Determinants of water-borne illness in rural Haiti: A participatory community assessment

Water-borne illness is a leading cause of mortality among children throughout the developing world, and accounts for significant morbidity among all age groups, especially those living with HIV. The transmission of enteric pathogens is directly related to water access, water quality, and hygiene. In Haiti, the nation ranked last in the Water Poverty Index, temporary solutions have been implemented in some villages; however, a community-based evaluation focusing on sustainable means of clean water access had yet to be undertaken. This study utilized a participatory approach and mixed-methods design to discern the barriers to sufficient clean water in a rural community in southern Haiti. From May-August 2006, surveys were conducted in 129 households with children under the age of five to ascertain indirect economic indicators, knowledge and education levels (32.3% considered diarrhea preventable), individual water consumption, and means of purification. These data, along with GIS mapping and bacterial cultures of water from community sources and households (89.8% contaminated) were used to draw correlations with child health indicators including stunting, mortality (16.0% of families had lost a child), and two-week diarrhea prevalence (24.9%). During the same time period, through focus group discussions and community meetings, we examined water-related beliefs and practices, and delineated shortcomings of previous interventions. These discussions revealed that many were concerned about the acute and chronic health effects of chlorine use, the taste of boiled water, and the efficacy of natural flocculants and disinfectants. Participants perceived contamination at water sources to be more detrimental to health than contamination in the home. These findings better enable us to work with the community to craft sustainable solutions to the water crisis in rural Haiti.