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Drinking Water Quality and Public Health

• S.I.: Drinking Water Quality and Public Health
• Published: 04 February 2019
• Volume 11 , pages 73–79, ( 2019 )

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• Peiyue Li   ORCID: orcid.org/0000-0001-8771-3369 1 , 2 &
• Jianhua Wu 1 , 2  

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Drinking water quality is one of the greatest factors affecting human health. However, drinking water quality in many countries, especially in developing countries is not desirable and poor drinking water quality has induced many waterborne diseases. This special issue of Exposure and Health was edited to gain a better understanding of the impacts of drinking water quality on public health so that proper actions can be taken to improve the drinking water quality conditions in many countries. This editorial introduction reviewed some latest research on drinking water quality and public health, summarized briefly the main points of each contribution in this issue, and then some research fields/directions were proposed to boost further scientific research in drinking water quality and public health. The papers in this issue are interesting and cover many aspects of this research topic, and will be meaningful for the sustainable drinking water quality protection.

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Acknowledgements

Prof. Andrew Meharg, the Editor in Chief of Exposure and Health and Fritz Schmuhl, the Publishing Editor are sincerely acknowledged for their approval and support on this special issue. The publisher and the entire editorial team are strong, making the publication smooth and quick. It is one of the top editorial teams in the publishing community. We are greatly grateful to contributors whose manuscripts have been rejected and those whose manuscripts have been published in this special issue, and many reviewers are also acknowledged. Without interested authors and without voluntary reviewers, it would be impossible to publish this special issue. We are also grateful to various funding agencies and organizations who have provided financial support to our research, and they are the National Natural Science Foundation of China (41502234, 41602238, 41572236 and 41761144059), the Research Funds for Young Stars in Science and Technology of Shaanxi Province (2016KJXX-29), the Special Funds for Basic Scientific Research of Central Colleges (300102298301), the Fok Ying Tong Education Foundation (161098), the General Financial Grant from the China Postdoctoral Science Foundation (2015M580804 and 2016M590911), the Special Financial Grant from the China Postdoctoral Science Foundation (2016T090878 and 2017T100719), the Special Financial Grant from the Shaanxi Postdoctoral Science Foundation (2015BSHTDZZ09 and 2015BSHTDZZ03), and the Ten Thousand Talents Program.

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School of Environmental Science and Engineering, Chang’an University, No. 126 Yanta Road, Xi’an, 710054, Shaanxi, China

Peiyue Li & Jianhua Wu

Key Laboratory of Subsurface Hydrology and Ecological Effects in Arid Region of the Ministry of Education, Chang’an University, No. 126 Yanta Road, Xi’an, 710054, Shaanxi, China

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Li, P., Wu, J. Drinking Water Quality and Public Health. Expo Health 11 , 73–79 (2019). https://doi.org/10.1007/s12403-019-00299-8

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Received : 16 January 2019

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Accepted : 21 January 2019

Published : 04 February 2019

Issue Date : 15 June 2019

DOI : https://doi.org/10.1007/s12403-019-00299-8

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• Published: 17 July 2020

The quality of drinking and domestic water from the surface water sources (lakes, rivers, irrigation canals and ponds) and springs in cholera prone communities of Uganda: an analysis of vital physicochemical parameters

• Godfrey Bwire   ORCID: orcid.org/0000-0002-8376-2857 1 ,
• David A. Sack 2 ,
• Atek Kagirita 3 ,
• Tonny Obala 4 ,
• Amanda K. Debes 2 ,
• Malathi Ram 2 ,
• Henry Komakech 1 ,
• Christine Marie George 2 &
• Christopher Garimoi Orach 1  

BMC Public Health volume  20 , Article number:  1128 ( 2020 ) Cite this article

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Water is the most abundant resource on earth, however water scarcity affects more than 40% of people worldwide. Access to safe drinking water is a basic human right and is a United Nations Sustainable Development Goal (SDG) 6. Globally, waterborne diseases such as cholera are responsible for over two million deaths annually. Cholera is a major cause of ill-health in Africa and Uganda. This study aimed to determine the physicochemical characteristics of the surface and spring water in cholera endemic communities of Uganda in order to promote access to safe drinking water.

