An Evolving Choice in a Diverse Water Market: A Quality Comparison of Sachet Water with Community and Household Water Sources in Ghana

Self-supply groundwater in five communities: Moshie Zongo, Aboabo, Kotei, Ayeduase and Apemso in Kumasi Metropolis, Ghana

Self-supply water has been acknowledged as a viable alternative to meeting the water needs of inhabitants. This study was designed to determine the main issues that influence self-supply water coverage in five (5) communities in the Kumasi Metropolis. The research employed a well-structured questionnaires and a total of 369 households were surveyed. The Statistical Package for Social Sciences (SPSS) version 26 and Microsoft Excel (2016) tools were used to analyse the data. The outcomes of the research show that a greater number of the respondents (77 %) did not have connections to the Ghana Water Company Limited (GWCL) distribution system. Approximately, 69 % of respondents had access to alternative water sources with mechanized boreholes forming the majority (32 %). However, a greater number of the respondents (64 %) did not disinfect their water to make it potable. The most favourable drinking water source for a greater number of the residents (51 %) was sachet water. The study showed there was a significant association between respondents' type or source of water with religion (p < 0.000), household size (p < 0.000), duration of stay (p = 0.026) and number of dependents (p = 0.006). However, there was no association between type or source of water with educational level (p = 0.130), occupation (p = 0.310), income level (p = 0.139) and type of home (p = 0.102). This study revealed that self-supply is contributing to the water needs of some residents in Kumasi and could contribute to the country's accomplishment of SDG 6.1 if residents ensure that it is safely managed. To broaden the scope of the study and the impact of self-supply groundwater, additional studies should be conducted in other communities, as well as the extent of other beneficiaries who have access to self-supply facilities other than the owners.

Particulate plastics in drinking water and potential human health effects: Current knowledge for management of freshwater plastic materials in Africa

Plastic materials have contributed to the release of environmentally relevant particulate plastics which can be found almost everywhere and may be present in drinking water. Human exposure to these materials is diverse and our understanding of their internalization in the human body is incipient. This review discusses the state of knowledge of particulate plastics exposure in drinking water and the potential risks of adverse health in the human body. Particulate plastics have problematized water systems worldwide, and about 4,000,000 fine plastics may be ingested from drinking water annually by an individual. Testing methods for these materials in environmental media are presently inconsistent and standard protocols do not exist. Their potential ecotoxicological consequences are recognised to be linked to their physicochemical diversity, biological transpositions, and cytological tolerance in living organisms. It is observed that toxicological endpoints are varied and lack properly defined modes of action. In particular, fine particulate plastics have been observed to translocate into body tissues and cells where they are capable of provoking endocrine disruption, genetic mutations, and cancer responses. We propose a reclassification of particulate plastics to cater for their biological deposition and attributable risks of adverse health. Environmental management of particulate plastics in many developing countries is weak and their potential releases into drinking water have received limited research. Given that large populations are exposed to fresh surface water and plastic packaged drinking water worldwide, and that the risk assessment pathways are unvalidated at the moment, we argue for developing countries to increase their capacity for the environmental monitoring and circular management of plastic materials. Large-scale epidemiological cohort studies and surrogate assessment pathways are also recommended to provide a better understanding of the hazard characterization of particulate plastics exposure.

Sachet water in Ghana: A spatiotemporal analysis of the recent upward trend in consumption and its relationship with changing household characteristics, 2010-2017

The consumption of packaged water in Ghana has grown significantly in recent years. By 2017, "sachet water"-machine-sealed 500ml plastic bags of drinking water-was consumed by 33% of Ghanaian households. Reliance on sachet water has previously been associated with the urban poor, yet recent evidence suggests a customer base which crosses socioeconomic lines. Here, we conduct a repeated cross-sectional analysis of three nationally representative datasets to examine the changing demography of sachet water consumers between 2010 and 2017. Our results show that over the course of the study period sachet water has become a ubiquitous source of drinking water in Ghana, with relatively wealthy households notably increasing their consumption. In 2017, the majority of sachet water drinking households had access to another improved water source. The current rate and form of urbanisation, inadequate water governance, and an emphasis on cost recovery pose significant challenges for the expansion of the piped water supply network, leading us to conclude that sachet water will likely continue to be a prominent source of drinking water in Ghana for the foreseeable future. The main challenge for policymakers is to ensure that the growing sachet water market enhances rather than undermines Ghana's efforts towards achieving universal and equitable access to clean drinking water and sanitation.

Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak

Background

Behavioural risk factors for cholera are well established in rural and semi-urban contexts, but not in densely populated mega-cities in Sub-Saharan Africa. In November 2017, a cholera epidemic occurred in Kinshasa, the Democratic Republic of the Congo, where no outbreak had been recorded for nearly a decade. During this outbreak, we investigated context-specific risk factors for cholera in an urban setting among a population that is not frequently exposed to cholera.

Methodology/Principal findings

We recruited 390 participants from three affected health zones of Kinshasa into a 1:1 matched case control study. Cases were identified from cholera treatment centre admission records, while controls were recruited from the vicinity of the cases’ place of residence. We used standardized case report forms for the collection of socio-demographic and behavioural risk factors. We used augmented backward elimination in a conditional logistic regression model to identify risk factors.

