Combining Sanitary Inspection and Water Quality Data in Western Uganda: Lessons Learned from a Field Trial of Original and Revised Sanitary Inspection Forms

Abstract

Risk assessment for drinking water systems combines sanitary inspections (SI) and water quality testing and is critical for effectively managing the safety of these systems. SI forms consist of question sets relating to the presence of potential sources and pathways of contamination specific to different types of water points, piped distribution systems, and household collection and storage practices. As part of the revision to the Guidelines for Drinking-water Quality (GDWQ), the World Health Organization (WHO) is updating the suite of SI forms to reflect and include the most recent technical and scientific information available. This paper reports the results from a field pilot of a selection of published and revised SI forms and water quality testing in the municipality of Bushenyi-Ishaka, Uganda. We collected data from 45 springs, 61 taps from piped distribution systems, and 129 household storage containers filled with water from those springs and taps. The median total risk scores, according to the revised forms, for spring, tap, and household practices were 36, 53, and 33%, respectively, with higher percentages indicating greater risk. The median Escherichia coli concentrations of spring, tap, and household storage systems were 17, <1, and 7 CFU/100 mL, respectively. We found that increased questioning in the revised SI forms do not necessarily translate to a higher total risk. There is potential for misinterpretation of terminology in the revised SI forms and occasional redundancy of concepts. For the revised SI form for springs, we suggest specific text changes to reduce potential bias. We recommend that users of SI forms receive training in their use and be familiar with their locale. Furthermore, the revised SI forms may need to be adapted in accordance with the local context.

Contextual Determinants of General Household Hygiene Conditions in Rural Indonesia

“…The SI has been widely used, especially in drinking water safety programs [9]. Daniel et al [11] suggest adapting the SI forms to "the local context to maximize their applicability". Since there is no "standard" SI available for measuring general household hygiene conditions, the variables that are measured can be inspired by previous studies or available and relevant SI forms.…”

“…There are some studies on household hygiene conditions that can inspire the questions used to measure household hygiene conditions, e.g., by [12,13]. Questions or variables from the SI form for household drinking water can also be used since they measure hygiene practices related to drinking water; see, for example, the studies of [5,11,14]. One can then use the adapted SI forms to inform which hygiene aspects should be tackled, which can then improve the general household hygiene conditions.…”

“…There are 16 hygiene-related variables used in this study (Table 1). As mentioned in the introduction, these variables were selected based on previous household hygiene studies [5,[11][12][13][14]. This study categorized those variables into four main clusters of household hygiene: sanitation, surrounding environment, drinking water, and personal hygiene (Figure 2).…”

Differences in levels of E. coli contamination of point of use drinking water in Bangladesh

“…coli in drinking water into categories of potential health risks. The standard procedure of measuring the association of categorical outcome variables with a set of covariates is to measure the adjusted odds ratio (AOR) in a multivariable analysis [ 12 , 32 – 34 ].…”