Volume 94, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



In the developing world, fetching water for drinking and other household uses is a substantial burden that affects water quantity and quality in the household. We used logistic regression to examine whether reported household water fetching times were a risk factor for moderate-to-severe diarrhea (MSD) using case–control data of 3,359 households from the Global Enterics Multi-Center Study in Kenya in 2009–2011. We collected additional global positioning system (GPS) data for a subset of 254 randomly selected households and compared GPS-based straight line and actual travel path distances to fetching times reported by respondents. GPS-based data were highly correlated with respondent-provided times (Spearman correlation coefficient = 0.81, < 0.0001). The median estimated one-way distance to water source was 200 m for cases and 171 for controls (Wilcoxon rank sums/Mann–Whitney = 0.21). A round-trip fetching time of > 30 minutes was reported by 25% of cases versus 15% of controls and was significantly associated with MSD where rainwater was not used in the last 2 weeks (odds ratio = 1.97, 95% confidence interval = 1.56–2.49). These data support the United Nations definition of access to an improved water source being within 30 minutes total round-trip travel time.


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  1. WHO/UNICEF Joint Water Supply and Sanitation Monitoring Programme, 2014, 2013. Progress on Drinking Water and Sanitation. [Google Scholar]
  2. United Nations, 2014. The Millennium Development Goals Report 2014. New York, NY: United Nations. [Google Scholar]
  3. Blackden CM, Wodon Q, , 2006. Gender, Time Use, and Poverty in Sub-Saharan Africa. Washington, DC: World Bank. Available at: http://siteresources.worldbank.org/INTAFRREGTOPGENDER/Resources/gender_time_use_pov.pdf. [Google Scholar]
  4. Goetz AM, United Nations Development Fund for Women, 2008. Who Answers to Women?: Gender & Accountability. New York, NY: United Nations Development Fund for Women. [Google Scholar]
  5. Sorenson SB, Morssink C, Campos PA, , 2011. Safe access to safe water in low income countries: water fetching in current times. Soc Sci Med 72: 15221526.[Crossref] [Google Scholar]
  6. Cairncross S, Pickford J, , 1987. The benefits of water supply. , ed. Developing World Water. London, United Kingdom: Grosvenor Press. [Google Scholar]
  7. Tumwine JK, International Institute for Environment and Development, , 2002. Drawers of Water II: 30 Years of Change in Domestic Water Use & Environmental Health in East Africa. Uganda Country Study. London, United Kingdom: International Institute for Environment and Development. [Google Scholar]
  8. Sakisaka K, Chadeka EA, Nagi S, Mwandembo DS, Jimba M, , 2015. Introduction of a community water supply in rural western Kenya: impact on community wellbeing and child health. Int Health 7: 204211.[Crossref] [Google Scholar]
  9. United Nations, 2013. The Post 2015 Water Thematic Consultation: Recognition of Outcomes, High Level Forum–World Water Day. Available at: http://www.unwater.org/downloads/Final9Aug2013_WATER_THEMATIC_CONSULTATION_REPORT.pdf. [Google Scholar]
  10. Water Supply and Sanitation Collaborative Council, 2014. WASH Post-2015: Proposed Targets and Indicators for Drinking-Water, Sanitation and Hygiene 112. Available at: http://www.unicef.org/wash/files/2_WSSCC_JMP_Fact_Sheets_2_UK_LoRes.pdf. [Google Scholar]
  11. Kotloff KL, Blackwelder WC, Nasrin D, Nataro JP, Farag TH, van Eijk A, Adegbola RA, Alonso PL, Breiman RF, Faruque AS, Saha D, Sow SO, Sur D, Zaidi AK, Biswas K, Panchalingam S, Clemens JD, Cohen D, Glass RI, Mintz ED, Sommerfelt H, Levine MM, , 2012. The Global Enteric Multicenter Study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case/control study. Clin Infect Dis 55 (Suppl 4): S232S245.[Crossref] [Google Scholar]
