Two studies investigate health impacts of continuous piped water supply

This week's issue of PLOS Medicine features two separate studies, each of which investigates the importance of uninterrupted piped water supplies to health outcomes. In a matched cohort study in Hubli-Dharwad, India, Ayse Ercumen of the University of California, Berkeley, and colleagues compared health outcomes for households that had been upgraded to receive continuous piped water to households with intermittent water supply. Aurélie Jeandron of the London School of Hygiene & Tropical Medicine and colleagues conducted a time-series regression of water supply to Uvira, Democratic Republic of the Congo and admissions to the local Cholera Treatment Centre (CTC).

Ercumen and colleagues found that in households with continuous as compared to intermittent piped water supplies, there was a 37% lower prevalence of dysentery among children under 5 in low-income segments of the population, and a 42% lower incidence of typhoid fever among all household members. However, there was no significant association found between upgraded water supply and other health outcome measures, such as overall diarrheal illness and growth in children under 5 years old.

Ercumen and colleagues say that their "findings suggest that intermittently operated piped water systems serve as a transmission pathway for waterborne pathogens in this urban population despite centralized treatment."

Jeandron and colleagues found that in the 12 days following a day without tap water in water supply, CTC admissions increased by 155% compared to admissions following a day with optimal water supply, and that suspected cholera cases attributable to low water supply accounted for 23.2% of total CTC admissions. Laboratory confirmation of suspected cholera cases was not available for this study, and the analysis did not suggest any association between chlorine levels and suspected cholera incidence.

Jeandron and colleagues say that their results "argue in favour of water supply investments that focus on the delivery of a reliable and sustainable water supply and not only on point-of-use water quality improvements as are often seen during cholera outbreaks."

In a Perspective linked to these two research articles, Clarissa Brocklehurst of the University of North Carolina at Chapel Hill and Tom Slaymaker of UNICEF discuss the importance of providing universal access to safe and reliable drinking water supplies as envisaged in the 2030 Sustainable Development Goals. Brocklehurst and Slaymaker write: "The studies in this issue of PLOS Medicine highlight the importance of continuous piped water supply, but also the pitfalls. Interruptions in the supply can negate the possible health benefits, and installing piped water without addressing other environmental concerns may not deliver the hoped-for health benefits."

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Ercumen et al., Upgrading a Piped Water Supply from Intermittent to Continuous Delivery and Association with Waterborne Illness: A Matched Cohort Study in Urban India

This work was supported by the Blum Center for Developing Economies at University of California, Berkeley. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors have declared that no competing interests exist.

Ercumen A, Arnold BF, Kumpel E, Burt Z, Ray I, Nelson K, et al. (2015) Upgrading a Piped Water Supply from Intermittent to Continuous Delivery and Association with Waterborne Illness: A Matched Cohort Study in Urban India. PLoS Med 12(10): e1001892. doi:10.1371/journal.pmed.1001892

Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America

Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California, United States of America

Aquaya Institute, Nairobi, Kenya Energy and Resources Group, University of California, Berkeley, Berkeley, California, United States of America

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001892

Ayse Ercumen

UC Berkeley
Division of Epidemiology, School of Public Health
50 University Hall, #7360
Berkeley, 94720
UNITED STATES
15102258828
aercumen@berkeley.edu

Jeandron et al., Water Supply Interruptions and Suspected Cholera Incidence: A Time-Series Regression in the Democratic Republic of the Congo

AJ received funding from the Agence Française de Développement (grant RCH 310-2013) for this work. AG was supported by a Methodology Research fellowship from UK Medical Research Council (Grant ID: G1002296).The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

The authors have declared that no competing interests exist.

Jeandron A, Saidi JM, Kapama A, Burhole M, Birembano F, Vandevelde T, et al. (2015) Water Supply Interruptions and Suspected Cholera Incidence: A Time-Series Regression in the Democratic Republic of the Congo. PLoS Med 12 (10): e1001893. doi:10.1371/journal.pmed.1001893

Environmental Health Group, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom

Ministère de la Santé Publique, Division Provinciale de la Santé Publique, District Sanitaire d'Uvira, Uvira, Sud-Kivu, République Démocratique du Congo

Ministère de la Santé Publique, Division Provinciale de la Santé Publique, Bukavu, Sud-Kivu, République Démocratique du Congo

Fondation Veolia, Nanterre, France

Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom

Department of Social and Environmental Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001893

Aurelie Jeandron

Research Fellow
London School of Hygiene and Tropical Medicine
Infectious and Tropical Diseases faculty, Diseases Control Department
Keppel Street
London, WC1E 7HT
UNITED KINGDOM
0044(0)207 927 2802.
press@lshtm.ac.uk

Brocklehurst and Slaymaker, Continuity in Water Supply

No funding supported this work.

I have read the journal's policy and have the following conflicts: TS is a Senior Statistics and Monitoring Specialist at UNICEF and manages the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation; CB consults for UNICEF, the World Bank, and WHO; CB is on an advisory committee for a CLTS project undertaken by PLAN International USA and is paid for this work; CB is a member of the Board of Trustees of WaterAid; CB is Chair of the Advisory Committee of One Drop Foundation; CB is a member of the Strategic Advisory Group of the WHO-UNICEF Joint Monitoring Program and the UN Water GLAAS Report; CB is a past board member of WaterCan (now WaterAid Canada).

Brocklehurst C, Slaymaker T (2015) Continuity in Drinking Water Supply. PLoS Med 12 (10): e1001894. doi:10.1371/journal.pmed.1001894

Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America

Data & Analytics Section/Division of Data, Research and Policy, UNICEF, New York, New York, United States of America

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001894

Clarissa Brocklehurst

Department of Environmental Sciences and Engineering,
Gillings School of Global Public Health, University of North Carolina at Chapel Hill
Chapel Hill , North Carolina 27599
UNITED STATES
16136052433
cbrocklehurst@unc.edu