Household Water Quality Research Articles

Evaluation of the Safe Water Optimization Tool to Provide Evidence-Based Chlorination Targets in Surface Waters: Lessons from a Refugee Setting in Uganda.

The Safe Water Optimization Tool (SWOT) generates evidence-based point-of-distribution free residual chlorine (FRC) targets to adjust chlorine dosing by operators and ensure water quality at point-of-consumption. To investigate SWOT effectiveness in surface waters, we conducted two before-and-after mixed-method evaluations in a Uganda refugee settlement served by piped and trucked surface water systems. We surveyed 888 users on water knowledge, attitudes, and practices; collected 2768 water samples to evaluate FRC,Escherichia coli, and disinfection by-products (DBPs) concentrations; and conducted nine key-informant interviews with system operators about SWOT implementation. After baseline data collection, SWOT chlorination targets were generated, increasing point-of-distribution FRC targets from 0.2 to 0.7-0.8 mg/L and from 0.3 to 0.9 mg/L for piped and trucked systems, respectively. At endline, household point-of-consumption FRC ≥ 0.2 mg/L increased from 23 to 35% and from 8 to 42% in the two systems. With these increases, we did not observe increased chlorinated water rejection or DBPs concentrations exceeding international guidelines. Informants reported that SWOT implementation increased knowledge and capacity and improved operations. Overall, SWOT-generated chlorination targets increased chlorine dosage, which improved household water quality in surface waters although less than previously documented with groundwater sources. Additional operator support on prechlorination water treatment processes is needed to ensure maximally effective SWOT implementation for surface water sources.

Prototype of Household Water Quality Monitoring System by Utilizing Internet of Things

This research aims to develop a household water quality monitoring system using the Internet of Things (IoT) by monitoring water quality parameters such as pH, Total Dissolved Solids (TDS), turbidity, and temperature in real time. The prototyping method in the development of this system allows continuous interaction between developers and users to meet the needs of the system. Data is collected through literature studies and observations to support system development. The results of this study are that every 1 minute, the sensor data is sent to the server, and then the sensor data will be displayed on the web platform; if the sensor data value is not at the predetermined value limit according to Permenkes number 2 of 2023, the displayed value will be red. The data collected by the sensor is sent to the server built with Node.js and stored in the PostgreSQL database. The monitoring results will also be displayed on a 20x4 I2C LCD. The system successfully monitors water quality parameters in real time, with results displayed on a web platform that is easily accessible to users. The implementation of IoT technology in this system provides an innovative solution for increasing public awareness of the importance of clean water quality. With this system, it is expected to create a healthier and safer household environment for families.

Design of an Intermittent Biosand Filter Amended with Oyster Shell Powders for the Improvement of Household Water Quality in Sub-Saharan Africa and Madagascar

Access to safe drinking water and the wide spread of water-borne diseases are major challenges in Sub-Saharan Africa and Madagascar. Based on this, a water purification models has been developed which can use on a local scale. It consists of an intermittent biosand filter amended with oyster shell powders designed from local materials. The performance of the filter was evaluated through physicochemical and bacteriological analyses using standardized methods on raw polluted well water with previously determined initial D0 characteristics. The effectiveness of the designed filter was assessed and a filtration operation was carried out over a monitoring period of 13 days (D13) prior to 7 days of acclimatization of the system. With a filtration rate of 0.75l/h-1, there is a very strong reduction in turbidity from 35.59NTU to 0 NTU and in BOD5 from 125mg/l to 2mg/l. More so, bacteriological analyses reveal a progressive and complete decrease from D0 to D13 of fecal coliforms from 9000 CFU/100ml to 0 CFU/100ml; total coliforms from 6,000 CFU/100 ml to 0 CFU/100 ml and fecal streptococci from 10,800 CFU/100 ml to 0 CFU/100 ml. Compared to the classic ceramic filter, no significant difference in the Duncan test is reported for the highlighted parameters. This filter presents potential among other water treatment methods at the local scale for reducing the risks of water-borne diseases and achieving Sustainable Development Goal 6 in developing countries.

