Uncovering infectious disease burden and socio-cultural determinants of water use and health in a peri-urban community in the dominican republic

The Dominican Republic is a low-middle income country located in the Caribbean that has been selected to be one of the seven pilot countries for the UN’s Millennium Development Project. Despite the economic growth experienced by this country within recent years, improvements in basic indicators of growth and development, such as water quality, have not been achieved. Given the critical importance of quality of water for community health and economic development, this study aims to describe the burden of infectious diseases associated with water quality, particularly diarrheal disease, in the municipality of Constanza in the Dominican Republic. A convenience sample of 88 households throughout the Constanza municipality was selected. Interviews with heads of households and ethnographic observations were conducted to obtain information about access to safe and clean water and to observe cultural practices surrounding water. A household survey was administered to examine self-reported diarrheal morbidity, water handling practices, and healthcare-seeking behavior. Survey questions were modeled after the Dominican Republic Demographic and Health Survey, and communities were GPS tagged. Water samples were collected from households and selected environmental sources (e.g. aqueducts) were analyzed for E. coli and coliform bacteria. Despite governmental potable water treatment recommendations, the majority (60.2%) of households reported not taking any measures to sanitize their water, which accounted for the majority of individuals self-reporting diarrheal disease (59.8%). Logistic regression analysis indicates that adults aged 65+ are at highest risk for diarrheal disease. Although aqueducts carrying potable water to the communities lacked measurable coliform bacteria contamination, most households (90.1%) had some contamination in the drinking water. This study revealed poor water quality and sanitation practices surrounding drinking water. Findings from this study will be utilized for an education program to encourage proper water storage and sanitation with the goal of increasing access to safe and clean water.Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Master of Public Health in the Department of Applied Health Science Indiana University May 2010 Accepted by the Graduate Faculty, Indiana University, in partial fulfillment of the requirements for the degree of Master of Public Health in Applied Health Scienc