Article Type: Original Article
Title: Identifying water sources, quality of drinking water, implications and prevalence of Gastrointestinal problems and its associated risk factors in a rural area of India: A Community-Based Cross-Sectional and Observational Study
Year: 2022; Volume: 2; Issue: 2; Page No: 4 – 13
Authors: Senthilvel Vasudevan1*
, Priyanka Raj C K2
https://doi.org/10.55349/ijmsnr.202222413
Affiliations: 1*Assistant Professor of Statistics, Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 2Associate Professor, Department of Epidemiology and Public Health and Biostatistics, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman.
Article Summary: Submitted: 10-April-2022; Revised: 12-May-2022; Accepted: 10-June-2022; Published: 30-June-2022
Corresponding Author:
Dr. Senthilvel Vasudevan,
Assistant Professor of Statistics (Biostatistics),
Department of Pharmacy Practice,
College of Pharmacy,
King Saud Bin Abdulaziz University for Health Sciences,
Riyadh, Saudi Arabia.
Email ID: vasudevans@ksau-hs.edu.sa
Abstract:
Background: Water is the most important and essential resource on earth. All creatures on earth depend on water. The quality of water is based on its physical, chemical and biological properties. Water quality plays a very important role in our health. Poor water quality can lead to many communicable and non-communicable diseases. In this study, we intend to identify water sources, quality of drinking water, its implications and the prevalence of Gastrointestinal problems and its associated risk factors in a rural area of South India.
Materials and Methods: A Community-Based Cross-Sectional and Observational Study of two villages namely Villipakkam and Puthirankottai was conducted with a sample of 1517 individuals were interviewed with a pre-tested pre-designed questionnaire.
Results: In our study, we surveyed two villages with a total of 1517 study participants, of which 797 (52.5%) were females. Overall, 58 (11.8%) of the households had gastrointestinal (GI) problems in the last 3 months. 64.4% were consuming non-chlorinated water and 53.3% of household members didn’t consume boiled water. 68.7% didn’t had toilet facility. Variables like educational status, occupational status, boiling of drinking water, washing hands before eating, using pipe water for drinking purpose showed statistically significant association with people those who were affected by GI problem with p<0.05. The mean pH level was found as 7.14 ± 0.43 (6.50 – 7.65).
Conclusion: Our study revealed that the population used water from various sources like tap water, pump water, and other sources like streams, rivers, lakes and tanks in both villages. More than half of the study participants weren’t consuming safe water and didn’t have proper latrine facilities. A few 11% of the households had GI problems. This was probably due to consumption of unsafe water, not washing their hands before eating and not consuming boiled drinking water. The results of microbiological analysis of the water samples showed the water quality was unsatisfactory. The overall study report of physical analysis of water samples was satisfactory. Health education program and IEC activities were undertaken in the study areas to create health awareness regarding safe drinking water and impact of water borne diseases on health.
