Export file:


  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text


  • Citation Only
  • Citation and Abstract

Risk assessment of waterborne infections in Enugu State, Nigeria: Implications of household water choices, knowledge, and practices

1 Parasitology and Public Health Research Laboratory, University of Nigeria, Nsukka, Nigeria
2 Science Laboratory Technology Department, Federal Polytechnic, Idah, Kogi State, Nigeria
3 Ecology and Environmental Biology, University of Nigeria, Nsukka, Nigeria

This research investigated the prevalence of waterborne infections (WBIs) and the risks associated with household drinking water choices, knowledge, and practices. A cross-sectional multi-stage sampling research design was employed. A well-structured questionnaire was used to sample 403 individuals representing 115 household; and stool samples collected and subjected to standard parasitic and bacterial diagnostic methods. From the 403 samples, 344 (85.4%) were positive for at least one waterborne pathogen of nine isolates: E. coli (38.0%), Giardia lamblia (35.2%), E. histolytica (33.0%), Salmonella typhi (19.9%), Proteus spp. (13.2%), Shigella dysentery (9.4%), Klebsiella spp. (7.4%), Enterobacter spp. (5.5%), and Cryptosporidium spp. (5.2%). Prevalence of WBIs was >75% in all age groups, but decreased with age. Prevalence of WBIs was >80% in all communities. Risk was not biased by gender. Odds of infection from public well (OR = 2.487; CI95: 1.296–4.774) and borehole/vendor (OR = 2.175; CI95: 1.231–3.843) users was over two times greater than non-users. Risk of WBDs was significantly reduced by 60% in sachet water drinkers (OR = 0.392; CI95: 0.217–0.709; p < 0.05). Surprisingly, river/stream water users had a significant reduced risk of WBDs than non-users (OR = 0.335; CI95: 0.150–0.749; p < 0.05). Poor hygiene was the most important determinant of WBIs; poor sanitary practice increased odds of WBIs by 400% (OR = 4.945; CI95: 2.358–10.371; p < 0.05). This study shows that most household water choices are vulnerable to contamination at many points in their journey from source to mouth; and advocates adequate provision of safe water, “point of use” household water treatment, and good storage methods to effectively curb WBIs.
  Article Metrics

Keywords water quality; safe drinking water; poor hygiene; waterborne diseases

Citation: Onyekachi Juliet Okpasuo, Ifeanyi Oscar Aguzie, Anunobi Toochukwu Joy, Fabian C Okafor. Risk assessment of waterborne infections in Enugu State, Nigeria: Implications of household water choices, knowledge, and practices. AIMS Public Health , 2020, 7(3): 634-649. doi: 10.3934/publichealth.2020050


