Effects of Sachet Water Consumption on Exposure to Microbe-Contaminated Drinking Water: Household Survey Evidence from Ghana.
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ABSTRACT:
SUBMITTER: Wright J
PROVIDER: S-EPMC4808966 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Packaged drinking water (PW) sold in bottles and plastic bags/sachets is widely consumed in low- and middle-income countries (LMICs), and many urban users in sub-Saharan Africa (SSA) rely on packaged sachet water (PSW) as their primary source of water for consumption. However, few rigorous studies have investigated PSW quality in SSA, and none have compared PSW to stored household water for consumption (HWC). A clearer understanding of PSW quality in the context of alternative sources is needed to inform policy and regulation. As elsewhere in SSA, PSW is widely consumed in Sierra Leone, but government oversight is nearly nonexistent. This study examined the microbiological and chemical quality of a representative sample of PSW products in Freetown, Sierra Leone at packaged water manufacturing facilities (PWMFs) and at points of sale (POSs). Samples of HWC were also analyzed for comparison. The study did not find evidence of serious chemical contamination among the parameters studied. However, 19% of 45 PSW products sampled at the PWMF contained detectable Escherichia coli (EC), although only two samples exceeded 10 CFU/100 mL. Concentrations of total coliforms (TC) in PSW (but not EC) increased along the supply chain. Samples of HWC from 60 households in Freetown were significantly more likely to contain EC and TC than PSW at the point of production (p<0.01), and had significantly higher concentrations of both bacterial indicators (p<0.01). These results highlight the need for additional PSW regulation and surveillance, while demonstrating the need to prioritize the safety of HWC. At present, PSW may be the least unsafe option for many households.
| S-EPMC4498897 | biostudies-literature
Project description:The consumption of packaged water in Ghana has grown significantly in recent years. By 2017, "sachet water"-machine-sealed 500ml plastic bags of drinking water-was consumed by 33% of Ghanaian households. Reliance on sachet water has previously been associated with the urban poor, yet recent evidence suggests a customer base which crosses socioeconomic lines. Here, we conduct a repeated cross-sectional analysis of three nationally representative datasets to examine the changing demography of sachet water consumers between 2010 and 2017. Our results show that over the course of the study period sachet water has become a ubiquitous source of drinking water in Ghana, with relatively wealthy households notably increasing their consumption. In 2017, the majority of sachet water drinking households had access to another improved water source. The current rate and form of urbanisation, inadequate water governance, and an emphasis on cost recovery pose significant challenges for the expansion of the piped water supply network, leading us to conclude that sachet water will likely continue to be a prominent source of drinking water in Ghana for the foreseeable future. The main challenge for policymakers is to ensure that the growing sachet water market enhances rather than undermines Ghana's efforts towards achieving universal and equitable access to clean drinking water and sanitation.
| S-EPMC9135223 | biostudies-literature
Project description:Packaged water, particularly bagged sachet water, has become an important drinking water source in West Africa as local governments struggle to provide safe drinking water supplies. In Ghana, sachet water has become an important primary water source in urban centers, and a growing literature has explored various dimensions of this industry, including product quality. There is very little data on sachet water quality outside of large urban centers, where smaller markets often mean less producer competition and less government regulation. This study analyzes the microbiological quality of sachet water alongside samples of other common water sources at point-of-collection (POC) and point-of-use (POU) in 42 rural, peri-urban, and small-town Ghanaian communities using the IDEXX Colilert® 18 (Westbrook, ME). Levels of coliform bacteria and Escherichia coli detected in sachet water samples were statistically and significantly lower than levels detected in all other water sources at POU, including public taps and standpipes, and statistically similar or significantly lower at POC. In diverse waterscapes where households regularly patch together their water supply from different sources, sachet water appears to be an evolving alternative for safe drinking water despite many caveats, including higher unit costs and limited opportunities to recycle the plastic packaging.
| S-EPMC6090358 | biostudies-literature
Project description:Background: Sachet water, popularly known as "pure water" has become an invaluable entity in most Ghanaian households. Despite its importance, there is no extensive nationwide investigations on its wholesomeness for consumption. The aim of this study was to determine the microbiological quality of 41 brands of sachet water sampled in 16 districts across 5 regions in Ghana. Methods: The samples were analyzed for the presence of total and fecal coliform ( Escherichia coli) using the Colilert*- 18 Test Kit. Results: Majority of the samples (56.09%) were excellent, 4.87% satisfactory and 14.63% suspicious. Ten samples (24.4%) were unsatisfactory. For the degree of fecal contamination, (85.56%) were satisfactory, four (9.76%) were suspicious, and two others (4.88%) were unsatisfactory. The contaminations observed could be attributed to poor sanitary conditions (during and/or after production) and failure of some production facilities to adhere to standard manufacturing practices. Conclusion: Our data suggest that microbiological quality sachet water from some sources have not yet attained levels that make it absolutely pure and wholesome for consumption in many areas.
