# Associations between Water Supply Interruptions and Water Use, Drinking Water Quality, Child Health, and Caregiver Stress in Peri-Urban Malawi

## TL;DR

This study explores how water supply interruptions in Malawi affect water use, water quality, child health, and caregiver stress, finding significant associations with diarrhea, respiratory infections, and antibiotic use.

## Contribution

The study quantifies previously unmeasured health risks (like respiratory infections and antibiotic use) linked to water supply interruptions in a low-resource setting.

## Key findings

- Households with water interruptions were 3−5 times more likely to be water-insecure and skip hygiene practices.
- Children under 5 in households with interruptions had higher rates of caregiver-reported diarrhea and respiratory infections.
- Water interruption frequency and duration were linked to distinct health outcomes, including increased antibiotic use and stress.

## Abstract

Interrupted water supplies contribute to water insecurity,
water
quality risks, diarrhea, and stress; other risks (acute respiratory
infections (ARIs), antibiotic use, antimicrobial resistance) remain
unquantified. We assessed associations between water interruptions
and various outcomes. Among 237 households in Malawi, we conducted
a cross-sectional questionnaire and tested drinking water for generic
and cefotaxime-resistant Escherichia coli (CREC). Water interruptions in the past month were reported by 32.5%
of households; interruptions were unpredictable and more common in
piped supplies. Households with interruptions were 3−5 times
more likely to be water-insecure, skip laundry and handwashing after
handling animal feces (p-values < 0.05). Most
water samples came from storage, and 65.7% harbored E. coli and 8.4% harbored CREC; households with vs
without interruptions had similar fecal contamination. Children <5
years experiencing interruptions had increased caregiver-defined diarrhea
(prevalence ratio [PR] = 1.85, 1.02−3.37) and ARI with fever
(PR = 1.98, 1.09−3.57). Rare (1−2/month) interruptions
were associated with diarrhea and antibiotic use; frequent (≥3/month)
or long (above-median duration) interruptions with ARI. Frequent or
short interruptions were associated with stress. Our findings highlight
respiratory risks from water interruptions and suggest that interruption
frequency and duration may influence enteric vs respiratory pathogen
transmission through distinct mechanisms. Prospective studies should
validate these associations and evaluate mitigation strategies.