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. 2025 Mar:264:114507.
doi: 10.1016/j.ijheh.2024.114507. Epub 2024 Dec 10.

Predictors of household drinking water E. coli contamination: Population-based results from rural areas of Ghana, Malawi, Mozambique, Niger, Rwanda, Uganda, and Zambia

Audrey R Yang  1 , James M Bowling  2 , Camille E Morgan  3 , Jamie Bartram  4 , Georgia L Kayser  5
Affiliations
Free article

Predictors of household drinking water E. coli contamination: Population-based results from rural areas of Ghana, Malawi, Mozambique, Niger, Rwanda, Uganda, and Zambia

Audrey R Yang et al. Int J Hyg Environ Health. 2025 Mar.
Free article

Abstract

Background: In sub-Saharan Africa, rural areas have lower rates of access to safe drinking water compared to urban areas. We investigated predictors of Escherichia coli contamination in drinking water of rural households in Ghana, Malawi, Mozambique, Niger, Rwanda, Uganda, and Zambia.

Methods: We used a population-based, cluster randomized sampling design to select rural households in each country. Household interviews on water access, sanitation, and hygiene (WaSH) practices and demographic characteristics were conducted and water samples from every fifth household were collected and enumerated for E. coli. Negative binomial regression models with survey sampling weights were run to evaluate predictors of E. coli contamination.

Results: A total of 18,747 rural household surveys (2,378-2,804 per country) were conducted and a total of 3,848 water samples (460-660 per country) were collected. Of surveyed rural households, 61-78% of households had high (11-100 E. coli cfu/100 mL) or very high (>100 cfu/100 mL) risk water quality in Ghana, Niger, and Uganda. Statistically significant WaSH predictors associated with lower E. coli incidence rates included using an improved-type primary water source (Mozambique), storing water in a narrow-mouthed container or container with a spigot (Niger), having continuous water supply during the dry season (Ghana), paying for water service (Rwanda), having soap or ash at handwashing points (Mozambique), having an improved-type household sanitation facility (Malawi), and attaining an education level greater than primary school (Niger and Zambia).

Conclusion: This study highlights the variability in WaSH access between rural areas of the study countries in association with microbial drinking water quality.

Keywords: Hygiene; Microbial water quality; Sanitation; Sub-saharan africa; WaSH; Water.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Georgia Kayser reports financial support was provided by National Institute of Environmental Health Sciences. Pete Kolsky (listed in acknowledgments) reports financial support was provided by World Vision International. Co-author currently serving on the editorial board for the International Journal of Hygiene and Environmental Health - Jamie Bartram If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.