The Impact of Urban Water Supply Improvements on Infant Enteric Pathogen Infection, Diarrhea, and Growth: Results from the PAASIM Matched Cohort Study

We conducted a matched-control study in Beira, Mozambique to assess the impact of neighborhood-level urban water system improvements on child health and enteric infections. The intervention did not impact infection with bacteria (aRR 0.97, 95%CI 0.90-1.05) or protozoa (aRR 0.93, 95%CI 0.74-1.16), but did impact overall infection with individual pathogens (aRR 0.90, 95%CI 0.81-0.99) and co-infection prevalence (aRR 0.87, 95%CI 0.78-0.98). We found no association between direct household water connections – independent of intervention status – on prevalence of bacteria (aRR 1.00, 95%CI 0.91, 1.09), protozoa (aRR 0.91, 95%CI 0.72-1.14), or co-infection (aRR 0.98, 95%CI 0.85-1.13). We found no associations with diarrhea, child growth, or child mortality. Our evidence points to potential impacts of the intervention on enteric pathogen infections, but our estimates were imprecise. The impact of the intervention may have been limited by the lack of provision of continuous, reliable water supply, and lack of safe water storage.