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Year : 2021  |  Volume : 65  |  Issue : 4  |  Page : 387-390  

Seasonal variation of diarrheal diseases and drinking water quality in resettlement colony in Delhi, India: A community-based cross-sectional study

1 Junior Resident, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
2 Director Professor and Head, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
3 Director Professor, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
4 Director Professor, Department of Microbiology, Lady Hardinge Medical College, New Delhi, India

Date of Submission30-Sep-2020
Date of Decision27-Jul-2021
Date of Acceptance24-Sep-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Risa Vernette Nengminza Sangma
Department of Community Medicine, Lady Hardinge Medical College, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.IJPH_1214_20

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Seasonal variation plays an important role in the occurrence of diarrheal diseases and distinct seasonal occurrence of diarrheal diseases, with bacterial diarrhea occurring more during the warm seasons and viral diarrhea occurring during the drier cool months, has been observed due to seasonal variation. Time-series cross-sectional study was conducted from January to December 2018 among 553 under-five children to assess seasonal variation of diarrheal diseases and its association with the drinking water quality in a resettlement colony of Delhi. The prevalence of diarrhea was 40.7% and was highest during the rainy season (67.6%). Majority of the water samples were found to be unsatisfactory for human consumption during the rainy and summer seasons. Significant and moderate relationship was found between the seasonal variation and occurrence of diarrhea (r = 0.728, P < 0.05) and most probable number count (r = 0.50, P < 0.05), respectively. Understanding the environmental factors that influences the occurrence of diarrheal diseases is warranted.

Keywords: Diarrheal diseases, drinking water quality, most probable number, seasonal variation, under-five children

How to cite this article:
Nengminza Sangma RV, Rasania S K, Prasuna J G, Das R, Jais M. Seasonal variation of diarrheal diseases and drinking water quality in resettlement colony in Delhi, India: A community-based cross-sectional study. Indian J Public Health 2021;65:387-90

How to cite this URL:
Nengminza Sangma RV, Rasania S K, Prasuna J G, Das R, Jais M. Seasonal variation of diarrheal diseases and drinking water quality in resettlement colony in Delhi, India: A community-based cross-sectional study. Indian J Public Health [serial online] 2021 [cited 2022 Aug 16];65:387-90. Available from:

The severity and occurrence of infectious diseases have shown correlation with climatic variation.[1] Hippocrates, after his detailed observation has also conveyed the importance of weather and climate and their role as a dominant factor in influencing public health.[1] Furthermore, Ballester, et al. in their work suggested seasonal variation to be considered an important factor when public health is being analyzed.[2]

Seasonal variation as a phenomenon for transmission of diarrheal diseases has been observed and documented[3],[4],[5],[6] and the levels at which it affects the transmission of diarrheal diseases may vary.[7] Shortage of water, floods, and variation in temperatures due to seasonal variation can lead to compromise of hygiene practices, consumption of contaminated water, contamination of water supplies, and also enable the growth of pathogenic organisms.[7],[8]

Diarrheal diseases are one of the major preventable public health problems among children under 5 years of age, especially in middle- and low-income countries.[9] In the South-Asian region, including India, rotavirus is the major cause of diarrhea in dry, cool seasons, and bacterial organisms being the major cause during warm, rainy seasons.[10],[11] In India, diarrheal diseases are responsible for 13% of all deaths[12] and yearly about 300,000 children lose their lives.[12] Globally, India and Nigeria accounting for 42% of the total global under-five deaths.[13]

The climate in Delhi is subtropical and has five distinct seasons, namely, summer, rainy, autumn, winter, and spring[14] and this study was conducted to find out seasonal variation of diarrheal diseases and the association of seasonal variation with the most probable number (MPN) count of drinking water.

A community-based cross-sectional study was conducted in the resettlement colony of Kalyanpuri, in Delhi, from January to December 2018. The study population included 553 under-five children residing in the resettlement colony.

The sample size was calculated using the formula[15] N = Zp × q/d2, with Z = 1.96 at 95% confidence interval, P (prevalence) = 14%,[16] q = (1 − p), d = relative precision of estimate, where d is considered 20% of p. The sample size turned out to be 553 under-five children.

The sampling method for microbiological analysis (MPN count) was conducted as per the WHO criteria.[17]

Data were collected from January 2018 to December 2018 to observe seasonal variation of diarrhea for which the months were divided according to different seasons, winter (December to February), spring (March and April), summer (May to June), rainy (July to September), and autumn (October and November). A predesigned, pretested questionnaire was used for data collection from mothers/caregivers. Five out of 10 blocks of the resettlement colony were selected on random basis and approximately 110 under-five children were selected from each block. In each season, a total of 110 different children were studied on random basis. If a household had more than one under-five children, all the children were considered for study. A period prevalence of 14 days was considered for this study and diarrhea was defined as passage of three or more loose or liquid stools per day or more frequent passage than is normal for the individual. Frequent passage of formed stool is not diarrhea nor is the passage of loose, pasty stools by breastfed babies.[13] Considering the minimum number of water samples that must be studied for microbiological analysis,[17] a total of 20 water samples (4 in each season) were collected and analyzed from each block, thereby a total of 100 water samples were analyzed to determine microbiological quality of drinking water using the MPN technique.[17] The five blocks were fixed throughout the study.

