermotolerant coliforms (TTC), a World Health Organization (WHO)-approved indicator of faecal contamination. Potential household and community-level determinants of household drinking water quality derived from household surveys, the 2012 Rwanda Population and Housing Census, and a precipitation dataset were assessed using multivariate logistic regression. Widespread faecal contamination was present, and only 24.9% (95% CI 20.9-29.4%, n=217) of household samples met WHO Guidelines of having no detectable TTC contamination, while 42.5% (95% CI 38.0-47.1%, n=361) of samples had >100TTC/100mL and considered high risk. Sub-national differences were observed, with poorer water quality in rural areas and Eastern province. In multivariate analyses, there was evidence for an association between detectable contamination and increased open waste disposal in a sector, lower elevation, and water sources other than piped to household or rainwater/bottled. Risk factors for intermediate/high risk contamination (>10TTC/100mL) included low population density, increased open waste disposal, lower elevation, water sources other than piped to household or rainwater/bottled, and occurrence of an extreme rain event the previous day. Modelling suggests non-household-based risk factors are determinants of water quality in this setting, and these results suggest a substantial proportion of Rwanda's population are exposed to faecal contamination through drinking water.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom. Electronic address: miles.kirby@lshtm.ac.uk.
authors.forename: Miles A
authors.initials: MA
authors.lastname: Kirby
authors.affiliation: Oregon Health and Science University, School of Nursing Portland Campus, 3455 SW US Veterans Hospital Road, SN-6S, Portland, OR 97239, USA. Electronic address: nagelc@ohsu.edu.
authors.forename: Corey L
authors.initials: CL
authors.lastname: Nagel
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom. Electronic address: ghislaine.rosa@lshtm.ac.uk.
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Rosa
authors.affiliation: DelAgua Health Rwanda Implementation, Ltd., 3rd Fl KG 19 Avenue, Kibagabaga Rd, Kigali, Rwanda. Electronic address: laurieniyakaremye1@gmail.com.
authors.forename: Laurien
authors.initials: L
authors.lastname: Iyakaremye
authors.affiliation: Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA 30322, USA. Electronic address: laura.zambrano@emory.edu.
authors.forename: Laura Divens
authors.initials: LD
authors.lastname: Zambrano
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom; Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA 30322, USA. Electronic address: thomas.f.clasen@emory.edu.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Clasen
mesh_terms: D003430:Cross-Sectional Studies; D060766:Drinking Water / Q000032:analysis*; D005191:Family Characteristics; D005243:Feces; D006801:Humans; D012307:Risk Factors; D012432:Rwanda; D060753:Water Quality
chemical_list: D060766:Drinking Water
keywords: Faecal contamination; Precipitation; Rwanda; Water quality