Household Drinking Water Sources Research Articles

Armed conflict and household water sources

AbstractAccess to safe drinking water is among the most important determinants of public health outcomes. We pair household-level data from Iraq together with data on armed conflict and adopt a generalized difference-in-differences approach to study the relationship between household drinking water sources and armed conflict intensity. We find that households located in conflict-affected areas are more likely to use piped water accessed at their homes or bottled water as their primary source of drinking water, but are less likely to use public water sources or tanked water delivered on trucks and carts. We explore the temporal dynamics of these adjustments as well as heterogeneity by household characteristics. We further present direct evidence that conflict-exposed households are less likely to travel to obtain water.

Physico-Chemical and Bacteriological Quality of Household Drinking Water from Source to Point of Use in Akewu Community in Ibadan, Oyo State, Southwest, Nigeria

Poor household water storage is one of the major factors contributing to contamination of drinking water in Nigeria. Studies have shown that sizes of containers opening can affect water quality, but little has been documented on comparative effect of storage containers with different opening sizes in improving drinking water quality in Ibadan. This study was designed to assess the effect of different storage containers on household drinking water quality in selected communities in Ibadan. A quasi-experimental design was adopted. Four communities in Ibadan North Local Government namely; Akewu using protected springs as household drinking water sources were purposively selected. Forty-four households (11 from each community) were selected and randomly assigned to four treatment groups; those with Covered Buckets with Taps (CBT), Covered Buckets without Tap (CB), Covered Kegs with Taps (CKT) and Covered Kegs without Tap (CK). Prior to introducing the treatment containers, water samples were collected from their Regular Storage Containers (RSC) and springs for physicochemical and bacteriological analysis using standard methods. Participants were thereafter encouraged to store drinking water in the treatment containers provided for them. Water samples were later collected from CBT, CB, CKT and CK containers twice daily for 3 alternate days over two weeks for bacteriological analysis. In addition, oldest female of selected households were interviewed using a pre-tested semi-structured questionnaire to elicit information on their socio-demographic characteristics, storage container cleaning and handwashing practices. Results of physicochemical and bacteriological findings were compared with Standard Organisation of Nigeria (SON) guidelines. Data were analysed using descriptive statistics, t- test and ANOVA at p=0.05. At baseline, mean pH values of water samples from the springs and RSC were 6.4±0.6 and 7.1±0.7 respectively compared with 6.5-8.5 limits recommended by SON. Mean chloride concentration of springs (14.3±7.4mg/l) and RSC (19.3±10.0 mg/l) samples were below 250mg/l limit recommended by SON. Mean Total Coliform Count (TCC) of the springs in the four communities was 18.0±4.0 and mean TCC of RSC was 12.7±4.9 which exceeded the SON standard of 10MPN/100ml. Five percent of water samples from RSC had mean E.coli count of 100/100ml compared with SON guidelines of 0/100ml. The mean TCC after introducing CB, CBT, CK and CKT in all the communities were 10.0±4.0, 8.5±4.2, 6.9±2.8 and 7.3±3.7 respectively (p<0.05). No E.coli was found in the samples collected from the treatment storage containers. The percentage difference of coliform count in water from springs and RSC was 29.4% while percentage difference from RSC and CB, CBT, CK and CKT were 21.5%, 33.2%, 45.5% and 42.5% respectively. Mean age of the 44 respondents interviewed was 37.9±10.7years. Seventy-three percent washed their hands with only water after defecation and 95.0% stored water for cooking and drinking in the same container. Sixty-eight percent cleaned their containers weekly while 32.0% cleaned twice weekly.

Analisis Sumber Air, Kepemilikan Septictank terhadap Total Coliform Air di Rumah Tangga Kecamatan Dumai Selatan Kota Dumai

A new study released by UNICEF in 2022, states that nearly 70 percent of the 20,000 household drinking water sources tested in Indonesia have been contaminated with fecal waste and one of the causes of the spread of diarrheal diseases. Based on data from the Bumi Ayu Health Center (2022), households are still found using the plengsengan and cemplung types of latrines. Improper fecal drainage conditions make clean water sources and drinking water cannot be used directly so that it can have an impact on public health. The purpose of this study was to analyze the source of water and septic tank ownership with total Coliform household clean water in the District of South Dumai. This study uses quantitative research with cross sectional design. Sampling technique is done by purposive sampling technique. The Data were obtained by using questionnaires and laboratory tests of clean water samples (Wells) consumed and <10 m with a septictank of 10 samples. The results of the questionnaire were analyzed using the chi square test and it is known that the entire sample contains total coliform bacteria (> 50 MPN). It is known that there is a relationship between the source of clean water used by respondents with septic tank ownership. Then the results of the analysis with total coliform content showed that all samples of well water, which is a subsurface water source, were contaminated by total coliform bacteria so that they did not meet hygiene and health standards. The suggestion is that people should be more selective in choosing and using water sources for consumption.
 Keywords: Septictank, Total Coliform, Water Source, Well Water

