Fecal Contamination of Drinking-Water in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
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{"title"=>"Fecal Contamination of Drinking-Water in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Robert", "last_name"=>"Bain", "scopus_author_id"=>"55059412700"}, {"first_name"=>"Ryan", "last_name"=>"Cronk", "scopus_author_id"=>"35766082400"}, {"first_name"=>"Jim", "last_name"=>"Wright", "scopus_author_id"=>"55276508600"}, {"first_name"=>"Hong", "last_name"=>"Yang", "scopus_author_id"=>"56180542700"}, {"first_name"=>"Tom", "last_name"=>"Slaymaker", "scopus_author_id"=>"56153993900"}, {"first_name"=>"Jamie", "last_name"=>"Bartram", "scopus_author_id"=>"6603696131"}], "year"=>2014, "source"=>"PLoS Medicine", "identifiers"=>{"pmid"=>"24800926", "doi"=>"10.1371/journal.pmed.1001644", "sgr"=>"84901299937", "isbn"=>"1549-1676 (Electronic)\\r1549-1277 (Linking)", "scopus"=>"2-s2.0-84901299937", "issn"=>"15491676", "pui"=>"373181650"}, "id"=>"4d3715f3-7160-3136-84eb-64446e557c42", "abstract"=>"BACKGROUND: Access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator \"use of an improved source,\" which does not account for water quality measurements. Our objectives were to determine whether water from \"improved\" sources is less likely to contain fecal contamination than \"unimproved\" sources and to assess the extent to which contamination varies by source type and setting.\\n\\nMETHODS AND FINDINGS: Studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of Escherichia coli or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for \"improved\" sources than \"unimproved\" sources (odds ratio [OR] = 0.15 [0.10-0.21], I2 = 80.3% [72.9-85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52-3.71]; p<0.001) and rural areas (OR = 2.37 [1.47-3.81] p<0.001) were more likely to be contaminated. Studies rarely reported stored water quality or sanitary risks and few achieved robust random selection. Safety may be overestimated due to infrequent water sampling and deterioration in quality prior to consumption.\\n\\nCONCLUSION: Access to an \"improved source\" provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe drinking-water and do not fully reflect disparities in access. An enhanced monitoring strategy would combine indicators of sanitary protection with measures of water quality.", "link"=>"http://www.mendeley.com/research/fecal-contamination-drinkingwater-low-middleincome-countries-systematic-review-metaanalysis-4", "reader_count"=>302, "reader_count_by_academic_status"=>{"Unspecified"=>6, "Professor > Associate Professor"=>5, "Student > Doctoral Student"=>16, "Researcher"=>44, "Student > Ph. D. Student"=>52, "Student > Postgraduate"=>27, "Student > Master"=>83, "Other"=>10, "Student > Bachelor"=>42, "Lecturer"=>10, "Lecturer > Senior Lecturer"=>3, "Professor"=>4}, "reader_count_by_user_role"=>{"Unspecified"=>6, "Professor > Associate Professor"=>5, "Student > Doctoral Student"=>16, "Researcher"=>44, "Student > Ph. D. Student"=>52, "Student > Postgraduate"=>27, "Student > Master"=>83, "Other"=>10, "Student > Bachelor"=>42, "Lecturer"=>10, "Lecturer > Senior Lecturer"=>3, "Professor"=>4}, "reader_count_by_subject_area"=>{"Unspecified"=>23, "Agricultural and Biological Sciences"=>38, "Arts and Humanities"=>5, "Business, Management and Accounting"=>5, "Veterinary Science and Veterinary Medicine"=>1, "Chemical Engineering"=>1, "Chemistry"=>9, "Computer Science"=>4, "Decision Sciences"=>1, "Earth and Planetary Sciences"=>4, "Economics, Econometrics and Finance"=>6, "Engineering"=>49, "Environmental Science"=>66, "Biochemistry, Genetics and Molecular Biology"=>10, "Nursing and Health Professions"=>8, "Medicine and Dentistry"=>38, "Neuroscience"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>2, "Social Sciences"=>19, "Immunology and Microbiology"=>11}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>38}, "Social Sciences"=>{"Social Sciences"=>19}, "Decision Sciences"=>{"Decision Sciences"=>1}, "Psychology"=>{"Psychology"=>2}, "Unspecified"=>{"Unspecified"=>23}, "Environmental Science"=>{"Environmental Science"=>66}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Chemical Engineering"=>{"Chemical Engineering"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>5}, "Engineering"=>{"Engineering"=>49}, "Chemistry"=>{"Chemistry"=>9}, "Neuroscience"=>{"Neuroscience"=>1}, "Earth and Planetary Sciences"=>{"Earth and Planetary Sciences"=>4}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>6}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>11}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>38}, "Computer Science"=>{"Computer Science"=>4}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>5}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>8}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>10}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>1}}, "reader_count_by_country"=>{"Ecuador"=>1, "United States"=>2, "Tanzania"=>1, "United Kingdom"=>3, "Spain"=>1, "Canada"=>2, "Sweden"=>1, "Netherlands"=>1, "Burkina Faso"=>1, "Brazil"=>1, "South Africa"=>2, "Australia"=>1, "Germany"=>1, "Indonesia"=>1}, "group_count"=>30}

