Contamination Of Household Drinking Water Research Articles

Household drinking water quality and its predictors in flood-prone settings of Northwest Ethiopia: A cross-sectional community-based study

Globally, the deterioration of drinking water quality is a major public health problem that contributes to the spread of disease and causes death. Therefore, it is important to have regular quality control monitoring. This study aimed to assess the level of physicochemical and bacteriological quality of household drinking water and its contributing factors in flood-prone settlements of South Gondar Zone, Ethiopia. A community-based cross-sectional study was conducted in flood-prone settings of Northwest Ethiopia from January 17 to March 30, 2021. Structured questionnaires were used to gather the sociodemographic, environmental, and behavioral data. A total of 675 drinking water samples were collected from water storage containers of selected households. Logistic regression models were used for both univariate and multivariable studies. The survey included a total of 675 households. The mean values of pH (5.9 ± 1.03), turbidity (6.7 ± 2.21 NTU), and free residual chlorine (0.02 ± 0.01 mg/l) did not meet the WHO recommended limits for drinking water. The prevalence of fecal contamination of drinking water in the study area was 62.2% with [95% CI (53–60%)]. Family size [AOR = 2.205, 95% CI (1.375–3.536), absence of latrine [AOR = 3.449, 95% CI (1.349–8.823)], and lack of a separate container to draw water from its storage [AOR = 0.454, 95% CI (0.249–0.827)] were significant predictors for fecal contamination of household drinking water. In conclusion, the water quality in terms of pH, turbidity, residual chlorine, and bacteriological parameters was poor and not suitable for consumption. High prevalence of fecal contamination of water was found, and it was significantly associated with family size, the absence of a latrine, and the lack of a separate cap to take water from the storage. Therefore, continuous chlorination and monitoring its concentration, educating the community on how to use stored water, educating the advantage of having a latrine, and promoting point-of-use treatments such as filtration and boiling are needed.

A STUDY OF THE QUALITY OF HOUSEHOLD WATER TANKS IN TIKRIT, IRAQ

This study was conducted to assess the quality of domestic tank’s water and its suitability for various daily uses. The physical, chemical and biological characteristics give an idea of the quality of water as people resort to using household tanks for the purpose of preserving water and meeting daily needs. The results showed normal proportions allowed within the Iraqi and international water specifications according to the physical and chemical factors, but it leads to an increase in the number of bacteria in the water. The reason for contamination of household drinking water with bacteria is the residents’ negligence of the constant cleanliness of the tanks and the lack of tight sealing of the tanks which exposes them to dust and animal excrement that interacts with the stagnant water in the ditches and it leads to the activation of bacteria. The study found the following results, the conductivity recorded the lowest value of 350 and the highest value of 690 microsomia / cm, the lowest value of dissolved oxygen was recorded 4.6 mg/l, and the highest value was recorded at 11.9 mg/l while the pH was recorded the lowest value of 6.2, the highest value of 8.8 while the total hardness ranged Between (88-225) mg/l. As for the total numbers of bacteria they increased in the winter months and decreased in the summer.

Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India

BackgroundPoor child feces management (CFM) is believed to be an important source of exposure to enteric pathogens that contribute to a large disease burden in low-income settings. While access to sanitation facilities is improving, national surveys indicate that even households with latrines often do not safely dispose of their child’s feces. Working with caregivers in rural Odisha, India, we co-developed an intervention aimed at improving safe disposal of child feces and encouraging child latrine use at an earlier age. We describe the rationale for the intervention and summarize the protocol for a cluster randomized trial (CRT) to evaluate its effectiveness at changing CFM practices.MethodsThe intervention consists of six behavior change strategies together with hardware provision: wash basin and bucket with lid to aid safe management of soiled nappies and a novel latrine training mat to aid safe disposal and latrine training. The intervention will be offered at the village level to interested caregivers of children < 5 years of age by a community-based organization. Following a baseline survey, 74 villages were randomly allocated to either intervention or control arm. The primary outcome is caregiver reported safe disposal of child feces after last defecation, either by the caregiver disposing of the child’s feces into the latrine or the child using the latrine, measured approximately four to six months following intervention delivery. Secondary outcomes include fecal contamination of household drinking water and the childs’ hands. A process evaluation will also be conducted to assess intervention fidelity and reach, and explore implementer and participant feedback.DiscussionThis study addresses a crucial knowledge gap in sanitation by developing a scalable intervention to improve safe management of child feces. The behavior change strategies were designed following the Risks, Attitudes, Norms, Abilities and Self-Regulation (RANAS) approach, which has shown to be effective for other environmental behavior change interventions in low-income settings. The latrine training mat hardware is a novel design developed cooperatively and manufactured locally. The evaluation follows a rigorous CRT study design assessing the impact of the intervention on CFM behavior change, as well as fecal contamination of two sources of potential exposure.Trial registrationThis trial is registered at ISRCTN: ISRCTN15831099.

Bacteriological quality of household drinking water in North Gondar Zone, Ethiopia; a community-based cross-sectional study

Ethiopia is one of the developing countries where only 52% of its population have access to safe drinking water. To determine the level of faecal contamination in drinking water, the E. coli has been found to be the most specific indicator. The purpose of this study was to determine household bacteriological drinking water quality and its associated factors in rural North Gondar Zone Ethiopia. A community-based cross-sectional study was conducted in rural parts of North Gondar Zone from April to June, 2016. Water samples from water storage at household level were taken using standardized water sampling techniques to determine the level of faecal contamination. Face-to-face interview using structured questionnaires and checklist were used to identify the associated factors. A total of 736 households participated in this study. The prevalence of positive faecal coliform in the households is found to be 72.6% (95%C.I; 69.4–75.8). In multivariate analysis; occupational status [AOR; 0.35, 95%; CI (0.16,0.77)], income [(AOR);0.45, 95%; CI (0.3, 0.68)], type of solid waste disposal habit [AOR; 0.16, 95%; CI (0.36, 0.66)], source of water [AOR; 0.42, 95%; CI (0.28, 0.65)], shortage of water [AOR; 2.8, 95%; CI (1.88, 4)] were variables identified as predictors for faecal coliform contamination of water in the household. There is high level of faecal contamination of household drinking water in North Gondar Zone. Occupational status, income, solid waste disposal habit, sources of drinking water, and shortage of water were predictor for presence of faecal coliform contamination in household drinking water.

Overview of Major Bacterial Contaminants of Drinking Water in Nigeria: A Review

Aim and Objectives: The objective of this study was to provide an overview of the microorganisms implicated in the contamination of household drinking water in Nigeria, their pattern of distribution and the regulatory gap(s) if any that is responsible for the cases of drinking water contamination and water borne diseases in Nigeria.&#x0D; Study Design and Methodology: The methodology employed for this study involved a comprehensive and critical review of ten randomly selected studies to identify the major bacterial contaminants of drinking water in Nigeria and their distribution. This review was restricted to microbiological measures of drinking water contamination excluding chemical aspects of water quality.&#x0D; Results: Escherchia coli was found to be the predominant microbial contaminant of drinking water in the studies reviewed with 70%, Klebsiella sp 60%, Pseudomonas aeruginos 60%, Staphylococcus aureus 50%, Proteus sp 50%, Enterobacter aerogenes 40%, Streptococcus fecalis 30%, Salmonella typhi 30% and 10% for Vibrio cholerae and Shigella sp.&#x0D; Conclusion: The presence of microbes in drinking water especially E. coli reported in 70 percent of the studies reviewed is a source of concern. The presence of toxin producing strains of E. coli like the O157:H7 in drinking water can result in fatal consequences like hemorrhagic diarrhea and kidney failure. The widespread presence of other disease-causing organisms further confirms that a good number of the drinking water presented as safe for consumption across Nigeria are actually not fit for human consumption. The gaps reported in most of the studies reviewed were mainly oversight gaps in monitoring by the National Agency for Food and Drug Administration and control, NAFDAC, the agency charged with monitoring food and drugs in the country.

