title: Effects of Sachet Water Consumption on Exposure to Microbe-Contaminated Drinking Water: Household Survey Evidence from Ghana.
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.
authors.affiliation: Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK. J.A.Wright@soton.ac.uk.
authors.forename: Jim
authors.initials: J
authors.lastname: Wright
authors.affiliation: Ghana School of Public Health, University of Ghana, Accra PO Box LG13, Ghana. mdzodzo@hotmail.com.
authors.forename: Mawuli
authors.initials: M
authors.lastname: Dzodzomenyo
authors.affiliation: Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK. Nicola.Wardrop@soton.ac.uk.
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Wardrop
authors.affiliation: Joint Monitoring Programme for Water Supply and Sanitation (JMP), Department of Public Health, Environmental and Social Determinants of Health (PHE), World Health Organization, Geneva 1211 Switzerland. johnstonr@who.int.
authors.forename: Richard
authors.initials: R
authors.lastname: Johnston
authors.affiliation: Social Sciences, University of Southampton, Southampton SO17 1BJ, UK. ah4e10@soton.ac.uk.
authors.forename: Allan
authors.initials: A
authors.lastname: Hill
authors.affiliation: Ghana School of Public Health, University of Ghana, Accra PO Box LG13, Ghana. cecearyeetey@yahoo.co.uk.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Aryeetey
authors.affiliation: Ghana School of Public Health, University of Ghana, Accra PO Box LG13, Ghana. rmadanu@yahoo.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Adanu
mesh_terms: D003430:Cross-Sectional Studies; D060766:Drinking Water / Q000382:microbiology*; D004781:Environmental Exposure / Q000032:analysis / Q000706:statistics & numerical data*; D004926:Escherichia coli / Q000302:isolation & purification*; D005869:Ghana; D006801:Humans; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014871:Water Microbiology; D014876:Water Pollution / Q000032:analysis / Q000706:statistics & numerical data*; D060753:Water Quality
chemical_list: D060766:Drinking Water
keywords: Escherichia coli; Survey methodology; West Africa; beverages; drinking water