Prüss-Ustün A , Wolf J , Bartram J , Clasen T , Cumming O , Freeman MC , Gordon B , Hunter PR , Medlicott K , Johnston R , 2019. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: an updated analysis with a focus on low- and middle-income countries. Int J Hyg Environ Health 222: 765–777.
Moore SR , Lima NL , Soares AM , Oriá RB , Pinkerton RC , Barrett LJ , Guerrant RL , Lima AAM , 2010. Prolonged episodes of acute diarrhea reduce growth and increase risk of persistent diarrhea in children. Gastroenterology 139: 1156–1164.
Lorntz B , Soares AM , Moore SR , Pinkerton R , Gansneder B , Bovbjerg VE , Guyatt H , Lima AM , Guerrant RL , 2006. Early childhood diarrhea predicts impaired school performance. Pediatr Infect Dis J 25: 513–520.
Berkman DS , Lescano AG , Gilman RH , Lopez SL , Black MM , 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564–571.
Brinkel J , Khan M , Kraemer A , 2009. A systematic review of arsenic exposure and its social and mental health effects with special reference to Bangladesh. Int J Environ Res Public Health 6: 1609–1619.
Winans B , Humble MC , Lawrence BP , 2011. Environmental toxicants and the developing immune system: a missing link in the global battle against infectious disease? Reprod Toxicol 31: 327–336.
Roberts JR , Karr CJ , Council on Environmental Health , 2012. Pesticide exposure in children. Pediatrics 130: e1765–e1788.
Feingold BJ , Vegosen L , Davis M , Leibler J , Peterson A , Silbergeld EK , 2010. A Niche for infectious disease in environmental health: rethinking the toxicological paradigm. Environ Health Perspect 118: 1165–1172.
Martínez-Santos P , 2017. Does 91% of the world’s population really have “sustainable access to safe drinking water”? Int J Water Resour Dev 33: 514–533.
World Health Organization, United Nations Children’s Fund (UNICEF) , 2017. Safely Managed Drinking Water: Thematic Report on Drinking Water 2017. Geneva, Switzerland: World Health Organization.
Bain R , Cronk R , Wright J , Yang H , Slaymaker T , Bartram J , 2014. Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis. PLOS Med 11: e1001644.
Kumpel E , Nelson KL , 2016. Intermittent water supply: prevalence, practice, and microbial water quality. Environ Sci Technol 50: 542–553.
Kumpel E , Nelson KL , 2013. Comparing microbial water quality in an intermittent and continuous piped water supply. Water Res 47: 5176–5188.
Naksen W , Prapamontol T , Mangklabruks A , Chantara S , Thavornyutikarn P , Robson MG , Ryan PB , Barr DB , Panuwet P , 2016. A single method for detecting 11 organophosphate pesticides in human plasma and breastmilk using GC-FPD. J Chromatogr B Analyt Technol Biomed Life Sci 1025: 92–104.
Midi H , Sarkar SK , Rana S , 2010. Collinearity diagnostics of binary logistic regression model. J Interdiscip Math 13: 253–267.
Corsini E , Sokooti M , Galli CL , Moretto A , Colosio C , 2013. Pesticide induced immunotoxicity in humans: a comprehensive review of the existing evidence. Toxicology 307: 123–135.
Larson AJ , Paz-Soldán VA , Arevalo-Nieto C , Brown J , Condori-Pino C , Levy MZ , Castillo-Neyra R , 2021. Misuse, perceived risk, and safety issues of household insecticides: qualitative findings from focus groups in Arequipa, Peru. PLOS Negl Trop Dis 15: e0009251.
Sánchez-Carbonel J , Tantaléan-Yépez D , Aguilar-Luis MA , Silva-Caso W , Weilg P , Vásquez-Achaya F , Costa L , Martins-Luna J , Sandoval I , del Valle-Mendoza J , 2018. Identification of infection by Chikungunya, Zika, and Dengue in an area of the Peruvian coast. Molecular diagnosis and clinical characteristics. BMC Res Notes 11: 175.
