Did Point-of-Use Chlorination Increase During a Cholera Epidemic?

McLennan, J.D. Original Research: Did point-of-use drinking water strategies for children change in the Dominican Republic during a cholera epidemic?  Public Health Nov 2015

Objective: Point-of-use (POU) strategies to improve drinking water, particularly chlorination, are promoted within cholera epidemics when centrally delivered safe drinking water is lacking. Most studies examining POU practices during cholera epidemics have relied on single cross-sectional studies which are limited for assessing behavioural changes. This study examined POU practices in a community over time during a cholera outbreak. 

Study design: Secondary data analysis of existing dataset. 

Methods: During attendance at well-baby clinics serving a low-income peri-urban community in the Dominican Republic, mothers had been routinely asked, using a structured questionnaire, about POU strategies used for drinking water for their children. Frequency distribution of reported practices was determined over a 21 month period during the cholera outbreak on the island of Hispaniola.

Results: An estimated 27.8% of children were reported to have had some exposure to untreated tap water. Unsustained reductions in exposure to untreated tap water were noted early in the epidemic. POU chlorination was infrequent and showed no significant or sustained increases over the study time period.

Conclusion: High reliance on bottled water, consistent with national household patterns prior to the cholera outbreak, may have reduced the perceived need for POU chlorination. Examination of the safety of relying on bottled water during cholera outbreaks is needed. Additionally, further inquiries are needed to understand variation in POU practices both during and beyond cholera outbreaks.

Chlorine addition to household drinking water was infrequent in the study community. No sustained water improvement practices were detected during a cholera outbreak. Extensive pre-existing bottled water use may have contributed to the lack of change.

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