Keywords: water quality, prevalence, rural population, water quality, water borne diseases, community-based study
Full Text
Introduction
Water is the most important and essential resource on earth. All creatures on earth depend on water. [1] The quality of water is based on its physical, chemical and biological properties. Water quality plays a very important role in our health. Poor water quality can lead to many communicable and non-communicable diseases. Safe water prevents and reduces the mortality and morbidity due to communicable diseases. [2] Globally one of the most common diseases is diarrhea, which is mainly attributed to unsafe water supply, inadequate sanitation and hygiene. Diarrheal diseases account for 11% of deaths globally. [3] It accounts for nearly 2.2 million deaths in children aged < 5 years in developing countries. [4] Over 3.86 million deaths occur annually due to diarrheal diseases. [5] As per the report of projection of Global Burden Disease, the Water Borne Disease (WBD) was the 2nd highest mortality in the year 1990, but lower in burden 9th most important mortality reason in the year 2020. [6] Nearly, one third of the communicable diseases in India are water borne as per World Bank report. In 1999, an estimated 7 million of deaths due to diarrhea alone occurred in India with an average of 1,600 deaths/day. The highest mortality from diarrhea is in children under the age of five, highlighting an urgent need for focused interventions to prevent diarrheal disease in this age group. [7] Water related diseases such as vector borne diseases are important public health problems. Large scale droughts and floods contribute to water related diseases. Especially in India, monsoon season results in stagnation of water which serves as breeding ground for vectors. Though water quality is not a major determinant of vector borne diseases, however, an intermediate link exists between household water storage and vector breeding. Globally in recent times, the prevalence rate of Dengue fever has increased by 50 times especially in tropical and sub-tropical countries including urban and rural areas where Aedes mosquitoes breed easily in small pits of stagnated water collections. [8] In recent years, the prevalence rate of dengue has increased to endemic level in India. [9] In 2012, about 9,249 cases and 60 deaths due to dengue were reported in Tamil Nadu thus contributing highest number of cases among all states in India. [10]
In India, most sources of water are susceptible to bacterial infections like Cholera and Typhoid. 68 outbreaks occurred in eighteen states and union territories and the overall number of cases was over 2.22 million. The states of Orissa, West Bengal, Andaman and Nicobar Islands, Assam and Chhattisgarh accounted for 91% of all outbreaks related cases in the year 1998. [11] The viral infection due to Rotavirus is third leading cause for Diarrhea resulting in hospitalization worldwide. [12] 151 cases were reported per 10,000 populations and 50 deaths were reported. [13] Most cases were reported as WBD from West Bengal, India. [14]
The 34th World Health Assembly in 1984 emphasized that safe drinking water is a basic element of “Primary health care”. [15] In 2001, safe drinking water was recognized as a basic need for human development. Health and drinking water are today accepted as a basic human right. In the Millennium Development Goal, Goal 7; Target 7 calls for reducing by half the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015. [16] Approximately 1.2 million people globally do not have access to safe drinking water. [17] Most Indian towns and cities don’t have access to safe drinking water. More and more water resources are polluted with untreated/partially treated wastes from industries, domestic sewage and fertilizer/pesticide run off from agriculture fields. There is a huge deficit of sewage treatment facilities in most cities and hardly any in rural parts of India. [18] This study was planned to assess the water quality and its implications in rural area in Tamil Nadu, to measure the prevalence of selected water borne diseases in the study area and to recommend the possible remedial measures based on the findings of the study to the community, panchayat leaders and to the policy makers.
Materials and Methods
A community-based cross-sectional and observational study of ten villages of Chunambedu area of Kancheepuram district, Tamil Nadu, was undertaken. These villages were Illedu, Villipakkam, Agaram, Kayanallur, Vannianallur, Manapakkam, Pudupattu, Chunampet, Puthirankottai and Kavanur falling under the field practice area of Rural Health Training Centre of Pondicherry Institute of Medical Sciences (PIMS), Pondicherry, India. This study was conducted between 6th January 2014 and 1st February 2014. Out of these ten villages, two villages namely Villipakkam and Puthirankottai under Cheyyur taluk were selected randomly and study was conducted as shown in Figure – 1. The total population of Puthirankottai was 1893 as per 2011 census and 471 households.
Figure: 1 Distribution of districts among Tamilnadu State and Taluka map of Kancheepuram district and the map of Chunampet Village
Calculation of Sample size: A study conducted by Janani et al showed a prevalence of gastrointestinal symptoms in the Northwest part of Chennai, South India [19] of (p) = 8.05%, Z1.96 at 5% alpha error (α) = 1.96; 95% statistical significance and 20% allowable error (d) of prevalence (in percentage). Sample size for our study was arrived by using the formula, N = 4pq/d2. The sample size was calculated as 1143. We recruited and included 1517 individuals for the current study.