  • 1. Ayoade AA, Sikiru S, Okanlawon PO (2017) Assessment of Water Provision and Associated Risks Among Children in Abeokuta Peri-Urban, Ogun State, Southwestern Nigeria: The Gender Implications. wH2O: J Gender Water 4: 9.
  • 2. World Health Organisation (2010) Progress on sanitation and drinking-water: Joint Monitoring Programme 2010 update. Available from: https://www.who.int/water_sanitation_health/publications/9789241563956/en.
  • 3. United Nations Children Education Fund (UNICEF)/World Health Organization (WHO) (2012) Progress on drinking water and sanitation-2012 update, USA. Available from: https://www.unicef.org/media/files/JMPreport2012.pdf.
  • 4. World Health Organization (2000) Global water supply and sanitation assessment report. Available from: https://www.who.int/water_sanitation_health/monitoring/jmp2000/en/.
  • 5. World Health Organization (2012) Burden of Diseases and Cost-Effectiveness Estimates. Available from: https://www.en.wikipedia.org/wiki/waterborne-diseases.
  • 6. United Nations Children's Fund (UNICEF)/World Health Organization (WHO) (2009) Diarrhoea: Why Children are still dying and what can be done. Available from: https://www.who.int/maternal_child_adolescent/document/9789241598415/2n/.
  • 7. Johnson JYM, Thomas JE, Graham TA, et al. (2003) Prevalence of Escherichia coli 0157: H7 and Salmonella spp, in surface waters of Southern Alberts and its relation to manure source. Can J Microbiol 49: 326–335.    
  • 8. Obiri-Danso K, Adjei B, Stanley KN, et al. (2009) Microbiological quality and metal levels in wells and boreholes water in some peri-urban communities in Kumasi, Ghana. Afr J Environ Sci Technol 3: 059–066.
  • 9. CNN Wire Staff (2010) Waterborne diseases outbreaks in developing countries. Available from: http://edition.cnn.com/2010/WORLD/africa/.
  • 10. Armah FA, Ekumah B, Yawson DO, et al. (2018) Access to improved water and sanitation in sub-Saharan Africa in a quarter century. Heliyon 4: e00931.    
  • 11. Malik A, Yasar A, Tabinda A, et al. (2012) Water-borne diseases, cost of illness and willingness to pay for diseases interventions in rural communities of developing countries. Iran J Public Health 41: 39–49.
  • 12. WASH-Plus (2010) WASH related diseases. Available from: http://washalerts.wordpress.com/author/envhealth/page/22/.
  • 13. Monique U (2012) Microbiological drinking water quality and prevalence of waterborne diseases in Masaka, Rwanda. Thesis, Durban University of Technology, Durban, South Africa.
  • 14. Fletcher SM, Mary-Louise M, John TE (2013) Prevalence of gastrointestinal pathogens in developed and developing countries: systematic review and meta-analysis. J Public Health Resour 2: 42–53.
  • 15. Pandey PK, Kass PH, Soupir ML, et al. (2014) Contamination of water resources by pathogenic bacteria. AMB Express 4: 51.    
  • 16. Okpasuo OJ, Okafor FC, Aguzie I, et al. (2019) Spatiotemporal trend of waterborne disease in Enugu Urban, Nigeria: A retrospective study. Int J Trop Dis Health 38: 1–13.
  • 17. Olajuyigbe AE, Alinaitwe P, Adegboyega SA, et al. (2012) Spatial Analysis of Factors Responsible for Incidence of Water Borne Diseases in Ile-Ife, Nigeria. J Sustainable Soc 1: 96–113.
  • 18. Akabuike BO (1990) A Short Text on Geography. Pegant Ventures, Enugu.
  • 19. Thomas B (2017) City population. Available from: http://www.citypopulation.info/php/nigeria-admin.php?adm2id=NGA014005.
  • 20. Ezenwaji EE, Anyadike RNC, Igu NI (2014) Optimal allocation of public water supply to the urban sectors of Enugu, Nigeria: a linear programming approach. Appl Water Sci 4: 73–78.    
  • 21. Vandepitte J, Verhaegen J, Engbaek K, et al. (2003) Basic laboratory procedures in clinical bacteriology, 2 Eds., World Health Organization, Geneva.
  • 22. Cheesbrough M (2006) District laboratory practice in tropical countries part 2. Cambridge University Press, New York.
  • 23. Odeyemi OA (2015) Bacteriological safety of packaged drinking water sold in Nigeria: public health implications. Springer plus 4: 642.    
  • 24. Olajuyigbe AE (2010) Some factors impacting on the quantity of water used by households in a rapidly urbanizing State capital in South Western Nigeria. J Sustainable Dev Afr 12: 322–337.
  • 25. Dalhat MM, Isa AN, Nguku P, et al. (2014) Descriptive characterization of the 2010 cholera outbreak in Nigeria. BMC Public Health 14: 1167.    
  • 26. Sule IB, Yahaya M, Aisha AA, et al. (2014) Descriptive epidemiology of a cholera outbreak in Kaduna State, Northwest Nigeria. Pan Afr Med J 27: 172.
  • 27. Raji MO, Ibrahim Y (2011) Prevalence of waterborne infections in Northwest Nigeria: A retrospective study. J Public Health Epidemiol 3: 382–385.
  • 28. United State Agency for International Development (USAID) (2014) Nigeria Water and Sanitation Profile. University Press, London, United Kingdom.
  • 29. WHO (2014) Water Quality and Health. Drinking water chlorination-A review of disinfection practices and issues. Available from: http://www.waterandhealth.org/drinkingwater/wp.html.
  • 30. Das JK, Salam RA, Bhutta ZA (2014) Global burden of childhood diarrhea and interventions. Curr Opin Infect Dis 27: 451–458.    
  • 31. Yang K, LeJeune J, Alsdorf D, et al. (2012) Global distribution of outbreaks of water-associated infectious diseases. PLoS Negl Trop Dis 6: e1483.    
  • 32. Hindman PT (2002) Household choice of drinking-water source in the Philippines. Asian Econ J 16: 303–316.    
  • 33. Onjala J, Ndiritu SW, Stage J (2013) Risk Perception, Choice of Drinking Water, and Water Treatment. Environ Dev, 13–10.
  • 34. Rosa G, Miller L, Clasen T (2010) Microbiological Effectiveness of Disinfecting Water by Boiling in Rural Guatemala. Am J Trop Med Hyg 82: 473–477.    
  • 35. Kioko KJ, Obiri JF (2012) Household attitudes and knowledge on drinking water enhance water hazards in peri-urban communities in Western Kenya. Jàmbá J Disaster Risk Stud 4: 49–54.
  • 36. Dunker L (2001) The KAP Tool for Hygiene. A Manual on: Knowledge, Attitudes and Practices in the Rural Areas of South Africa. WRC Report No.TT 144/00, Water Research Commission, Pretoria, South Africa.
  • 37. Nala NP, Jagals P, Joubert G (2003) The effect of a water-hygiene educational programme on the microbiological quality of container-stored water in households. Water SA 29: 171.
  • 38. Lantagne D, Quick R, Mintz E (2006) Household water treatment and safe storage options in developing countries: a review of current implementation practices. Washington DC: Woodrow Wilson International Center.
  • 39. Center for Disease Control (2010) Global Water Sanitation and Hygiene. Available from: http://www.cdc.gov/healthywater/global/index.html.
  • 40. Pruss-Ustun A, Bos R, Gore F, et al. (2012) Safe Water, Better Health: Cost, Benefits and Sustainability of Interventions to Protect and Promote Health. World Health Organization, Geneva, Switzerland.


Copyright Info: © 2020, Onyekachi Juliet Okpasuo, licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Associated material

PubMed record



PDF downloads(299)

HTML views(234)



Other articles by authors

[+] on Google Scholar

[+] on PubMed


Related pages

on Google Scholar

on PubMed



Download XML

Email to a friend

Order reprints

Copyright © AIMS Press All Rights Reserved