Original Research
Diarrheal disease and associations with water access and sanitation in Indigenous Shawi children along the Armanayacu River basin in Peru
AUTHORS
Paola A Torres-Slimming1 PhD, Fulbright Amazonia Fellow * 
Cesar P Carcamo2 PhD, Professor
Carlee J Wright3 MSc, Creative Director at Agricultural Communications and Edidemiological Research Consulting
Guillermo Lancha4 Nurse technician
Carol Zavaleta-Cortijo5 PhD, Wellcome International Training Fellow
Nia King6 BSc, Medical Resident
James D Ford7 PhD, Priestley chair
Patricia J Garcia8 PhD, Professor
Sherilee L Harper10 PhD, Professor
AFFILIATIONS
1 Graduate School, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urbanización Ingeniería, San Martín de Porres, Lima, Peru
2, 8 Indigenous Health Adaptation to Climate Change Research Team (IHACC); and School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urbanización Ingeniería, San Martín de Porres, Lima, Peru
3 School of Public Health, University of Alberta, 116 St & 85 Avenue, Edmonton, AB T6G 2R3, Canada
4 Puesto de Salud Nuevo Tocache, Red de Salud Lamas, San Martin, Peru
5 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urbanización Ingeniería, San Martín de Porres, Lima, Peru
6 School of Public Health, University of Alberta, 116 St & 85 Avenue, Edmonton, AB T6G 2R3, Canada; and School of Medicine, Queen’s University, 15 Arch Street, Kingston, ON K7L 3L4, Canada
7 Indigenous Health Adaptation to Climate Change Research Team (IHACC); and Priestley International Centre for Climate, University of Leeds, Leeds LS2 9JT, UK
10 Indigenous Health Adaptation to Climate Change Research Team (IHACC); and School of Public Health, University of Alberta, 116 St & 85 Avenue, Edmonton, AB T6G 2R3, Canada
ACCEPTED: 2 March 2023
early abstract:
Introduction: Diarrheal disease, particularly in children under 5 years old, remains a global health challenge due to its high prevalence and chronic health consequences. Public health interventions that reduce diarrheal disease risk include improving access to water, sanitation, and hygiene. While Peru achieved the 2015 Millennium Development Goal (MDG) indicators for water access, less progress was achieved on sanitation. Furthermore, many Indigenous Peoples were overlooked in the MDG indicators, resulting in a prioritization of Indigenous Peoples in the 2030 Sustainable Development Goals (SDGs). This study aimed to estimate the prevalence of childhood diarrhea, characterize access to water and sanitation, and determine the association of childhood diarrhea with water access and sanitation indicators in 10 Shawi Indigenous communities along the Armanayacu River in the Peruvian Amazon.
Methods: A cross-sectional survey (n=82) which captured data on diarrheal disease, sociodemographic variables, and water and sanitation exposures was conducted in 10 Shawi communities. Nutritional status of children under 5 was also assessed via physical examination. Descriptive and comparative statistics were conducted.
Results: A small proportion (n=7; 8.54%) of participating children reported an episode of diarrhea in the prior month. Almost half (46%) of participating children had stunting, wasting, or both. Children living in households that used latrines were 4.29 times (95%CI: 1.01 – 18.19) more likely to report an episode of diarrhea compared to children living in households that practiced open defecation. Although not statistically significant, children living in households that used water treatment methods were 4.25 times (95%CI: 0.54 – 33.71) more likely to report an episode of diarrhea than children living in households that did not.
Conclusions: The prevalence of childhood diarrhea was lower for Shawi compared to other Amazon areas. The higher prevalence of childhood diarrhea in households that used latrines and water treatments warrants further investigation into local risk and protective factors. These Shawi communities scored low for the WHO/UNICEF Joint Monitoring Programme indicators for water and sanitation, indicating that they should be prioritized in future water, sanitation, and hygiene initiatives. Research will be required to understand and incorporate local Indigenous values and cultural practices into WASH initiatives to maximize intervention uptake and effectiveness.