Daily water usage and childhood diarrheal morbidity: A case study of

under-five in Ahiazu Mbaise

Keywords:
Usage, Water sources, quantity, quality, under-five, diarrheal morbidity,
mortality, Ahiazu Mbaise.
ABSTRACT:

Diarrhea related ill-health especially among under-five children in developing
countries might be associated with inadequate water usage and poor hygienic
condition resulting to high morbidity and mortality rates. The relationship between
quantity of water used daily by households and diarrhea morbidity in children aged 0-
4 years in communities in Ahiazu Mbaise was determined. Descriptive cross-sectional
study was carried out among households with under-five children using systematic
random sampling method. Water quantity usage was measured using established
standards and the results were subjected to standard statistical analysis. A total of
315(34.1%) of the 925 households studied used water quantity within recommended
standard. At P<0.05, there was significant relationships between; quantity of water
used daily and pattern of diarrhea morbidity, distance travelled to water source and
quantity of water used daily, cost of providing water for households daily and
diarrhea, and water recycling and occurrence of diarrhea. At P>0.05, there was no
significant relationship between household size and quantity of water used daily. This
implied that distance to water source and cost of providing water for households
affected the quantity of water used and water recycling indicated water inadequacy.
Provision of adequate portable water sources within households at minimal or no
cost will help to reduce diarrhea occurrence in under-five children in Ahiazu Mbaise in
achieving the worlds target of health for all by the year 2020.
007-013 | JRPH | 2012 | Vol 1 | No 1

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www.jhealth.info
Journal of Research in
Public Health
An International
Scientific Research Journal
Authors:
Esomonu OC
1
,
Abanobi OC
1
and
Ihejirika CE
2
.




Institution:
1. Department of Public
Health.


2. Department of
Environmental Technology,
Federal University of
Technology, Owerri, +234,
Nigeria.




Corresponding author:
Esomonu OC.




Email:
nachiihejirika@yahoo.com.





Phone No:
+234-8033917824




Web Address:
http://www.jhealth.info/
documents/PH0004.pdf.

Dates:
Received: 16 Jan 2012 /Accepted: 29 Jan 2012 /Published: 13 Mar 2012
Article Citation:
Esomonu OC, Abanobi OC and Ihejirika CE.
Daily water usage and childhood diarrheal morbidity: A case study of under-five in
Ahiazu Mbaise.
Journal of Research in Public Health (2012) 1: 007-013
Original Research
Journal of Research in Public Health
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An International Scientific Research Journal


INTRODUCTION
Despite the significant decline in developed
world infant and child morbidity and mortality rate
remain disturbingly high in developing countries
(Ogunjuyigbe, 2004). Diarrheal disease remain one of
the most important causes of child morbidity and
mortality in developing countries, especially in Africa
(Teran, 1991), conceivably because of the unsanitary
conditions to which young children are known to be
more vulnerable to than adults (Folashade et al., 1998).
One hundred years ago, diarrheal diseases were among
the principal causes of death of children in the United
States, with seasonal episodes occurring during summer
(CDC, 1992). Today, this pattern of illness is replicated
on a wider scale in many developing counties, where 1.5
billion episodes of diarrhea and 4 million associated
deaths occur among children each year (Bern et al.,
1992).
Much of the ill-health which affects humanity,
especially in developing countries can be traced to lack
of safe and wholesome water supply, that is, water that
is easily accessible, adequate in quantity, free from
contamination, safe and readily available throughout
the year (Aderibigbe et al., 2008). USAID recommended
20-40 litres of water per capita per day for rural
communities (USAID, 1982). The lack of water supply
and sanitation is the primary reason why diseases
transmitted via feces are common in developing
countries (Aderibigbe et al., 2008). The most important
of these diseases in children is diarrhea which accounts
for 10% disease burden in developing countries (Park,
2002). Washing hand after defecation and before
preparation and eating of food is of particular
importance in reducing disease transmission, but
without water in or near homes, hygienic practices
become difficult or impossible (Aderibigbe et al., 2008).
Water is not only a vital environmental factor to all
forms of life, but it has also a great role to play in socio-
economic development of human population. It was in
recognition of this that 34
th
World Health Assembly in
1981 made a resolution emphasizing that safe drinking
water is a basic element of Primary Health Care which
is the key to the attainment of Health for all citizens of
the world (USAID, 1982).
This study was targeted at determining the
relationship between quantity of water used daily by
households compared with established standards, and
diarrhea morbidity among children between the ages of
0-4 years, and factors that affect quantity of water
available to households in Ahiazu Mbaise.
Design and methods
This descriptive cross-sectional study was carried
using systematic random sampling method to select 925
households in Ahiazu Mbaise with under-five children.
Where no child aged less than five was found in a
particular household, the household is skipped and the
next was selected. The instrument used (questionnaire)
was carefully developed to seek information on the
social and demographic characteristic of respondents,
water availability and accessibility and occurrence of
diarrhea among children aged less than five (5) years.
The data was supplied by mothers with under five aged
children. Quantity of water usage was measured using
established standards.
The quantitative data generated from this
research was analyzed using SPSS software package.

