Research article

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

  • 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.

    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[J]. AIMS Public Health, 2020, 7(3): 634-649. doi: 10.3934/publichealth.2020050

    Related Papers:

    [1] Antonio Gagliano, Salvatore Giuffrida, Francesco Nocera, Maurizio Detommaso . Energy efficient measure to upgrade a multistory residential in a nZEB. AIMS Energy, 2017, 5(4): 601-624. doi: 10.3934/energy.2017.4.601
    [2] Afamia Elnakat, Juan D. Gomez, Martha Wright . A measure to manage approach to characterizing the energy impact of residential building stocks. AIMS Energy, 2016, 4(4): 574-588. doi: 10.3934/energy.2016.4.574
    [3] Hamza El Hafdaoui, Ahmed Khallaayoun, Kamar Ouazzani . Activity and efficiency of the building sector in Morocco: A review of status and measures in Ifrane. AIMS Energy, 2023, 11(3): 454-485. doi: 10.3934/energy.2023024
    [4] Hossam A. Gabbar, Ahmed Eldessouky, Jason Runge . Evaluation of renewable energy deployment scenarios for building energy management. AIMS Energy, 2016, 4(5): 742-761. doi: 10.3934/energy.2016.5.742
    [5] Sergio Copiello . Building energy efficiency: New challenges for incentive policies and sustainable business models. AIMS Energy, 2024, 12(2): 481-483. doi: 10.3934/energy.2024022
    [6] Theocharis Tsoutsos, Stavroula Tournaki, Maria Frangou, Marianna Tsitoura . Creating paradigms for nearly zero energy hotels in South Europe. AIMS Energy, 2018, 6(1): 1-18. doi: 10.3934/energy.2018.1.1
    [7] Fiona Bénard-Sora, Jean-Philippe Praene, Yatina Calixte . Assess the local electricity consumption: the case of Reunion island through a GIS based method. AIMS Energy, 2018, 6(3): 436-452. doi: 10.3934/energy.2018.3.436
    [8] Abanda F.Henry, Nkeng G.Elambo, Tah J.H.M., Ohandja E.N.Fabrice, Manjia M.Blanche . Embodied Energy and CO2 Analyses of Mud-brick and Cement-block Houses. AIMS Energy, 2014, 2(1): 18-40. doi: 10.3934/energy.2014.1.18
    [9] Zhongjiao Ma, Zichun Yan, Mingfei He, Haikuan Zhao, Jialin Song . A review of the influencing factors of building energy consumption and the prediction and optimization of energy consumption. AIMS Energy, 2025, 13(1): 35-85. doi: 10.3934/energy.2025003
    [10] Lamya Lairgi, Rachid Lagtayi, Yassir Lairgi, Abdelmajid Daya, Rabie Elotmani, Ahmed Khouya, Mohammed Touzani . Optimization of tertiary building passive parameters by forecasting energy consumption based on artificial intelligence models and using ANOVA variance analysis method. AIMS Energy, 2023, 11(5): 795-809. doi: 10.3934/energy.2023039
  • 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.


    As far as the built environment is concerned, improving performance implies reasoning on multiple levels and taking action on a variety of elements in a building or a building unit. The expression building performance is a broad concept with no univocal definition in the literature, possibly because constructions are durable goods and complex systems. Forasmuch as building performance is difficult to define, it is also hard to evaluate. Early examples of building performance evaluation were developed in the US between the late sixties and the mid-seventies, leading authors to use the expression post-occupancy evaluation for the methodologies meant to evaluate building performance after their construction and occupation. More recently, the academic and professional debate has further evolved, expanding the research interest in performance evaluation to the whole building life-cycle [1,2].

    A broad research strand has long since focused on building performance from the perspective of energy saving and efficiency [3,4,5], especially concerning energy consumption from non-renewable sources, not least because of the implications in the matter of greenhouse gas emissions [6,7,8,9]. Over time, the research strand mentioned above branched out into several specific fields of study, some of which—among the primary ones—can be identified as follows: 1) building system optimization as well as integration of innovative technologies into the building and use of advanced and highly performing building materials [10,11]; 2) integration of passive systems and architectural design optimization concerning the characteristics that influence the most energy consumption, such as orientation and shape [12,13]. Nonetheless, the topic of building performance improvement is much broader, encompassing issues such as the home and workplace healthiness and safety [14,15,16], the comfort perceived by the users [17,18], and other aspects [19]. Actually, the attention paid by authors in the literature to the overall building performance increased earlier and faster than the focus on building energy efficiency, and is still growing stronger (Figure 1).