The association between domestic animal presence and ownership and household drinking water contamination among peri-urban communities of Kisumu, Kenya.

IntroductionHousehold drinking water can be contaminated by diarrheagenic enteropathogens at numerous points between the source and actual consumption. Interventions to prevent this contamination have focused on preventing exposure to human waste through interventions to improve drinking water, sanitation and hygiene (WASH). In many cases though, the infectious agent may be of zoonotic rather than human origin suggesting that unsafely managed animal waste may contribute to the contamination of household drinking water and the associated diarrheal disease burden.MethodsA cross-sectional household survey of 800 households was conducted across three informal peri-urban neighborhoods of Kisumu, Kenya, collecting stored drinking water samples, administering a household survey including water, sanitation and hygiene infrastructure and behaviors, and recording domestic animal presence and ownership. We used multivariate logistic regression to assess the association of traditional WASH factors and domestic animal presence and ownership on microbial contamination of household drinking water.ResultsThe majority of households sampled had fecally contaminated drinking water (67%), defined by the presence of any colony forming units of the fecal indicator bacteria enterococci. After adjustment for potential confounders, including socio-economic status and water and sanitation access, both household animal ownership (aOR 1.31; CI 1.00–1.73, p = 0.05) and the presence of animal waste in the household compound (aOR 1.38; CI 1.01, 1.89, p = 0.04) were found to be significantly associated with household drinking water contamination. None of the conventional WASH variables were found to be significantly associated with household drinking water contamination in the study population.ConclusionsWater, sanitation, and hygiene strategies to reduce diarrheal disease should consider the promotion of safe animal contact alongside more traditional interventions focusing on the management of human waste. Future research on fecal contamination of unsafe household drinking water should utilize host-specific markers to determine whether the source is human or animal to prepare targeted public health messages.

Drivers of microbiological quality of household drinking water – a case study in rural Ethiopia

This study aims at assessing the determinants of microbiological contamination of household drinking water under multiple-use water systems in rural areas of Ethiopia. For this analysis, a random sample of 454 households was surveyed between February and March 2014, and water samples from community sources and household storage containers were collected and tested for fecal contamination. The number of Escherichia coli (E. coli) colony-forming units per 100 mL water was used as an indicator of fecal contamination. The microbiological tests demonstrated that 58% of household stored water samples and 38% of protected community water sources were contaminated with E. coli. Moreover, most improved water sources often considered to provide safe water showed the presence of E. coli. The result shows that households' stored water collected from unprotected wells/springs had higher levels of E. coli than stored water from alternative sources. Distance to water sources and water collection containers are also strongly associated with stored water quality. To ensure the quality of stored water, the study suggests that there is a need to promote water safety from the point-of-source to point-of-use, with due considerations for the linkages between water and agriculture to advance the Sustainable Development Goal 6 of ensuring access to clean water for everyone.

Assessing factors of E. coli contamination of household drinking water in suburban and rural Laos and Thailand

Abstract Drinking water (DW) can serve as a route for disease transmission if not properly managed. The study assessed the effect of different factors on Escherichia coli quantities in DW in household water storage containers in suburban and rural villages in Laos and Thailand. Higher E. coli concentrations in DW were found in Laos compared to Thailand, especially in households without toilets (in Laos) and in rural rather than in suburban villages. In suburban Laos, house material, storage container types and lack of toilets were significantly associated with E. coli contamination of DW, whereas in rural Laos, corresponding significant factors were rain-fed water, containers with lids and lack of toilets. In suburban Thailand, rain-fed water, storage container types and container cleaning frequency were significantly associated with DW contamination, while house materials, manually collected rainwater and container cleaning frequency were associated with contamination in rural Thailand. Socio-demographic characteristics were less associated with E. coli contamination of DW in this study. Treatment of household stored water (e.g. boiling), regular cleaning of rain jars as well as the provision of household toilets, especially in Laos, can provide barriers against E. coli contamination of DW.

