Drinking Water Quality, Feeding Practices, and Diarrhea among Children under 2 Years of HIV-Positive Mothers in Peri-Urban Zambia

Rachel Peletz London School of Hygiene and Tropical Medicine, London, United Kingdom; Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia; Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom

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Michelo Simuyandi London School of Hygiene and Tropical Medicine, London, United Kingdom; Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia; Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom

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Kelvin Sarenje London School of Hygiene and Tropical Medicine, London, United Kingdom; Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia; Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom

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Kathy Baisley London School of Hygiene and Tropical Medicine, London, United Kingdom; Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia; Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom

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Paul Kelly London School of Hygiene and Tropical Medicine, London, United Kingdom; Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia; Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom

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Suzanne Filteau London School of Hygiene and Tropical Medicine, London, United Kingdom; Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia; Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom

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Thomas Clasen London School of Hygiene and Tropical Medicine, London, United Kingdom; Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia; Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom

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In low-income settings, human immunodeficiency virus (HIV)-positive mothers must choose between breastfeeding their infants and risking transmission of HIV or replacement feeding their infants and risking diarrheal disease from contaminated water. We conducted a cross-sectional study of children < 2 years of age of 254 HIV-positive mothers in peri-urban Zambia to assess their exposure to waterborne fecal contamination. Fecal indicators were found in 70% of household drinking water samples. In a multivariable analysis, factors associated with diarrhea prevalence in children < 2 years were mother having diarrhea (adjusted odds ratio [aOR] = 5.18, 95% confidence interval [CI] = 1.65–16.28), child given water in the past 2 days (aOR = 4.08, 95% CI = 1.07–15.52), child never being breastfed (aOR = 2.67, 95% CI = 1.06–6.72), and rainy (versus dry) season (aOR = 4.60, 95% CI = 1.29–16.42). Children born to HIV-positive mothers were exposed to contaminated water through direct intake of drinking water, indicating the need for interventions to ensure microbiological water quality.

Author Notes

*Address correspondence to Rachel Peletz, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. E-mail: rachel.peletz@lshtm.ac.uk

Financial support: This work was funded by Vestergaard-Frandsen SA and the US National Science Foundation.

Authors' addresses: Rachel Peletz, Kathy Baisley, Suzanne Filteau, and Thomas Clasen, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mails: rachel.peletz@lshtm.ac.uk, kathy.baisley@lshtm.ac.uk, suzanne.filteau@lshtm.ac.uk, and thomas.clasen@lshtm.ac.uk. Michelo Simuyandi and Kelvin Sarenje, Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia, E-mails: msimuyandi@gmail.com and kelvinsarenje@yahoo.com. Paul Kelly, Tropical Gastroenterology and Nutrition Group, University Teaching Hospital, Lusaka, Zambia and Barts and The London School of Medicine, Queen Mary, University of London, London, United Kingdom, E-mail: m.p.kelly@qmul.ac.uk.

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