Sampling technique for the main survey: The study was conducted in the rural areas of in and around areas of Chunambedu, Chithamur Block in Kancheepuram district, Tamil Nadu, India which comes under the field practice area of PIMS RHTC, Chunambedu Village. Villipakkam and Puthirankottai villages were included in the present study and the samples were collected by simple random method. Water samples were collected from the common water sources of study areas and tested microbiologically. Data were collected from the permanent residents of both the villages.
Method of data collection: Data collection was done by house-to-house survey by the undergraduate medical students with the supervision of Community Medicine faculty by using a proforma, and were additionally guided by the interns, postgraduate medical students, nurses and social workers of rural health and training centre of PIMS, Chunampet, Tamil Nadu, India. Study tool: The proforma contained a questionnaire which was pre-designed and pre-tested and was used to collect basic demographic information, sources, details of drinking water, gastrointestinal symptoms from the households. The need and purpose of the study were clearly explained to the study participants. Written consent was obtained from the participants. The filled proformas were verified by Interns, postgraduates and community medicine faculty and staff on the same day and preserved at the PIMS training center, Chunampet, Tamil Nadu, India.
Inclusion criterion: All permanent residents of the villages identified by their respective ration cards were included in the study.
Exclusion criterion: Those who were critically ill, not permanent resident and those who weren’t willing to participate were excluded from the study.
Methodology of the collection of water samples from various water sources and its progress: The water samples collected from Puthirankottai and Villipakkam villages were subjected to microbiological analysis.
- Method of Water Samples Obtained from various water sources: Water samples were obtained in heat sterilized glass bottles of 230 ml with ground glass stoppers protected by Kraft paper. (i). Sampling from a tap or pump outlet: The tap or pump outlet was cleaned from outside. The tap was turned at a maximum flow rate and the water was let to flow for 5 minutes. The stopper was opened, filled with water and the stopper was replaced. (ii). Sampling of water from a reservoir (Streams, rivers, lakes and tanks): The stopper was opened, and the bottle was submerged to a depth of about 20 cms with mouth facing upwards.
- Transport of water samples: The water bottles were wrapped in a Kraft paper. The water samples were properly labelled with details of the source, time and date of collection and delivered to the microbiology laboratory within 4 hours. The water samples were processed on the same day.
- Methods of Analysis: The test was employed normally for water bacteriology and follows: (i). Presumptive coliform count; (ii). Differential coliform count.
- Presumptive coliform count: Multiple tube method was generally adopted for measuring of probable number of coliform bacilli in water. By this, the most probable number of coliform organisms were detected in hundred ml.
a). Media: Twice and single strength Mac Conkey broths in bottles or tubes containing Durham’s tube for indication of gas production were used. These media contain bromocresol blue as indicator.
b). Procedure: Measured amounts of water samples were added by sterile graduated pipettes as below: Each bottle of 50 ml in one and double strength medium respectively. 10 ml of water each to 5 tubes of 10 ml double strength medium. In each to 5 tubes of 1 ml of water and of 5 ml single strength medium.
The inoculated tubes/bottles were incubated at 370 C for 48 hrs. An estimate of coliform count per 100 ml was made from the tubes / bottles showing acid and gas production using the probability table. The presumptive coliform count of 0 taken as excellent, 1 – 3 as satisfactory, 4 – 10 as suspicious and >10 unsatisfactory per 100 ml.
- Differential coliform count Eijkman test: Some spore-bearing organisms give false positive reactions in the presumptive coliform test. The test was done to confirm that the coliform bacilli detected in the presumptive test are Escherichia coli. After the usual presumptive test, subcultures were made from all +ve tubes/bottles to fresh tubes of single strength Mac Conkey broth with Durham’s tube. These were incubated at 440 Celsius in water bath and examined after 24 hrs. Those tubes showed gas in Durham’s tube contained Escherichia coli. Confirmation of Escherichia coli was made by plating on solid media and indole production.
