The impact of on-premises piped water supply on fecal contamination pathways in rural Zambia

Reliable access to water, sanitation, and hygiene (WASH) services is a critical component of child health and development. However, as piped water systems with taps conveniently close to households are rare in rural, sub-Saharan Africa, there is limited evidence of their impact. We conducted a quasi-experimental study in four rural villages of southern Zambia between April 2018 and May 2019 in which we measured the impact of installing on-premises piped water systems on fecal contamination of stored water and caregivers' hands. Gaining access to piped water was associated with a 0.5 log(10) reduction of E. coli concentration in drinking water (p < 0.05) but no changes in hand contamination. The piped water systems in this study reduced the median distance to a safe drinking water source by over 90%, but we measured only small improvements in microbiological outcomes and no changes in the duration of self-reported, in-home water storage. These findings emphasize the need for future impact assessments of piped water systems to measure a comprehensive set of indicators directly linked to human well-being such as time savings.

Automated summary

Improving access to water, sanitation, and hygiene services in rural areas can significantly reduce E. coli concentration in drinking water. However, installing piped water systems did not show any impact on hand contamination. While the systems improved the accessibility of safe drinking water, there were only minor improvements in microbiological outcomes and no changes in the duration of in-home water storage.