The role of water supply in improving health in poor countries (with special reference to Bangladesh) : paper presented to the U.S. National Academy of Science workshop on effective interventions to reduce infection in malnourished populations, Haiti, Jun

The consumption of insufficient quantities of water of poor bacterial quality is widely believed to be a major factor contributing to the high incidence of gastrointestinal disease in poor countries. Governments of these countries have undertaken water improvement programs in the belief that such programs will result in substantial improvements in the health of the populations served. In a rural area in the flooding plain of the Megha River in Bangladesh 4 recent studies have examined the effect of the provision of domestic water through hand pumped tubewells on the incidence of cholera and other diarrheal diseases. These studies have uniformly concluded that drinking tubewell water was not associated with a reduction in the diseases studied. Each of the studies has suggested reasons for this surprising finding. These explanations are closely examined and an alternative hypothesis is offered, which a subsequent study has suggested is also questionable. The implications of the findings for the formulation of water policy are examined. It is noted that the problems arising from using cholera as a paradigm for all water related diseases emphasize the need to take into account different ecological conditions in the formulation of programs. The need for understanding the factors which affect the behavior of individuals who face a variety of sources of domestic water, and the importance of including the proposed users in the design of water improvement programs, are emphasized. (Author)