The location of the water sources was plotted on the respective village maps. Geographic Information System was used to map the villages. The base maps of Puthirankottai and Villipakkam villages were downloaded from Google Earth. The village maps were obtained from the concerned Village Administrative Officer. The Latitude and Longitude of the common water sources in those villages were recorded with the help of a compass, at the time of collection of the water samples. The location of these common water sources was plotted on the respective base maps with the help of Arc GIS software [20], with the assistance of the Department of Earth Science, Pondicherry University. The contaminated water sources, the households with Gastrointestinal symptoms and demarcation of houses receiving water from a particular water source were plotted on the respective base maps as shown in Figure-2 and Figure-3.
Figure – 2 Distribution of water sources in Villipakkam Village
Figure – 3 Distribution of water sources in Puthirankottai Village
Data analysis and statistical methods: Descriptive statistics like mean and standard deviation were used to express continues variables, frequency and proportions were expressed as qualitative variables. For association between the categorical variables was performed by Chi-Square test. Data was analyzed by SPSS 20.0 version [IBM Ltd., USA]. Data analysis was done by the students under the guidance of the Postgraduates Medical Students and faculties.
Data entry and management: Data was entered and complied by using Microsoft excel 2010 [Microsoft Ltd., USA]. The entered excel sheets were verified and checked for the wrong entry, missing data by the undergraduate and post graduate medical students and faculty. The level of significant was stated as p-value < 0.05.
Ethical Approval and Clearance: The study was done with prior permission from the Director-Principal and the Head of the Department of Community Medicine of PIMS, Kalapet, Pondicherry, India. The ethical approval was obtained properly from the Institutional Research and Ethical Committee of PIMS. The patients’ data were kept confidential and preserved in the RHTC, Chunampet, Chyyar Taluk, Kanchipuram District, Tamilnadu India.
Results
A total of 492 households were surveyed of which 224 (45.5%) were from Villipakkam and 268 (54.5%) were from Puthirankottai villages. Form these household, 1517 individuals were interviewed face-to-face. Among 1517 individuals, 797 (52.5%) were females and 720 (47.5%) were males. 348 (22.9%) were illiterate, 135 (8.9%) had higher secondary education, 32 (2.1%) were professionals, 109 (7.2%) were graduates, 8 (0.5%) were postgraduates and 55 (3.6%) were children with below 3 years.
384 (25.3%) were clerical, shop owners and farmers, 154 (10.2%) were skilled workers, and 495 (32.6%) were unemployed. In the surveyed 492 households, 156 (31.7%) heads of the households were illiterate, 239 (48.6%) heads of the households were clerical/shop owners/farmers.
421 (85.6%) households belong to nuclear family. Out of 492 households, 230 (46.7%) were overcrowded, 244 (49.6%) belong to Class-II Socio-economic status. 241 (49%) were kutcha house, 338 (68.7%) threw the dry waste in open, 338 (68.7%) didn’t had toilet facility, 252 (51.2%) used wood for cooking and 292 (59.3%) households used piped water for drinking purposes.
Majority 457 (92.9%) did not have any complaints of any odor in their drinking water. Majority 465 (94.5%) did not complain of any taste/unpleasant taste in their drinking water. Among 492, majority 424 (86.2%) of households were reported that the drinking water looked clear, while 230 (46.7%) consumed boiled water. 37 (18.5%) households found precipitates on boiling the drinking water and 18 (9%) had foam when using water with soap. 447 (90.9%) washed the vessels before collecting water, 337 (68.5%) households were using closed vessels while storing the drinking water. More than half of the households 284 (57.7%) used plastic pots/containers for storing water. 175 (35.6%) households consumed chlorinated water. 47 (39.2%) of the study population clean their household water tank. 44 (36.7%) of households use water tanks with lid. Majority 457 (92.9%) of the households wash their hands before eating, most of the households 145 (29.5%) used soap for washing their hands. Overall, 58 (11.8%) of the households had gastrointestinal (GI) problems in the last 3 months. 8 (13.7%) of the households who had attended function/festival/fair and had GI problems in the last 3 months as shown in Figure – 4 (Map – 5 and Map – 6).
