Household-specific feedback on the microbiological safety of drinking water may result in changes to water management practices that reduce exposure risks. We conducted a randomized, controlled trial in India to determine if information on household drinking water quality could change behavior and improve microbiological quality as indicated by Escherichia coli counts. We randomly assigned 589 participating households to one of three arms: (1) a messaging-only arm receiving messaging on safe water management ( n = 237); (2) a standard testing arm receiving the same messaging plus laboratory E. coli testing results specific to that household's drinking water ( n = 173); and (3) a test kit arm receiving messaging plus low-cost E. coli tests that could be used at the household's discretion ( n = 179). Self-reported water treatment increased significantly in both the standard testing arm and the test kit arm between baseline and follow-up one month later. Mean log E. coli counts per 100 mL in household stored drinking water increased in the messaging-only arm from 1.42 to 1.87, while decreasing in the standard testing arm (1.38 to 0.89, 65% relative reduction) and the test kit arm (1.08 to 0.65, 76% relative reduction). Findings indicate that household-specific water quality information can improve both behaviors and drinking water quality.
Current microbiological water safety testing methods are not feasible in many settings because of laboratory, cost, and other constraints, particularly in low-income countries where water quality monitoring is most needed to protect public health. We evaluated two promising E. coli methods that may have potential in at-scale global water quality monitoring: a modified membrane filtration test followed by incubation on pre-prepared plates with dehydrated culture medium (CompactDry TM), and 10 and 100 ml presence-absence tests using the open-source Aquatest medium (AT). We compared results to membrane filtration followed by incubation on MI agar as the standard test. We tested 315 samples in triplicate of drinking water in Bangalore, India, where E. coli counts by the standard method ranged from non-detect in 100 ml samples to TNTC (>200). Results suggest high sensitivity and specificity for E. coli detection of candidate tests compared with the standard method: sensitivity and specificity of the 100 ml AT test was 97% and 96% when incubated for 24 h at standard temperature and 97% and 97% when incubated 48 h at ambient temperatures (mean: 27°C). Sensitivity and specificity of the CompactDry TM test was >99 and 97% when incubated for 24 h at standard temperature and >99 and 97% when incubated 48 h at ambient temperatures. Good agreement between these candidate tests compared with the reference method suggests they are suitable for E. coli monitoring to indicate water safety.
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