RESULTS
Water quantity determination:
The number of under-five aged children in
households revealed that majority (43.2%) were 0-1
year old children. Household size showed that majority
(53.4%) were between the ranges of five to nine (5- 9)
members. The majority (96.4%) of households studied
Esomonu et al.,2012
008 Journal of Research in Public Health (2012) 1: 007-013
had no public running tap water in their homes.
Domestic water source(s) of respondents revealed that
majority (67.9%) of households used borehole water.
Out of the 925 households studied, only 315 households
used up to the water quantity standard recommended
by established standards. Out of 647 children that
showed symptoms of diarrhea during the past three
months, reports from the mothers showed that slightly
above half (51.3) were rendered morbid for 7 days,
245 (37.9) children were rendered morbid for 1 2
weeks while 70 participants were rendered morbid for
more than two weeks. Result showed that 610 (65.9%)
do not use adequate quantity of water while 315
(334.1%) use adequate quantity of water. Relationship
between quantity of water used daily by households
and clinical symptoms of diarrhea showed that 325
(53.3%) of 610 who do not use adequate had diarrhea
while 119 (37.8%) of 315 that use adequate water
equally had diarrhea. Relationship between recycling of
water and clinical symptoms of diarrhea showed that
325(57.3%) of 567 households who recycle water and
119 (33.2%) of 358 households who do not recycle
water had diarrhea while 242 (42.7%) of 567 households
who recycle water and 239 (66.8%) of households who
do not recycle water had no diarrhea.
Report on water adequacy as shown in Table 1,
showed that 610 (65.9%) do not use adequate quantity
of water while 315 (334.1%) use adequate quantity of
water.
Relationship between quantity of water used
daily by households and clinical symptoms of diarrhea is
as shown in Table 2. The test showed that 325 (53.3%)
of 610 who do not use adequate had diarrhea while 119
(37.8%) of 315 that use adequate water equally had
diarrhea. There is a significant relationship between
quantity of water used daily and occurrence of diarrhea.
Relationship between distances (m) travelled to
the source of water and quantity of water used daily by
households is as shown in Table 3. 314 (61.7%) of 509
households who travel less than 100m to the water
source do not use adequate quantity of water, 217
(67.8%) of 320 households that travel between 100-
200m do not use adequate quantity of water, 78 (82.1
%) of 95 households who travel between 200 -300m do
not use adequate water quantity while (100%) the only
household that travels more than 300m do not use
adequate quantity of water. There is a significant
relationship between distance travelled to the water
source and the quantity of water used daily by
households.
Relationship between cost of providing water
for household daily and clinical symptoms of diarrhea
shown in Table 4 revealed that 167 (52.4%) of 319
households who obtain water free of charge, 213
(50.4%) of 423 who spend between N5 - N 20, 33
(39.8%) of 87 households who spend between N25 - N
40 and 29 (30.2%) of 96 who spend more than N 40
daily to provide water for the family all suffered
diarrhea during the last three months. There is a
significant relationship between cost and the
occurrence of diarrhea in under-five children.
Relationship between household size and the
quantity of water is as shown in Table 5. It revealed
that 217(69.3%) of 313 households whose members
were between the range of 1-4, 321 (65%) of 494
household who were between the range of 5-9, and 72
(61.0%) of 118 whose household members were from
Esomonu et al.,2012
Journal of Research in Public Health (2012) 1: 007-013 009
Table 1: Adequacy of water quantity usage
Absolute Frequency Relative Frequency
Not adequate
610 65.9
Adequate 315 34.1
Total 925 100.0


