HGS-4 A Systematic Review of the Association between Drinking Water Quality and Health Outcomes in Low and Middle-Income Countries
Start Date
12-4-2024 9:30 AM
End Date
12-4-2024 11:30 AM
Location
University Readiness Center Greatroom
Document Type
Poster
Abstract
Background:
E. Coli and fecal coliforms are used as measures of water quality because their presence indicates fecal contamination. Given this many research studies use E. coli and fecal coliforms as a proxy measure for health status. We aimed to answer if there is a connection between water quality and health status. Our objective was to review existing observational studies and assess the impact of water quality on various health indicators, including diarrhea, nutritional status, and gastrointestinal diseases in low- and middle-income countries. We hypothesized that water quality is not a strong predictor of health outcomes if water storage practices, hygiene practices, and water availability are not considered.
Methods:
We conducted a search on PubMed and web of science to identify the relevant articles using a search criteria that identified studies which included water quality, health outcomes, and coliforms.
From the initial search we identified 574 articles. After screening the titles and abstracts of these articles, 439 studies were considered irrelevant and 27 were duplicates. We evaluated the full texts of the remaining 119 studies. Ultimately, 19 studies were used for data extraction. Furthermore, we included an additional 12 relevant articles from a previous systematic review (Gruber et al., 2014). Totalling in 31 studies being included in our systematic review. The final search was performed on June 22nd, 2023.
Results:
Of the seven studies with significant results one studied fecal coliforms and four measured E.coli. The two other studies that found significant results were only for fecal streptococci and enterococci which are not traditionally used to measure fecal contamination of water sources. This translates to 22.58% of all the studies, 5.88% of studies that measured fecal coliforms, and 21.05% of studies studying E.coli having significant results. These results significantly undermine the association between E.coli and fecal coliforms as proxies for health outcomes related to water quality in observational studies.
Based on our systematic review of available literature, despite tradition, there is limited evidence to support the use of E.coli and fecal coliforms as proxy measures for human health outcomes. While water, sanitation, and hygiene interventions can improve both health outcomes and the water quality when reviewing data from observational studies there is no established link between coliforms and health indicators.
Keywords
Water quality, global health, E.coli, diarrhea, low and middle income countries
HGS-4 A Systematic Review of the Association between Drinking Water Quality and Health Outcomes in Low and Middle-Income Countries
University Readiness Center Greatroom
Background:
E. Coli and fecal coliforms are used as measures of water quality because their presence indicates fecal contamination. Given this many research studies use E. coli and fecal coliforms as a proxy measure for health status. We aimed to answer if there is a connection between water quality and health status. Our objective was to review existing observational studies and assess the impact of water quality on various health indicators, including diarrhea, nutritional status, and gastrointestinal diseases in low- and middle-income countries. We hypothesized that water quality is not a strong predictor of health outcomes if water storage practices, hygiene practices, and water availability are not considered.
Methods:
We conducted a search on PubMed and web of science to identify the relevant articles using a search criteria that identified studies which included water quality, health outcomes, and coliforms.
From the initial search we identified 574 articles. After screening the titles and abstracts of these articles, 439 studies were considered irrelevant and 27 were duplicates. We evaluated the full texts of the remaining 119 studies. Ultimately, 19 studies were used for data extraction. Furthermore, we included an additional 12 relevant articles from a previous systematic review (Gruber et al., 2014). Totalling in 31 studies being included in our systematic review. The final search was performed on June 22nd, 2023.
Results:
Of the seven studies with significant results one studied fecal coliforms and four measured E.coli. The two other studies that found significant results were only for fecal streptococci and enterococci which are not traditionally used to measure fecal contamination of water sources. This translates to 22.58% of all the studies, 5.88% of studies that measured fecal coliforms, and 21.05% of studies studying E.coli having significant results. These results significantly undermine the association between E.coli and fecal coliforms as proxies for health outcomes related to water quality in observational studies.
Based on our systematic review of available literature, despite tradition, there is limited evidence to support the use of E.coli and fecal coliforms as proxy measures for human health outcomes. While water, sanitation, and hygiene interventions can improve both health outcomes and the water quality when reviewing data from observational studies there is no established link between coliforms and health indicators.