Diarrhoeal disease is a significant contributor to child morbidity and mortality, particularly
in the developing world. Poor sanitation, a lack of personal hygiene and inadequate water supplies
are known risk factors for diarrhoeal disease. Since risk factors may vary by population or setting,
we evaluated the prevalence of diarrhoeal disease at the household level using a questionnaire to
better understand household-level risk factors for diarrhoea in selected rural areas in South Africa.
In a sub-sample of dwellings, we measured the microbial quality of drinking water. One in five
households had at least one case of diarrhoea during the previous summer. The most widespread
source of drinking water was a stand-pipe (inside yard) (45%) followed by an indoor tap inside the
dwelling (29%). Storage of water was common (97%) with around half of households storing water in
plastic containers with an opening large enough to fit a hand through. After adjusting for confounders,
the occurrence of diarrhoea was statistically significantly associated with sourcing water from an
indoor tap (Adjusted Odds Ratio (AOR): 2.73, 95% CI: 2.73, 1.14–6.56) and storing cooked/perishable
food in non-refrigerated conditions (AOR: 2.17, 95% CI: 2.17, 1.44–3.26). The highest total coliform
counts were found in water samples from kitchen containers followed by stand-pipes. Escherichia coli
were most often detected in samples from stand-pipes and kitchen containers. One in four households
were at risk of exposure to contaminated drinking water, increasing the susceptibility of the study
participants to episodes of diarrhoea. It is imperative that water quality meets guideline values and
routine monitoring of quality of drinking water is done to minimise diarrhoea risk in relevant rural
communities. The security of water supply in rural areas should be addressed as a matter of public
health urgency to avoid the need for water storage.
Supplementary Materials: Figure S1: Full study questionnnaire.