2026 article
Associations between Water Supply Interruptions and Water Use, Drinking Water Quality, Child Health, and Caregiver Stress in Peri-Urban Malawi
Niven, C. G., Clark, B., Floess, E., Chirwa, B., Matekenya, M., Budden, E., … Ercumen, A. (2026, January 15). Environmental Science & Technology, Vol. 1.
open access via doi.org (publisher)
Interrupted water supplies contribute to water insecurity, water quality risks, diarrhea, and stress; other risks (acute respiratory infections (ARIs), antibiotic use, antimicrobial resistance) remain unquantified. We assessed associations between water interruptions and various outcomes. Among 237 households in Malawi, we conducted a cross-sectional questionnaire and tested drinking water for generic and cefotaxime-resistant <i>Escherichia coli</i> (CREC). Water interruptions in the past month were reported by 32.5% of households; interruptions were unpredictable and more common in piped supplies. Households with interruptions were 3-5 times more likely to be water-insecure, skip laundry and handwashing after handling animal feces (<i>p</i>-values < 0.05). Most water samples came from storage, and 65.7% harbored <i>E. coli</i> and 8.4% harbored CREC; households with vs without interruptions had similar fecal contamination. Children <5 years experiencing interruptions had increased caregiver-defined diarrhea (prevalence ratio [PR] = 1.85, 1.02-3.37) and ARI with fever (PR = 1.98, 1.09-3.57). Rare (1-2/month) interruptions were associated with diarrhea and antibiotic use; frequent (≥3/month) or long (above-median duration) interruptions with ARI. Frequent or short interruptions were associated with stress. Our findings highlight respiratory risks from water interruptions and suggest that interruption frequency and duration may influence enteric vs respiratory pathogen transmission through distinct mechanisms. Prospective studies should validate these associations and evaluate mitigation strategies.