Abstract
There remain few nationally representative studies of drinking water quality at the point of consumption in developing countries. This study aimed to examine factors associated with E. coli contamination in Ghana. It drew on a nationally representative household survey, the 2012−2013 Living Standards Survey 6, which incorporated a novel water quality module. E. coli contamination in 3096 point-of-consumption samples was examined using multinomial regression. Surface water use was the strongest risk factor for high E. coli contamination (relative risk ratio (RRR) = 32.3, p < 0.001), whilst packaged (sachet or bottled) water use had the greatest protective effect (RRR = 0.06, p < 0.001), compared to water piped to premises. E. coli contamination followed plausible patterns with digit preference (tendency to report values ending in zero) in bacteria counts. The analysis suggests packaged drinking water use provides some protection against point-of-consumption E. coli contamination and may therefore benefit public health. It also suggests viable water quality data can be collected alongside household surveys, but field protocols require further revision.
Highlights
IntroductionUtilities in many cities in sub-Saharan Africa struggle to provide sufficient domestic water to meet residents’ needs [1]
Given continued population growth, utilities in many cities in sub-Saharan Africa struggle to provide sufficient domestic water to meet residents’ needs [1]
In the GLSS6 data, surface water was associated with the greatest risk of high levels of E. coli contamination at the point of consumption, whilst contamination risks were higher for standpipes than for water piped to the premises (Table 3)
Summary
Utilities in many cities in sub-Saharan Africa struggle to provide sufficient domestic water to meet residents’ needs [1]. The gap between supply capacity and demand manifests itself through water rationing, with supply interruptions common in many urban neighbourhoods [2]. Residents have to find alternative sources of water when piped supplies are unavailable and store water to prepare for interruptions, but they may be exposed to water contamination events associated with pressure drops within the supply system [3]. Stored water may often become contaminated [4], and recent systematic review evidence suggests the extent of stored water contamination is greater among those using piped supplies [5]. A recent nationally representative household survey in Ghana, the Living Standards Survey. Round 6 (GLSS6), was conducted in 2012–2013 and included an additional module on drinking water quality. Some household surveys have previously collected water quality parameters [6], Int. J. Public Health 2016, 13, 303; doi:10.3390/ijerph13030303 www.mdpi.com/journal/ijerph
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