10 and above, all had inadequate quantity of water.
There is no significant relationship between household
size and quantity of water used daily.

DISCUSSION
Based on the data collected, very low (3.3%) of
respondents in this study had public running tap water
in their homes in Ahiazu Mbaise. It is however different
from the findings of Falkemark (1994), in a work he
carried out in a developed nation where he reported
that all homes had running taps and water only ceases
to run in taps on very rare occasions. Majority of
respondents in this study who did have public running
taps at home resorted to boreholes, underground tanks,
and other sources such as rain harvesting and rivers.
WHO (1995) reported that water from sources such as
rivers are usually contaminated and often times unfit for
human consumption.

Using USAID (1982) water quantity standard for
rural community, (20-40 liters per capita per day), only
34.1% of households studied used up to this standard.
Water is said to be adequate when it is supplied in the
right quantity to meet all the uses. Non-availability of
adequate water quantity usually results to water related
diseases (Andrea et al., 1998; Davidson et al., 1998;
Teran, 1991; Aderibigbe et al., 2008). Without adequate
water quantity, there may not be proper washing of
hands, vegetables, and plates. This practice may be
dangerous for under-five children whose care-givers or
nannies do not wash their hands properly (Timaeus and
Lush, 1995). Glieck (1996) pointed out that water must
be affordable, accessible, portable, and available
throughout the year. Also that 567 households (61.3%)
reuse water is an indication that water is not adequate
in the study area. The implications of these findings are
poor hygiene and sanitation which has significant
relationship with diarrheal diseases (MacDougall and
McGahey, 2003). This will consequently make
individuals and families to divert their meager financial
resources to paying for health care services when there
is diarrheal outbreak.
Furthermore, the study also revealed that there
was relationship between distance and the quantity of
Esomonu et al.,2012
010 Journal of Research in Public Health (2012) 1: 007-013
Table 3: Relationship between distances in meters
travelled to the water source and water quantity adequacy.
Distance
Water quantity
usage Not
Adequate
Adequate Total
Less than 100
meters
314 (61.7%) 195 (38.3%) 509
100-200 meters 217 (67.8%) 103 (32.2%) 320
200- 300 meters 78 (82.1%) 17 (19.9%) 95
300m and above 1 (100%) 0 (.0%) 1
Total 610 (65.9%) 315 (34.1%) 925
X
2

cal
= 16.16., X
2

cal
7.81, df = 3, p- value = 0.001
Table 4: Relationship between cost of providing water
for household daily and clinical symptoms of Diarrhea
X
2

cal
= 17.79 X
2

tab
7.81, df = 3, p- value = 0.0001
Clinical symptoms of diarrhea

Diarrhea No diarrhea Total
Water cost
daily
Free of
charge
167 (52.4%) 152 (47.6%) 319
N5 - N 20 213 (50.4%) 210 (49.6%) 423
N25 - N 40 33 (39.8%) 54 (62.0) 87
Above N 40 29 (30.2%) 67 (69.8%) 96
Total 442 (48.0%) 479 (52.0) 925
Table 2: Relationship between quantity of water
used and clinical symptoms of diarrhea Water quan-
tity used Clinical symptoms of Diarrhea
Yes (%) No (%) Total
Not adequate 325 (53.3) 285 (46.7) 610
Adequate 119 (37.8) 196 (62.2) 315
Total 444 (48.0) 481 (52.0) 925
X
2