Figure – 4 Distribution of households who had attended function/festival/fair and had GI problems in the last 3 months
Out of 492 households, 58 (11.8%) households had GI problems in the last 3 months. The association between gender, using soap while hand washing, washing the vessel before collecting, consumption of chlorinated water didn’t show any statistical significance with people those who were affected by gastrointestinal disease (p>0.05). But, the variables like educational status, occupational status, boiling of drinking water, washing hands before eating, using pipe water for drinking purpose showed a significant association with people those who were affected by GI (p<0.05). Gender, using soap while hand washing, washing the vessel before collecting water, consumption of chlorinated water didn’t show any significant association, with p-value of > 0.05 as shown in Table – 1.
Table – 1 Distribution and association between socio economic, other variables and people affected by Gastrointestinal in the past three months (N = 1517)
| Basic Characteristics and Other Variables | People affected by Gastrointestinal in the past three months | Total
N (%) |
Chi-Square test value &
p-value |
|
| Yes
45 (2.97%) |
No
1472 (97.03%) |
|||
| Gender (N=1517) | ||||
| Male | 26 (57.8) | 694 (47.1) | 720 (47.5) | 1.979
0.159 |
| Female | 19 (42.2) | 778 (52.9) | 797 (52.5) | |
| Educational Status (N=1517) | ||||
| Illiterate | 4 (8.9) | 344 (23.4) | 348 (22.9) | 12.953
0.044* |
| Primary | 6 (13.3) | 187 (12.7) | 193 (12.7) | |
| Middle | 12 (26.7) | 313 (21.3) | 325 (21.4) | |
| High School | 17 (37.8) | 295 (20.1) | 311 (20.6) | |
| Higher secondary | 3 (6.7) | 132 (9.0) | 135 (8.9) | |
| Profession | 0 (0.0) | 32 (2.2) | 32 (2.1) | |
| Graduate | 2 (4.4) | 107 (7.3) | 109 (7.2) | |
| Post graduate | 1 (2.2) | 7 (0.5) | 8 (0.5) | |
| Other (Children below 3 years)* | 0 (0) | 55 (3.7) | 55 (3.6) | |
| Occupational Status (N=1517) | ||||
| Profession | 0 (0) | 56 (3.8) | 56 (3.7) | 7.535
0.006** |
| Semi-profession | 0 (0) | 30 (2.0) | 30 (2.0) | |
| Clerical, shop owners, farmers | 6 (13.3) | 378 (25.7) | 384 (25.3) | |
| Skilled worker | 14 (31.1) | 140 (9.5) | 154 (10.2) | |
| Semi-skilled worker | 2 (4.4) | 54 (3.7) | 56 (3.7) | |
| Unskilled worker | 0 (0.0) | 28 (1.9) | 28 (1.8) | |
| Unemployed | 14 (31.1) | 481 (32.7) | 495 (32.6) | |
| Students | 9 (20.0) | 250 (17.0) | 259 (17.1) | |
| Children below 3 years* | 0 (0.0) | 55 (3.7) | 55 (3.6) | |
| Boiling of drinking water (N=492) | ||||
| Yes | 8 (3.5) | 222 (96.5) | 230 (46.7) | 3.940
0.047* |
| No | 20 (71.4) | 242 (52.2) | 262 (53.3) | |
| Washing Hands Before eating (N=492) | ||||
| Yes | 11 (39.3) | 446 (96.1) | 457 (92.9) | 129.080
0.0001** |
| No | 17 (48.6) | 18 (3.9) | 35 (7.1) | |
| Using soap while hand washing (N=492) | ||||
| Yes^ | 4 (2.4) | 141 (29.3) | 145 (29.5) | 0.111
0.739^ |
| No | 7 (2.0) | 340 (98.0) | 347 (70.5) | |
| Washing the vessel before collecting water (N=492) | ||||
| Yes | 26 (92.9) | 421 (90.7) | 447 (90.9) | 0.143
1.000^ |
| No | 2 (7.1) | 43 (9.3) | 45 (9.1) | |
| Consumption of Chlorinated Water (N=492) | ||||
| Yes | 7 (4.0) | 168 (96.0) | 175 (35.6) | 1.447
0.229 |
| No | 21 (6.6) | 296 (93.4) | 317 (64.4) | |
| Using pipe water for drinking purpose (N=492) | ||||
| Yes | 22 (7.9) | 255 (92.1) | 277 (56.3) | 5.985
0.014* |
| No | 6 (2.8) | 209 (97.2) | 215 (43.7) | |
^Missing Value Occurred
