Evaluation of WASH indicators associated with diarrhoeal disease among under-five children in an urban slum pocket, Mumbai city, India: a community-based repeated cross-sectional study

Abstract

Abstract Water, Sanitation and Hygiene (WASH) practices are important factors in preventing diarrhoea. The objectives of this study were to assess the behaviour of the mothers of under-five children with regard to WASH practices, water quality, incidence rate of diarrhoea and the WASH predictors responsible for diarrhoea and water contamination, using multivariate regression analysis. The present study was conducted in households (n=55) having under-five children (n = 88) based in an urban slum pocket of Mumbai city, India. Key satisfactory practices included (percent household following them in parenthesis) boiling of water (63.6%) and daily cleaning of storage containers (74.5%). Households followed unsatisfactory practices during water transfer (72.7%), handwashing (58.2%), defaecation location (96.4%) and disposal of children's faeces (98.2%). The incidence rate of diarrhoea among <5-year-old children was 4.7 diarrhoeal episodes/100 child months. 86 and 39.7% of untreated and boiled drinking water samples had coliforms, while 12.5 and 5.1% had E. coli, respectively. Untreated drinking water and water sourced from shared taps were significantly associated with the incidence of diarrhoea (p < 0.05), and inconsistent in-house treatment of water was significantly associated with the presence of coliforms in drinking water (p < 0.05). The study results suggest that WASH advocacy and an improvement in sanitation-related infrastructure for the slum population can reduce diarrhoeal incidence.