Urban water, sanitation, and hygiene access and the presence of Escherichia coli in the urinary tracts of women in Ahmedabad, India

Introduction: Municipalities often struggle to build and maintain basic infrastructure for informal slums in urban cities for its most vulnerable populations. One impact of inadequate water and sanitation access is the creation of an environment that breeds water borne pathogens that are the agents of infectious disease. Escherichia coli is a common bacteria found in water, often as an indicator of fecal contamination in the water supply. This study looks at one of the most common diseases found in women that results from E. coli growth, urinary tract infection. Specifically, this study aims to examine and describe factors of water, sanitation, and hygiene that are associated with positive E. coli urine results among women. The study took place in Ahmedabad, Gujarat, one of India's wealthier cities, in which heavy investments have been made in improving slum settlements throughout the rapidly expanding city.

Method: This was a cross-sectional study of 250 women recruited from households in urban Ahmedabad from October to December 2017. To determine positive cases of E. coli urinary tract infection, urine samples were collected from each participant. A commercial laboratory performed the urine analyses using a culture method. The threshold for positive cases was 10,000 CFU/mL or greater for E. coli. To obtain information on the water, sanitation, and hygiene practices, each participant completed a structured survey that included questions on demographics, working environment, reproductive health, sanitation access, family relationships, public toilets and social customs.

Results: Of the 250 participants, 23 (9.2%) were above the 100,000 CFU/mL threshold for E. coli, and therefore defined as a positive case. There were 124 (49.6%) participants who attempted a treat method, such as over the counter medicine or home self-treatments, for feminine health in the last three month. There were three factors that significantly correlated with positive cases. The first was the location of the handwashing facility, which could be either inside or outside of the dwelling. The second factor was antibiotic use in the last three weeks. The third factor was a participant living in a home with a child under the age of 5 years old, who experienced diarrhea.

Conclusion: This study identified a higher point prevalence of positive E. coli urine cultures than what we would want or would have expected for a sample population that all had access to piped water and a toilet inside of the dwelling. There is evidence to suggest that hygiene management around water use has an impact on a woman's susceptibility for E. coli causing infections in the urinary tract. Because half of the participants sought a form of treatment over the last three months for feminine health, a longitudinal study that tracks these women over a three month period, could provide relevant information on the incidence of new infections as well as prolonged urinary tract infections, particularly since multi-drug resistant E. coli infections are on the rise.