Does financial inclusion improve household drinking water source? An application to the case of Togo

ABSTRACT This study investigates the impact of financial inclusion in bringing the financing gap of water infrastructure in developing countries using Togo as case study. Using a number of robust estimation techniques, we found that financial inclusion is associated with an increase in access to improved drinking water and a decline in the travel time to the water source, especially among the rural poor areas, female heads households and the northern part of the country. The influence of formal inclusive finance is higher and significant in contrast to informal financial inclusiveness, which has no significant impact. Policy implications are discussed.

The dynamics of household water security and treatment practices: a population-based, cross-sectional study in Osun State, Southwest Nigeria.

A minimum of basic water supply service is pertinent to improving living standards and water-dependent quality of life indices. In Nigeria, 14% have access to safely managed drinking water services, though approximately 30% of water pumps and schemes are likely to fail within 12months of construction. This study aims to determine household water security and its predictors in Osun State, Nigeria. The cross-sectional study recruited 548 households through a five-stage sampling technique and used a semi-structured questionnaire for data collection.Results were presented by descriptive and inferential statistics, while binary logistic regression identified water-security predictors at Pά 0.05. Hand-dug wells (27.7%) and motorized boreholes (21.2%) were the predominant household drinking water sources. A total of 43.7% of households were water-secured while 35.2% of water sources were within residential settlements. A total of 25.1% of households experienced water scarcity, and 27.2% of households treat drinking water mainly by chlorination (56.7%) and boiling (14.7%). A total of 21.2%, 64.2%, and 9% of households, respectively, have safely managed basic and limited water supply services. Drinking water sources were associated with house ownership (p = 0.001) and residence period (p = 0.025) while water treatment was associated with gender (p = 0.010) and wealth (p = 0.0001). Age (p = 0.002) and wealth (p = 0.0001) are predictors of household water security. Two-fifths of households were water-secured, highlighting the dearth of potable water supply services and the need to incorporate strategic predictors of household water security in the existing national and state-level water resources regulations.

Assessment of Bacteriological Quality of Vended Water in Jerry Cans for Domestic Use in Zaria, Kaduna State, Nigeria

The practice of vending water in plastic jerry cans for domestic use has become a major source of household drinking water in Zaria due to inadequate pipe-borne water. The unhygienic practice of the water vendors and poor sanitary condition of the jerry cans and the water sources are of public health concern. Accordingly, this research was conducted to examine the bacteriological quality of vended water from jerry cans in Zaria city, Kaduna state, Nigeria. Water samples from five different vendors from twenty different locations were collected and used for isolation and enumeration of bacterial loads. The isolation and biochemical characterizations of the isolates revealed the presence of seven genera represented by eight bacterial species namely: Escherichia coli, Proteus mirabilis, Salmonella typhi, Klebsiella pneumoniae, Corynebacterium sp, Proteus vulgaris, Citrobacter freundi and Bacillus subtilis. Escherichia coli is the most predominant bacterial species among the vended water samples (44.44%) followed by S. typhi (18.52%) while Proteus mirabilis, Corynebacterium sp and Citrobacter freundi are the least prevalent with 3.70%. Most of the identified bacterial species in the samples were pathogenic. More so, the bacterial loads associated with the jerry cans water ranged between 1.0x106–8.0x106 CFU/mL from the plates count which is above WHO standard limit of ˂1.0x101 CFU/mL. It was therefore inferred that the bacterial counts associated with the jerry cans can pose public health risk. Proper sanitation and orientation on personal hygiene to the vendors are urgently needed.

Association of water, sanitation, hygiene and food practices with enteric fever in a paediatric cohort in North India

BackgroundOur aim was to assess the association of water, sanitation and hygiene (WASH) and food practices with culture-confirmed enteric fever in children <15 years of age.MethodsWe followed a cohort of...

