It is supposed to be safe for the children, but it isn’t. Piped water in urban Punjab is inferior in quality than other sources.
Despite the state being the source of piped water, the incidence of waterborne diseases is more prevalent among young children in urban Punjab among households that rely on piped water supply. Cross-contamination from ill-placed sewage pipes is the likely reason for unsafe piped water.
Maliha Cheema analysed the 2007-08 data from the Punjab Multiple Indicator Cluster Survey (MICS) for her doctoral dissertation at the North Carolina State University. Her research revealed that piped water is less safe than other sources in urban Punjab. In rural Punjab, piped water, where available, has no discernable impact on the health of children under five.
Dr Cheema’s findings have far-reaching implications for public health policies and priorities in Punjab in particular, and Pakistan in general.
First, the very assumption that piped water is safer than other sources, such as water obtained from wells and streams, may not hold. Second, it is imperative to improve the quality of piped water.
Public health experts believe waterborne diseases cause 1.2 million deaths each year in Pakistan; the worse-affected are young children. Diarrhoea caused by consuming unsafe water results in the death of an estimated 250,000 under five children in Pakistan.
These numbers are indicative of a national emergency. Yet, the governments across Pakistan appear unmoved by the millions dying from consuming unsafe water.
MICS is an excellent source of data to understand public health indicators in Punjab. The 2011 data set revealed that 17 per cent of rural children under the age of five, reported episodes of diarrhoea in the two weeks prior to the survey. The incidence was lower for young children living in urban areas. Only a fraction of the children suffering from diarrhoea received ORS fluids to maintain levels of essential salts and chemicals.
The incidence of diarrhoea was more frequent for children less than a year old and declined with the age of the child. Children raised by educated mothers were less likely to have experienced diarrhoea than the rest did. Similarly, children born in the lowest income strata were the most likely to suffer from diarrhoea.
The 2007-08 data, which was analyzed by Dr Cheema, comprise responses from over 91,000 households, of which 65 per cent respondents lived in rural households. She was particularly interested in determining the impact of the source of water supply on the physical well-being of young children.
In her sample, the households obtained water from piped water supply; motorised pumped water; a public tap located in a public place; other improved sources (covered wells, bottled water, etc); and unimproved sources. Almost 73 per cent of the households obtained water from pumps, and another 15 per cent used piped water. The percentage of households using piped water was higher in urban Punjab.
Test results indicated that almost 50 per cent of the households received contaminated water, which rendered it unsafe for drinking. It was further discovered that a mere 5 per cent of the households treated water before consumption. The number of households using ineffective water treatment was much larger.
The systematic analysis of water supply revealed that piped water supply had no effect on the incidence of diarrhoea in rural areas in Punjab. At the same time, piped water correlated with a higher incidence of diarrhoea among children under five years of age.
“In urban areas, piped water is associated with increasing the probability of diarrhoea in children by an average of 2.2 percentage points,” Dr Cheema concluded. She further observed that households with higher incomes households and presence of educated mothers reduced the probability of diarrhoea.
The reason behind the unsafe piped water supply in urban areas is the antiquated design standards followed by the Public Health and Engineering Department in Punjab. The design standards call for locating water and sewage pipes equidistance from the surface. The design standards recommend burying water mains three feet below the surface and sewage pipes 2.5-feet beneath the surface.
“This increases the possibility of cross contamination of water and sewage pipelines,” noted Dr Cheema.
Piped water is inadequately priced in urban Pakistan. Water of any quality is in short supply, potable water is even harder to find at affordable rates. Dr Cheema believes higher willingness to pay exists for better quality water, a point we also made in an earlier blog.
The donor agencies have pressed governments in Pakistan to improve the coverage of piped water supply. This is a desirable, yet insufficient objective.
Apart from expanding the coverage, the goal should be to supply safe drinking water so that the burden of disease in Pakistan can be reduced.