The benefit of clean water on child health: An empirical analysis with specific reference to Escherichia Coli water contamination

Microorganism-mediated degradation of water quality is a major public health concern in developing countries. Previous literature has shown an association between household water pollution and childhood diarrhoea; however, its effects on child growth, respiratory health, and infant mortality have not been widely investigated. This study assesses the impact of household drinking water contaminated with Escherichia coli (E. coli) on child's weight-for-height and weight-for-age z-scores, acute respiratory infections (ARI), and diarrhoea incidence among five years children, and on infant mortality rate (IMR) in Pakistan. We use district-level geospatial information and the latest waves of unique Multiple Indicator Cluster Survey (MICS) data containing information on ‘point-of-service delivery’ (POS) and ‘point-of-consumption’ (POC) water quality, collected for the first time on a large scale in Pakistan. We employ an instrumental variable approach to address potential endogeneity issues in household drinking water quality, finding that POC drinking water contamination significantly affects children's weight-for-height and weight-for-age z-scores and diarrhoea but insignificantly affects ARI and IMR. The effects of contaminated water are found to be particularly significant in children older than 6 months of age and an insignificant effect is observed for younger children. To protect the children from growth failure and contracting diarrhoea, household water quality should be improved.

Bottled Water Consumption and Perceptions of Household Water Quality: An Intra-Urban Analysis of Greensboro, North Carolina

abstract: Perceived household water quality can affect decision-making about bottled water consumption, an issue of environmental justice. Residents who do not trust the quality of their tap water may drink bottled water as an alternative, but people also choose to drink bottled water for other reasons, such as taste or convenience. This study examines patterns of bottled water consumption and perceptions of tap water quality across neighborhoods of Greensboro, North Carolina, with differing income levels. Household surveys were used to investigate residents' consumption of bottled water and tap water and their stated reasons for consuming bottled water. Results indicate that respondents in low-income neighborhoods report drinking significantly (p=0.001) more bottled water than respondents in higher-income neighborhoods. Concerns about the safety of tap water were a significantly (p=0.00005) more important reason for respondents in low-income neighborhoods to choose bottled water compared to respondents in higher-income neighborhoods. The results of this study indicate that intra-urban differences in perceptions of household water quality are a major environmental justice issue in that concerns about safety drive low-income residents to spend their limited income on bottled water.

Manganese exposure from spring and well waters in the Shenandoah Valley: interplay of aquifer lithology, soil composition, and redox conditions

Manganese (Mn) is of particular concern in groundwater, as low-level chronic exposure to aqueous Mn concentrations in drinking water can result in a variety of health and neurodevelopmental effects. Much of the global population relies on drinking water sourced from karst aquifers. Thus, we seek to assess the relative risk of Mn contamination in karst by investigating the Shenandoah Valley, VA region, as it is underlain by both karst and non-karst aquifers and much of the population relies on water wells and spring water. Water and soil samples were collected throughout the Shenandoah Valley, to supplement pre-existing well water and spring data from the National Water Information System and the Virginia Household Water Quality Program, totaling 1815 wells and 119 springs. Soils were analyzed using X-ray fluorescence and Mn K-Edge X-ray absorption near-edge structure spectroscopy. Factors such as soil type, soil geochemistry, and aquifer lithology were linked with each location to determine if correlations exist with aqueous Mn concentrations. Analyzing the distribution of Mn in drinking water sources suggests that water wells and springs within karst aquifers are preferable with respect to chronic Mn exposure, with < 4.9% of wells and springs in dolostone and limestone aquifers exceeding 100 ppb Mn, while sandstone and shale aquifers have a heightened risk, with > 20% of wells exceeding 100 ppb Mn. The geochemistry of associated soils and spatial relationships to various hydrologic and geologic features indicates that water interactions with aquifer lithology and soils contribute to aqueous Mn concentrations. Relationships between aqueous Mn in spring waters and Mn in soils indicate that increasing aqueous Mn is correlated with decreasing soil Mn(IV). These results point to redox conditions exerting a dominant control on Mn in this region.

Suboptimal Bacteriological Quality of Household Water in Municipal Ibadan, Nigeria.

Access to potable water is difficult for many African residents. This study evaluated the bacteriological quality of household water collected in the dry and wet seasons across five municipal local government areas (LGAs) in Ibadan, a large city in southwest Nigeria. A total of 447 water samples (dry season, n = 250; wet season, n = 197) were aseptically collected from a random sample of mapped households within Ibadan's five municipal LGAs. The pH values and total aerobic and coliform bacterial counts were measured, and samples were screened for Escherichia coli, Salmonella, Shigella, and Yersinia by standard phenotypic techniques and multiplex polymerase chain reaction. The most common source of water was well (53.2%), followed by borehole (34%). None of the households used municipal tap water. Cumulatively, aerobic (P = 0.0002) and coliform (P = 0.0001) counts as well as pH values (P = 0.0002) changed significantly between seasons, with increasing and decreasing counts depending on the LGA. Nonpotable water samples were found to be very common during the dry (86.8%) and wet (74.1%) seasons. Escherichia coli spp., as indicators of recent fecal contamination, were isolated from 115 (25.7%) of the household water sources. Thirty three Salmonella, four enteroaggregative E. coli, and four enterotoxigenic E. coli isolates but no Shigella or Yersinia isolates were identified. This study revealed the absence of treated tap water and the poor quality of alternative sources with detectable pathogens in municipal Ibadan. Addressing the city-wide lack of access to potable water is an essential priority for preventing a high prevalence of feco-orally transmitted infections.

