Did the Millennium Development Goal Target 7c (to halve between 1990 and 2015 the proportion of the global population without sustainable access to safe drinking water) Reduce the Prevalence of Diarrheal Illness in the Dominican Republic
AffiliationThe University of Arizona College of Medicine - Phoenix
MetadataShow full item record
PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractBackground: Waterborne diseases are caused by a variety of microorganisms, biotoxins, and toxic contaminants, which lead to devastating illnesses. According to the World Health Organization, diarrheal illnesses are the ninth leading cause of death worldwide. Developing countries are at especially high risk due to the lack of quality infrastructure and the Dominican Republic is no exception. Access to a quality public water supply has been shown to significantly reduce the incidence of diarrheal illnesses worldwide and in 2012, the Dominican government celebrated as achieved the completion of the Millennium Development Goal Target 7c (to halve between 1990 and 2015 the proportion of the global population without sustainable access to safe drinking water). Our aim was to determine whether the initiative was successful at reducing the prevalence of diarrheal illnesses across the country. Methods: This is a cross-sectional study that obtained data using the Demographic and Health Surveys Database. Census data from the Dominican Republic was obtained from 2002, 2007 and 2013 Since the Millennium Development Goal Target 7c was celebrated as complete in 2012, data from 2002 and 2007 censuses were used to compare the change in prevalence of diarrheal illness in the 2013 census data. Odds ratio values and 95% confidence intervals were then calculated to evaluate various demographics and outcomes. Findings: Census data from the Dominican Republic including the years 2002, 2007, and 2013 actually revealed a steadily increasing prevalence when participants were asked if they had, “Diarrhea within the last 2 weeks (2002: 15.6%, 2007: 16.5%, and 2013: 17.7%; p=0.03).” This increase was observed throughout the course of the Millennium Development Goal Target 7c, which began in 1990 and was celebrated as accomplished in 2012. Before 2012, a total of 16.1% of participants reported that they had, “Diarrhea within the last 2 weeks”, while after 2012, 17.7% of participants reported that they had (p=<0.0001). This resulted in an odds ratio of 1.23 (p=<0.0001) with the current water supply. Other data that supports the poor state of the current water supply is the increased odds of having diarrhea when water is piped into the dwelling or brought in by a tanker, with odds ratios of 1.24 (p=<0.0001) and 1.11 (p= 0.043) when compared to a bottled water source respectively. Higher education decreased the odds of contracting diarrheal illness with an odds ratio of 0.77 (p=0.003). Secondary and higher education also decreased the risk of blood in the stool with odds ratios of 0.44 (p=0.01) and 0.45 (p=0.03) respectively. Interpretation: It appears the Millennium Development Goal Target 7c (to halve between 1990 and 2015 the proportion of the global population without sustainable access to safe drinking water), was ineffective at reducing the prevalence of diarrhea in the Dominican Republic. In fact, the prevalence has increased throughout the course of the initiative. The increase was especially notable in populations that used water piped into dwellings and tanker truck water sources. This is precisely the water supply that the initiative set out to improve. Using diarrhea as a single factor to determine the water quality in the Dominican Republic, it appears that the state of the country’s water is significantly worse than before.