The Role of Municipal Water Supply in Diarrhea Prevention in East Africa: A Review

Mugo Moses H.

School of Natural and Applied Sciences Kampala International University Uganda

                                                                      ABSTRACT
Diarrhoeal disease remains a leading cause of illness and death among children under five in low- and middle-income regions, including East Africa. Municipal (piped) water supply, when safely managed, reliably available, and microbiologically safe at the point of use, is a central public-health intervention that can reduce exposure to enteric pathogens and lower diarrhoeal incidence. This review synthesizes evidence on how municipal water systems affect diarrhea outcomes in East Africa, examines the mechanisms by which piped water reduces disease risk, and discusses barriers that limit protective effects (intermittency, contamination, inequitable access, household storage practices, and governance). We summarize findings from global systematic reviews and regional primary studies showing sizeable reductions in diarrhoea associated with improved and safely managed water services, but also emphasize mixed results when systems are intermittent or water quality is poor. Climate variability, urbanization, and aging infrastructure further challenge the delivery of safe municipal water in East African cities and towns. We highlight successful programmatic elements, continuous piped supply, disinfection at source, household connection coverage, leak control, and community engagement, and propose a set of policy, investment, and research priorities tailored to the East African context. Strengthening municipal water systems is necessary but not sufficient for sustained diarrhoea reduction; coordinated action across water, sanitation, hygiene (WASH), health, and urban planning sectors is required. Finally, we identify critical research gaps, including robust impact evaluations of municipal upgrades on health outcomes, cost-effectiveness analyses in East African settings, and operational studies addressing intermittency and equity.

Keywords: Municipal water supply, Diarrhoeal disease, East Africa, Water quality, Intermittent supply, Equity.

CITE AS: Mugo Moses H. (2026). The Role of Municipal Water Supply in Diarrhea Prevention in East Africa: A Review. INOSR APPLIED SCIENCES 14(2):56-61.
https://doi.org/10.59298/INOSRAS/2025/14.2.5661