title: Hands, water, and health: fecal contamination in Tanzanian communities with improved, non-networked water supplies.
abstract: Almost half of the world's population relies on non-networked water supply services, which necessitates in-home water storage. It has been suggested that dirty hands play a role in microbial contamination of drinking water during collection, transport, and storage. However, little work has been done to evaluate quantitatively the association between hand contamination and stored water quality within households. This study measured levels of E. coli, fecal streptococci, and occurrence of the general Bacteroidales fecal DNA marker in source water, in stored water, and on hands in 334 households among communities in Dar es Salaam, Tanzania, where residents use non-networked water sources. Levels of fecal contamination on hands of mothers and children were positively correlated to fecal contamination in stored drinking water within households. Household characteristics associated with hand contamination included mother's educational attainment, use of an improved toilet, an infant in the household, and dissatisfaction with the quantity of water available for hygiene. In addition, fecal contamination on hands was associated with the prevalence of gastrointestinal and respiratory symptoms within a household. The results suggest that reducing fecal contamination on hands should be investigated as a strategy for improving stored drinking water quality and health among households using non-networked water supplies.
authors.affiliation: Emmet Interdisciplinary Program in Environment and Resources, School of Earth Sciences, Stanford University, Stanford, California 94305, USA.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Pickering
authors.forename: Jennifer
authors.initials: J
authors.lastname: Davis
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Walters
authors.forename: Helena M
authors.initials: HM
authors.lastname: Horak
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Keymer
authors.forename: Douglas
authors.initials: D
authors.lastname: Mushi
authors.forename: Rachelle
authors.initials: R
authors.lastname: Strickfaden
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Chynoweth
authors.forename: Jessie
authors.initials: J
authors.lastname: Liu
authors.forename: Annalise
authors.initials: A
authors.lastname: Blum
authors.forename: Kirsten
authors.initials: K
authors.lastname: Rogers
authors.forename: Alexandria B
authors.initials: AB
authors.lastname: Boehm
mesh_terms: D001419:Bacteria / Q000378:metabolism; D004247:DNA / Q000378:metabolism; D004926:Escherichia coli / Q000378:metabolism; D005243:Feces; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D006920:Hygiene; D013636:Tanzania; D014038:Toilet Facilities; D014871:Water Microbiology; D014873:Water Pollutants / Q000302:isolation & purification*; D018508:Water Purification; D014881:Water Supply
chemical_list: D014873:Water Pollutants; D004247:DNA