Correlation between Catch-up Growth in Early Childhood with Cognitive Ability among School-Aged Children (10–12 Years): A Longitudinal Study

BACKGROUND: Children’s cognitive abilities are influenced by the nutritional condition of children in early childhood. Catch-up growth in early childhood affects cognitive abilities at school age. AIM: This study aims to analyze the effect of catch-up growth in early childhood on the cognitive abilities of school-aged children in Indonesia. METHODS: This study was a cohort study incorporating 10 years of follow-up using three waves of secondary data (1997, 2000, and 2007) from the Indonesia Family Life Survey. Research studies and data analysis were carried out from April to September 2021. The initial data collection of the study was conducted in 1997 when the children were 0–23 months old, then followed in 2000 (age 3–5 years) and 2007 (age 10–12 years). The study subjects were 537 children aged 0–23 months in 1997. Cognitive ability was measured using the Raven Progressive Matrices method. Statistical analysis for cognitive ability scores with catch-up growth was carried out using one-way analysis of variance and multivariate analysis using the generalized linear model. RESULTS: Significant differences were observed in the cognitive ability scores of normal children and stunted children who did not experience catch-up growth (p&lt;0.001), but the cognitive scores of normal children are not significantly different from the stunting catch-up growth group. Other factors that affect the cognitive ability score were as follows: (1) Child factors consist of child stunting status, head circumference, hemoglobin levels, duration of breastfeeding, and complete basic immunization history; (2) parental factors such as father’s occupation, parental education, and number of parity; (3) household socioeconomic factors (household income and wealth index); and (4) environmental factors (housing area, father’s smoking habit, defecation facilities, and household drinking water sources). CONCLUSION: Cognitive abilities of school-age children were most influenced by catch-up growth, stunting status, duration of breastfeeding, number of parity, father’s education, father’s occupation, and father’s smoking habit. Children who experience catch-up growth have better cognitive abilities than stunted non-catch-up group or who experience stunting during early life.

Re-examining the effects of drought on intimate-partner violence.

Droughts are associated with several societal ills, especially in developing economies that rely on rainfed agriculture. Recently, researchers have begun to examine the effect of droughts on the risk of Intimate-Partner Violence (IPV), but so far this work has led to inconclusive results. For example, two large recent studies analyzed comparable data from multiple sub-Saharan African countries and drew opposite conclusions. We attempt to resolve this apparent paradox by replicating previous analyses with the largest data set yet assembled to study drought and IPV. Integrating the methods of previous studies and taking particular care to control for spatial autocorrelation, we find little association between drought and most forms of IPV, although we do find evidence of associations between drought and women's partners exhibiting controlling behaviors. Moreover, we do not find significant heterogeneous effects based on wealth, employment, household drinking water sources, or urban-rural locality.

Domestic drinking water management: Quality assessment in Oforikrom municipality, Ghana.

Drinking water in Ghana is estimated at 79%, but this only represents the proportion of the population with access to improved drinking water sources without regard to the quality of water consumed. This study investigated the quality of household drinking water sources in the Oforikrom municipality where potable water requirements are on the rise due to an ever-increasing population. Both quantitative and qualitative methods were employed in this study. One Hundred households were randomly selected and interviewed on the available options for drinking water and household water treatment and safe storage. A total of 52 points of collection (POC) and 97 points of use (POU) water samples from households were collected for physicochemical and microbial water quality analysis. Amongst the available drinking water options, sachet water (46%) was mostly consumed by households. Water quality analysis revealed that the physicochemical parameters of all sampled drinking water sources were within the Ghana Standards Authority (GSA) recommended values expected for pH (ranging from 4.50 to 7.50). For the drinking water sources, bottled (100%, n = 2) and sachet water (91%, n = 41) showed relatively good microbial water quality. Generally, POC water samples showed an improved microbial water quality in comparison to POU water samples. About 38% (n = 8) of the households practicing water quality management, were still exposed to unsafe drinking water sources. Households should practice good water quality management at the domestic level to ensure access to safe drinking water. This may include the use of chlorine-based disinfectants to frequently disinfect boreholes, wells and storage facilities at homes.

Climate variability and health in extremely vulnerable communities: investigating variations in surface water conditions and food security in the West African Sahel

In this project we consider the ways that different livelihood strategies impact the climate-health linkage. Specifically, we build on knowledge of livestock mobility in the Sahel and use remotely sensed-based measures of waterholes with health survey data to investigate the linkages between child health outcomes related to food security. We focus on the landscape characteristics relevant to limitedly studied, but highly climate-vulnerable populations, pastoralists and agro-pastoralists in the Sahel. We combine remotely sensed-based data on surface waterholes and spatially referenced health survey data and use flexible regression modeling techniques to uncover the quantitative relationship between waterhole depth and a child’s height-for-age z-score (HAZ). The results suggest that the water depth level of nearby waterholes does indeed impact a child’s HAZ, even after accounting for other environmental factors. This relationship is impacted, however, by the livelihood practices of the area as well as by the source of household drinking water.