Bottled Water Consumption and Perceptions of Household Water Quality: An Intra-Urban Analysis of Greensboro, North Carolina

Perceived household water quality can affect decision-making about bottled water consumption, an issue of environmental justice. Residents who do not trust the quality of their tap water may drink bottled water as an alternative, but people also choose to drink bottled water for other reasons, such as taste or convenience. This study examines patterns of bottled water consumption and perceptions of tap water quality across neighborhoods of Greensboro, North Carolina, with differing income levels. Household surveys were used to investigate residents’ consumption of bottled water and tap water and their stated reasons for consuming bottled water. Results indicate that respondents in low-income neighborhoods report drinking significantly (p=0.001) more bottled water than respondents in higher-income neighborhoods. Concerns about the safety of tap water were a significantly (p=0.00005) more important reason for respondents in low- income neighborhoods to choose bottled water compared to respondents in higher-income neighborhoods. The results of this study indicate that intra-urban differences in perceptions of household water quality are a major environmental justice issue in that concerns about safety drive low-income residents to spend their limited income on bottled water.

Pengaruh Soda Ash dan Media Filter Sintetis Terhadap Kekeruhan dan pH Air

Water treatment methods are very diverse, including neutralization methods and filtration methods. In this study, the material used in the neutralization process is soda ash, while filtration uses synthetic filter media. This method is used to improve the quality of clean water in households on turbidity and pH parameters. The purpose of the study was to determine the effect of the addition of soda ash and filtration using synthetic filter media on turbidity and pH of Anjir Pasar river water. This type of research is an experiment with pretest-postest design with control group. Variations of synthetic filter media used are without filter media, catridge foam, cloth, cotton, and a combination of filter media types. Turbidity before treatment was 42 NTU with a pH of 3.8. After neutralization using 10 grams of soda ash, the pH of the river water became 7.5. Meanwhile, the turbidity decreased to 36.55 NTU, 18.26 NTU, 3.89 NTU, 10.75 NTU, and 7.9 NTU after filtration with a media thickness of 60 cm with a turbidity reduction percentage of 13%, 57%, 91%, 74%, and 84%. The results of statistical analysis showed that there were differences in each type of synthetic filter media on the decrease in turbidity level and there were no differences in each type of synthetic filter media on the pH quality of Anjir Pasar river water.

Faucet-mounted point-of-use drinking water filters to improve water quality in households served by private wells

Approximately 13 % of Americans rely on private wells for household potable water. As private wells are not regulated beyond initial construction and often employ limited or no treatment, source water from wells can be vulnerable to contamination. While several studies have assessed applications of point-of-use (POU) filters in improving municipal tap water quality, few have investigated their use with private well water. This effort aims to build on previous examinations of POU treatment as a strategy to reduce adverse household drinking water exposures by: 1) assessing the effectiveness of commercially available faucet-mounted POU filters for improving microbial and chemical water quality in homes with private wells; and 2) documenting household ease of use and satisfaction with the filters. Faucet-mounted POU filters were distributed to 21 homes reliant on private wells in southern West Virginia and southwestern Virginia. Study participants were asked to collect water samples from two taps in their homes pre-filter installation, and again two-weeks and four-weeks post-installation. Participants filled out surveys about perceptions of their drinking water and the filter. Concentrations of Total Coliform, Ba, Cd, Cr, U, Cu, Pb, Al, Fe, Mn, Zn, and Sr were significantly lower (p < 0.05, Wilcoxon Rank Sum) in filtered water samples compared to paired unfiltered samples (n = 42) for the study period. However, concentrations of certain contaminants in filtered samples from homes with high levels of source water contamination still exceeded drinking water standards. Less than half of study participants reported that they intended to keep using the filters, citing issues of flowrate. Our findings suggest that faucet-mounted POU filters, while effective in reducing contaminants, might not be an appropriate intervention to improve water quality for all homes on private well water. Future investigation is required to improve filter user satisfaction and better assess appropriate source water chemistries for implementation.