Microbiological Analysis of water: For microbiological analysis of water, four samples from Villipakkam and six samples from Puthirankottai were collected. The water samples collected from Villipakkam showed heavy growth of Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterobacter. The water samples collected from Puthirankottai showed heavy growth of Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. But this is unlikely to cause any GI illness in our study population as shown in Table – 2.
Table – 2 List of sources of water and results of microbiological analysis of the water samples
| Sample
no. |
Name of the Village | Sources | Inference | Reports |
| 1 | Villipakkam | Pond water | Klebsiellapneumoniae | Unsatisfactory |
| 2 | Overhead water tank | Pseudomonas aeruginosa | Unsatisfactory | |
| 3 | Water tank | Klebsiellapneumoniae,
Enterobacter |
Unsatisfactory | |
| 4 | Water tank | Klebsiellapneumoniae,
Enterobacter |
Unsatisfactory | |
| 5 | Puthirankottai | Water tank | Klebsiellapneumoniae,
Pseudomonas aeruginosa |
Unsatisfactory |
| 6 | Hand pump | Pseudomonas aeruginosa | Unsatisfactory | |
| 7 | Hand pump | Klebsiellapneumoniae,
Pseudomonas aeruginosa |
Unsatisfactory | |
| 8 | Water tank | Klebsiellapneumoniae,
Pseudomonas aeruginosa |
Unsatisfactory | |
| 9 | Water tank | Klebsiellapneumoniae | Unsatisfactory | |
| 10 | Water tank | Klebsiellapneumoniae, E.coli | Unsatisfactory |
The mean pH level was found as 7.14 ± 0.43 (6.50 – 7.65). The overall report of the results of physical analysis of the water samples was satisfactory as shown in Table – 3.
Table: 3 Distribution of results of physical analysis of the water samples
| S_No | pH
(6.5 – 8.5) |
TDS
(500 – 2000 mg/L) |
EC
(< 2000 us/cm) |
Reports |
| 1 | 7.32 | 1638.848 | 1048.863 | Satisfactory |
| 2 | 7.45 | 1132.305 | 724.6752 | Satisfactory |
| 3 | 7.42 | 1837.716 | 1176.138 | Satisfactory |
| 4 | 7.5 | 1250.871 | 800.5574 | Satisfactory |
| 5 | 7.17 | 1277.538 | 817.6243 | Satisfactory |
| 6 | 7.65 | 2923.789 | 1871.225 | Satisfactory |
| 7 | 6.79 | 973.946 | 623.3254 | Satisfactory |
| 8 | 6.99 | 1694.681 | 1084.596 | Satisfactory |
| 9 | 7.55 | 1004.771 | 643.0534 | Satisfactory |
| 10 | 7.58 | 968.561 | 619.879 | Satisfactory |
| 11 | 6.69 | 1314.61 | 841.3504 | Satisfactory |
| 12 | 7.55 | 738.59 | 472.6976 | Satisfactory |
| 13 | 7.58 | 1464.987 | 937.5917 | Satisfactory |
| 14 | 6.69 | 1434.849 | 918.3034 | Satisfactory |
| 15 | 6.52 | 1221.775 | 781.936 | Satisfactory |
| 16 | 6.54 | 1057.84 | 677.0176 | Satisfactory |
| 17 | 6.51 | 1625.625 | 1040.400 | Satisfactory |
| 18 | 6.50 | 1979.762 | 1267.048 | Satisfactory |
| 19 | 7.34 | 1638.681 | 1048.756 | Satisfactory |
| 20 | 7.42 | 1527.241 | 1536.028 | Satisfactory |
Discussion:
Among the study population, half of the study population belonged to Class – II Socioeconomic status based on Modified BG Prasad classification 2013. One fourth of the study population were clerical/shop owners/farmers and were illiterate. In these villages, more than half of the study population were using piped water for drinking purposes. Among 492 households, 230 (46.7%) were consuming non-chlorinated water and 262 (53.3%) of household members didn’t consume boiled water. Three fourth of the households didn’t have proper latrine facilities. Very less no. of household members had gastrointestinal problems in the past 3 months. In our study, nearly more than half of the household members didn’t consume chlorinated water, and it was associated with gastrointestinal problems/episodes.
