Hands, Water, and Health: Fecal Contamination in Tanzanian Communities with Improved, Non-Networked Water Supplies

Abstract

Almost half of the world's population relies on non-networked water supply services, which necessitates in-home water storage. It has been suggested that dirty hands play a role in microbial contamination of drinking water during collection, transport, and storage. However, little work has been done to evaluate quantitatively the association between hand contamination and stored water quality within households. This study measured levels of E. coli, fecal streptococci, and occurrence of the general Bacteroidales fecal DNA marker in source water, in stored water, and on hands in 334 households among communities in Dar es Salaam, Tanzania, where residents use non-networked water sources. Levels of fecal contamination on hands of mothers and children were positively correlated to fecal contamination in stored drinking water within households. Household characteristics associated with hand contamination included mother's educational attainment, use of an improved toilet, an infant in the household, and dissatisfaction with the quantity of water available for hygiene. In addition, fecal contamination on hands was associated with the prevalence of gastrointestinal and respiratory symptoms within a household. The results suggest that reducing fecal contamination on hands should be investigated as a strategy for improving stored drinking water quality and health among households using non-networked water supplies.

Modeling the Complexities of Water, Hygiene and Health in Limpopo, South Africa

“…The recontamination of water between source and household is well documented in the literature for many parts of the world (Wright et al , 2004) and the sources of recontamination are similar to those found in previous studies in Honduras (Trevett et al , 2005) and Tanzania (Pickering et al , 2010b). Finally, the water and sanitation behaviors and practices of the residents have likewise been observed in a number of previous studies (Thompson, 2001;.…”

“…Although this method is adequate for rinsing o↵ dirt, it is ine↵ective at removing bacteria. As was found in previous studies, improper hand-hygiene might therefore be a significant source of coliforms in the community (Pickering et al , 2010b) which might lead to diarrhea (Aiello et al , 2008). The percentage of positive results are higher than has been found previously by Trevett et al (2005) who found a lower percentage 44% (n = 14) of contaminated hands than was found in this study, 96% (n = 48).…”

“…Some researchers have tried to quantify biofilm layers (Jagals et al , 2003) while others have suggested that water may frequently be recontaminated through handcontact (Roberts et al , 2001;Pickering et al , 2010b). However, these studies were conducted under atypical conditions that do not represent average conditions in developing countries.…”

Fecal Indicator Bacteria Contamination of Fomites and Household Demand for Surface Disinfection Products: A Case Study from Peru

“…[2][3][4] High concentrations of fecal indicator bacteria (FIB) and pathogens can be in food, water, soil, and on hands and surfaces. 3,5 Elevated levels of fecal contamination in the environment are attributed to inadequate sanitation, a leading cause of child morbidity and mortality from diarrheal diseases, malnutrition, and stunting. 6 In addition, fecal contamination on surfaces is linked to increased risk of diarrheal disease, as highlighted by a study at a child care center in the United States.…”

Contextual and Psychosocial Determinants of Effective Handwashing Technique: Recommendations for Interventions from a Case Study in Harare, Zimbabwe

“…[1][2][3][4][5] By acquiring pathogens from surfaces in the environment and transferring them to the mouth or nose, hands constitute a key route for the transmission of infectious diseases. 6 Handwashing with soap has been shown to decontaminate hands [7][8][9] and reduce the risk of ingesting pathogens and acquiring diarrhea.…”