Water quality and Inuit health: an examination of drinking water consumption, perceptions, and contamination in Rigolet, Canada

ABSTRACTCanadian Inuit have often reported concerns about the quality of their municipal drinking water; research has also shown that some Inuit communities experience some of the highest incidence rates of self-reported acute gastrointestinal illness (AGI) in Canada and globally. The goal of this thesis research was to investigate drinking water perceptions and consumption patterns, as well as water contamination and potential associations with AGI in the Inuit community of Rigolet, Canada. Three census cross-sectional surveys captured data on AGI, drinking water, and water storage (2012–2014); additionally, bacterial contamination of household drinking water was assessed alongside the 2014 survey. Concerns regarding the taste, smell, and colour of tap water were associated with lower odds of consuming tap water. The use of transfer devices (i.e. small bowls or measuring cups) was associated with household water contamination; while no water-related risk factors for AGI were identified, incidence of AGI was high compared with southern Canada. This thesis research provides a valuable contribution to the limited literature assessing drinking water and health in the Arctic. Ultimately, this work is intended to inform safe water management practices, as well as contextually appropriate drinking water interventions, risk assessments, and public health messaging in the Canadian Arctic.

Widespread copper and lead contamination of household drinking water, New South Wales, Australia

This study examines arsenic, copper, lead and manganese drinking water contamination at the domestic consumer’s kitchen tap in homes of New South Wales, Australia. Analysis of 212 first draw drinking water samples shows that almost 100% and 56% of samples contain detectable concentrations of copper and lead, respectively. Of these detectable concentrations, copper exceeds Australian Drinking Water Guidelines (ADWG) in 5% of samples and lead in 8%. By contrast, no samples contained arsenic and manganese water concentrations in excess of the ADWG. Analysis of household plumbing fittings (taps and connecting pipework) show that these are a significant source of drinking water lead contamination. Water lead concentrations derived for plumbing components range from 108µg/L to 1440µg/L (n=28, mean – 328µg/L, median – 225µg/L). Analysis of kitchen tap fittings demonstrates these are a primary source of drinking water lead contamination (n=9, mean – 63.4µg/L, median – 59.0µg/L). The results of this study demonstrate that along with other potential sources of contamination in households, plumbing products that contain detectable lead up to 2.84% are contributing to contamination of household drinking water. Given that both copper and lead are known to cause significant health detriments, products for use in contact with drinking water should be manufactured free from copper and lead.

Faecal contamination of household drinking water in Rwanda: A national cross-sectional study

Unsafe drinking water is a leading cause of morbidity and mortality, especially among young children in low-income settings. We conducted a national survey in Rwanda to determine the level of faecal contamination of household drinking water and risk factors associated therewith. Drinking water samples were collected from a nationally representative sample of 870 households and assessed for thermotolerant coliforms (TTC), a World Health Organization (WHO)-approved indicator of faecal contamination. Potential household and community-level determinants of household drinking water quality derived from household surveys, the 2012 Rwanda Population and Housing Census, and a precipitation dataset were assessed using multivariate logistic regression. Widespread faecal contamination was present, and only 24.9% (95% CI 20.9–29.4%, n=217) of household samples met WHO Guidelines of having no detectable TTC contamination, while 42.5% (95% CI 38.0–47.1%, n=361) of samples had >100TTC/100mL and considered high risk. Sub-national differences were observed, with poorer water quality in rural areas and Eastern province. In multivariate analyses, there was evidence for an association between detectable contamination and increased open waste disposal in a sector, lower elevation, and water sources other than piped to household or rainwater/bottled. Risk factors for intermediate/high risk contamination (>10TTC/100mL) included low population density, increased open waste disposal, lower elevation, water sources other than piped to household or rainwater/bottled, and occurrence of an extreme rain event the previous day. Modelling suggests non-household-based risk factors are determinants of water quality in this setting, and these results suggest a substantial proportion of Rwanda's population are exposed to faecal contamination through drinking water.

