World Health Organization, 2015. Drinking Water, Fact sheet no. 391. Available at: http://www.who.int/mediacentre/factsheets/fs391/en/. Accessed September 5, 2015.
Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare, 2013. National Health Profile 2013. New Delhi, India: Government of India.
UNICEF/WHO, 2009. Diarrhoea: Why Children Are Still Dying and What Can Be Done. Geneva, Switzerland: WHO.
Hodge J, Chang HH, Boisson S, Collin SM, Peletz R, Clasen T, 2016. Assessing the association between thermotolerant coliforms in drinking water and diarrhea: an analysis of individual level data from multiple studies. Environ Health Perspect, doi: 10.1289/EHP156.
Fewetrell L, Kauffman R, Kay D, Enanoria W, Haller L, Colford J, 2005. Water, sanitation, and hygiene interventions to reduce diarrhea in less developed countries: a systematic review and meta-analysis. Lancet 5: 42–52.
Wisner B, Adams J, 2003. Environmental Health in Emergencies and Disasters: A Practical Guide. Geneva, Switzerland: World Health Organization.
Lloyd BJ, Helmer R, 1991. Surveillance of Drinking Water Quality in Rural Areas. New York, NY: Logman Scientific and Technical, Co-published in the United States with John Wiley and Sons, Inc.
WHO, 1993. Guidelines for Drinking-Water Quality, Vol. 1: Recommendation, 2nd edition. Geneva, Switzerland: World Health Organisation.
Lloyd BJ, Bartram JK, 1991. Surveillance solutions to microbiological problems in water quality control in developing countries. J Water Science Technol 24: 61–75.
WHO, 1997. Guidelines for Drinking-Water Quality, Vol. 3: Surveillance and Control of Community Supplies, 2nd edition. Geneva, Switzerland: World Health Organization.
ARGOSS, 2001. Guidelines for Assessing the Risk to Groundwater from On-Site Sanitation. Swindon, United Kingdom: British Geological Survey Commissioned Report, CR/01/142, 97. Available at: http://www.susana.org/_resources/documents/default/2-1926-argoss-manual.pdf.
Luby S, Gupta S, Sheikh M, Johnston R, Ram R, Islam S, 2008. Tubewell water quality and predictors of contamination in three flood-prone areas in Bangladesh. J Appl Microbiol 105: 1002–1008.
Barthiban S, Lloyd B, Maier M, 2012. Sanitary hazards and microbial quality of open dug wells in the Maldives Islands. J Water Resource Prot 4: 474–486.
Mushi D, Byamukama D, Kirscher A, Mach R, Brunner K, Farnleitner A, 2012. Sanitary inspection of wells using risk-of-contamination scoring indicates a high predictive ability for bacterial faecal pollution in the peri-urban tropical lowlands of Dar es Salaam, Tanzania. J Water Health 10: 236–243.
Parker A, Youlten R, Dillon D, Nussbaumer T, Carter R, Tyrell S, Webster J, 2010. An assessment of microbiological water quality of six water source categories in north-east Uganda. J Water Health 8: 550–560.
Howard G, Pedley S, Barrett M, Nalubega M, Johal K, 2003. Risk factors contributing to microbiological contamination of shallow ground water in Kampala, Uganda. Water Res 37: 3421–3429.
Lloyd BJ, Boonyakarnkul T, 1991. Combined Assessment of Sanitary Hazards and Faecal Coliform Intensity for Rural Groundwater Supply Improvement in Thailand. National conference on Geologic Resources of Thailand: Potential for Future Development. November 17–24, 1992. Department of Mineral Resources, Bangkok, Thailand.
Ministry of Drinking Water and Sanitation, Government of India, 2013. Uniform Drinking Water Quality Monitoring Protocol. New Delhi, India: s.n. Ministry Of Drinking Water And Sanitation, Government Of India.
Bureau of Indian Standards, 1981. Methods of Sampling and Microbiological Examination of Water (First Revision). IS 1622. New Delhi, India: s.n. Bureau of Indian Standards.
Byamukama D, Mach RL, Kansiime F, Manafi M, Farnleitner AH, 2005. Discrimination efficacy of faecal pollution detection in different aquatic habitats of a high altitude tropical country using presumptive coliform, Escherichia coli and Clostridium perfringes spores. Appl Environ Microbiol 71: 65–71.
Solo-Gabriele HM, Wolfert MA, Desmarais TR, Palmer CJ, 2000. Sources of Escherichia coli in a coastal subtropical environment. Appl Environ Microbiol 66: 230–237.
Ishii S, Sadowsky MJ, 2008. Escherichia coli in the environment: implications for water quality. Microbes Environ 23: 101–108.
WHO, 1996. Guidelines for Drinking-Water Quality, Vol. 2: Health and Supporting Criteria, 2nd edition. Geneva, Switzerland: World Health Organization.
