Survey of water quality in northern Malawi, Africa, and communication of human health risk

Throughout Malawi, governmental, non-governmental, religious and civic organizations are targeting the human need for water. Diarrheal diseases, often associated with unsafe drinking water, are a leading cause of mortality in children under five in Malawi, with over 6,000 children dying per year (World Health Organization, 2010). A lack of risk communication in Southern Africa may be a factor leading to high rates of diarrheal disease from waterborne contamination. From January to March 2012, a field study was undertaken in Malawi to study water quality and develop a public health risk communication strategy. The region studied, Area 1B, represents a comparatively new peri-urban area on the edge of Mzuzu city. Groundwater samples were collected from 30 shallow dug well sites and analyzed for nitrate, total coliform, Escherichia coli, total hardness, total alkalinity and pH. Total coliform and E. coli were also analyzed in 30 drinking water samples collected from a storage container located in households using the monitored well waters. In addition to water quality analyses, a structured household questionnaire was administered by interpreters to adult residents of 51 households, encompassing 284 individuals, who were using the monitored wells. The questionnaire included sections addressing water sources, sanitation, health, consumption patterns, and socioeconomics. A risk communication program utilized the water quality data and human dimension questionnaire results to develop a household risk presentation. Results showed 67% of groundwater and 50% of household drinking water samples would be considered of unacceptable quality based on World Health Organization (WHO) standards for E. coli contamination. Low levels of nitrate were found in groundwater, but only one well exceeded WHO standards. The resident-reported high diarrheal rate among children under the age of five was not associated with sources of drinking water and/or presence or absence of treatment methods. E. coli contamination in drinking water could be the result of a combination of storing drinking water, contamination arising from poor sanitation practices, and local risk perceptions.