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  • {"files"=>["https://ndownloader.figshare.com/files/1487326"], "description"=>"<p>Source: UNICEF/WHO <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001644#pmed.1001644-WHOUNICEF1\" target=\"_blank\">[5]</a>.</p>a<p>Households using bottled water as their primary source of water for drinking are generally considered to use an improved source if one of the above sources is used for washing and cooking. The JMP estimates that 6% of the urban population and 1% of the rural population primarily use bottled water as their source of drinking-water.</p>b<p>An estimated 3% of the global population use surface waters and a further 8% use “other unimproved sources” such as tanker trucks, unprotected dug wells, and unprotected springs.</p>c<p>Published estimates include do not distinguish protected and unprotected. In the absence of data we assumed half are protected.</p>", "links"=>[], "tags"=>["biotechnology", "Applied microbiology", "microbiology", "Environmental engineering", "Water management", "Public and occupational health", "Global health"], "article_id"=>1018317, "categories"=>["Biological Sciences"], "users"=>["Robert Bain", "Ryan Cronk", "Jim Wright", "Hong Yang", "Tom Slaymaker", "Jamie Bartram"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001644.t001", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Types_of_improved_source_and_the_estimated_proportion_of_the_global_population_using_these_as_their_primary_source_of_drinking_water_/1018317", "title"=>"Types of improved source and the estimated proportion of the global population using these as their primary source of drinking-water.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-05-06 03:51:17"}
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  • {"files"=>["https://ndownloader.figshare.com/files/1487320"], "description"=>"<p>Matching drinking-water source types to the classification used by the Joint Monitoring Programme.</p>", "links"=>[], "tags"=>["biotechnology", "Applied microbiology", "microbiology", "Environmental engineering", "Water management", "Public and occupational health", "Global health", "drinking-water", "types", "classification", "monitoring"], "article_id"=>1018311, "categories"=>["Biological Sciences"], "users"=>["Robert Bain", "Ryan Cronk", "Jim Wright", "Hong Yang", "Tom Slaymaker", "Jamie Bartram"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001644.g001", "stats"=>{"downloads"=>2, "page_views"=>50, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Matching_drinking_water_source_types_to_the_classification_used_by_the_Joint_Monitoring_Programme_/1018311", "title"=>"Matching drinking-water source types to the classification used by the Joint Monitoring Programme.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-05-06 03:51:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/1487321"], "description"=>"<p>Flowchart for a review of safety of sources of drinking-water.</p>", "links"=>[], "tags"=>["biotechnology", "Applied microbiology", "microbiology", "Environmental engineering", "Water management", "Public and occupational health", "Global health", "sources"], "article_id"=>1018312, "categories"=>["Biological Sciences"], "users"=>["Robert Bain", "Ryan Cronk", "Jim Wright", "Hong Yang", "Tom Slaymaker", "Jamie Bartram"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001644.g002", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flowchart_for_a_review_of_safety_of_sources_of_drinking_water_/1018312", "title"=>"Flowchart for a review of safety of sources of drinking-water.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-05-06 03:51:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/1487328", "https://ndownloader.figshare.com/files/1487329", "https://ndownloader.figshare.com/files/1487330", "https://ndownloader.figshare.com/files/1487331", "https://ndownloader.figshare.com/files/1487332", "https://ndownloader.figshare.com/files/1487333", "https://ndownloader.figshare.com/files/1487334", "https://ndownloader.figshare.com/files/1487335", "https://ndownloader.figshare.com/files/1487336", "https://ndownloader.figshare.com/files/1487337", "https://ndownloader.figshare.com/files/1487338", "https://ndownloader.figshare.com/files/1487339", "https://ndownloader.figshare.com/files/1487340", "https://ndownloader.figshare.com/files/1487341", "https://ndownloader.figshare.com/files/1487342", "https://ndownloader.figshare.com/files/1487343"], "description"=>"<div><p>Background</p><p>Access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator “use of an improved source,” which does not account for water quality measurements. Our objectives were to determine whether water from “improved” sources is less likely to contain fecal contamination than “unimproved” sources and to assess the extent to which contamination varies by source type and setting.</p><p>Methods and Findings</p><p>Studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of <i>Escherichia coli</i> or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for “improved” sources than “unimproved” sources (odds ratio [OR] = 0.15 [0.10–0.21], I<sup>2</sup> = 80.3% [72.9–85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52–3.71]; <i>p</i><0.001) and rural areas (OR = 2.37 [1.47–3.81] <i>p</i><0.001) were more likely to be contaminated. Studies rarely reported stored water quality or sanitary risks and few achieved robust random selection. Safety may be overestimated due to infrequent water sampling and deterioration in quality prior to consumption.