Relationship between household safe drinking water, hygienic toilet and prevalence of stunting for Chinese children aged 0 to 5 years old in 2013

To investigate the relationship between household drinking water, toilet status and the prevalence of stunting for Chinese children aged 0 to 5 years old in 2013. Data was extracted from the Chinese National Nutrition and Health Surveillance in 2013. A total of 32 861 children aged 0 to 5 years old were selected from 165 townships(streets) of 55 counties(cities/districts) in 30 provinces. Caregivers were face to face interviewed to collect data, including demographic characteristics of children, mothers and household, main source of household drinking water and main type of household toilet. Height/Length of children was measured using a standard procedure. Height(Length) for age Z score(HAZ(LAZ)) was calculated using WHO Anthro Survey Analyser software(online version), and stunting was defined as HAZ(LAZ)&lt;-2. SAS 9. 4 was used to analyze. SURVEYFREQ procedure was used to calculate the coverage rate of safe drinking water, hygienic toilet, and the prevalence of stunting. SURVEYLOGISTIC procedure was used to analyze the relationship between household safe drinking water, hygienic toilet and prevalence of stunting for Chinese children aged 0 to 5 years old in 2013. A total of 32 861 children completed the study. The coverage rate of safe drinking water was 86. 9%. The proportion of water piped into household, a public tab and water from a protected spring or well was 49. 4%, 15. 9% and 15. 6%, respectively. The coverage rate of hygienic toilet was 56. 8%. The proportion of pour-flush toilet and pit latrine were 52. 1% and 4. 7%. The prevalence of stunting for 0 to 5 years old children was 8. 1% in China. The prevalence of stunting were 8. 1% for children aged 0-5 years old with safe household drinking water and 7. 8% for those without safe household drinking water. The difference was not significant(P=0. 882). The prevalence of stunting was 6. 6% for children aged 0-5 years old with hygienic household toilet and 10. 0% for those without hygienic household toilet. The difference was not significant(P=0. 069). There was no significant relationship between household sanitary condition and stunting for children aged 0 to 5 years old. Household sanitary conditions, including main source of household drinking water and the main type of household toilet may not be associated with the prevalence of stunting for children aged 0 to 5 years old in this settings.

The effect of wealth on the choice of household drinking water sources in West Africa

AbstractMany developing countries are experiencing high population growth rates (an average of 2.7%). The increase in their respective populations leads to an increase in the need for drinking water. However, governments fail to provide the population with sufficient hydraulic infrastructure in terms of quality and quantity, with regard to the various priorities. In such situations, households take individual initiatives. However, the weakness of the available means may be a significant obstacle. This article seeks to identify the factors that determine the choice of household water sources in West African countries by putting an emphasis on the role of wealth. The study covers four countries, Burkina Faso, Mali, Ghana and Nigeria, and uses data from 28,444 observations from the United States Agency for International Development (USAID) and statistics agencies of the four countries being studied. When applied to the adjusted logit model, the data reveal that the higher the household wealth, the greater the chance of using piped water. There are also other factors, such as household size, the number of women and children, and the level of education that also determine the choice of water sources. These results suggest that governments need to increase their efforts to reduce inequalities between rural and urban areas in terms of improved access to drinking water and introduce a subsidy or fee policy to enable poor households to have adequate access to drinking water.

Children drinking private well water have higher blood lead than those with city water

Although the Flint, Michigan, water crisis renewed concerns about lead (Pb) in city drinking water, little attention has been paid to Pb in private wells, which provide drinking water for 13% of the US population. This study evaluates the risk of Pb exposure in children in households relying on private wells. It is based on a curated dataset of blood Pb records from 59,483 North Carolina children matched with household water source information. We analyze the dataset for statistical associations between children's blood Pb and household drinking water source. The analysis shows that children in homes relying on private wells have 25% increased odds (95% CI 6.2 to 48%, P < 0.01) of elevated blood Pb, compared with children in houses served by a community water system that is regulated under the Safe Drinking Water Act. This increased Pb exposure is likely a result of corrosion of household plumbing and well components, because homes relying on private wells rarely treat their water to prevent corrosion. In contrast, corrosion control is required in regulated community water systems. These findings highlight the need for targeted outreach to prevent Pb exposure for the 42.5 million Americans depending on private wells for their drinking water.