cal
= 19.997, X
2

cal
3.84, df = 1, p- value = 0.0001
water usage. This study is in agreement with several
notions and authoritative positions such as those
elicited in the literature. Opara (2003) observed that the
distance trek to water source affects the quantity of
water collected per day. Also Thomas et al. (2008) in his
study of Relationship between In-home water service
and the risk of respiratory track, skin and
gastrointestinal tract infection among rural Alaska
natives found that water was available in Alaska but
the distribution method, where families must travel long
distances to obtain water made it difficult to obtain
adequate amount of water needed for basic
consumption and hygienic practices. Also Sandifod et
al. (1990) in a work carried out in 1029 households in
Nicaragua showed that a decrease in distance to the
water source from 1000 to 10m is associated with
increase in per capita water consumption of 20%. It also
corroborates with result of a survey conducted in Brazil
on domestic water use in rural villages with emphasis on
spatial patterns, sharing of water and factors in water
use (Andrea et al., 1998), where it was observed that
distance played a very significant role in the quantity of
water used by the inhabitants.
There also is significant relationship between
cost of providing water daily for households and
occurrence of diarrhea in children aged 0-4years in
Ahiazu Mbaise. This is in line with the findings of
Davidson et al. (1998) and Victoria et al. (1993), that
families with low income level seem to be more
susceptible to the effect of cost of water compared with
families with high level of income. Victoria et al. (1993)
also pointed out that incidence of diarrhea increases as
water cost increases.
The study shows that there is statistically
significant relationship between water recycling and
diarrhea occurrence in children aged 0-4 years. Five
hundred and sixty seven respondents accepted that
they sometimes use water used to washed vegetables
to wash plates and pots, and for other uses. This is line
with the findings of Ekanem et al. (1991) where he
reported high incidence of diarrhea due to water
recycling in communities that lacked adequate portable
water.
Moreover, the study showed that there is no
significant relationship between household size and the
quantity of water used daily by households. However,
this finding is different from that of Hunning and
Hunning (1996), where they observed that per capita
use falls as family grows. Martin (1999) pointed out in a
study conducted in Israel that the increase in domestic
water use could be statistically explained by growth of
number of household. This result might suggest
availability of more hands in larger households that
assist in provision of water than in smaller households.

CONCLUSION
This research established a relationship between
quantity of water used daily by households and pattern
of diarrhea morbidity in children aged 0-4 years in
Ahiazu Mbaise. The implication is that inadequate
potable water quantity usage exposes the inhabitants to
diarrhea owing to poor personal and domestic hygiene
like proper washing of fruits, vegetables, childrens
feeding bottle, cooking utensils, washing of hands and
recycling of untreated water.
Esomonu et al.,2012
Journal of Research in Public Health (2012) 1: 007-013 011
Table 5: Relationship between household size
and water quantity
Members Not Adequate Adequate Total
1-4 217 (69.3%) 96 (30.7%) 313
5-9 321 (65%) 173 (35.0%) 494
10 + 72 (61.0%) 46 (39.0%) 118
Total 610 (65.9%) 315 (34.1) 925
P - value = 0.215, df = 2


REFERENCES
Aderibigbe SA, Awoyemi AO and Osagbami GK. 2008.
Availability, Adequacy and Quality of Water supply in
Ilorin Metropolis Nigeria. European Journal of Scientific
Research 23(4):528-536.

Andrea G, Marcia SC, Iara S and Matilde MM. 1998.
Domestic water use in rural village in Minas Gerais,
Brazil, with an emphasis on spatial patterns, sharing of
water, and factors in water use. Cedernos de Saude
Publica 14(2):3.

