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Coliform Bacteria as Indicators of Diarrheal Risk in Household Drinking Water: Systematic Review and Meta-Analysis

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  • Joshua S Gruber
  • Ayse Ercumen
  • John M Colford Jr

Abstract

Background: Current guidelines recommend the use of Escherichia coli (EC) or thermotolerant (“fecal”) coliforms (FC) as indicators of fecal contamination in drinking water. Despite their broad use as measures of water quality, there remains limited evidence for an association between EC or FC and diarrheal illness: a previous review found no evidence for a link between diarrhea and these indicators in household drinking water. Objectives: We conducted a systematic review and meta-analysis to update the results of the previous review with newly available evidence, to explore differences between EC and FC indicators, and to assess the quality of available evidence. Methods: We searched major databases using broad terms for household water quality and diarrhea. We extracted study characteristics and relative risks (RR) from relevant studies. We pooled RRs using random effects models with inverse variance weighting, and used standard methods to evaluate heterogeneity and publication bias. Results: We identified 20 relevant studies; 14 studies provided extractable results for meta-analysis. When combining all studies, we found no association between EC or FC and diarrhea (RR 1.26 [95% CI: 0.98, 1.63]). When analyzing EC and FC separately, we found evidence for an association between diarrhea and EC (RR: 1.54 [95% CI: 1.37, 1.74]) but not FC (RR: 1.07 [95% CI: 0.79, 1.45]). Across all studies, we identified several elements of study design and reporting (e.g., timing of outcome and exposure measurement, accounting for correlated outcomes) that could be improved upon in future studies that evaluate the association between drinking water contamination and health. Conclusions: Our findings, based on a review of the published literature, suggest that these two coliform groups have different associations with diarrhea in household drinking water. Our results support the use of EC as a fecal indicator in household drinking water.

Suggested Citation

  • Joshua S Gruber & Ayse Ercumen & John M Colford Jr, 2014. "Coliform Bacteria as Indicators of Diarrheal Risk in Household Drinking Water: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(9), pages 1-14, September.
    • Handle: RePEc:plo:pone00:0107429
    DOI: 10.1371/journal.pone.0107429
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    1. David Cutler & Grant Miller, 2005. "The role of public health improvements in health advances: The twentieth-century United States," Demography, Springer;Population Association of America (PAA), vol. 42(1), pages 1-22, February.
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    2. Essayas Ayana, 2019. "Determinants of Declining Water Quality," World Bank Publications - Reports 33224, The World Bank Group.
    3. Jim Wright & Mawuli Dzodzomenyo & Nicola A. Wardrop & Richard Johnston & Allan Hill & Genevieve Aryeetey & Richard Adanu, 2016. "Effects of Sachet Water Consumption on Exposure to Microbe-Contaminated Drinking Water: Household Survey Evidence from Ghana," IJERPH, MDPI, vol. 13(3), pages 1-17, March.
    4. Mustafa Sikder & Elena N. Naumova & Anthonia O. Ogudipe & Mateo Gomez & Daniele Lantagne, 2021. "Fecal Indicator Bacteria Data to Characterize Drinking Water Quality in Low-Resource Settings: Summary of Current Practices and Recommendations for Improving Validity," IJERPH, MDPI, vol. 18(5), pages 1-19, February.
    5. Xiaotong Wen & Feiyu Chen & Yixiang Lin & Hui Zhu & Fang Yuan & Duyi Kuang & Zhihui Jia & Zhaokang Yuan, 2020. "Microbial Indicators and Their Use for Monitoring Drinking Water Quality—A Review," Sustainability, MDPI, vol. 12(6), pages 1-14, March.

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