Is drinking water in Abidjan, Cote d'Ivoire, safe for infant formula?

Objective: To survey knowledge, attitudes, and practices regarding water us e and infant feeding in the Koumassi District of Abidjan, Cote d'lvoire, an d to evaluate the microbiologic quality of source and stored drinking water . Design: Random-cluster household survey. Methods: We randomly selected 20 clusters, each comprising six households w ith at least 1 child aged less than or equal to3 years. In each household, we administered a questionnaire and collected source and stored drinking wa ter samples and tested these for chlorine levels and for total coliform and fecal bacteria count (Escherichia coli). Results: Municipal water was used for drinking in 112 (93%) of 120 househol ds, and in 99 (83%), it was stored for later use. By I month of age, 97 (90 %) of 108 infants given drinking water were given stored water for drinking . In 8 (66%) of 12 households where children were receiving artificial feed ing, formula was prepared from municipal water without additional treatment . Stored water had lower levels of free chlorine than source water (median of 0.05 versus 0.2 mg/dl; p < .001), and E. coli was detected in 36 (41%) o f 87 stored water samples and 1 (1%) of 108 source water samples (p < .001) . Conclusions: In the Koumassi District of Abidjan, where municipal water is widely available and of good quality, drinking water is stored in most hous eholds, is often contaminated with E. coli, and is given to children at a y oung age. If replacement feeding is to be more widely used to prevent postn atal transmission of HIV-1, communities using stored water need interventio ns to make stored water safer.