The consumption of sachet water was strongly associated with the risk of being a cholera case (p-value 0.019), which increased with increasing frequency of consumption from rarely (OR 2.2, 95% CI 0.9–5.2) to often (OR 4.0, 95% CI 1.6–9.9) to very often (OR 4.1, 95% CI 1.0–16.7). Overall, more than 80% of all participants reported consumption of this type of drinking water. The risk factors funeral attendance and contact with someone suffering from diarrhoea showed a p-value of 0.09 and 0.08, respectively. No socio-demographic characteristics were associated with the risk of cholera.

Conclusions/Significance

Drinking water consumption from sachets, which are sold informally on the streets in most Sub-Saharan African cities, are an overlooked route of infection in urban cholera outbreaks. Outbreak response measures need to acknowledge context-specific risk factors to remain a valuable tool in the efforts to achieve national and regional targets to reduce the burden of cholera in Sub-Saharan Africa.

Cholera is a diarrheal disease caused by ingestion of the Vibrio cholerae bacterium. Outbreaks in urban areas are becoming increasingly frequent in Sub-Saharan Africa. Risk factors for cholera have been studied in rural settings but not sufficiently in urban areas. Understanding context-specific risk factors is key for successful outbreak response. During a cholera outbreak in Kinshasa, the Democratic Republic of the Congo we were able to identify a previously unknown behavioural risk factor of particular relevance in urban settings–the consumption of drinking water from plastic sachets. Water sachets are sold on the streets of all major cities in Sub-Saharan Africa. It requires biting off an edge and sucking out the water, and we think that external contamination of these sachets was an important transmission route in the Kinshasa outbreak. Water sachets are predominantly consumed by socio-economically disadvantaged groups who lack piped water supply in their homes and have poor access to sanitary infrastructure. This makes our findings particularly relevant because these are the very populations who are at increased risk of getting and transmitting cholera. Health messaging and response measures should include consumption of water sachets as a potential risk factor during future cholera outbreaks in urban low-resource settings.

Domestic drinking water management: Quality assessment in Oforikrom municipality, Ghana

Drinking water in Ghana is estimated at 79%, but this only represents the proportion of the population with access to improved drinking water sources without regard to the quality of water consumed. This study investigated the quality of household drinking water sources in the Oforikrom municipality where potable water requirements are on the rise due to an ever-increasing population. Both quantitative and qualitative methods were employed in this study. One Hundred households were randomly selected and interviewed on the available options for drinking water and household water treatment and safe storage. A total of 52 points of collection (POC) and 97 points of use (POU) water samples from households were collected for physicochemical and microbial water quality analysis. Amongst the available drinking water options, sachet water (46%) was mostly consumed by households. Water quality analysis revealed that the physicochemical parameters of all sampled drinking water sources were within the Ghana Standards Authority (GSA) recommended values expected for pH (ranging from 4.50 to 7.50). For the drinking water sources, bottled (100%, n = 2) and sachet water (91%, n = 41) showed relatively good microbial water quality. Generally, POC water samples showed an improved microbial water quality in comparison to POU water samples. About 38% (n = 8) of the households practicing water quality management, were still exposed to unsafe drinking water sources. Households should practice good water quality management at the domestic level to ensure access to safe drinking water. This may include the use of chlorine-based disinfectants to frequently disinfect boreholes, wells and storage facilities at homes.

Multiple water source use in low- and middle-income countries: a systematic review

The Joint Monitoring Programme (JMP) 2017 Update and Sustainable Development Goals (SDGs) Baselines report classified 71% of the global population as having access to 'safely managed' drinking water. Current global monitoring efforts to track access to safely managed drinking water rely on collecting information on the 'primary' source of drinking water. However, there is evidence that households often rely on multiple sources to meet their water needs in many low- and middle-income countries (LMICs). This systematic review was designed to compile the literature related to the practice of multiple water source use (MWSU) for drinking water in LMICs. A total of 5,318 studies were collected, and after abstract and full-text review, 74 articles were identified for inclusion. Studies reviewed reported from 4 to 100% of the study populations practicing MWSU. Additionally, the practice of supplemental unimproved source use was reported globally, representing households with improved primary source water also accessing unimproved water sources throughout the year. These findings expose gaps in current global water monitoring efforts, revealing potential inflation of reports of 'safe drinking water access' and unaccounted exposure to drinking water from unimproved sources.

'We Are Drinking Diseases': Perception of Water Insecurity and Emotional Distress in Urban Slums in Accra, Ghana

Water security is critical to the health and well-being of people around the world, especially among populations experiencing water stresses and rapid urbanization in low- to middle-income countries (LMICs). Recent research suggests water insecurity is associated with negative mental health outcomes. Despite global improvement in access to safe water across the world, the World Health Organization (WHO) reports that access to safe water in urban areas has not changed significantly or has stagnated in certain countries. In most African cities, entrepreneurial water vendors have stepped up to fill supply gaps in the formal delivery system by selling vended water. As part of a larger research program that aims to assess and analyze public perceptions around vended water, this paper explores the links connecting water insecurity and emotional distress among urban slum dwellers who mostly use vended water in Accra, Ghana. We used a parallel mixed-methods approach. Our quantitative results show that water-insecure households (OR = 2.23, p = 0.01) were more likely to report emotional distresses compared to water-secure households. However, households with improved sanitation (OR = 0.28, p = 0.01) and those willing to participate for improved water and sanitation (OR = 0.28, p = 0.01) were less likely to report emotional distress. Our qualitative results offered support for the quantitative results, as participants not only hold various perceptions regarding the safety and quality of vended water but expressed emotional distresses such as fear of contamination, discomfort, worry over arbitrary change in prices, and anxiety. The implications of the results for policy and practice, specifically to ensuring access to safe water, are discussed.