Volume 97, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Microbiological water quality is usually assessed by the identification of (), a fecal indicator. The hydrogen sulfide (HS) test is an inexpensive, easy-to-use, and portable alternative field-based water quality test. Our study evaluated the HS test’s effectiveness as a water quality indicator for diarrhea risk. Field workers collected stored drinking water samples for HS analysis and detection of by membrane filtration and measured caregiver-reported diarrhea among children < 5 years in the same households 1 month later. We assessed the association between the HS test (incubated for 24 hours and 48 hours) and diarrhea prevalence, with 2-day and 7-day symptom recall periods ( = 1,348). We determined the sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of the HS test compared with ( = 525). Controlling for potentially confounding covariates, HS-positive water (at 24 or 48 hours) was not associated with 2-day diarrhea prevalence (24-hour prevalence ratio [PR] = 1.03, 95% confidence interval [CI]: 0.63–1.69; 48-hour PR = 0.89, 95% CI: 0.58–1.38) or 7-day diarrhea prevalence (24-hour PR = 1.17, 95% CI: 0.76–1.78; 48-hour PR = 1.21, 95% CI: 0.81–1.80). The sensitivity, PPV, and NPV of the HS test was significantly higher when the HS test was incubated for 48 versus 24 hours whereas specificity showed the opposite trend. HS test sensitivity, PPV, and NPV increased with increasing levels, consistent with previous evidence that the HS test is a useful water quality tool in high-contamination settings. However, our results suggest that the HS test is not an effective indicator for waterborne diarrhea.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. WHO, 2011. Guidelines for Drinking Water Quality, 4th edition. Geneva, Switzerland: World Health Organization.
  2. WHO, 2003. Assessing Microbial Safety of Drinking Water Improving Approaches and Methods: Improving Approaches and Methods. Paris, France: Organization for Economic Co-operation and Development.
  3. Arnold BF, Colford JM, , 2007. Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: a systematic review and meta-analysis. Am J Trop Med Hyg 76: 354364. [Google Scholar]
  4. Clasen T, Schmidt W-P, Rabie T, Roberts I, Cairncross S, , 2007. Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis. BMJ 334: 782. [Google Scholar]
  5. Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM, , 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4252. [Google Scholar]
  6. McMahan L, Grunden AM, Devine AA, Sobsey MD, , 2012. Evaluation of a quantitative H2S MPN test for fecal microbes analysis of water using biochemical and molecular identification. Water Res 46: 16931704. [Google Scholar]
  7. Khush RS, Arnold BF, Srikanth P, Sudharsanam S, Ramaswamy P, Durairaj N, London AG, Ramaprabha P, Rajkumar P, Balakrishnan K, , 2013. H2S as an indicator of water supply vulnerability and health risk in low-resource settings: a prospective cohort study. Am J Trop Med Hyg 89: 251259. [Google Scholar]
  8. Manja K, Maurya M, Rao K, , 1982. A simple field test for the detection of faecal pollution in drinking water. Bull World Health Organ 60: 797. [Google Scholar]
  9. Gupta S, Sheikh M, Islam M, Rahman K, Jahan N, Rahman M, Hoekstra R, Johnston R, Ram P, Luby S, , 2008. Usefulness of the hydrogen sulfide test for assessment of water quality in Bangladesh. J Appl Microbiol 104: 388395. [Google Scholar]
  10. Gandhi R, , 2006. National Drinking Water Mission Guideline for National Rural Drinking Water Quality Monitoring and Surveillance Programme. New Delhi, India: Ministry of Rural Development.
  11. Sobsey MD, Pfaender FK, , 2002. Evaluation of the H2S Method for Detection of Fecal Contamination of Drinking Water. Geneva, Swtizerland: World Health Organization.
  12. Ercumen A, Arnold BF, Naser AM, Unicomb L, Colford JM, Luby SP, , 2017. Potential sources of bias in the use of Escherichia coli to measure waterborne diarrhea risk in low‐income settings. Trop Med Int Health 22: 211. [Google Scholar]
  13. Ercumen A, Naser AM, Unicomb L, Arnold BF, Colford JM, Jr Luby SP, , 2015. Effects of source-versus household contamination of tubewell water on child diarrhea in rural Bangladesh: a randomized controlled trial. PLoS One 10: e0121907. [Google Scholar]
  14. Oshiro R, , 2002. Method 1604: Total Coliforms and Escherichia coli in Water by Membrane Filtration Using a Simultaneous Detection Technique (MI Medium). Washington, DC: US Environmental Protection Agency.
  15. Baqui AH, Black RE, Yunus M, Hoque AA, Chowdhury H, Sack RB, , 1991. Methodological issues in diarrhoeal diseases epidemiology: definition of diarrhoeal episodes. Int J Epidemiol 20: 10571063. [Google Scholar]
  16. Schmidt W-P, Arnold BF, Boisson S, Genser B, Luby SP, Barreto ML, Clasen T, Cairncross S, , 2011. Epidemiological methods in diarrhoea studies—an update. Int J Epidemiol 40: 16781692. [Google Scholar]
  17. Arnold BF, Galiani S, Ram PK, Hubbard AE, Briceño B, Gertler PJ, Colford JM, , 2013. Optimal recall period for caregiver-reported illness in risk factor and intervention studies: a multicountry study. Am J Epidemiol 177: 361370. [Google Scholar]
  18. Zafar SN, Luby S, Mendoza C, , 2010. Recall errors in a weekly survey of diarrhoea in Guatemala: determining the optimal length of recall. Epidemiol Infect 138: 264269. [Google Scholar]
  19. Gundry S, Wright J, Conroy R, , 2004. A systematic review of the health outcomes related to household water quality in developing countries. J Water Health 2: 113. [Google Scholar]
  20. Levy K, Nelson KL, Hubbard A, Eisenberg JN, , 2012. Rethinking indicators of microbial drinking water quality for health studies in tropical developing countries: case study in northern coastal Ecuador. Am J Trop Med Hyg 86: 499507. [Google Scholar]
  21. Wu J, Long S, Das D, Dorner S, , 2011. Are microbial indicators and pathogens correlated? A statistical analysis of 40 years of research. J Water Health 9: 265278. [Google Scholar]
  22. Gruber JS, Ercumen A, Colford JM, Jr, 2014. Coliform bacteria as indicators of diarrheal risk in household drinking water: systematic review and meta-analysis. PLoS One 9: e107429. [Google Scholar]
  23. Luby SP, Halder AK, Huda TM, Unicomb L, Islam MS, Arnold BF, Johnston RB, , 2015. Microbiological contamination of drinking water associated with subsequent child diarrhea. Am J Trop Med Hyg 93: 904911. [Google Scholar]
  24. Levy K, Nelson KL, Hubbard A, Eisenberg JN, , 2008. Following the water: a controlled study of drinking water storage in northern coastal Ecuador. Environ Health Perspect 116: 1533. [Google Scholar]
  25. Luby SP, Agboatwalla M, Hoekstra RM, , 2011. The variability of childhood diarrhea in Karachi, Pakistan, 2002–2006. Am J Trop Med Hyg 84: 870877. [Google Scholar]
  26. Wright JA, Yang H, Walker K, Pedley S, Elliott J, Gundry SW, , 2012. The H2S test versus standard indicator bacteria tests for faecal contamination of water: systematic review and meta‐analysis. Trop Med Int Health 17: 94105. [Google Scholar]

Data & Media loading...

  • Received : 17 May 2017
  • Accepted : 25 Jul 2017
  • Published online : 16 Oct 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error