Water sources are associated with childhood diarrhoea prevalence in rural east-central Mali.

BACKGROUND Water supply improvements generally reduce the incidence of diarrhoea. However, populations with limited access to a safe water supply may continue to draw water from unimproved sources, thereby increasing their risk of diarrhoea. Furthermore, young children who are not breastfed may be even more susceptible to water-borne diarrhoeal pathogens. Our study explored the interactive protective effects against diarrhoea of exclusively using improved water sources and breastfeeding among children in rural Mali. METHODS Interviews were conducted with parents or guardians of children under 7 years of age in seven villages with access to a variety of water supplies. Water sources used, breastfeeding status, demographics and recent diarrhoea symptoms were determined for 1117 children. The cross-sectional findings were used to compare diarrhoea prevalence among exclusive and non-exclusive users of improved water sources. Variation in prevalence by age and exclusive breastfeeding status was evaluated using chi-square and multivariate analyses. RESULTS Children whose water was drawn exclusively from wells had a significantly lower prevalence of diarrhoea as compared with children whose water was drawn from a spring or stream (5.9% vs. 8.7%; P=0.04). The exclusive use of improved water sources had no impact on diarrhoea prevalence among children who were exclusively breastfed. Similarly, the strongest protective effect was observed among children who were not exclusively breastfed. CONCLUSIONS Our results indicate that using surface water as a primary or secondary water source exposes children to greater risk of diarrhoeal disease than using only improved sources such as wells. It is particularly beneficial for young children who are not exclusively breastfed to be supplied with water drawn from improved sources.