A longitudinal study was carried out between February 2015 and January 2016 in cholera prone communities of Uganda. Surface and spring water used for domestic purposes including drinking from 27 sites (lakes, rivers, irrigation canal, springs and ponds) were tested monthly to determine the vital physicochemical parameters, namely pH, temperature, dissolved oxygen, conductivity and turbidity.

Overall, 318 water samples were tested. Twenty-six percent (36/135) of the tested samples had mean test results that were outside the World Health Organization (WHO) recommended drinking water range. All sites (100%, 27/27) had mean water turbidity values greater than the WHO drinking water recommended standards and the temperature of above 17 °C. In addition, 27% (3/11) of the lake sites and 2/5 of the ponds had pH and dissolved oxygen respectively outside the WHO recommended range of 6.5–8.5 for pH and less than 5 mg/L for dissolved oxygen. These physicochemical conditions were ideal for survival of Vibrio. cholerae .

Conclusions

This study showed that surface water and springs in the study area were unsafe for drinking and had favourable physicochemical parameters for propagation of waterborne diseases including cholera. Therefore, for Uganda to attain the SDG 6 targets and to eliminate cholera by 2030, more efforts are needed to promote access to safe drinking water. Also, since this study only established the vital water physicochemical parameters, further studies are recommended to determine the other water physicochemical parameters such as the nitrates and copper. Studies are also needed to establish the causal-effect relationship between V. cholerae and the physicochemical parameters.

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Water is the most abundant resource on the planet earth [ 1 ], however its scarcity affects more than 40% of the people around the world [ 2 ]. Natural water is an important material for the life of both animals and plants on the earth [ 3 ]. Consequently, access to safe drinking water is essential for health and a basic human right that is integral to the United Nations Resolution 64/292 of 2010 [ 4 ]. The United Nations set 2030 as the timeline for all countries and people to have universal access to safe drinking water; this is a Sustainable Development Goal (SDG) 6 of the 17 SDGs [ 5 ]. The availability of and access to safe water is more important to existence in Africa than it is elsewhere in the world [ 6 ]. Least Developed Countries (LDCs) especially in sub-Saharan Africa have the lowest access to safe drinking water [ 7 ]. In Africa, rural residents have far less access to safe drinking water and sanitation than their urban counterparts [ 8 ].

Natural water exists in three forms namely; ground water, rain water and surface water. Of the three forms, surface water is the most accessible. Worldwide, 144 million people depend on surface water for their survival [ 9 ]. In Uganda, 7% of the population depends on surface water (lakes, rivers, irrigation canal, ponds) for drinking water [ 10 ]. The same surface water is a natural habitat for many living organisms [ 11 ] some of which are responsible for transmission of infectious diseases such as cholera, typhoid, dysentery, guinea worm among others [ 12 ]. Surface water sources include lakes, rivers, streams, canals, and ponds. These surface water sources are often vulnerable to contamination by human, animal activities and weather (storms or heavy rain) [ 13 , 14 ]. Globally, waterborne diseases such as diarrheal are responsible for more than two million deaths annually. The majority of these deaths occur among children under-5 years of age [ 15 ].

