Relationship between Use of Water from Community-Scale Water Treatment Refill Kiosks and Childhood Diarrhea in Jakarta

Abstract

Abstract. In developing countries, safe piped drinking water is generally unavailable, and bottled water is unaffordable for most people. Purchasing drinking water from community-scale decentralized water treatment and refill kiosks (referred to as isi ulang depots in Indonesia) is becoming a common alternative. This study investigates the association between diarrhea risk and community-scale water treatment and refill kiosk. We monitored daily diarrhea status and water source for 1,000 children 1-4 years of age in Jakarta, Indonesia, for up to 5 months. Among children in an urban slum, rate of diarrhea/1,000 child-days varied significantly by primary water source: 8.13 for tap water, 3.60 for bottled water, and 3.97 for water kiosks. In multivariable Poisson regression analysis, diarrhea risk remained significantly lower among water kiosk users (adjusted rate ratio [RR] = 0.49, 95% confidence interval [CI] = 0.29-0.83) and bottled water users (adjusted RR = 0.45, 95% CI = 0.21-0.97), compared with tap water users. In a peri-urban area, where few people purchased from water kiosk (N = 28, 6% of total population), diarrhea rates were lower overall: 2.44 for well water, 1.90 for bottled water, and 2.54 for water kiosks. There were no significant differences in diarrhea risk for water kiosk users or bottled water users compared with well water users. Purchasing water from low-cost water kiosks is associated with a reduction in diarrhea risk similar to that found for bottled water.

Water Sources Quality in Urban Slum Settlement along the Contaminated River Basin in Indonesia: Application of Quantitative Microbial Risk Assessment

“…This fact demonstrates that the possibility of recontamination during transportation or inappropriate cleaning methods of the storage among urban slum dwellers is high. The previous study by Sima et al showed that the usage of water from community-scale water refill stations can reduce the risk of childhood diarrhea [26], but if the quality of refill water is not properly monitored, the community will have risk of consume unstandardized drinking water. Lack of government control on the quality of refill water station production is also an important factor; subsequently, the implementation of an integrated monitoring system for bottled water production is urgently needed.…”

Modeling Risk Categories to Predict the Longitudinal Prevalence of Childhood Diarrhea in Indonesia

“…Participant selection and data collection are described elsewhere. 19 In brief, study participants were selected from among all age-eligible children registered at public child health centers (Posyandu). Data were collected from children via two methods.…”

“…4 Gastrointestinal disease can be transmitted by a number of interdependent environmental factors, which are in turn influenced by socioeconomic factors. 4,11 Water and sanitation risk factors, including inconsistent hand washing, 12,13 access to sanitation, 14 and access to clean drinking water, [15][16][17][18][19][20] have been characterized, in addition to socioeconomic and agerelated risk factors. 4,[21][22][23] Infectious agents for diarrhea differ by transmission route, with different associated disease characteristics likely associated with differing risk-factors and transmission routes.…”

Effectiveness of Membrane Filtration to Improve Drinking Water: A Quasi-Experimental Study from Rural Southern India

“…Decentralized water treatment solutions provide an important alternative to traditional source-based and point-of-use water treatment 14,15. Small-scale systems are decentralized solutions that cater to several families or a small community and, by definition, are smaller than centralized systems 15.…”