Determinants of Household Drinking Water Quality in Rural Ethiopia

Safe and adequate water supply is a vital element to preserve human health; however, access to clean water is limited in many developing countries. Furthermore, improved water sources are often contaminated with fecal matters and consumption of unsafe water poses a great public health risk. This study seeks to identify determinants of microbial contamination of household drinking water under multiple-use water systems in rural areas of Fogera and Mecha districts of Ethiopia. In this analysis, a random sample of 454 households was surveyed from February to March 2014, and water samples from community sources and storage containers were collected and tested for fecal contamination. The number of Escherichia coli (E.coli) colony forming units per 100ml (cfu/100ml) water was used as an indicator of fecal contamination. The results show that 50% of households used protected water sources, 38% used unprotected wells/ spring and 12% used surface water sources. However, water microbiological tests demonstrated that 58% of household storage water samples and 74% of water sources were contaminated with E.coli. After controlling for household sanitary factors, high level of E.coli bacteria colonies were observed in unprotected water compared to surface water and protected wells/springs sources. To ensure the quality and safety of water stored in the household, our findings suggest that point-of-use water treatment, safe water handling and storage, proper hygiene practices such as washing hands after critical times and proper disposal of household garbage should be promoted. On-site water wells should be properly designed to prevent seepage from unhygienic household pit latrine. Furthermore, community water sources should be adequately protected and sanitary measures should be undertaken regularly to reduce contamination from human and animal waste.

The challenge of improving boiling: lessons learned from a randomized controlled trial of water pasteurization and safe storage in Peru.

Boiling is the most common method of household water treatment in developing countries; however, it is not always effectively practised. We conducted a randomized controlled trial among 210 households to assess the effectiveness of water pasteurization and safe-storage interventions in reducing Escherichia coli contamination of household drinking water in a water-boiling population in rural Peru. Households were randomized to receive either a safe-storage container or a safe-storage container plus water pasteurization indicator or to a control group. During a 13-week follow-up period, households that received a safe-storage container and water pasteurization indicator did not have a significantly different prevalence of stored drinking-water contamination relative to the control group [prevalence ratio (PR) 1·18, 95% confidence interval (CI) 0·92-1·52]. Similarly, receipt of a safe-storage container alone had no effect on prevalence of contamination (PR 1·02, 95% CI 0·79-1·31). Although use of water pasteurization indicators and locally available storage containers did not increase the safety of household drinking water in this study, future research could illuminate factors that facilitate the effective use of these interventions to improve water quality and reduce the risk of waterborne disease in populations that boil drinking water.

Fecal contamination of drinking water in Kericho District, Western Kenya: role of source and household water handling and hygiene practices.

Inadequate protection of water sources, and poor household hygienic and handling practices have exacerbated fecal water contamination in Kenya. This study evaluated the rate and correlates of thermotolerant coliform (TTC) household water contamination in Kericho District, Western Kenya. Culture and multiplex polymerase chain reaction (PCR) techniques were used to characterize TTCs. The disk diffusion method was used for antibiotic susceptibility profiling of pathogenic Escherichia coli. Out of the 103 households surveyed, 48 (46.6%) had TTC contaminated drinking water (TTC levels of >10 cfu/100 mL). Five of these households were contaminated with pathogenic E. coli, including 40% enteroaggregative E. coli, 40% enterotoxigenic E. coli, and 20% enteropathogenic E. coli. All these pathogenic E. coli strains were multidrug resistant to sulfamethoxazole/trimethoprim, ampicillin, tetracycline and ampicillin/sulbactam. Rural household locality, drinking water hand contact, water storage container cleaning practice, hand washing before water withdrawal, water source total coliforms <10 cfu/100 mL, temperature, and free chlorine levels were associated with TTC contamination of household drinking water. Significant proportions of household drinking water in Kericho District are contaminated with TTCs including with pathogenic multidrug-resistant E. coli. Source and household hygiene and practices contribute significantly to drinking water contamination.

