A Study of Risk Factors related to Water and Sanitation in Pune, west India

Introduction: Piped water systems are considered to be the gold standard for drinking water according to the Joint Water Monitoring Study. However, poor maintenance of distribution pipes, intermittency of water supply, and sewage water intrusion have contributed to a number of water-borne disease episodes in developed and developing countries. Methods: This study investigated the risk burden related to drinking water and sanitation in population clusters of Pune, western India that are being served by a piped distribution system through a cross-sectional survey. Two-stage stratified convenience sampling was carried out. The city was divided into administrative wards of which the city center, the neo-urban and the peri-urban settlement were selected. In the second step a higher (HSG) and a lower socioeconomic group (LSG) were selected from each of the three studied wards. A questionnaire including close-ended items was used to conduct the survey. Results: In 2711 individuals studied, risk burden related to drinking water and sanitation was found to be higher in the LSG; 60% (677 of 1121), 70% (1029 of 1473) , 74% (1325 of 1791) from the LSGs did not have a private water tap and continuous water supply, and did not treat the water at the household level, respectively. 98% (1403 of 1426) had neither a private water tap nor a private sanitary facility. The socioeconomic difference was significant (p<0.0001). 51 (3.5%) individuals from the LSGs and 42 (3.49%) ones from HSGs reported having suffered from severe diarrhea in the recall period of 2 years. Although the number of disease cases was lower than the overall risk burden, the potential of the latter to cause a disease outbreak cannot be eliminated. Conclusion: The study highlights that piped drinking water system which is considered as a safe source can become a source of pathogenic microorganisms if not properly maintained. A holistic approach to risk assessment, i.e., from the catchment and its source water to the consumer, is required.