    Figure 1.  Occurrences of the expressions "building performance" and "building energy efficiency" in English books (source: Google Books Ngram Viewer, https://books.google.com/ngrams, last accessed 21.05.2024).

    In this position paper, we argue that two somewhat niche topics—whether the focus is on energy efficiency or other aspects shaping the notion of building performance—are deeply intertwined with the issue of improving that performance, and thus, they deserve greater attention. The first topic—discussed below in Section 2—is hinged upon the notion of budget constraint, which plays a crucial role in the decision-making processes on the construction of new buildings or the renovation of existing ones, as it significantly affects the planning and execution stages, as well as the outcomes. The second topic discussed later in Section 3 is related to operating in critical scenarios, meaning dealing with building performance improvement while facing problematic situations, such as rapidly developing demographic phenomena and other anthropological changes, for instance, overcrowding due to fast population growth and recurrent natural disasters such like sea level rise and flash flooding due to climate change.

    Economic issues are known to be tied to achievable levels of building performance [20]. The role played by economic parameters in shaping the viability of adopting efficiency measures is a case in point [21,22,23]. An additional case in point is represented by the examination of the financial incentives to push the adoption of efficiency measures, in addition to the rise and growth of innovative business models [24,25] to exploit those incentives in the building industry [26,27,28]. Another pertinent example is given in the studies dealing with the appraisal of the cost premium [29,30] and the price premium [31,32] of highly efficient buildings compared to conventional ones [33,34,35]. Nonetheless, the comparative analysis of the profitability of investing in high-performance constructions—whether performed through well-known cost-benefit or life-cycle cost models [36,37,38], or even novel economic and multi-criteria models [39,40]—often misses considering a second feasibility dimension, namely, the ability to meet a given budget constraint.

    The early literature on the topic explored a variety of market failures and barriers—such as imperfect and asymmetric information, bounded rationality, split incentives, transaction costs, and more [41,42,43]—that hinder the adoption of state-of-the-art and high-performance solutions in buildings. While the actual occurrence of all these barriers is disputed [44,45,46], consumers' and firms' spending ability is recognized as a barrier itself [47,48]. There is an inherent conflict - apparent and yet still partly neglected - between the substantial costs required to get high-performance buildings and the limited ability to incur capital expenditures by property owners and other investors (Figure 2). A budget constraint is seldom included in the evaluation of performance optimization measures to be adopted in new [49,50] and existing buildings [51]. Its consideration is largely connected with the use of analytical models derived from the life-cycle costing approach and the cost-optimal methodology [52,53]. It is additionally linked to the planning of maintenance and renovation actions of building elements according to their deterioration function in a couple of research papers [54,55], as well as used among the inputs in investment decision optimization tools concerning retrofit measures in multiple buildings in another couple of studies [56,57,58].

    Figure 2.  Economic optimum and budget constraint for capital expenditures (source: authors' study based on [5], page 1072, Figure 6).

    There is a case for arguing that the research on the investments meant to improve building energy efficiency—and building performance, more broadly—has been focused primarily in Western economies and developed countries [59]. Thus, it has predominantly advanced in the EU and US contexts [60] with a few other additional areas, following the adoption and implementation of targeted policies, codes, and regulations in those countries, as also shown by the International Energy Agency in its 2018 report (Figure 3). Only recently, the literature reported studies of efficiency and performance in the least-developed countries. Such studies are still limited to a small number [61,62].

    Figure 3.  (a) Building energy codes by jurisdiction (source: International Energy Agency, 2018, "Global Status Report Towards a zero-emission, efficient and resilient buildings and construction sector", https://www.iea.org, last accessed 21.05.2024). (b) Per capita GDP as of the year 2021 (source: World Bank, 2023, GDP per capita—dataset, World Development Indicators—original data, with minor processing by Our World in Data, https://ourworldindata.org/grapher/gdp-per-capita-worldbank, last accessed 21.05.2024).

