Water’s Forgotten Path: Contaminated Household Storage as a Source of Diarrheal Disease in Rural Areas

Sofia Marchetti¹, Yun Zhao², James Whitaker³, Grace Davies⁴

Abstract

Abstract:

Background:
While global water access has improved, rural households often rely on basic collection methods and store water in unsanitary containers. This overlooked storage step may contribute substantially to diarrheal disease transmission among children under five.

Objective:
To evaluate the microbiological quality of stored household water and its association with diarrheal incidence in rural communities across three low-resource districts.

Methods:
A cross-sectional survey and water sampling initiative were conducted across 9 villages in rural areas of southern China and eastern Africa between April and August 2024. A total of 516 households were enrolled. Water samples were collected at both source and storage container levels and tested for E. coli, total coliforms, and turbidity. Household demographics, sanitation practices, and 2-week diarrhea history among children were recorded. Multivariable logistic regression assessed the association between contamination and diarrheal outcomes.

Results:
While 89.1% of water sources met WHO microbiological standards, only 53.6% of stored water samples remained within acceptable limits. E. coli was detected in 41.8% of stored water samples compared to 9.7% at source (p < 0.001). Diarrhea prevalence among under-5 children was 22.4%, with higher risk in households using wide-mouth, uncovered containers (OR: 2.9, 95% CI: 1.8–4.6, p < 0.001). Container cleaning frequency less than once weekly was also independently associated with illness (p = 0.012).

Conclusion:
Household water storage practices represent a critical but underappreciated transmission point for diarrheal disease. Interventions must go beyond access and address container hygiene, design, and behavioral habits. Community-level education on safe storage could significantly reduce preventable childhood illness.