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FACTORS ASSOCIATED WITH E. COLI CONTAMINATION OF HOUSEHOLD DRINKING WATER AMONG TSUNAMI AND EARTHQUAKE SURVIVORS, INDONESIA

The December 2004 tsunami in Sumatra, Indonesia, destroyed drinking water infrastructure, placing over 500,000 displaced persons at increased risk of waterborne disease. In June 2005, we assessed the relationship of water handling behaviors to household water quality in three districts: Aceh Besar, Simeulue, and Nias. We surveyed 1,127 households from 21 communities and tested stored drinking water. Factors associated with a reduced likelihood of having contaminated stored drinking water included obtaining water from improved sources (Aceh Besar, adjusted odds ratio (aOR) 0.41, P < 0.01; Simeulue, aOR 0.48, P = 0.02), using chlorine solution (Simeulue, aOR 0.41, P < 0.01), and having free chlorine in stored water (Aceh Besar, aOR 0.42, P < 0.01; Nias, aOR 0.28, P < 0.01). Reported boiling, even among those who could describe correct practice, was not associated with improved water quality. Water source improvement and household water chlorination appear to be useful strategies to improve household stored drinking water quality in post-disaster situations.

Received June 7, 2006. Accepted for publication December 5, 2006.

Acknowledgments: The authors acknowledge the research team for their assistance. We are grateful to project partners, which included the Government of Indonesia, United States Agency for International Development, Johns Hopkins University Center for Communications Programs, CARE International Indonesia, International Medical Corps, and UNICEF. We also thank Heather Van Sice, Bertha Butar Butar, Rustini Floranita, Gercelina Silaen, and Frank Tyler for logistical and technical support.

Financial support: This evaluation was financed and supported by CARE International Indonesia, with assistance from International Medical Corps.

Disclaimer: There are no relationships or support among any of the authors that might be perceived as constituting a conflict of interest.

^* Address correspondence to Sundeep K. Gupta, Epidemic Intelligence Service, Foodborne and Diarrheal Disease Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A38, Atlanta, GA 30333. E-mail: sgupta2{at}cdc.gov

Authors’ addresses: Sundeep K. Gupta and Rob Quick, Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A38, Atlanta, GA 30333, Telephone: +1 (404) 639-2206, Fax: +1 (404) 639-2205, E-mails: sgupta2{at}cdc.gov and rquick{at}cdc.gov. Astrid Suantio, Rollins School of Public Health, Emory University, 2871 Wyndcliff Ct NE, Marietta, GA 30066, Telephone: +1 (770) 419-1739, E-mail: astridmelani{at}yahoo.com. Alicia Gray, Yale University School of Public Health and School of Forestry and Environmental Science, 42 Bourne Point Road, Wareham, MA 02571, Telephone: +1 (203) 915-5485, E-mail: alicia.gray{at}yale.edu. Endang Widyastuti and Rieneke Rolos, CARE International Indonesia, Patimura no 33, Kebayoran Baru, Jakarta Selatan 12110, Telephone: +62 21 7279 6661, Fax: +61 21 7222 552, E-mails: endang{at}careind.or.id and rieneke{at}careind.or.id. Neena Jain, International Medical Corps, 2252 Emerson St., Denver, CO 80205, Telephone: +1 (303) 898-9428, E-mail: pxesante{at}yahoo.com. Robert M. Hoekstra, Biostatistics and Information Management Branch, National Center for Infectious Diseases, Centers For Disease Control and Prevention, Mailstop C09, 1600 Clifton Road, NE, Atlanta, GA 30333, Telephone: +1 (404) 639-4712, Fax: +1 (404) 639-0070, E-mail: mhoekstra{at}cdc.gov.

Reprint requests: Sundeep K. Gupta, Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A38, Atlanta, GA 30333, Telephone: +1 (404) 639-2206, Fax: +1 (404) 639-2205, E-mail: sgupta2{at}cdc.gov.

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