Efficacy of solar water disinfection treatment system in improving rural and peri-urban household drinking water quality and reducing waterborne diarrhoeal diseases

Abstract Consumption of untreated microbiologically contaminated water, prevalent in many developing countries, exposes the vulnerable population to inordinate health risks including most life-threatening diarrhoeal diseases like cholera and other illnesses. In response, innovative techniques for treating water at the household level, known as household water treatment (HWT), have emerged as practical and cost-effective solutions. Solar water disinfection (SODIS) has gained recognition as one such method that utilizes sunlight to inactivate harmful micro-organisms in water. This review examines the effectiveness of SODIS as an HWT technique by analysing scientifically robust evidence documenting its microbiological efficacy and the positive health gains among SODIS users. It explores the challenges and limitations that impact its inactivation efficiency and sustainability. Its novelty lies in its expanded exploration of the available strategies and techniques for enhancing the effectiveness of SODIS to address its associated limitations and challenges. By providing a comprehensive analysis of the scientific evidence, this review presents compelling reasons for the implementation and scalability of SODIS in the developing world. This novel perspective contributes to the existing literature on improving access to safe drinking water in underserved communities, offering valuable insights into the advancement of SODIS as a practical and sustainable HWT solution.

Household drinking water quality and its predictors in flood-prone settings of Northwest Ethiopia: A cross-sectional community-based study

Globally, the deterioration of drinking water quality is a major public health problem that contributes to the spread of disease and causes death. Therefore, it is important to have regular quality control monitoring. This study aimed to assess the level of physicochemical and bacteriological quality of household drinking water and its contributing factors in flood-prone settlements of South Gondar Zone, Ethiopia. A community-based cross-sectional study was conducted in flood-prone settings of Northwest Ethiopia from January 17 to March 30, 2021. Structured questionnaires were used to gather the sociodemographic, environmental, and behavioral data. A total of 675 drinking water samples were collected from water storage containers of selected households. Logistic regression models were used for both univariate and multivariable studies. The survey included a total of 675 households. The mean values of pH (5.9 ± 1.03), turbidity (6.7 ± 2.21 NTU), and free residual chlorine (0.02 ± 0.01 mg/l) did not meet the WHO recommended limits for drinking water. The prevalence of fecal contamination of drinking water in the study area was 62.2% with [95% CI (53–60%)]. Family size [AOR = 2.205, 95% CI (1.375–3.536), absence of latrine [AOR = 3.449, 95% CI (1.349–8.823)], and lack of a separate container to draw water from its storage [AOR = 0.454, 95% CI (0.249–0.827)] were significant predictors for fecal contamination of household drinking water. In conclusion, the water quality in terms of pH, turbidity, residual chlorine, and bacteriological parameters was poor and not suitable for consumption. High prevalence of fecal contamination of water was found, and it was significantly associated with family size, the absence of a latrine, and the lack of a separate cap to take water from the storage. Therefore, continuous chlorination and monitoring its concentration, educating the community on how to use stored water, educating the advantage of having a latrine, and promoting point-of-use treatments such as filtration and boiling are needed.

The Relationship Between Household Drinking Water Quality and The Incidence of Stunting

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;Unhealthy housing conditions will hurt human health, one of which is ARI. Based on data from the Stabat Health Center, ARI is among the top 10 diseases. Based on 2019 data, there were 1572 cases; the increase in cases occurred from 2020 to 1692, with 206 cases in Sidomulyo Village. Moreover, the physical condition of the houses in Sidomulyo still needs to meet the requirements of a healthy home. Based on the Basic Health Research (Riskesdas) report, the prevalence of stunting in Indonesia increased from 2016 to 2018, namely 27.5% in 2016, 29.6% in 2017, and 30.8% in 2018 (Riskesdas, 2018). Factors causing stunting are divided into direct causal factors and indirect causal factors. This study aimed to determine the relationship between household drinking water quality and the incidence of stunting in children aged 6-59. Observational research with a case-control design on children aged 6-59 months in the Talun Kenas Health Center Area, Deli Serdang Regency. The sampling technique was carried out by consecutive sampling with a total sample of 42 subjects in each group. Stunting was categorized based on TB/U score &amp;lt; -2 SD according to KEPMENKES RI anthropometric standard table. Drinking water quality was tested using a sanitarian kit—bivariate analysis using the Chi-Square test by looking at the Odds Ratio (OR). The results of the bivariate analysis show that the quality of household drinking water is associated with stunting in children aged 6-59 months (p=0.004; OR=4.144), meaning that the quality of drinking water that does not meet the requirements increases the incidence of stunting in children aged 6-59 months. This study concludes a significant relationship between the quality of household drinking water and the incidence of stunting in children aged 6-59 months.&lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;