  12. Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, Wu Y, Sow SO, Sur D, Breiman RF, Faruque AS, Zaidi AK, Saha D, Alonso PL, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ochieng JB, Omore R, Oundo JO, Hossain A, Das SK, Ahmed S, Qureshi S, Quadri F, Adegbola RA, Antonio M, Hossain MJ, Akinsola A, Mandomando I, Nhampossa T, Acacio S, Biswas K, O'Reilly CE, Mintz ED, Berkeley LY, Muhsen K, Sommerfelt H, Robins-Browne RM, Levine MM, , 2013. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet 382: 209222.[Crossref] [Google Scholar]
  13. University of Maryland, 2014. Global Enterics Multi-Center Study (GEMS). Available at: http://medschool.umaryland.edu/GEMS/. Accessed November 20, 2014. [Google Scholar]
  14. Subaiya S, Cairncross S, , 2011. Response to Wang and Hunter: a systematic review and meta-analysis of the association between self-reported diarrheal disease and distance from home to water source. Am J Trop Med Hyg 84: 504, author reply 505.[Crossref] [Google Scholar]
  15. Wang X, Hunter PR, , 2010. A systematic review and meta-analysis of the association between self-reported diarrheal disease and distance from home to water source. Am J Trop Med Hyg 83: 582584.[Crossref] [Google Scholar]
  16. Omore R, O'Reilly CE, Williamson J, Moke F, Were V, Farag TH, van Eijk AM, Kotloff KL, Levine MM, Obor D, Odhiambo F, Vulule J, Laserson KF, Mintz ED, Breiman RF, , 2013. Health care-seeking behavior during childhood diarrheal illness: results of health care utilization and attitudes surveys of caretakers in western Kenya, 2007–2010. Am J Trop Med Hyg 89: 2940.[Crossref] [Google Scholar]
  17. Jet Propulsion Laboratory, 2014. ASTER Global Digital Elevation Map Announcement. Available at: http://asterweb.jpl.nasa.gov/gdem.asp. Accessed September 1, 2014. [Google Scholar]
  18. Levine R, Norenzayan A, , 1999. The pace of life in 31 countries. J Cross Cult Psychol 30: 178205.[Crossref] [Google Scholar]
  19. Ho JC, Russel KC, Davis J, , 2014. The challenge of global water access monitoring: evaluating straight-line distance versus self-reported travel time among rural households in Mozambique. J Water Health 12: 173183.[Crossref] [Google Scholar]
  20. WaterAid, 2013. Rainwater Harvesting. Technical Brief, 110. Available at: http://www.wateraid.org/∼/media/Publications/Rainwater-harvesting.pdf. [Google Scholar]
  21. Dobrowsky PH, De Kwaadsteniet M, Cloete TE, Khan W, , 2014. Distribution of indigenous bacterial pathogens and potential pathogens associated with roof-harvested rainwater. Appl Environ Microbiol 80: 23072316.[Crossref] [Google Scholar]
  22. Ahmed W, Vieritz A, Goonetilleke A, Gardner T, , 2010. Health risk from the use of roof-harvested rainwater in southeast Queensland, Australia, as potable or nonpotable water, determined using quantitative microbial risk assessment. Appl Environ Microbiol 76: 73827391.[Crossref] [Google Scholar]
  23. Dean J, Hunter PR, , 2012. Risk of gastrointestinal illness associated with the consumption of rainwater: a systematic review. Environ Sci Technol 46: 25012507.[Crossref] [Google Scholar]
  24. Haynes R, Jones AP, Sauerzapf V, Zhao H, , 2006. Validation of travel times to hospital estimated by GIS. Int J Health Geogr 5: 40.[Crossref] [Google Scholar]
  25. Hornik J, , 1984. Subjective vs. objective time measures: a note on the perception of time in consumer behavior. J Consum Res 11: 615618.[Crossref] [Google Scholar]
  26. Crow B, Davies J, Paterson S, Miles J, , 2013. Using GPS and recall to understand water collection in Kenyan informal settlements. Water Int 38: 4360.[Crossref] [Google Scholar]
  27. Kenya National Bureau of Statistics, 2010. Kenya Demographic and Health Survey, 2008–2009. Nairobi, Kenya: Kenya National Bureau of Statistics. [Google Scholar]
  28. Pickering AJ, Davis J, , 2012. Freshwater availability and water fetching distance affect child health in sub-Saharan Africa. Environ Sci Technol 46: 23912397.[Crossref] [Google Scholar]

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  • Received : 26 May 2015
  • Accepted : 21 Jan 2016
  • Published online : 04 May 2016

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