Data were analyzed by the SPSS version 25 Manufacturer Company name: IBM (International Business Machines). The Chi-square test was used for comparing data. The level of significance was set at P < 0.05. Presumptive MPN technique was used to determine microbiological quality of drinking water.[17] Test of normality along with Spearman's correlation was conducted to find out the relationship between seasonal variation and occurrence of diarrheal diseases and also between the occurrence of diarrheal diseases and MPN count of water samples.

The overall prevalence of diarrheal diseases among under-five children was found to be 40.7%. It was found to be the highest (57.7%) among children belonging to 13–24 months of age followed by children belonging to 25–36 months of age group (51.7%) and was found to be the least (21.4%) in children belonging to 0–12 months of age [Table 1].
Table 1: Age wise distribution and seasonal variation in prevalence of diarrheal diseases

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The prevalence of diarrhea was found to be the highest (67.6%) in rainy season and was 47.7% in autumn season [Table 1].

[Table 2] describes the MPN count and seasonal variation in water quality. The distribution and statistical interpretation show that seasonal change has a role to play in determining the quality of water [Table 2].
Table 2: Most probable number count and seasonal variation of water quality

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Test for normality was done and it was found that the occurrence of diarrheal diseases (D = 0.389, P < 0.05) and seasonal change (D = 0.160, P < 0.05) significantly differ from normal distribution; hence, Spearman's correlation was carried out to find the relationship between different variables. Significant relationship was found between the seasonal variation and occurrence of diarrhea (r = 0.728, P < 0.05) implying that change in season can lead to increase in occurrence of diarrheal diseases. Furthermore, moderate positive correlation was found between seasonal variation and MPN count of water (r = 50, P < 0.05).

The prevalence of diarrhea in the resettlement colony was found to be 40.7%. Higher diarrheal diseases prevalence was also observed in the study conducted by Balakrishnan Kalakheti et al.[18] and Chilambwe et al.[19] in which the prevalence of diarrhea was found to be 40.2%, 40.5%, and 32.6%, respectively. The diarrheal prevalence was found to be the highest among13–24 months children and lowest among 0–12 months of age [Table 1]. The trend of diarrhea among different age groups was also observed to be similar between male and female children as well. Similar findings were observed by Woldu et al.[20] in which the prevalence of diarrhea was highest among children of 12–24 months of age. The high prevalence of diarrhea in this age group could likely be related to the exposure of children crawling on the floor to organisms responsible for causing diarrhea.[20]

A study conducted by Kulinkina et al.[21] showed that seasonal variation had an effect on both water quality and diarrheal disease. It was found that total coliform concentrations in the piped water supplies in both urban and rural areas were the highest during the rainy seasons.[21] In our study, the prevalence of diarrhea was found to be the highest in rainy season (67.6%). Similarly, results of the study conducted by Abeje et al.[21] indicated that a relatively high incidence rate of childhood diarrhea was observed during the prerainy season and peaked incidence rate was observed at the beginning of rainy season, in June. It was observed that common causes of infectious diarrhea (bacteria) follow seasonal patterns and multiply rapidly in the warmer months, where higher temperatures for longer periods can result in higher than expected diarrhea incidences.[22]

In this study, quality of water was analyzed according to different seasons and it was found that the quality of drinking water was of better quality during the winter and spring seasons as compared to rainy, summer, and autumn season. According to the study conducted by Simane et al.[23] and Kulinkina et al.[21] on historical monthly data of rainfall, maximum temperature, and minimum temperature, this is the transition from driest to the rainy season showed that increase in temperature was positively associated with diarrhea incidence. The incidence rate starts to slowly decline through time to reach its lowest peaks in the months of July to November. Shortage of water in the dry season has been associated with increased prevalence of diarrhea. This may be due to less availability of freshwater or concentration of contaminants in smaller volumes of water and worsened personal hygiene. Extreme rainfall days and associated flooding were also strongly related to diarrhea-associated morbidity. Study conducted by Agarwal et al.[24] reported two peaks of diarrhea during the summer month and other during winter months. Summer month being breeding season for flies acts as a mechanical carrier for pathogens that enter into the food and water. In winter, viral diseases flare up because of rotavirus infection in children causing diarrhea. Similar results to that of our study were also reported by others.[25]

Understanding the environmental factors that influences the occurrence of diarrheal diseases and drinking water quality can help in predicting the expected number of cases according to seasons at a particular place and help reduce the incidence of diarrheal diseases among under-five children. In low- and middle-income countries, diarrheal diseases are still the major public health problem and preventive intervention can be directed to reduce morbidity due to diarrheal diseases. Furthermore, microbiological assessment of drinking water should be done on a regular basis and as prescribed by the WHO to ensure quality of drinking water to reduce the burden of diarrheal diseases.

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Conflicts of interest

There are no conflicts of interest.

   References Top

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  [Table 1], [Table 2]


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