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In 2015, a typhoid fever outbreak began in downtown Kampala, Uganda, and spread into adjacent districts. In response, an environmental survey of drinking water source types was conducted in areas of the city with high case numbers. A total of 122 samples was collected from 12 source types and tested for , free chlorine, and conductivity. An additional 37 grab samples from seven source types and 16 paired large volume (20 liter) samples from wells and springs were also collected and tested for the presence of serovar Typhi. was detected in 60% of kaveras (drinking water sold in plastic bags) and 80% of refilled water bottles; free chlorine was not detected in either source type. Most jerry cans (68%) contained and had free chlorine residuals below the WHO-recommended level of 0.5 mg/liter during outbreaks. Elevated conductivity readings for kaveras, refilled water bottles, and jerry cans (compared to treated surface water supplied by the water utility) suggested that they likely contained untreated groundwater. All unprotected springs and wells and more than 60% of protected springs contained Water samples collected from the water utility were found to have acceptable free chlorine levels and no detectable While Typhi was not detected in water samples, spp. were detected in samples from two unprotected springs, one protected spring, and one refilled water bottle. These data provided clear evidence that unregulated vended water and groundwater represented a risk for typhoid transmission. Despite the high incidence of typhoid fever globally, relatively few outbreak investigations incorporate drinking water testing. During waterborne disease outbreaks, measurement of physical-chemical parameters, such as free chlorine residual and electrical conductivity, and of microbiological parameters, such as the presence of or the implicated etiologic agent, in drinking water samples can identify contaminated sources. This investigation indicated that unregulated vended water and groundwater sources were contaminated and were therefore a risk to consumers during the 2015 typhoid fever outbreak in Kampala. Identification of contaminated drinking water sources and sources that do not contain adequate disinfectant levels can lead to rapid targeted interventions.

Background Household water storage remains a necessity in many communities worldwide, especially in the developing countries. Water storage often using tanks/vessels is envisaged to be a source of water contamination, along with related user practices. Several studies have investigated this phenomenon, albeit in isolation. This study aimed at developing a systematic review, focusing on the impacts of water storage tank/vessel features and user practices on water quality. Methods Database searches for relevant peer-reviewed papers and grey literature were done. A systematic criterion was set for the selection of publications and after scrutinizing 1106 records, 24 were selected. These were further subjected to a quality appraisal, and data was extracted from them to complete the review. Results and discussion Microbiological and physicochemical parameters were the basis for measuring water quality in storage tanks or vessels. Water storage tank/vessel material and retention time had the highest effect on stored water quality along with age, colour, design, and location. Water storage tank/vessel cleaning and hygiene practices like tank/vessel covering were the user practices most investigated by researchers in the literature reviewed and they were seen to have an impact on stored water quality. Conclusions There is evidence in the literature that storage tanks/vessels, and user practices affect water quality. Little is known about the optimal tank/vessel cleaning frequency to ensure safe drinking water quality. More research is required to conclusively determine the best matrix of tank/vessel features and user practices to ensure good water quality.

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