</p><p>Conclusion</p><p>Access to an “improved source” provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe drinking-water and do not fully reflect disparities in access. An enhanced monitoring strategy would combine indicators of sanitary protection with measures of water quality.</p><p><i>Please see later in the article for the Editors' Summary</i></p></div>", "links"=>[], "tags"=>["biotechnology", "Applied microbiology", "microbiology", "Environmental engineering", "Water management", "Public and occupational health", "Global health", "contamination", "drinking-water", "low-", "middle-income", "systematic"], "article_id"=>1018319, "categories"=>["Biological Sciences"], "users"=>["Robert Bain", "Ryan Cronk", "Jim Wright", "Hong Yang", "Tom Slaymaker", "Jamie Bartram"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001644.s001", "https://dx.doi.org/10.1371/journal.pmed.1001644.s002", "https://dx.doi.org/10.1371/journal.pmed.1001644.s003", "https://dx.doi.org/10.1371/journal.pmed.1001644.s004", "https://dx.doi.org/10.1371/journal.pmed.1001644.s005", "https://dx.doi.org/10.1371/journal.pmed.1001644.s006", "https://dx.doi.org/10.1371/journal.pmed.1001644.s007", "https://dx.doi.org/10.1371/journal.pmed.1001644.s008", "https://dx.doi.org/10.1371/journal.pmed.1001644.s009", "https://dx.doi.org/10.1371/journal.pmed.1001644.s010", "https://dx.doi.org/10.1371/journal.pmed.1001644.s011", "https://dx.doi.org/10.1371/journal.pmed.1001644.s012", "https://dx.doi.org/10.1371/journal.pmed.1001644.s013", "https://dx.doi.org/10.1371/journal.pmed.1001644.s014", "https://dx.doi.org/10.1371/journal.pmed.1001644.s015", "https://dx.doi.org/10.1371/journal.pmed.1001644.s016"], "stats"=>{"downloads"=>73, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Fecal_Contamination_of_Drinking_Water_in_Low_and_Middle_Income_Countries_A_Systematic_Review_and_Meta_Analysis_/1018319", "title"=>"Fecal Contamination of Drinking-Water in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-05-06 03:51:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/1487327"], "description"=>"<p>With the exception of stored versus source, we restricted the analysis to source water samples. We excluded emergencies from the meta-regression.</p>a<p>Post hoc analysis.</p>b<p>Top tercile of studies versus bottom two terciles.</p><p>Obs.,number of observations.</p>", "links"=>[], "tags"=>["biotechnology", "Applied microbiology", "microbiology", "Environmental engineering", "Water management", "Public and occupational health", "Global health", "studies"], "article_id"=>1018318, "categories"=>["Biological Sciences"], "users"=>["Robert Bain", "Ryan Cronk", "Jim Wright", "Hong Yang", "Tom Slaymaker", "Jamie Bartram"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001644.t004", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Between_studies_meta_regression_/1018318", "title"=>"Between studies meta-regression.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-05-06 03:51:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/1487324"], "description"=>"<p>Quality criteria used to assess studies of microbial water quality.</p>", "links"=>[], "tags"=>["biotechnology", "Applied microbiology", "microbiology", "Environmental engineering", "Water management", "Public and occupational health", "Global health", "studies", "microbial"], "article_id"=>1018315, "categories"=>["Biological Sciences"], "users"=>["Robert Bain", "Ryan Cronk", "Jim Wright", "Hong Yang", "Tom Slaymaker", "Jamie Bartram"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001644.t002", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Quality_criteria_used_to_assess_studies_of_microbial_water_quality_/1018315", "title"=>"Quality criteria used to assess studies of microbial water quality.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-05-06 03:51:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/1487323"], "description"=>"<p>Forest plot of the odds of fecal contamination for improved and unimproved sources.</p>", "links"=>[], "tags"=>["biotechnology", "Applied microbiology", "microbiology", "Environmental engineering", "Water management", "Public and occupational health", "Global health", "fecal", "contamination", "unimproved"], "article_id"=>1018314, "categories"=>["Biological Sciences"], "users"=>["Robert Bain", "Ryan Cronk", "Jim Wright", "Hong Yang", "Tom Slaymaker", "Jamie Bartram"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001644.g004", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Forest_plot_of_the_odds_of_fecal_contamination_for_improved_and_unimproved_sources_/1018314", "title"=>"Forest plot of the odds of fecal contamination for improved and unimproved sources.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-05-06 03:51:17"}

PMC Usage Stats | Further Information

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Relative Metric

{"start_date"=>"2014-01-01T00:00:00Z", "end_date"=>"2014-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Earth sciences/Hydrology", "average_usage"=>[272]}, {"subject_area"=>"/Engineering and technology", "average_usage"=>[282]}, {"subject_area"=>"/Medicine and health sciences/Health care", "average_usage"=>[283, 456]}]}
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