Zou KH, O'Malley AJ, Mauri L, 2007. Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 115: 654–657.
Alonzo TA, Pepe MS, 2002. Distribution-free ROC analysis using binary regression techniques. Biostatistics 3: 421–432.
Colak E, Mutlu F, Bal C, Oner S, Ozdamar K, Gok B, Cavusoglu Y, 2012. Comparison of semiparametric, parametric, and nonparametric ROC analysis for continuous diagnostic tests using a simulation study and acute coronary syndrome data. Comput Math Methods Med 2012: 2012.
Ware JH, 2006. The limitations of risk factors as prognostic tools. N Engl J Med 355: 2615–2617.
Pepe MS, Janes H, Longton G, Leisenring W, Newcomb P, 2004. Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. Am J Epidemiol 159: 882–890.
Bain R, Cronk R, Wright J, Yang H, Skaymaker T, Bartram J, 2014. Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 11: e1001644.
Leclerc HDAA, Mossel DAA, Edberg SC, Struijk CB, 2001. Advances in the bacteriology of the coliform group: their suitability as markers of microbial water safety. Annu Rev Microbiol 55: 201–234.
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The use of sanitary inspections combined with periodic water quality testing has been recommended in some cases as screening tools for fecal contamination. We conducted sanitary inspections and tested for thermotolerant coliforms (TTCs), a fecal indicator bacteria, among 7,317 unique water sources in West Bengal, India. Our results indicate that the sanitary inspection score has poor ability to identify TTC-contaminated sources. Among deep and shallow hand pumps, the area under curve (AUC) for prediction of TTC > 0 was 0.58 (95% confidence interval [CI] = 0.53–0.61) and 0.58 (95% CI = 0.54–0.62), respectively, indicating that the sanitary inspection score was only marginally better than chance in discriminating between contaminated and uncontaminated sources of this type. A slightly higher AUC value of 0.64 (95% CI=0.57–0.71) was observed when the sanitary inspection score was used for prediction of TTC > 0 among the gravity-fed piped sources. Among unprotected springs (AUC = 0.48, 95% CI = 0.38–0.55) and unprotected dug wells (AUC = 0.41, 95% CI = 0.20–0.66), the sanitary inspection score performed more poorly than chance in discriminating between sites with TTC < 1 and TTC > 0. Aggregating over all source types, the sensitivity (true positive rate) of a high/very high sanitary inspection score for TTC contamination (TTC > 1 CFU/100 mL) was 29.4% and the specificity (true negative rate) was 77.9%, resulting in substantial misclassification of the sites when using the established risk categories. These findings suggest that sanitary surveys are inappropriate screening tools for identifying TTC contamination at water points.
Financial support: The data collection and analysis carried out for this article was funded by the West Bengal Public Health and Engineering Department and DelAgua Health Limited.
Disclosures: Christian Snoad and Evan Thomas were compensated consultants to DelAgua Health, commissioned to carry out the testing program through a contract from the West Bengal Public Health Engineering Department headed by Animesh Bhattacharya.
Authors' addresses: Christian Snoad, DelAgua Health, The Old Dairy, Marlborough, Wiltshire, United Kingdom, E-mail: christian.snoad@delagua.org. Corey Nagel, OHSU/PSU School of Public Health, Oregon Health and Science University, Portland, OR, E-mail: nagelc@ohsu.edu. Animesh Bhattacharya, West Bengal Public Health Engineering Department, Kolkata, India, E-mail: animeshbhat@gmail.com. Evan Thomas, Department of Mechanical and Materials Engineering, Portland State University, Portland, OR, E-mail: evan.thomas@pdx.edu.
World Health Organization, 2015. Drinking Water, Fact sheet no. 391. Available at: http://www.who.int/mediacentre/factsheets/fs391/en/. Accessed September 5, 2015.
Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare, 2013. National Health Profile 2013. New Delhi, India: Government of India.
UNICEF/WHO, 2009. Diarrhoea: Why Children Are Still Dying and What Can Be Done. Geneva, Switzerland: WHO.
Hodge J, Chang HH, Boisson S, Collin SM, Peletz R, Clasen T, 2016. Assessing the association between thermotolerant coliforms in drinking water and diarrhea: an analysis of individual level data from multiple studies. Environ Health Perspect, doi: 10.1289/EHP156.
Fewetrell L, Kauffman R, Kay D, Enanoria W, Haller L, Colford J, 2005. Water, sanitation, and hygiene interventions to reduce diarrhea in less developed countries: a systematic review and meta-analysis. Lancet 5: 42–52.
Wisner B, Adams J, 2003. Environmental Health in Emergencies and Disasters: A Practical Guide. Geneva, Switzerland: World Health Organization.
Lloyd BJ, Helmer R, 1991. Surveillance of Drinking Water Quality in Rural Areas. New York, NY: Logman Scientific and Technical, Co-published in the United States with John Wiley and Sons, Inc.