Bern C, Martin J, de Zoysa I and Glass RI. 1992. The
magnitude of the global problems of diarrheal diseases,
a ten year update. Bull WHO 70(6):188-96.

CDC. 1992. The management of acute diarrhea in
children: Oral rehydration maintenance and nutritional
therapy. CDC Atlantia, Georgia.

Davidson HH, Jonathan S, Donald T and Gerald TK.
1998. Chilldhood Diarrhea in Sub-Saharan African. Child
Health research project special report 2(1):7-16.

Ekanem EE, Akitoye CO and Adedeji OT. 1991. Food
hygiene behaviour and childhood diarrhoea in Lagos,
Nigeria: a case-control study. J Diarrhoeal Dis Res., 9:219
-226.

Falkemark M. 1994. Population, environment and
development; A water perspective in population
environment and development: proceedings of United
Nations expert group meeting on regulation,
environment and development 99-116.

Folashade OO, Adefunke O, Mynepallike S, Isaac OO
and Joshua FO. 1998. Diarrhea in children of Nigerian
Market Women. J. Diarrheal Dis Re., 16(3): 121-200.

Gleick P. 1996. Basic Water requirements for human
activities meeting basic needs. Internationally Water 21
(2):83-92.

Hunnings L and Hunnings J. 1996. Household
wastewater treatment and septic systems. Fact Sheet
No 3, Polytechnic Institute and State University.

MacDougall J and McGahey C. 2003. Three community-
based Environmental sanitation and Hygiene project
conducted in Democgratic Republic of Congo. : Activity
Report; 119 USAID New York.

Martin N. 1999. Population, households and domestic
water use in countries of the Mediterranean Middle
East (Jordan, Lebanon, Syria, the West Bank, Gaza and
Israel). International Institute of Institute for Applied
System Analysis Report, Schlossplatz1, A-2361 Laxenbug,
Austria.

Ogunjuyigbe PO. 2004. Under-five mortality in Nigeria:
perception and attitudes of the Yorubas towards the
existence of abiku Demographic Research 11(2):43-56.

Opara AA. 2003. Water supplies in some rural
communities around Calabar, Cross Rivers State
Nigeria : the impact on water related disease. Tropical
Freshwater Biology 12(13):93-98.

Park K. 2002. Environment and Health in: Park Textbook
of preventive and social medicine 17.

WHO 1995. Bridging the gaps, The World Health Report
41.

Sandiford P, Sandiford AC, Gorter JG and Pauw JP.
1990. Determinants of domestic water use in rural
Nicaragua, J. Trop. Med. Hyg 93(6):383-389.

Teran MM. 1991. Early Feeding Pattern and Childrens
Health in Mexico. DHS World Conference August,
August 5-7, Proceeding, Washington D.C 1:451-474.

Esomonu et al.,2012
012 Journal of Research in Public Health (2012) 1: 007-013
USAID. 1982. Domestic water and sanitation PPC policy
paper Washington. USAID.

Thomas WH, Troy R, Robert CH, Dana LBB, Krrista LY,
Lisa B, James EC, Rosalyn JS and Jelf S. 2008. The
relationship between in-home water service and the risk
of respiratory track, skin and gastrointestinal tract
infection among rural Alaska native 98(11):2072-2078.

Timaeus IM and Lush L. 1995. Intra-urban differentials
in child health. Health Transition Review 5:163-190.

Victoria CG, Huttly SR, Fuch SC, Barros FC, Garenne M,
Leroy O and Fontaine HR. 1993. International
Differences in chemical patterns of Diarrheal Deaton S.A
comparison of children from Brazil, Senegal,
Bangladesh, and India. Journal of Diarrheal Diseases
Research II (1):25-29.
Esomonu et al.,2012
Journal of Research in Public Health (2012) 1: 007-013 013
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