Escherichia coli Contamination in Drinking Water with Stunting Among Children Under Five: A Case-Control Study

Abstract

Stunting remains a major public health problem influenced by nutritional, infectious, and environmental factors. The presence of Escherichia coli in drinking water indicates fecal contamination and potential exposure to enteric pathogens that may contribute to impaired child growth. This study aimed to examine the association between E. coli contamination in household drinking water and stunting among children aged 24-59 months in Kejajar District, Wonosobo Regency, while also assessing selected child-related and household WASH factors. An analytical observational case-control study included 70 children, comprising 35 stunted cases and 35 non-stunted controls. Case and control status was determined using height-for-age data of e-PPGBM/SIGIZI Terpadu system. Data were collected through caregiver interviews, household observations, review of health records, and laboratory examination of household drinking water. E. coli was examined using the Most Probable Number method. Bivariate associations were assessed using the Chi-square or Fisher’s exact test. E. coli contamination was detected in 58.6% of household drinking-water samples and was significantly associated with stunting (OR = 3.852; 95% CI: 1.401-10.590; p = 0.008). Significant associations were also observed for low birth weight (OR = 3.273), diarrhea history (OR = 3.692), poor handwashing with soap practices (OR = 3.333), and inadequate household latrine sanitation (OR = 3.750). Exclusive breastfeeding was not significantly associated with stunting (p = 0.145). These findings indicate associations rather than causal effects and support the relevance of safe household drinking water, sanitation, hand hygiene, diarrhea prevention, and child health monitoring within integrated stunting-prevention strategies in this highland agricultural community.