How water intermittency and water perceptions influence household coping strategies in northwestern Ecuador.

Intermittent water supply (IWS) systems are characterized by water services that are unavailable for hours or days at a time, resulting in water insecurity even among households with piped water connections. While coping strategies for IWS are well-documented, their specific associations with measures of intermittency, such as weekly frequency, daily duration, and predictability of intermittent periods, are not well understood. Most existing research relies on descriptive comparisons across sites, with limited use of multivariable models to quantify these associations. To address these gaps, we used an explanatory sequential mixed-methods design to characterize household piped water intermittency and their association with coping strategies across three communities in northwestern Ecuador. In the quantitative phase, household surveys captured data on water supply and coping strategies for IWS. In the qualitative phase, semi-structured in-depth interviews explored resident's perceptions of water access and quality. All three study communities experienced IWS, but the weekly frequency and daily duration of intermittent periods varied by location. Within Borbón, the largest town, neighborhood-level differences in IWS patterns were observed. After adjusting for household sociodemographic factors, each additional day per week without water supply was associated with a 30% higher odds of households treating their domestic water (1.30 [1.18-1.41]), and an 18% lower odds of relying on multiple drinking water sources (OR: 0.82 [0.72-0.92]). Each additional 3-hours per day without water supply was associated with a 12% higher odds of treating domestic water (OR: 1.12 [1.04 - 1.22]). Qualitative findings further suggested that household coping strategies were influenced by perceptions of water safety and quality, convenience, cost, and predictability. Unreliable water systems may erode trust in piped water, prompting households to adopt coping strategies that have their own risks and costs. Interventions that promote continuous water services and improved water management are essential to reduce health risks.