Access to improved water and its relationship with diarrhoea in Kathmandu Valley, Nepal: a cross-sectional study

Abstract

ObjectiveTo assess the associations between diarrhoea and types of water sources, total quantity of water consumed and the quantity of improved water consumed in rapidly growing, highly populated urban areas in developing countries.DesignCross-sectional analysis using population-representative secondary data obtained from an interview survey conducted by the Asian Development Bank for the 2009 Kathmandu Valley Water Distribution, Sewerage and Urban Development Project.SettingKathmandu Valley, Nepal.Participants2282 households.MethodsA structured questionnaire was used to collect information from households on the quantity and sources of water consumed; health, socioeconomic and demographic status of households; drinking water treatment practices and toilet facilities.ResultsFamily members of 179 households (7.8%) reported having developed diarrhoea during the previous month. For households in which family members consumed less than 100 L of water per capita per day (L/c/d), which is the minimum quantity recommended by WHO, the risk of contracting diarrhoea doubled (1.56-fold to 2.92-fold). In households that used alternative water sources (such as wells, stone spouts and springs) in addition to improved water (provided by a water management authority), the likelihood of contracting diarrhoea was 1.81-fold higher (95% CI 1.00 to 3.29) than in those that used only improved water. However, access to an improved water source was not associated with a lower risk of developing diarrhoea if optimal quantities of water were not consumed (ie, <100 L/c/d). These results were independent of socioeconomic and demographic variables, daily drinking water treatment practices, toilet facilities and residential areas.ConclusionsProviding access to a sufficient quantity of water—regardless of the source—may be more important in preventing diarrhoea than supplying a limited quantity of improved water.

Dynamics of Domestic Water Consumption in the Urban Area of the Kathmandu Valley: Situation Analysis Pre and Post 2015 Gorkha Earthquake

“…These results indicated that the water market was well established in the valley within a period of six years and that water buying has been a widely practiced coping strategy as reported by Pasakhala et al [15]. In contrast to 26% of households in 2009 [28], our study observed that none of the households (see Supplementary Materials, Table S4) relied on piped water alone. These wide differences between the studies, conducted within a short time span, suggests that households' dependency on different water sources changes swiftly in water scarce incessantly populating areas, and that real situations should be scanned properly before planning any related projects or policies.…”

Water crises in a water-rich country: case studies from rural watersheds of Nepal's mid-hills

“…Nepal is a small, beautiful landlocked country, located entirely in the Ganges basin, bordering with India in the east, west, and south, and China in the north. The northern border region of Nepal contains 200 peaks of more than 6,000 m and 13 peaks of more than 8,000 m high, including Mount Everest (Shrestha & Aryal, 2011;Shrestha et al, 2013). The Nepal Himalaya covers approximately 35% of the total area and contains a large number of glaciers and glacial lakes that provide huge natural storage of freshwater in the form of ice (WECS, 2011;Shrestha et al, 2013).…”

“…The northern border region of Nepal contains 200 peaks of more than 6,000 m and 13 peaks of more than 8,000 m high, including Mount Everest (Shrestha & Aryal, 2011;Shrestha et al, 2013). The Nepal Himalaya covers approximately 35% of the total area and contains a large number of glaciers and glacial lakes that provide huge natural storage of freshwater in the form of ice (WECS, 2011;Shrestha et al, 2013). Nepal is also known as the Land of Everest and contains approximately 3,252 glaciers with a total coverage of 5,323 km 2 and 481 km 3 of estimated ice reserves (Mool et al, 2001;Bajracharya & Shrestha, 2011;WECS, 2011).…”

“…Competition for access to water resources increases when the renewable water availability decreases, and the poor household/community cannot afford to pay for water resources (Guppy & Anderson, 2017). Kathmandu, the capital city of Nepal, has been experiencing a dire situation regarding water, both availability and quality, for more than 30 years (Shrestha et al, 2013). The Kathmandu valley is the most urbanized and populated area and the daily water demand is more than 360 million liters per day (MLD) (Udmale et al, 2016;Raina, 2017).…”

Water Quality Change from Source to the Point-of-Consumption in an Intermittent Water Supply System

“…Additionally, in water constraint situations as in the KV, water utilities supplement the network with sources such as the deep tube wells without treating or a limited treatment (only plain sedimentation and/or filtration). Although increasing the quantity of water supplied has been associated with reduced diarrheal contaminations 15) , supplementing the IWS system with no/limited treatment can increase the chances of other diseases causing bacterial species such as Vibrio, Salmonella, and Shigella to release into the network ( Table 1).…”