Wu J , Long SC , Das D , Dorner SM , 2011. Are microbial indicators and pathogens correlated? A statistical analysis of 40 years of research. J Water Health 9: 265–278.
Mattioli MCM , Davis J , Boehm AB , 2015. Hand-to-mouth contacts result in greater ingestion of feces than dietary water consumption in Tanzania: a quantitative fecal exposure assessment model. Environ Sci Technol 49: 1912–1920.
Committee on Infectious Diseases , 2013. Clostridium difficile infection in infants and children. Pediatrics 131: 196–200.
Sammons JS , Toltzis P , Zaoutis TE , 2013. Clostridium difficile infection in children. JAMA Pediatr 167: 567.
Eglow R , Pothoulakis C , Itzkowitz S , Israel EJ , O’Keane CJ , Gong D , Gao N , Xu YL , Walker WA , LaMont JT , 1992. Diminished Clostridium difficile toxin A sensitivity in newborn rabbit ileum is associated with decreased toxin A receptor. J Clin Invest 90: 822–829.
Platts-Mills JA et al., 2015. Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED). Lancet Glob Health 3: e564–e575.
Grados O , Bravo N , Black RE , Butzler J-P , 1988. Paediatric Campylobacter diarrhoea from household exposure to live chickens in Lima, Peru. Bull World Health Organ 66: 369–374.
George CM , Sima L , Arias MHJ , Mihalic J , Cabrera LZ , Danz D , Checkley W , Gilman RH , 2014. Arsenic exposure in drinking water: an unrecognized health threat in Peru. Bull World Health Organ 92: 565–572.
de Meyer CMC , Rodríguez JM , Carpio EA , García PA , Stengel C , Berg M , 2017. Arsenic, manganese and aluminum contamination in groundwater resources of Western Amazonia (Peru). Sci Total Environ 607–608: 1437–1450.
Fano D , Vásquez-Velásquez C , Aguilar J , Gribble MO , Wickliffe JK , Lichtveld MY , Steenland K , Gonzales GF , 2019. Arsenic concentrations in household drinking water: a cross-sectional survey of pregnant women in Tacna, Peru, 2019. Expo Health 12: 555–560.
Reuer MK , Bower NW , Koball JH , Hinostroza E , De la Torre Marcas ME , Surichaqui JAH , Echevarria S , 2012. Lead, arsenic, and cadmium contamination and its impact on children’s health in La Oroya, Peru. ISRN Public Health 2012: 1–12.
Wu J et al., 2011. Increase in diarrheal disease associated with arsenic mitigation in Bangladesh. PLOS ONE 6: e29593.
Barnaby R , Liefeld A , Jackson BP , Hampton TH , Stanton BA , 2017. Effectiveness of table top water pitcher filters to remove arsenic from drinking water. Environ Res 158: 610–615.
United Nations Children’s Fund and World Health Organization , 2020. Integrating Water Quality Testing into Household Surveys: Thematic Report on Drinking Water. New York, NY: WHO and UNICEF.
Smith AH , Steinmaus CM , 2009. Health effects of arsenic and chromium in drinking water: recent human findings. Annu Rev Public Health 30: 107–122.
Rodríguez-Barranco M , Lacasaña M , Aguilar-Garduño C , Alguacil J , Gil F , González-Alzaga B , Rojas-García A , 2013. Association of arsenic, cadmium and manganese exposure with neurodevelopment and behavioural disorders in children: a systematic review and meta-analysis. Sci Total Environ 454–455: 562–577.
Sauvé S , Desrosiers M , 2014. A review of what is an emerging contaminant. Chem Cent J 8: 15.
