Abstract

Background:

The 2030 Sustainable Development Goals (SDGs) set an ambitious new benchmark for safely managed drinking water services (SMDWs), but many countries lack national data on the availability and quality of drinking water.

Objectives:

We quantified the availability and microbiological quality of drinking water, monitored SMDWs, and examined risk factors for Escherichia coli (E. coli) contamination in 27 low-and middle-income countries (LMICs).

Methods:

A new water quality module for household surveys was implemented in 27 Multiple Indicator Cluster Surveys. Teams used portable equipment to measure E. coli at the point of collection (PoC, $n=\mathrm{61,170}$) and at the point of use (PoU, $n=\mathrm{64,900}$) and asked respondents about the availability and accessibility of drinking water. Households were classified as having SMDW services if they used an improved water source that was free of E. coli contamination at PoC, accessible on premises, and available when needed. Compliance with individual SMDW criteria was also assessed. Modified Poisson regression was used to explore household and community risk factors for E. coli contamination.

Results:

E. coli was commonly detected at the PoC (range 16–90%) and was more likely at the PoU (range 19–99%). On average, 84% of households used an improved drinking water source, and 31% met all of the SMDW criteria. E. coli contamination was the primary reason SMDW criteria were not met (15 of 27 countries). The prevalence of E. coli in PoC samples was lower among households using improved water sources [$\text{risk ratio\hspace{0.17em}}\left(\text{RR}\right)=0.74$; 95% confidence interval (CI): 0.64, 0.85] but not for households with water accessible on premises ($\text{RR}=0.99$; 95% CI: 0.94, 1.05) or available when needed ($\text{RR}=0.95$; 95% CI: 0.88, 1.02). E. coli contamination of PoU samples was less common for households in the richest vs. poorest wealth quintile ($\text{RR}=0.70$; 95% CI: 0.55, 0.88) and in communities with high ($>75\%$) improved sanitation coverage ($\text{RR}=0.94$; 95% CI: 0.90, 0.97). Livestock ownership ($\text{RR}=1.08$; 95% CI: 1.04, 1.13), rural vs. urban residence ($\text{RR}=1.10$; 95% CI: 1.04, 1.16), and wet vs. dry season sampling ($\text{RR}=1.07$; 95% CI: 1.01, 1.15) were positively associated with contamination at the PoU.

Discussion:

Cross-sectional water quality data can be collected in household surveys and can be used to assess inequalities in service levels, to track the SDG indicator of SMDWs, and to examine risk factors for contamination. There is an urgent need for better risk management to reduce widespread exposure to fecal contamination through drinking water services in LMICs. https://doi.org/10.1289/EHP8459

中文翻译：

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在低收入和中等收入国家的全国代表性家庭调查中监测饮用水质量：2014-2020 年 27 项多指标类集调查的横截面分析

摘要

背景：

2030 年可持续发展目标 (SDG) 为安全管理的饮用水服务 (SMDW) 设定了雄心勃勃的新基准，但许多国家缺乏有关饮用水供应和质量的国家数据。

目标：

我们量化了饮用水的可用性和微生物质量，监测了 SMDW，并检查了 27 个低收入和中等收入国家 (LMIC) 中大肠杆菌( E. coli ) 污染的风险因素。

方法：

在 27 项多指标类集调查中实施了新的家庭调查水质模块。团队使用便携式设备在收集点测量大肠杆菌（PoC、$n=\mathrm{61,170}$) 和使用点 (PoU,$n=\mathrm{64,900}$) 并询问受访者关于饮用水的可用性和可及性。如果家庭在 PoC 使用没有大肠杆菌污染的改良水源、在房屋内可使用且在需要时可用，则被归类为具有 SMDW 服务的家庭。还评估了对个人 SMDW 标准的遵守情况。修正泊松回归用于探索大肠杆菌污染的家庭和社区风险因素。

结果：

大肠杆菌通常在 PoC 中检测到（范围 16-90%），更有可能在 PoU 中检测到（范围 19-99%）。平均而言，84% 的家庭使用改良的饮用水源，31% 的家庭符合所有 SMDW 标准。大肠杆菌污染是不符合 SMDW 标准的主要原因（27 个国家中的 15 个）。在使用改良水源的家庭中，PoC 样本中大肠杆菌的流行率较低 [$\text{风险比\hspace{0.17em}}\left(\text{RR}\right)=0.74$; 95% 置信区间 (CI): 0.64, 0.85] 但不适用于房屋内有水的家庭 ($\text{RR}=0.99$; 95% CI：0.94, 1.05）或在需要时可用（$\text{RR}=0.95$; 95% CI：0.88, 1.02)。PoU 样本的大肠杆菌污染在最富有和最贫穷五分之一的家庭中不太常见（$\text{RR}=0.70$; 95% CI: 0.55, 0.88) 和高 ($>75\%$) 改善卫生设施覆盖率 ($\text{RR}=0.94$; 95% CI：0.90, 0.97)。畜牧业所有权 ($\text{RR}=1.08$; 95% CI：1.04, 1.13），农村与城市居住（$\text{RR}=1.10$; 95% CI：1.04, 1.16），以及湿季与旱季采样（$\text{RR}=1.07$; 95% CI: 1.01, 1.15) 与 PoU 的污染呈正相关。

讨论：

可以在家庭调查中收集横截面水质数据，并可用于评估服务水平的不平等，跟踪 SMDW 的 SDG 指标，以及检查污染的风险因素。迫切需要更好的风险管理，以减少中低收入国家通过饮用水服务广泛接触粪便污染。https://doi.org/10.1289/EHP8459