Effectiveness of a water-vending kiosk intervention toward household water quality and surveyed water security in Freetown, Sierra Leone

Low-income urban residents of Freetown, Sierra Leone, have limited access to safely managed piped drinking water services. The Government of Sierra Leone, in partnership with the United States Millennium Challenge Corporation, implemented a demonstration project of ten water kiosks providing distributed, stored, treated water among two neighborhoods in Freetown. This study quantifies the impact of the water kiosk intervention by utilizing a quasi-experimental propensity score matched difference-in-differences study design. Results indicate a 0.6 % improvement in household microbial water quality and an 8.2 % improvement in surveyed water security within the treatment group. Furthermore, low functionality and adoption of the water kiosks were observed.

Are better existing WASH practices in urban slums associated with a lower long-term risk of severe cholera? A prospective cohort study with 4 years of follow-up in Mirpur, Bangladesh

ObjectiveTo investigate the association between existing household water quality, sanitation and hygiene (WASH) practices and severe cholera risk in a dense urban slum where cholera is highly endemic.Design, setting and...

Intention Versus Action: Household Adoption of Best Management Practices for Water Quality

AbstractAdoption rates of household water quality management practices remain extremely low, despite survey evidence indicating substantial willingness to adopt. Using a quasi‐experimental survey design, we investigate the presence of hypothetical bias in household stormwater surveys and compare the effectiveness of two ex‐ante bias mitigation techniques: survey consequentiality and a cheap talk script. Households facing survey consequentiality are willing to pay 38% less for stormwater practices compared with the control. This results in expected adoption rates that are up to 60% lower than those indicated by responses in the control group. In contrast the cheap talk script did not significantly alter willingness to pay for any management practice analyzed. After accounting for hypothetical bias, local policy goals for rain garden adoption imply a household subsidy program that consumes almost three times the budget of that implied by survey responses without a consequentiality reminder.

Developing early warning systems to predict water lead levels in tap water for private systems

Lead is a chemical contaminant that threatens public health, and high levels of lead have been identified in drinking water at locations across the globe. Under-served populations that use private systems for drinking water supplies may be at an elevated level of risk because utilities and governing agencies are not responsible for ensuring that lead levels meet the Lead and Copper Rule at these systems. Predictive models that can be used by residents to assess water quality threats in their households can create awareness of water lead levels (WLLs). This research explores and compares the use of statistical models (i.e., Bayesian Belief classifiers) and machine learning models (i.e., ensemble of decision trees) for predicting WLLs. Models are developed using a dataset collected by the Virginia Household Water Quality Program (VAHWQP) at approximately 8000 households in Virginia during 2012–2017. The dataset reports laboratory-tested water quality parameters at households, location information, and household and plumbing characteristics, including observations of water odor, taste, discoloration. Some water quality parameters, such as pH, iron, and copper, can be measured at low resolution by residents using at-home water test kits and can be used to predict risk of WLLs. The use of at-home water quality test kits was simulated through the discretization of water quality parameter measurements to match the resolution of at-home water quality test kits and the introduction of error in water quality readings. Using this approach, this research demonstrates that low-resolution data collected by residents can be used as input for models to estimate WLLs. Model predictability was explored for a set of at-home water quality test kits that observe a variety of water quality parameters and report parameters at a range of resolutions. The effects of the timing of water sampling (e.g., first-draw vs. flushed samples) and error in kits on model error were tested through simulations. The prediction models developed through this research provide a set of tools for private well users to assess the risk of lead contamination. Models can be implemented as early warning systems in citizen science and online platforms to improve awareness of drinking water threats.