Delahoy MJ , Wodnik B , McAliley L , Penakalapati G , Swarthout J , Freeman MC , Levy K , 2018. Pathogens transmitted in animal feces in low- and middle-income countries. Int J Hyg Environ Health 221: 661–676.
Wright J , Gundry S , Conroy R , 2004. Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use. Trop Med Int Health 9: 106–117.
Oswald WE , Lescano AG , Bern C , Calderon MM , Cabrera L , Gilman RH , 2007. Fecal contamination of drinking water within peri-urban households, Lima, Peru. Am J Trop Med Hyg 77: 699–704.
Lantagne DS , Gallo W , Centers for Disease Control and Prevention , 2008. Safe Water for the Community: A Guide for Establishing a Community-Based Safe Water System Program. Atlanta, GA: Centers for Disease Control and Prevention.
Duong VT et al., 2016. Evaluation of Luminex xTAG gastrointestinal pathogen panel assay for detection of multiple diarrheal pathogens in fecal samples in Vietnam. J Clin Microbiol 54: 1094–1100.
World Health Organization, United Nations Children’s Fund (UNICEF) , 2021. Advocacy Brief: Nutrition for Growth Year of Action: Nine Smart Breastfeeding Pledges. Geneva, Switzerland: World Health Organization.
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Chemical and microbiological drinking water contaminants pose risks to child health but are not often evaluated concurrently. At two consecutive visits to 96 households in Piura, Peru, we collected drinking water samples, administered health and exposure questionnaires, and collected infant stool samples. Standard methods were used to quantify heavy metals/metalloids, pesticides, and Escherichia coli concentrations in water samples. Stool samples were assayed for bacterial, viral, and parasitic enteropathogens. The primary drinking water source was indoor piped water for 70 of 96 households (73%); 36 households (38%) stored drinking water from the primary source in containers in the home. We found high prevalence of chemical and microbiological contaminants in household drinking water samples: arsenic was detected in 50% of 96 samples, ≥ 1 pesticide was detected in 65% of 92 samples, and E. coli was detected in 37% of 319 samples. Drinking water samples that had been stored in containers had higher odds of E. coli detection (adjusted odds ratio [aOR]: 4.50; 95% CI: 2.04–9.95) and pesticide detection (OR: 6.55; 95% CI: 2.05–21.0) compared with samples collected directly from a tap. Most infants (68%) had ≥ 1 enteropathogen detected in their stool. Higher odds of enteropathogen infection at the second visit were observed among infants from households where pesticides were detected in drinking water at the first visit (aOR: 2.93; 95% CI: 1.13–7.61). Results show concurrent risks of exposure to microbiological and chemical contaminants in drinking water in a low-income setting, despite high access to piped drinking water.
Financial support: This work was supported by the HERCULES: Exposome Research Center [grant number NIEHS: P30 ES0197767] at Emory University and by the National Institute for Allergy and Infectious Diseases [grant numbers K01AI103544 and 5T32ES12870] at the US National Institutes of Health. AGL and CC are sponsored by the training grant D43 TW007393 awarded by the Fogarty International Center of the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Disclaimer: No authors had financial disclosures to report.
Authors’ addresses: Miranda J. Delahoy, Sydney Hubbard, and Mia Mattioli, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Carlos Culquichicón, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru, and School of Health Sciences, Universidad Nacional de Piura, Piura, Peru, E-mail: email@example.com. Jackie Knee, Disease Control Department, London School of Hygiene & Tropical Medicine, London, UK, E-mail: firstname.lastname@example.org. Joe Brown, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: email@example.com. Lilia Cabrera, Asociación Benéfica PRISMA, Lima, Peru, E-mail: firstname.lastname@example.org. Dana Boyd Barr and P. Barry Ryan, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, E-mails: email@example.com and firstname.lastname@example.org. Andres G. Lescano, Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mail: email@example.com. Robert H. Gilman, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: firstname.lastname@example.org. Karen Levy, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, and Department of Environmental, and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, E-mail: email@example.com.