Cholera, a waterborne disease causes many deaths each year in Africa, Asia and Latin America [ 16 ]. In 2018 alone, a total of 120,652 cholera cases and 2436 deaths were reported from 17 African countries to World Health Organization [ 17 ]. Cholera is a major cause of morbidity and mortality in Uganda [ 18 ]. The fishing communities located along the major lakes and the rivers in the African Great Lakes basin of Uganda constitutes 5% of the Uganda’s population, however these communities were responsible for the majority (58%) of the reported cholera cases during the period 2011–2015 [ 19 ]. Cholera outbreaks affect predominantly communities using the surface water and the springs. There is also high risk of waterborne disease outbreaks in the communities using these types of water [ 20 , 21 ]. Studies of the surface water from water sources located in the lake basins of the five African Great Lakes in Uganda identified Vibrio. cholerae [ 22 , 23 ] though no study isolated the toxigenic V. cholerae O1 or O139 that cause epidemic cholera. Cholera outbreaks in the African Great Lakes basins in Uganda have been shown to be propagated through water contaminated with sewage [ 20 , 24 ]. Cholera is one of the diseases targeted for elimination globally by the WHO by 2030 [ 25 ]. Hence, to prevent and control cholera outbreaks in these communities, promotion of use of safe water (both quantity and quality), improved sanitation and hygiene are the interventions prioritized by the Uganda Ministry of Health [ 26 ]. Most importantly, provision of adequate safe water is a major pillar of an effective cholera prevention program given that water is the main mode of V. cholerae transmission [ 27 , 28 ].

Availability of adequate safe water is essential for prevention of enteric diseases including cholera [ 29 ]. Therefore, access to safe drinking and domestic water in terms of quantity and quality is key to cholera prevention. Water quality is defined in terms of three key quality parameters namely, physical, chemical and microbiological characteristics [ 30 ]. A less common but important parameter is the radiological characteristics [ 31 ]. In regards to the physicochemical parameters, there are five parameters that are essential and impacts life (both flora and or fauna) within the aquatic systems [ 32 ]. These vital physicochemical parameters include pH, temperature, dissolved oxygen, conductivity and turbidity [ 32 ].

pH is a value that is based on logarithm scale of 0–14 [ 33 ]. Aquatic organisms prefer pH range of 6.5–8.5 [ 34 , 35 , 36 ]. Low pH can cause the release of toxic elements or compounds into the water [ 37 ]. The optimal pH for V. cholerae survival is in basic range (above 7). Vibrio cholerae may not survive for long in acidic pH [ 38 ]. A solution of pH below 4.5 will kill V.cholerae bacteria [ 39 ].

Most aquatic organisms are adapted to live in a narrow temperature range and they die when the temperature is too low or too high [ 34 ]. Vibrio cholerae , bacteria proliferate during algae bloom resulting in cholera outbreaks [ 40 , 41 ]. This proliferation could be due favourable warm temperature [ 42 ]. Relatedly, V. cholerae isolation from natural water in endemic settings is strongly correlated with water temperature above 17 °C [ 43 ].

Dissolved oxygen is the oxygen present in water that is available to aquatic organisms [ 34 ]. Dissolved oxygen is measured in parts per million (ppm) or milligrams per litre (mg/L) [ 35 ]. Organisms in water need oxygen in order to survive [ 44 ]. Decomposition of organic materials and sewage are major causes of low dissolved oxygen in water [ 12 ].

Water conductivity is the ability of water to pass an electrical current and is expressed as millisiemens per metre (1 mS m- 1  = 10 μS cm − 1 ) [ 29 ]. Most aquatic organisms can only tolerate a specific conductivity range [ 45 ]. Water conductivity increases with raising temperature [ 46 ]. There is no set standard for water conductivity [ 45 ]. Freshwater sources have conductivity of 100 – 2000μS cm − 1 . High water conductivity may be due to inorganic dissolved solids [ 46 ].

Turbidity is an optical determination of water clarity [ 47 ]. Turbidity can come from suspended sediment such as silt or clay [ 48 ]. High levels of total suspended solids will increase water temperatures and decrease dissolved oxygen (DO) levels [ 12 ]. In addition, some pathogens like V. cholerae, Giardia lambdia and Cryptosporidia exploit the high water turbidity to hide from the effect of water treatment agents and cause waterborne diseases [ 49 ]. Consequently, high water turbidity can promotes the development of harmful algal blooms [ 41 , 50 ].

Given the importance of the water physicochemical parameters, in order to ensure that they are within the acceptable limits, the WHO recommends that they are monitored regularly [ 51 ]. The recommended physicochemical parameters range for raw water are for pH of 6.5–8.5, turbidity of less than 5Nephlometric Units (NTU) and dissolved oxygen of not less than 5 mg/L [ 51 ]. Surface and spring water with turbidity that exceeds 5NTU should be treated to remove suspended matter before disinfection by either sedimentation (coagulation and flocculation) and or filtration [ 52 ].