“Improved” But Not Necessarily Safe: An Assessment of Fecal Contamination of Household Drinking Water in Rural Peru

The indicator used to measure progress toward the Millennium Development Goal (MDG) for water is access to an improved water supply. However, improved supplies are frequently fecally contaminated in developing countries. We examined factors associated with Escherichia coli contamination of improved water supplies in rural Pisco province, Peru. A random sample of 207 households with at least one child less than 5 years old was surveyed, and water samples from the source and storage container were tested for E. coli contamination. Although over 90% of households used an improved water source, 47% of source and 43% of stored water samples were contaminated with E. coli. Pouring or using a spigot to obtain water from the storage container instead of dipping a hand or object was associated with decreased risk of contamination of stored water (adjusted prevalence ratio [aPR] = 0.58, 95% confidence interval [CI] = 0.42, 0.80). Container cleanliness (aPR = 0.67, 95% CI = 0.45, 1.00) and correct handwashing technique (aPR = 0.62, 95% CI = 0.42, 0.90) were also associated with decreased contamination risk. These findings highlighted the limitations of improved water supplies as an indicator of safe water access. To ensure water safety in the home, household water treatment and improved hygiene, water handling, and storage practices should be promoted.

The role of sanitation and hygiene practices in contamination of household drinking water in rural households of South Africa

The role of sanitation and hygiene practices in contamination of household drinking water in rural households of South Africa

Promoting household water treatment through women's self help groups in Rural India: assessing impact on drinking water quality and equity.

Household water treatment, including boiling, chlorination and filtration, has been shown effective in improving drinking water quality and preventing diarrheal disease among vulnerable populations. We used a case-control study design to evaluate the extent to which the commercial promotion of household water filters through microfinance institutions to women's self-help group (SHG) members improved access to safe drinking water. This pilot program achieved a 9.8% adoption rate among women targeted for adoption. Data from surveys and assays of fecal contamination (thermotolerant coliforms, TTC) of drinking water samples (source and household) were analyzed from 281 filter adopters and 247 non-adopters exposed to the program; 251 non-SHG members were also surveyed. While adopters were more likely than non-adopters to have children under 5 years, they were also more educated, less poor, more likely to have access to improved water supplies, and more likely to have previously used a water filter. Adopters had lower levels of fecal contamination of household drinking water than non-adopters, even among those non-adopters who treated their water by boiling or using traditional ceramic filters. Nevertheless, one-third of water samples from adopter households exceeded 100 TTC/100ml (high risk), and more than a quarter of the filters had no stored treated water available when visited by an investigator, raising concerns about correct, consistent use. In addition, the poorest adopters were less likely to see improvements in their water quality. Comparisons of SHG and non-SHG members suggest similar demographic characteristics, indicating SHG members are an appropriate target group for this promotion campaign. However, in order to increase the potential for health gains, future programs will need to increase uptake, particularly among the poorest households who are most susceptible to disease morbidity and mortality, and focus on strategies to improve the correct, consistent and sustained use of these water treatment products.

International network to promote household water treatment and safe storage.