Socio-demographic and water handling practices affecting quality of household drinking water in Kisii Town, Kisii County, Kenya

Household drinking water quality is dependent on a number of determinants which could be arising at the source, during transportation or due to storage and handling practices. The challenge of unsafe water is even big in urban settings that are often characterized by exponential population growth, increased urbanization, industrialization and poor sanitary facilities. Contaminated water is a leading cause of water borne diseases which are a major public health and policy makers concern. In fact, Water borne diseases are third cause of mortality in Kenya whereas they are ranked second in Kisii. The study was designed to investigate the factors affecting household drinking water quality in Kisii Town that has four main zones which include: Mwembe, Jogoo, Nyanchwa and CBD. Demographics, level of awareness in terms of water quality as well as hygiene and sanitation practices of the study population were studied using questionnaires. The questionnaires were filled by interviewing household heads from 422 sampled households. Qualitative data was also obtained by use of Focused group discussions (FGDs). Perspectives of key people such as public health officers were acquired through Key informant interviews (KIIs). The study found a significant relationship between household size and water quality in terms of presence of total coliforms. The following hygiene and sanitation factors were found to be having significant relationship with presence of E. coli in household drinking water; source of water (p = 0.002), transportation container (p = 0.029), covering during transportation (p = 0.012), storage container (p < 0.001), method of drawing from storage container (p < 0.001), feces disposal (p = 0.001) and garbage disposal method (p = 0.04). The conclusion of this study is that good hygiene and sanitation practices are important in ensuring total safety of drinking water at the point of use. There is therefore need for more capacity building in this region to ensure that people do not consume contaminated water which is a major contributing factor to water-borne diseases.

Genetic characterization and antimicrobial susceptibility of Escherichia coli isolated from household water sources in northern Ghana.

The microbial quality of household water is an important issue in developing countries, especially in Ghana, where many people still depend on unimproved sources of water. The present study investigated the prevalence, genetic characteristics, and antimicrobial resistance profile of Escherichia coli from surface water sources. Fifty-two water samples were analyzed by using a spread plate, a biochemical test, and multiplex polymerase chain reactions. E. coli was isolated from each of the 52 water samples. Of these isolates, 75% were noted to possess virulence genes. Approximately 54% of the isolates were characterized as follows: enterotoxigenic E. coli (ETEC, 10.26%), enteropathogenic E. coli (EPEC, 17.95%), verotoxigenic E. coli (VTEC, 23.07%), and enteroinvasive E. coli (EIEC, 2.57%). Eighteen of the fifty-two isolates could not be characterized due to heterogeneity in banding. The disc diffusion method was used to test for antimicrobial susceptibility. The isolates were most resistant to ceftazidime, augmentin, and cefuroxime. Multidrug resistance was recorded in 48.1% of the isolates. In contrast, the isolates were most susceptible to ciprofloxacin (86.5%), nitrofurantoin (84.6%), and ofloxacin (75%). These results revealed a high diversity and widespread of E. coli in northern Ghana. The study provides important data for public health nationwide surveillance of E. coli in surface water across the country.

Seasonal Variability Influence on the Prevalence of Diarrhoea among Under-Five-Year-old Children in Kersa District, Eastern Ethiopia: A Community-Based Longitudinal Study

Background:The health effects of climate change have been found to be a global concern for the last 2 centuries. However, the effect of climate variability on diarrhoea among under-five-year-old children is perhaps undocumented or otherwise unknown. The aim of the present study was to determine the effect of climate variability on diarrhoea among children under 5 years of age.Methods:A community-based longitudinal study was conducted over 8 repeated visits from June 2016 to May 2018 at the Kersa Demographic Surveillance and Health Research Center. A total of 500 randomly selected households and their 48 improved water sources were included in the survey from 3 agro-ecological zones, the rural and urban areas of the study area. Data was collected on household characteristics, diarrhoea, WASH practices, water quality and quantity in households, and improved water sources. A structured pre-tested questionnaire, an observational check list and laboratory tests were used for data collection. The data was entered into Epi Data Version 3.01 and transferred to Stata Version 12 for analysis. Multilevel mixed-effect Poisson regression was used to determine the relationship between predictors and outcome variables. A P-value of less than .05 was the cut-off point for statistically significant.Results:The prevalence of diarrhoea in 2 weeks among children under 5 years of age was 17.2% (95% CI: 15.8-19.71). Rainfall, E. coli contamination of drinking water at the source and in the home, 20 L of water consumption per capita per day, sharing water sources with animals and home water treatment by residents of the mid- and lowlands were all predictors of diarrhoea. The space-time scan statistic confirmed that child diarrhoea had random variation in both space and time.Conclusion:Climate variability has influenced the prevalence of diarrhoea among under-five-year-old children. Climate-resilient measures should be taken to reduce the burden of diarrhoea in the community.