A study done by Sathe et al [21] showed 6.67% persons had GI problems due to drink non-chlorinated water. Firth et al [22] conducted a study in India on point of use intervention to decrease water contamination and importance of chlorination of water in a rural area. In our present study, half of the household members didn’t wash their hand before eating which was a risk factor for GI illness. Lee et al [23] revealed that using alcohol-based hand sanitizer would increase the GI problem in 3/4th of persons in house because not wash their hands properly before eating. In our study more than half of household members didn’t consume boiled water which probably caused GI problems.
Sophie et al showed that the process of heating of drinking water could kill almost all the microorganism, viruses and by this helped to decontaminate the water. [24]. In our study, we have found that GI illness was associated with factors like consuming non-chlorinated water, without heating, not washing hands before eating, poor latrine facility and disposing waste in open space. Similar type of results and relationships were found in a study by Greenwell et al [25] wherein it was seen that typhoid was preventable by use of safe water, adequate sanitation and, simple hygienic behavior like hand washing by using soap. In our study, more than half of the households used pipe water for drinking purposes.
Similar results were seen in a study conducted by Gasem et al. [26] In our study, 11 (39.3%) of the individuals were affected with GI problems and they weren’t washing their hand before eating and the association was highly significant with p-value = 0.0001 (<0.001). Similar results were found in a study by Vollaard et al. [27] In this study, very few (8.9%) of the subjects were illiterate and showed statistically significant with p-value = 0.044 (<0.05) and 64% of household members were consuming non-chlorinated water but didn’t show statistical significance with p-value = 0.229.
A study conducted by Tran et al [28] on-risk factors associated with typhoid fever, showed that illiteracy was significant associated, with p-value = 0.03 (<0.05) and consumption of untreated water was independently associated with typhoid fever with p<0.001. In our study, 13.3% of the individuals were unemployed and showed significant with GI problems with p<0.001. A review article by Duncan said that no water borne disease was ever associated with Klebisella in drinking water, but it caused only hospital acquired (nosocomial) infection. [29] The WHO article on “Heterophilic Plate count Measurement in Drinking Water Safety Management” concludes that there is no evidence for association of Pseudomonas aeruginosa, Acinetobacter spp., Aeromonas spp. Klebsiella pneumonia, Enterobacter with GI infection through the water-borne route among the population. [30]
Reza et al [31] conducted a study on ground water quality index in Orissa. Water quality index (WQI) rating was carried out to quantify overall ground water quality status of the area. The values of WQI have been affected mainly by the concentration of dissolved ions (F, NO, Ca and Mg) in ground water. Kumar et al [32] conducted a study on Ground water quality assessment using WQI in Vedaranayam, Tamil Nadu, India. They had collected 44 groundwater samples from bore and tube well. Nearly above half (66%) of ground water samples in post-monsoon season and one third of the samples in summer season which were found as non-consumable status. Fe and F values were found more in the 36 samples. NO3 was found more value in 27 samples. This increment of poor category in post-monsoon when compared to summer season indicates the ground water quality in the study area was slowly getting degraded. Higher values of calcium and magnesium were found.