Shigella sonnei Outbreak Investigation During a Municipal Water Crisis-Genesee and Saginaw Counties, Michigan, 2016.

Objectives. To investigate a shigellosis outbreak in Genesee County, Michigan (including the City of Flint), and Saginaw County, Michigan, in 2016 and address community concerns about the role of the Flint water system.Methods. We met frequently with community members to understand concerns and develop the investigation. We surveyed households affected by the outbreak, analyzed Shigella isolate data, examined the geospatial distribution of cases, and reviewed available water quality data.Results. We surveyed 83 households containing 158 cases; median age was 10 years. Index case-patients from 55 of 83 households (66%) reported contact with a person outside their household who wore diapers or who had diarrhea in the week before becoming ill; results were similar regardless of household drinking water source. Genomic diversity was not consistent with a point source. In Flint, no space-time clustering was identified, and average free chlorine residual values remained above recommended levels throughout the outbreak period.Conclusions. The outbreak was most likely caused by person-to-person contact and not by the Flint water system. Consistent community engagement was essential to the design and implementation of the investigation.

Human Enteric Pathogens in Eight Rivers Used as Rural Household Drinking Water Sources in the Northern Region of South Africa.

People living in rural areas still rely on the use of environmental water that is contaminated by human and animal activities. This study assessed the occurrence of human enteric pathogens in rivers that are used by rural communities Vhembe District of South Africa as a source of drinking water covering two seasons (winter and summer) over a one-year period. Water quality was assessed using physico characteristics and indicator organisms (total coliforms, E. coli, Clostridium perfringens). Pathogens tested included bacteria (Pathogenic E. coli, Salmonella-, Shigella- and Vibrio spp.), protozoa (Cryptosporidium- and Giardia spp.), and enteric viruses (Rota-, Noro-, Entero-, and Adenoviruses) while using published molecular protocols. The results showed that the indicator bacteria counts exceeded South African drinking water quality guideline limits and pathogenic E. coli was detected in the samples. No Shigella spp. were isolated, while Vibrio spp. and Salmonella spp. were present; parasites were detected in four rivers and Enteric viruses were predominantly detected in the winter season. The results indicated the poor condition of water and the potential health risks to consumers highlighting the need for implementing river catchment management strategies for continued sustainability in these rivers.

Determinants of Urogenital Schistosomiasis Among Pregnant Women and its Association With Pregnancy Outcomes, Neonatal Deaths, and Child Growth.

Background Schistosoma haematobium is a parasitic helminth that causes urogenital pathology. The impact of urogenital schistosomiasis during pregnancy on birth outcomes and child growth is poorly understood.MethodsRisk factors for urogenital schistosomiasis were characterized among 4437 pregnant women enrolled in a cluster-randomized community-based trial in rural Zimbabwe. Infection was defined via urine microscopy (≥1 S. haematobium egg) and urinalysis (hematuria). Associations between infection and pregnancy outcomes were assessed in case-control analyses using conditional logistic regression. The association of maternal infection with birthweight and length-for-age Z scores (LAZ) at 1 and 18 months of age were assessed using generalized estimating equations.ResultsUrogenital schistosomiasis (egg positive and/or hematuria positive) was detected in 26.8% of pregnant women. Risk factors significantly associated with infection were maternal age, education, marital status, and religion; household drinking water source and latrine; study region; and season. Urogenital schistosomiasis was not significantly associated with adverse pregnancy outcomes (miscarriage, stillbirth, preterm, and small-for-gestational age), birthweight, neonatal death, or LAZ.ConclusionsIncluding pregnant women in antihelminthic treatment programs would benefit a large number of women in rural Zimbabwe. However, clearance of the low-intensity infections that predominate in this context is unlikely to have additive benefits for pregnancy outcomes or child growth.Clinical Trials RegistrationNCT01824940.

