Drinking Water Improvement Strategies and Childhood Diarrhea in a Poor Peri-urban Community in the Dominican Republic


  • Nathanael Reid Turner Universtiy of Calgary
  • John McLennan


Background: Diarrhea is a major cause of morbidity and mortality of children in low- and middle-income countries1-2. Contaminated drinking water is an important contributor to diarrheal   illness2-3. Point of use strategies for improving drinking water may be employed4-5, but the extent of use of different strategies and their relationship with childhood diarrhea is inadequately known outside of trial studies.

Design and methodology: Caregivers of 199 children under the age of five participating in a child growth monitoring program based in a poor peri-urban community in the Dominican Republic agreed to participate in the study.  Caregivers were asked a series of drinking water questions at each growth monitoring appointment. Multiple responses per child were adjusted by weighting.

Original data and results: Approximately 22% of children had diarrhea within 2 weeks of growth monitoring appointments. The most common water improvement strategy endorsed as “always” used for the child in the last four weeks was bottled water (53% ) followed by boiling (12%) and chlorination (6%). No reported strategy use was related to child diarrhea, including when stratified by age.

Conclusion: Childhood diarrhea was higher in this community than the national average (14%)6.  High levels of bottled water use are consistent with high household level reports in the Dominican Republic. The lack of relationship between water improvement strategies and diarrhea was unexpected, although in some cases the strategy may have been implemented in response to childhood diarrhea. Analysis of child drinking water samples is required to assess the effectiveness of reported practices.


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2. Copeland, C. C., Beers, B. B., Thompson, M. R., Fitzgerald, R. P., Barrett, L. J., Sevilleja, J. E., Alencar, S., et al. (2009). Faecal contamination of drinking water in a Brazilian shanty town: importance of household storage and new human faecal marker testing. Journal of Water and Health, 7(2), 324–331. doi:10.2166/wh.2009.081

3. Boisson, S., Kiyombo, M., Sthreshley, L., Tumba, S., Makambo, J., & Clasen, T. (2010). Field assessment of a novel household-based water filtration device: A randomised, placebo-controlled trial in the Democratic Republic of Congo. (Q. Nizami, Ed.)PLoS ONE, 5(9), e12613. doi:10.1371/journal.pone.0012613

4. McLennan, J. D., & Farrelly, A. (2010). Reported care giver strategies for improving drinking water for young children. Archives of Disease in Childhood, 95(11), 898–902. doi:10.1136/adc.2009.179648

5. Rosa, G. & Classen T. (2010). Estimating the scope of household water treatment in low-and medium income countries. The American Journal of Tropical Medicine and Hygiene 82(2), 289-300. doi:10.4269/ajtmh.2010.09-0382

6. Centro de Estudios Sociales y Demográficos (CESDEM) y Macro International Inc. 2008. Encuesta Demográfica y
de Salud 2007. Santo Domingo, República Dominicana: CESDEM y Macro International Inc.