| S-EPMC7117957 | biostudies-literature
Project description:BACKGROUND:The synthetic solvent tetrachloroethylene (PCE), commonly used in dry cleaning operations, is a human neurotoxicant and carcinogen. However, its effect on reproduction is poorly understood, as prior studies have been limited to small occupational cohorts. We examined the association between PCE exposure from contamination of the public drinking water supply and time-to-pregnancy (TTP) in a cohort of mothers from Cape Cod, Massachusetts. METHODS:The Cape Cod Family Health Study is a retrospective cohort study designed to examine the reproductive and developmental health effects of exposure to PCE-contaminated drinking water. Our analysis included 1565 women who reported 3826 planned pregnancies from 1949 to 1990. Women completed self-administered questionnaires that ascertained TTP for each of her pregnancies, regardless of the outcome, as well as residential history and demographic information. We utilized EPANET water distribution system modeling software and a leaching and transport model to assess PCE exposure for each pregnancy. We used log-binomial regression models to estimate relative risks (RR) and 95% confidence intervals (CI), adjusting for potential confounders. We performed a probabilistic bias analysis to examine the effect of outcome misclassification on our results. RESULTS:Any cumulative PCE exposure before pregnancy was associated with a 15% reduction in risk of TTP?>?12 months (RR = 0.85, 95% CI: 0.70, 1.03). However, women with the highest average monthly PCE exposure around the time of the pregnancy attempt (? 2.5?g) had increased risk of TTP?>?12 months (RR = 1.36, 95% CI: 1.06, 1.76). CONCLUSIONS:We found little evidence for long-term, cumulative adverse effects of PCE exposure on TTP, but high levels of PCE exposure around the time of the pregnancy attempt were associated with longer TTP. These associations may be underestimated due to the exclusion of unsuccessful pregnancy attempts from our study population, and may be biased by outcome and exposure misclassification given the long-term recall of TTP and use of a leaching and transport model to estimate PCE exposure.
| S-EPMC6399737 | biostudies-literature
Project description:Background:Five hundred milliliter bags of water, referred to as 'sachet water,' are widely used in Liberia, as they are low cost, safe sources of clean drinking water for the population. Objectives:This study aims to determine sources of drinking water in the study area, the rate of sachet water use, empty sachet water disposal methods and environmental problems associated with sachet water waste disposal. Methods:Using a simple random sampling technique, 257 respondents were interviewed between April and June 2018 using structured questionnaires. On a five-point Likert scale with a mean score of 3 as the cutoff point, data were analyzed using descriptive statistics. Results:The paper found that sachet water (mean (M)=4.37) is an essential source of drinking water in Liberia with a daily consumption rate of at least 6 bags of sachet water per individual. Affordability, availability, and safety were named by respondents as reasons for their consumption of sachet water. Improper disposal methods practiced by the residents of Liberia included ground littering (M=3.42) and burning (M=3.03). Conclusions:Sachet water consumption has contributed to environmental issues such as drainage system clogs, littering of the environment, the death of terrestrial and aquatic animals due to plastic waste consumption, reduction of oxygen for aquatic life and soil infertility. We recommend the creation of policies and enforcement of sachet water production to include reuse and recycling of sachet water by-products as a requirement for licensing of producers, provision of adequate waste bins and the use of public education campaigns to educate residents on environmental best practices. Ethics Approval:This study was approved by the Institute for Population Studies, University of Liberia, Monrovia, Liberia. Informed Consent:Obtained. Competing Interests:The authors declare no competing financial interests.
| S-EPMC6285681 | biostudies-literature
Project description:We conducted a randomized, placebo-controlled, triple-blinded trial to determine the health impact of daily use of sodium dichloroisocyanurate (NaDCC) tablets for household drinking water treatment in periurban Ghana. We randomized 240 households (3,240 individuals) to receive either NaDCC or placebo tablets. All households received a 20-liter safe water storage vvessel. Over 12 weeks, 446 diarrhea episodes (2.2%) occurred in intervention and 404 (2.0%) in control households (P = 0.38). Residual free chlorine levels indicated appropriate tablet use. Escherichia coli was found in stored water at baseline in 96% of intervention and 88% of control households and at final evaluation in 8% of intervention and 54% of control households (P = 0.002). NaDCC use did not prevent diarrhea but improved water quality. Diarrhea rates were low and water quality improved in both groups. Safe water storage vessels may have been protective. A follow-up health impact study of NaDCC tablets is warranted.