Factors influencing household access to drinking water in Nigeria

Sustainable Development Goal 6 of the United Nations, adopted in 2015, aims at equitable access to safe and affordable drinking water for all by 2030. Attaining this goal is difficult without focusing on inequalities among regions and populations. This article explores the factors that influence household access to drinking water in Nigeria using 2013 Demographic and Health Surveys. Descriptive and inferential statistics show that about 88% of all households that used surface water are from rural areas. The Northwest and Northeast regions are home to 78% of all households that use unprotected wells. Whereas 64% of households with access to piped water into dwelling are richer and richest households, the middle-class, poorer and poorest households constitute 83.4% of surface water users. Household drinking water sources are significantly (p = 0.01) influenced by place of residence (χ2 = 8328.2), geopolitical zone (χ2 = 12042.8), education (χ2 = 5346.2), wealth index (χ2 = 16540.3), ethnicity (χ2 = 8649.9), access to electricity (χ2 = 8040.9), and gender (χ2 = 537.3). Logistic regression analysis indicates that these variables, as well as state of residency, water collection time, and number of rooms, are significant predictors of access to improved or unimproved water sources. Toilet type and household size are not significant. Based on the findings, we recommend providing public standpipes and community boreholes as interim measures and piped water eventually, household water treatment as a stop-gap measure for improving water safety, and targeted interventions in poor communities and marginalized regions.

Investigating risk factors for under-five mortality in an HIV hyper-endemic area of rural South Africa, from 2000-2014.

IntroductionDespite global progress, there remains a disproportionate burden of under-five year old deaths in sub-Saharan Africa (SSA), where four out of five child deaths occur. Substantial progress has been made in improving sanitation, controlling communicable diseases and the spread of HIV in most parts of the world. However, significant strides to address some key risk factors related to under-five mortality are still needed in rural SSA if they are to attain relevant 2030 SDG targets. The aim of this study is to investigate the risk factors for under-five mortality in an HIV hyper-endemic area of rural South Africa, from 2000–2014. Some of the key risk factors investigated are, for example: household wealth, source of drinking water, distance to the national road and birth order.MethodsWe conducted a statistical analysis of 759 births from a population-based cohort in rural KwaZulu-Natal Province, South Africa, from 2000 to 2014. A Cox Proportional Hazards model was used to identify the risk factors and key socio-demographic correlates of under-five mortality leveraging the longitudinal structure of the population cohort.ResultsChild mortality rates declined by 80 per cent from 2000 to 2014, from >140 per 1,000 persons in years 2001–2003 to 20 per 1,000 persons in the year 2014. The highest under-five mortality rate was recorded in 2002/2003, which decreased following the start of antiretroviral therapy rollout in 2003/4. The results indicated that under-five and infant mortality are significantly associated with a low wealth index of 1.49 (1.007–2.48) for under-fives and 3.03 (1.72–5.34) for infants. Children and infants with a lower wealth index had a significantly increased risk of mortality as compared to those with a high wealth index. Other significant factors included: source of household drinking water (borehole) 3.03 (1.72–5.34) for under-fives and 2.98 (1.62–5.49) for infants; having an HIV positive mother 4.22 (2.68–6.65) for under-fives and 3.26 (1.93–5.51) for infants, and period of death 9.13 (5.70–14.6) for under-fives and 1.28 (0.75–2.20) for infants. Wealth index had the largest population attributable fraction of 25.4 per cent.ConclusionsThe research findings show a substantial overall reduction in under-five mortality since 2003. Unsafe household water sources and having an HIV-positive mother were associated with an increased risk of under-five mortality in this rural setting. The significant risk factors identified align well with the SDG 2030 targets for reducing child mortality, which include improved nutrition, sanitation, hygiene and reduced HIV infections. Current trajectories suggest that there is some hope for meeting the 2030 SGD targets in rural South Africa and the region if the identified significant risk factors are adequately addressed.

Household Transmission of Ebola Virus: Risks and Preventive Factors, Freetown, Sierra Leone, 2015.

Knowing risk factors for household transmission of Ebola virus is important to guide preventive measures during Ebola outbreaks. We enrolled all confirmed persons with Ebola who were the first case in a household, December 2014-April 2015, in Freetown, Sierra Leone, and their household contacts. Cases and contacts were interviewed, contacts followed prospectively through the 21-day incubation period, and secondary cases confirmed by laboratory testing. We enrolled 150 index Ebola cases and 838 contacts; 83 (9.9%) contacts developed Ebola during 21-day follow-up. In multivariable analysis, risk factors for transmission included index case death in the household, Ebola symptoms but no reported fever, age <20 years, more days with wet symptoms; and providing care to the index case (P < .01 for each). Protective factors included avoiding the index case after illness onset and a piped household drinking water source (P < .01 for each). To reduce Ebola transmission, communities should rapidly identify and follow-up all household contacts; isolate those with Ebola symptoms, including those without reported fever; and consider closer monitoring of contacts who provided care to cases. Households could consider efforts to minimize risk by designating one care provider for ill persons with all others avoiding the suspected case.