On February 25, 2003, more than 30 representatives from United Nations agencies, international nongovernmental organizations, research institutions, professional associations, and private companies met in Geneva, Switzerland, to establish the International Network to Promote Household Water Treatment and Safe Storage, sponsored by the World Health Organization (WHO) (Figure). The group has since convened at the Kyoto World Water Forum, Kyoto, Japan, in Washington, D.C., and in Cape Town, South Africa. At the next plenary meeting, in Nairobi, Kenya, on June 14–15, 2004, participants will consider a 5-year strategic plan to reduce waterborne disease through specific actions in research, advocacy, communication, and implementation. Figure Cover and inside page of brochure, The Network. This first phase has seen progress in the organization and expansion of the network's participant base and real work in the field, building on the evidence that household water management can significantly contribute to meeting the Millennium Development Goals for child survival and water security. This fieldwork has reaffirmed the conclusion of a WHO-sponsored review: simple, low-cost interventions for home water treatment and storage lead to dramatic improvements in drinking water quality and reductions in diarrheal disease (1). The Safe Water System, developed by the Centers for Disease Control and Prevention (CDC), the Pan American Health Organization (PAHO), and WHO, combines point-of-use water disinfection with locally produced sodium hypochlorite, safe storage in narrow-mouth containers, and community education and has consistently been effective in preventing diarrhea (2,3). In recently published trials, the Safe Water System reduced diarrhea by 24% in Bangladesh (4) and 25% in Guatemala (5). In a 2003 study, the Safe Water System reduced diarrhea by 30% among persons with HIV infection in rural Uganda (6). In 2003, accounts of field trials of a household-based flocculant-disinfectant for water treatment were published for the first time. Developed by the Procter & Gamble Company and CDC, the intervention combines a chemical flocculant with a timed-release hypochlorite disinfectant. Through precipitation, coagulation, and flocculation, the combined product physically removes a broad range of microbial pathogens and chemicals, including arsenic, and concurrently inactivates remaining microbes with free chlorine (7,8). In a randomized, controlled trial in Guatemala, use of the product reduced the incidence of diarrhea among intervention households by 24%, or 29% when the treated water was stored in a vessel designed specifically for safe storage (5). In 2003, considerable progress was made in evaluating the impact of household-based filtration. In a large field trial, Rita Colwell and colleagues showed that simple filters made from sari cloth or nylon, combined with appropriate education, reduced cholera by 48% compared to controls (9). Locally produced slow sand and ceramic filters were evaluated by Massachusetts Institute of Technology postgraduate students (10–12). In a trial in Bolivia, locally fabricated filters that used imported ceramic candles eliminated all detectable fecal coliform bacteria in household drinking water and reduced levels of diarrhea by 64% (13). In 2004, a systematic review of 57 studies assessed the extent and causes of microbiological contamination of household drinking water between the source and the consumer (14). The reviewers concluded that water quality declines substantially after collection and recommended household treatment and safe storage of water. A systematic review of the health impact of improved water quality is under way, driven in part by the burgeoning evidence indicating that substantial health gains result when water is treated in households and protected against recontamination (15,16). In Nairobi, network members will review recent progress and plan their next steps for advancing household-based water management. Stakeholders from all organizations are urged to participate in, contribute to, and take full advantage of, this important new movement in the battle against waterborne disease. For more information on the network and to register for the Nairobi meeting, readers are referred to: http://www.cdc.gov/safewater/network.htm

A systematic review of the health outcomes related to household water quality in developing countries

In developing countries, the microbial contamination of household drinking water is implicated in the prevalence of various diseases. This systematic review is concerned with two health outcomes, general diarrhoea and cholera, and their relationship with water quality at point-of-use. Observational studies investigating this relationship are reviewed, as well as studies of home water treatment and storage interventions. For cholera, a clear relationship was found with contaminated water. Home water treatment and storage interventions were also found to reduce cholera. For general diarrhoea, no clear relationship was found with point-of-use water quality, although interventions did significantly reduce diarrhoeal incidence. Reasons for these apparently contradictory results concerning general diarrhoea are discussed and suggestions for further research offered. The policy implications of the findings are also discussed.

Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use.

To assess the extent and causes of microbiological contamination of household drinking water between source and point-of-use in developing countries. A systematic meta-analysis of 57 studies measuring bacteria counts for source water and stored water in the home to assess how contamination varied between settings. The bacteriological quality of drinking water significantly declines after collection in many settings. The extent of contamination after water collection varies considerably between settings, but is proportionately greater where faecal and total coliform counts in source water are low. Policies that aim to improve water quality through source improvements may be compromised by post-collection contamination. Safer household water storage and treatment is recommended to prevent this, together with point-of-use water quality monitoring.