WHO, 1993. Guidelines for Drinking-Water Quality, Vol. 1: Recommendation, 2nd edition. Geneva, Switzerland: World Health Organisation.
Lloyd BJ, Bartram JK, 1991. Surveillance solutions to microbiological problems in water quality control in developing countries. J Water Science Technol 24: 61–75.
WHO, 1997. Guidelines for Drinking-Water Quality, Vol. 3: Surveillance and Control of Community Supplies, 2nd edition. Geneva, Switzerland: World Health Organization.
ARGOSS, 2001. Guidelines for Assessing the Risk to Groundwater from On-Site Sanitation. Swindon, United Kingdom: British Geological Survey Commissioned Report, CR/01/142, 97. Available at: http://www.susana.org/_resources/documents/default/2-1926-argoss-manual.pdf.
Luby S, Gupta S, Sheikh M, Johnston R, Ram R, Islam S, 2008. Tubewell water quality and predictors of contamination in three flood-prone areas in Bangladesh. J Appl Microbiol 105: 1002–1008.
Barthiban S, Lloyd B, Maier M, 2012. Sanitary hazards and microbial quality of open dug wells in the Maldives Islands. J Water Resource Prot 4: 474–486.
Mushi D, Byamukama D, Kirscher A, Mach R, Brunner K, Farnleitner A, 2012. Sanitary inspection of wells using risk-of-contamination scoring indicates a high predictive ability for bacterial faecal pollution in the peri-urban tropical lowlands of Dar es Salaam, Tanzania. J Water Health 10: 236–243.
Parker A, Youlten R, Dillon D, Nussbaumer T, Carter R, Tyrell S, Webster J, 2010. An assessment of microbiological water quality of six water source categories in north-east Uganda. J Water Health 8: 550–560.
Howard G, Pedley S, Barrett M, Nalubega M, Johal K, 2003. Risk factors contributing to microbiological contamination of shallow ground water in Kampala, Uganda. Water Res 37: 3421–3429.
Lloyd BJ, Boonyakarnkul T, 1991. Combined Assessment of Sanitary Hazards and Faecal Coliform Intensity for Rural Groundwater Supply Improvement in Thailand. National conference on Geologic Resources of Thailand: Potential for Future Development. November 17–24, 1992. Department of Mineral Resources, Bangkok, Thailand.
Ministry of Drinking Water and Sanitation, Government of India, 2013. Uniform Drinking Water Quality Monitoring Protocol. New Delhi, India: s.n. Ministry Of Drinking Water And Sanitation, Government Of India.
Bureau of Indian Standards, 1981. Methods of Sampling and Microbiological Examination of Water (First Revision). IS 1622. New Delhi, India: s.n. Bureau of Indian Standards.
Byamukama D, Mach RL, Kansiime F, Manafi M, Farnleitner AH, 2005. Discrimination efficacy of faecal pollution detection in different aquatic habitats of a high altitude tropical country using presumptive coliform, Escherichia coli and Clostridium perfringes spores. Appl Environ Microbiol 71: 65–71.
Solo-Gabriele HM, Wolfert MA, Desmarais TR, Palmer CJ, 2000. Sources of Escherichia coli in a coastal subtropical environment. Appl Environ Microbiol 66: 230–237.
Ishii S, Sadowsky MJ, 2008. Escherichia coli in the environment: implications for water quality. Microbes Environ 23: 101–108.
WHO, 1996. Guidelines for Drinking-Water Quality, Vol. 2: Health and Supporting Criteria, 2nd edition. Geneva, Switzerland: World Health Organization.
Zou KH, O'Malley AJ, Mauri L, 2007. Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation 115: 654–657.
Alonzo TA, Pepe MS, 2002. Distribution-free ROC analysis using binary regression techniques. Biostatistics 3: 421–432.
Colak E, Mutlu F, Bal C, Oner S, Ozdamar K, Gok B, Cavusoglu Y, 2012. Comparison of semiparametric, parametric, and nonparametric ROC analysis for continuous diagnostic tests using a simulation study and acute coronary syndrome data. Comput Math Methods Med 2012: 2012.
Ware JH, 2006. The limitations of risk factors as prognostic tools. N Engl J Med 355: 2615–2617.
Pepe MS, Janes H, Longton G, Leisenring W, Newcomb P, 2004. Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. Am J Epidemiol 159: 882–890.
Bain R, Cronk R, Wright J, Yang H, Skaymaker T, Bartram J, 2014. Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 11: e1001644.
Leclerc HDAA, Mossel DAA, Edberg SC, Struijk CB, 2001. Advances in the bacteriology of the coliform group: their suitability as markers of microbial water safety. Annu Rev Microbiol 55: 201–234.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 1555 | 1303 | 1034 |
Full Text Views | 734 | 15 | 9 |
PDF Downloads | 318 | 13 | 6 |