    One of the issues with that lies in the lack of representativeness [63]. Western economies and developed countries hardly provide a comprehensive representation of the various situations the majority of the world's population faces, both in terms of rapidly evolving demographic phenomena— or other anthropological changes—and recurring natural disasters. We refer to them as critical scenarios. On the demographic and anthropological side, they include exponential population growth, fast rural-to-urban migration resulting in intensive land-use changes, overcrowding of urban areas, and other migratory movements with related shifts in needs and wants, tastes, and preferences [64,65,66]. On the environmental side, they also include sea level rise, flash flooding, drought, overheating, and desertification due to ongoing climate change, which represents a source of substantial risk for urban areas [67,68,69,70].

    Since many of the above-mentioned disruptive phenomena are bound to occur in developing and underdeveloped countries [71,72,73], the dynamic interplay between budget constraints and critical scenarios looks like an interesting field of study. From a normative analysis perspective, what strategies and tactics should be adopted to cope with limitations on spending power while simultaneously dealing with challenging situations? Also, from a positive analysis perspective, what actual actions do the affected people, households, and firms put into play? How much do critical scenarios worsen the burden of budget constraints, especially in large urban areas and in developing countries? Thus, how much does exposure to critical scenarios exacerbate budget constraints? How do budget constraints in critical scenarios interact with medium-to long-run policy goals as far as building performance is concerned? These are just a few instances of the research questions populating this field of inquiry.

    In the near future, we expect more and more studies to address the above research issues and, perhaps, other related research topics so as to start shedding light on this under-explored topic.

    This paper is meant as the opening of the special issue "Budget constraints in critical scenarios: challenges to improving building performance" in the journal AIMS Energy. Please see: https://www.aimspress.com/aimse/article/6744/special-articles.

    The authors declare no conflicts of interest.


    Acknowledgments



    We acknowledge Mr Kenneth Ugwu of Classical Biomedicals and Diagnostic Centre for the resourceful assistance and guidance during microbial examination of samples. We thank Abergel Megan for English proofreading of the manuscript.

    Study limitations



    The authors note two important limitations of this study:
    1. Symptomatic and asymptomatic carriers, which would have helped ascertain the risk asymptomatic infected people pose, was not reported. Symptomatic and asymptomatic individuals pose risk, but symptomatics are more likely to seek treatment, reducing the risk of transmission.
    2. We did not distinguish stream water users based on the level of treatment they give to their water. Also, other impacts of stream water (e.g. presence of heavy metal, runoffs from agricultural farms, etc.) on users was not ascertained. We did not also verify whether stream users received more frequent treatment for WBDs due to the high probability of their constant exposure to WBDs arising from drinking stream water. This limitation was unanticipated and surprisingly due to reduced risk of WBDs among stream water users. Thus, this deficiency would hopefully be addressed from further studies in this regard.
    These two limitations do not, however, reduce the relevance of our findings nor the generalizability of same.

    Conflicts of interest



    The authors declare that there was no conflict of interest.

    [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. doi: 10.1139/w03-046
    [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. doi: 10.1016/j.heliyon.2018.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 Durban, South Africa: Thesis, Durban University of Technology.
    [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. doi: 10.1186/s13568-014-0051-x
    [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 Enugu: Pegant Ventures.
    [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. doi: 10.1007/s13201-013-0131-0
    [21] Vandepitte J, Verhaegen J, Engbaek K, et al. (2003)  Basic laboratory procedures in clinical bacteriology Geneva: World Health Organization.
    [22] Cheesbrough M (2006)  District laboratory practice in tropical countries part 2 New York: Cambridge University Press. doi: 10.1017/CBO9780511543470
    [23] Odeyemi OA (2015) Bacteriological safety of packaged drinking water sold in Nigeria: public health implications. Springer plus 4: 642. doi: 10.1186/s40064-015-1447-z
    [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. doi: 10.1186/1471-2458-14-1167
    [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] (2014) United State Agency for International Development (USAID)Nigeria Water and Sanitation Profile. London, United Kingdom: University Press.
    [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. doi: 10.1097/QCO.0000000000000096
    [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. doi: 10.1371/journal.pntd.0001483
    [32] Hindman PT (2002) Household choice of drinking-water source in the Philippines. Asian Econ J 16: 303-316. doi: 10.1111/1467-8381.t01-1-00154
    [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. doi: 10.4269/ajtmh.2010.09-0320
    [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. doi: 10.4102/jamba.v4i1.49
    [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 Geneva, Switzerland: World Health Organization.
  • publichealth-07-03-050-s001.pdf
  • Reader Comments
  • © 2020 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(6880) PDF downloads(295) Cited by(9)

Figures and Tables

Figures(2)  /  Tables(4)

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog