Extent of Fecal Contamination of Household Drinking Water in Nepal: Further Analysis of Nepal Multiple Indicator Cluster Survey 2014

Abstract

Abstract. Water sources classified as "improved" may not necessarily provide safe drinking water for householders. We analyzed data from Nepal Multiple Indicator Cluster Survey 2014 to explore the extent of fecal contamination of household drinking water. Fecal contamination was detected in 81.2% (95% confidence interval [CI]: 77.9-84.2) household drinking water from improved sources and 89.6% (95% CI: 80.4-94.7) in water samples from unimproved sources. In adjusted analysis, there was no difference in odds of fecal contamination of household drinking water between improved and unimproved sources. We observed significantly lower odds of fecal contamination of drinking water in households in higher wealth quintiles, where soap and water were available for handwashing and in households employing water treatment. The extent of contamination of drinking water as observed in this study highlights the huge amount of effort required to ensure the provision of safely managed water in Nepal by 2030 as aimed in sustainable development goals.The 2011 census of Nepal suggested 85% of households had "improved" drinking water sources, an increase of 39% points from the 1990s.1 These improved water sources are expected to better protect the water from extraneous contamination compared with unimproved sources. "Improved" water sources comprise water piped to premises, public taps/standpipes, tube wells or boreholes, protected wells, protected springs, and rainwater.2 "Unimproved" sources comprise unprotected springs, unprotected wells, tanker trucks, surface waters, and bottled water. 2But water from improved sources also have varied risk of fecal contamination, particularly in a developing country scenario such as in Nepal where poor management of water sources, household water storage practices, and water-related behaviors increase the risk of contamination. 3 The recently endorsed sustainable development goals (SDGs) intend to measure the goal of "achieving universal and equitable access to safe and affordable drinking water for all by 2030" based on the percentage of population using "safely managed drinking water services." 4 This refers to water from improved sources that are located on premises, available when needed, and free of fecal and priority chemical contamination. 4 In this study, we present the extent of fecal contamination of household drinking water and associated factors in Nepal using a nationally representative survey-Nepal Multiple Indicator Cluster Survey (NMICS) 2014. 5In the NMICS 2014, the number of Escherichia coli colony forming units (CFUs) was measured in water samples using a field-based method. A 100 mL volume of water sample was filtered through a filtration membrane (0.45 μm), and the membrane was then placed over a compact dry E. coli growth media plate. In addition, 1 mL water sample was directly plated on to another media plate. Media plates were incubated in a body-belt incubator or in a phase-change incubator for 24 hours. Blank tests were conducted for quality control. For further details...

Monitoring Drinking Water Quality in Nationally Representative Household Surveys in Low- and Middle-Income Countries: Cross-Sectional Analysis of 27 Multiple Indicator Cluster Surveys 2014–2020

“…The MICS used a standardized approach to achieve robust random selection of households and collect quantitative information on E. coli levels and samples at both the point of collection (PoC) and point of use (PoU). As such, these data address several key limitations identified by systematic reviews of water quality in LMICs (Bain et al 2014;Shields et al 2015;Wright et al 2004) and enable a multicountry assessment informed by prior research on household-and community-level risk factors for E. coli contamination (Cronin et al 2017;Harris et al 2017;Kandel et al 2017;Kirby et al 2016;Kumpel et al 2016;Pickering et al 2010;Wang et al 2017b;Wardrop et al 2018;Yang et al 2013).…”

Drinking Water Quality and Public Health in the Kathmandu Valley, Nepal: Coliform Bacteria, Chemical Contaminants, and Health Status of Consumers

“…In a 2014 Nepal-wide drinking water survey, Kandel et al found bacterial contamination in over 80% of all sources, with no significant differences in contamination between “improved” water sources compared to “unimproved sources” [ 9 ]. In the Kandel et al study, “improved” sources included piped water, tube wells, protected dug wells, protected springs, and rain water, while “unimproved” sources included unprotected dug wells, tanker trucks, surface waters, and bottled water [ 9 ]. However, Warner et al found that water from stone spouts and dug wells in the Kathmandu Valley had more bacterial contamination than water from deep tube wells and noted that sanitation and waste management in the region are virtually nonexistent [ 2 ].…”

“…Depth of the water source was not correlated with total (r s (33) � −0.37, p � 0.073) or fecal coliform counts (r s (33) � −0.11, p � 0.603). In a 2014 Nepal-wide drinking water survey, Kandel et al found bacterial contamination in over 80% of all sources, with no significant differences in contamination between "improved" water sources compared to "unimproved sources" [9]. In the Kandel et al study, "improved" sources included piped water, tube wells, protected dug wells, protected springs, and rain water, while "unimproved" sources included unprotected dug wells, e WHO DWG of 0.01 mg/L for arsenic is based on treatment performance and analytical achievability rather than health effects [17,81].…”

“…Unsafe concentrations of metals including arsenic, iron, manganese, and mercury have been reported in other studies [ 3 – 8 ]. Numerous studies have reported that bacterial contamination affected over 80% of samples, including water from dug wells, stone spouts, shallow tube wells, deep tube wells, tap water, and bottled water [ 6 , 9 – 16 ].…”

Monitoring drinking water quality in nationally representative household surveys: cross-sectional analysis of 20 Multiple Indicator Cluster Surveys 2014-2019

“…This work builds on earlier studies supported by the JMP, in particular the Rapid Assessment of Drinking water Quality (Aldana 2010; Aliev et al 2010; Howard et al 2009; Ince et al 2010; Tadesse et al 2010). Final reports published by the implementing agencies are available from the MICS website (mics.unicef.org) and researchers have begun to explore the risk factors for contamination (Kandel et al 2017; Wardrop et al 2018) and associations with child health and development (Haque et al 2017). With the exception of Nigeria, without the water quality data made available from household surveys, none of the 20 countries included in this study would have the nationally representative data necessary for monitoring SMDW.…”