| S-EPMC2803503 | biostudies-literature
Project description:High level arsenic exposure is associated with reproductive toxicity in experimental and observational studies; however, few data exist to assess risks at low levels. Even less data are available to evaluate the impact of low level arsenic exposure on human fecundity. Our aim in this pilot study was a preliminary evaluation of associations between low level drinking water arsenic contamination and female fecundity. This retrospective study was conducted among women previously recruited to a hospital-based case-control study of spontaneous pregnancy loss in Timiṣ County, Romania. Women (n=94) with planned pregnancies of 5-20 weeks gestation completed a comprehensive physician-administered study questionnaire and reported the number of menstrual cycles attempting to conceive as the time to pregnancy (TTP). Drinking water samples were collected from residential drinking water sources and we determined arsenic levels using hydride generation-atomic absorption spectrometry (HG-AAS). Multivariable Cox-proportional hazards regression with Efron approximation was employed to evaluate TTP as a function of drinking water arsenic concentrations among planned pregnancies, adjusted for covariates. There was no main effect for drinking water arsenic exposure, yet the conditional probability for pregnancy was modestly lower among arsenic exposed women with longer TTPs, relative to women with shorter TTPs, and relative to unexposed women. For example, 1µg/L average drinking water arsenic conferred 5%, 8%, and 10% lower likelihoods for pregnancy in the 6th, 9th, and 12th cycles, respectively (P=0.01). While preliminary, our results suggest that low level arsenic contamination in residential drinking water sources may further impair fecundity among women with longer waiting times; however, this hypothesis requires confirmation by a future, more definitive study.
| S-EPMC5328919 | biostudies-literature
Project description:Exposure to lead (Pb) through drinking water has been linked to adverse health outcomes. Children are particularly susceptible. This study was designed to measure Pb contamination level in drinking water of the Ethiopian city Addis Ababa and assess the associated health risks. Eighty-eight fully-flushed drinking water samples were collected from all ten sub-cities of Addis Ababa. Pb concentration was measured using an Inductively Coupled Plasma Mass Spectrometer (ICP-MS). The chronic daily intake (CDI), the hazard quotient (HQ), and the cancer risk (CR) of Pb were determined to assess exposure levels and health effects. Blood lead level (B-Pb) for children was modelled using the integrated exposure uptake biokinetic model (IEUBK). The mean concentration of Pb in the drinking water was 17.8 μg/l, where >50% of the samples exceeded WHO's 10 μg/l guideline. Significant spatial variation of Pb was noticed among sub-cities. The mean CDI was 1.43 and 0.59 μg/kg/day for children and adults, respectively. The HQ showed that 8% of children and 2.3% of adults exceeded the safe limit. The predicted geometric mean of B-Pb ranged from 3.23 to 14.65 μg/dl. The risk of a child having a B-Pb level >5 μg/dl at the median water Pb concentration (10.5 μg/l) was estimated at 13.4%. Based on the 95th percentile Pb concentration (75.1 μg/l), 89.6% of children would have B-Pb levels above the 5 μg/dl threshold. The estimated CR was found in the range of 1 × 10-7 to 9.9 × 10-5; hence cancer risks are not a concern. The study concluded that Addis Ababa's drinking water is likely to be a source of lead exposure where consumers at specific city locations are at risk of numerous non-cancer health effects. The impacts are expected to be severe in the Ethiopian context; hence further investigations and coordinated interventions are required.
| S-EPMC8441166 | biostudies-literature
Project description:While adult exposure to PCE is known to have toxic effects, there is little information on the long-term impact of prenatal and early childhood exposure. We undertook a retrospective cohort study to examine the effects of their early life exposure to PCE-contaminated drinking water. This retrospective cohort study examined whether prenatal and early childhood exposure to PCE-contaminated drinking water influenced the risk of a variety of chronic conditions among adults who were born between 1969 and 1983 in the Cape Cod area of Massachusetts.Eight hundred and thirty-one participants with prenatal and early childhood PCE exposure and 547 unexposed participants were studied. Individuals completed questionnaires to gather information on demographic characteristics, chronic conditions, and other sources of solvent exposure. The location of residences from birth through 1990 were used to estimate PCE exposure with U.S. EPA's water distribution system modeling software (EPANET) modified to incorporate a leaching and transport model.No associations were observed between early life PCE exposure and current occurrence of obesity, diabetes, cardiovascular disease, hypertension, color blindness, near- and far sightedness and dry eyes. In contrast, a 1.8-fold increased risk of cancer (95% CI: 0.8, 4.0) was seen among individuals with any early life exposure. These results were based on 31 participants (23 exposed and 8 unexposed) who reported cancers at a variety of anatomical sites, particularly the cervix. A 1.5-fold increase in the risk of epilepsy (95% CI: 0.6, 3.6, based on 16 exposed and 7 unexposed participants) was also observed among individuals with any early life exposure that was further increased to 1.8 (95% CI: 0.7, 4.6) among those with exposure at or above the sample median.These results suggest that the risk of epilepsy and certain types of cancer such as cervical cancer may be increased among adults who were exposed to PCE-contaminated drinking water exposure during gestation and early childhood. These findings should be interpreted cautiously because of the study limitations and confirmed in follow-up investigations of similarly exposed populations with medically-confirmed diagnoses. This relatively young study population should also be monitored periodically for subsequent changes in disease risk.
| S-EPMC4397674 | biostudies-other