Revelle [33] has recommended the Cl-/(CO32- + HCO3-) be introduced to evaluate the salt water intrusion. The second parameter suggested for identification of saltwater contamination is total alkalinity/total hardness ratio (TA/TH). Priya et al [34] conducted a study on assessment of water quality Indices for Ground water in Singanallur Basin, Coimbatore. The study concludes that groundwater quality of city needs greater attention because it is the alternative source of water for domestic and agricultural purposes. The technology adopted combines field investigations and GIS (Geographic Information System) in Coimbatore aera. The WQI has been calculated for the Singanallur sub-basin and the entire sub-basin was zoned to study the suitability of water for drinking purposes using ArcGIS software and the results concluded that the ground water quality was unfit for drinking in some of the areas scoring a WQI>100. Although there were variations in the physical and chemical parameters of water from the normal levels, it is more unlikely to cause any gastrointestinal manifestations in our study population.
Conclusion
Our study revealed that the population used water from various sources like tap water, pump water, and other sources like streams, rivers, lakes and tanks in both villages. Water samples were taken from all these sources for physical and microbiological analysis. Half of the households were using piped water for drinking purposes. Most of the participants weren’t consuming chlorinated water. More than half of the study participants weren’t consuming boiled/safe water and didn’t have proper latrine facilities. The variables like educational status, occupational status, boiling of drinking water, washing hands before eating, using pipe water for drinking purpose showed statistically significant association with people those who were affected by GI problems.
The results of microbiological analysis of the water samples collected showed the water quality to be unsatisfactory, but they were unlikely to cause any GI illness in the present study. The overall report of the results of physical analysis of the water samples was satisfactory. In our present study, 11.8% of the households had GI problems. This was probably due to consumption of unsafe water, not washing their hands before eating and not consuming boiled drinking water which were the prominent risk factors for acquiring GI problems. Health education program and IEC activities were undertaken in the study areas through Government organizations, our institution and other non-Governmental organizations (NGOs) to create health awareness regarding safe drinking water and impact of water borne diseases on health.
Recommendation of possible remedial measures based on the findings of the study to the community, panchayat leaders and to the policy makers:
To the Community: To clean of all overhead and water tanks once in a month, to avoid pond water for drinking purpose, to avoid stagnation of drainage near drinking water sources, to clean the containers properly before storage, water containers and water pots to be covered, to consume boiled water and to wash hands properly with soap before eating as per WHO report.
Recommendations to the panchayat leaders: To ensure that all overhead tanks and water tanks are thoroughly cleaned and chlorinated once in every month, to provide bleaching powder regularly for disinfection of the water tanks, to provide proper toilet facilities for their respective village, to provide pipe water facility at doorstep.
Recommendations to the policy makers: To locate the households affected with GI problems and to identify the water source used by them, with the help of GIS and to take necessary corrective measures and to conduct Behavior Change Communication (BCC) programs in the locality.
Acknowledgement: Thanks to Director – Principal, Pondicherry Institute of Medical Sciences for the guidance and help, and special thanks to all participants to our study.
Author Contributions: SV – Conceived and designed the analysis and collected the data; SV, PR – Performed the analysis, wrote the paper. SV – Guided throughout the process, Contributed data and analysis tools. SV, PR – Wrote and checked the article.
Here, SV – Senthilvel Vasudevan; PR – Priyanka Raj
Conflict of Interest: There are no conflicts of interest to the authors
Source of funding: No funding received from the parent institution (or) from any other financial institution. We didn’t give any incentives to our study participants.
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