Limited Access to Safe Drinking Water and Sanitation in Alabama’s Black Belt: A Cross-Sectional Case Study

Anecdotal evidence from the 17-county Black Belt region of Alabama has suggested that safe-water access may be limited by piped water infrastructure problems and private well contamination, possibly resulting in degradation of water quality and therefore elevated risk of waterborne disease. On-site sanitation access is limited as well since existing approved technology options suitable for the poorly draining soils that predominate in this area are too costly for many households. We conducted a cross-sectional study of 305 households to examine (i) drinking water quality at the household level (private wells and county public supply), (ii) possible associations between water infrastructure characteristics and drinking water quality, (iii) availability of on-site sanitation, and (iv) risk of Highly Credible Gastrointestinal Illness (HCGI). Participating households completed one survey on water use, basic demographics, health, water system performance, and on-site sanitation and submitted one drinking water sample for analysis of fecal coliform (FC), turbidity, pH, and total and free chlorine. Approximately 8 % of public water system samples and 20 % of private well water samples were positive for FC, with 33 % of piped water supply samples lacking detectable free chlorine. We found a significant increase (OR 4.0, 95 % CI 1.3–14) in HCGI risk for individuals whose drinking water sample was positive for FC. Sanitation access was not universal, with 18 % of households lacking any means of on-site wastewater disposal. Results from this study suggest that safe-water access and on-site sanitation options may be limited in this area. Residents may be subject to increased risk of water and sanitation-related illness.