Water chlorination using chlorine tablets or other chlorine releasing reagent is one of the most common methods employed to disinfect drinking water [ 53 , 54 ]. Chlorination is an important component of cholera prevention and control program [ 55 ]. In addition to disinfection to kill the pathogens, drinking water should also be safe in terms of physicochemical parameters as recommended by WHO [ 51 ]. However, to effectively make the water safe using chlorine tablets and other reagents, knowledge of the physicochemical properties of the surface and spring water being disinfected is important as several of the parameters affect the active component in the chlorine tablets [ 56 ]. For example, chlorine is not effective for water with pH above 8.5 or turbidity of above 5NTU [ 53 ].

Generally, there is scarcity of information about the quality and safety of drinking water in Africa [ 57 ]. Similarly, few studies exist on the physicochemical characteristics of the drinking water and water in general in Uganda. Furthermore, information from such studies is inadequate for use to increase safe water in cholera prone districts of Uganda where the need is greatest. The cholera endemic communities of Uganda [ 19 , 21 , 24 ] have adequate quantities of water that is often collected from the Great lakes, rivers and other surface water sources located within the lake basins. However, the water is of poor quality in terms of physicochemical and microbiological characteristics. Several studies conducted in Uganda have documented microbiological contamination of drinking water [ 20 , 24 , 58 , 59 ]. However, few studies exist on the physicochemical characteristics of these water. Furthermore, these studies focused on few water sources, for example testing the lakes and omitted the rivers, springs and ponds or testing the rivers and omitted the other water types. One such study was carried out on the water from the three lakes in western Rift valley and Lake Victoria in Uganda [ 23 ], This study did not assess the other common water sources such as the rivers, ponds and springs that were used by the communities for drinking and other household purposes. Other studies on water physicochemical characteristics assessed heavy metal water pollution of River Rwizi (Mbarara district, Western Uganda) [ 60 ] and of the drinking water (bottled, ground and tap water) in Kampala City (Central Uganda) [ 61 ] and Bushenyi district (Western Uganda) [ 62 ]. These studies found high heavy metal water pollution in the drinking water tested. The information gathered from such studies is useful in specific study area and is inadequate to address the lack of safe water in the cholera endemic districts of Uganda where the need for safe drinking water is greatest. Several epidemiological studies in Uganda have attributed cholera outbreaks to use of contaminated surface water [ 20 , 21 , 24 , 63 ]. Furthermore, studies conducted on the surface water focus on pathogen identification [ 63 , 64 ] leaving out the water physicochemical parameters which are equally important in the provision of safe drinking water [ 53 ] and are necessary for survival of all living organisms (both animals and plants) [ 44 ].

Therefore, the aim of this study was to determine the physicochemical characteristics of the surface water sources and springs located in African Great Lakes basins in Uganda so as to guide the interventions for provision of safe water to cholera prone populations [ 19 , 20 , 21 , 24 , 58 ] of Uganda. This study in addition has the potential to guide Uganda to attain the United Nations SDG 6 target of universal access to safe drinking water [ 2 ] and the WHO cholera elimination Roadmap [ 25 ] by 2030. Furthermore, these findings may guide future studies including those on causal-effect relationship between physicochemical parameters and infectious agents (pathogens).

This was a longitudinal study that was conducted between February 2015 and January 2016 in six districts of Uganda that are located in the African Great Lakes basins of the five lakes (Victoria, Albert, Kyoga, Edward and George). These districts had ongoing cholera outbreaks or history of cholera outbreaks in the previous five to 10 years (2005–2015). In addition, the selected study districts had border access to the following major water bodies (lakes: Victoria, Albert, Edward, George and Kyoga). The study area was purposively selected because the communities residing along these major lakes contributed most (58%) of the reported cholera cases and deaths in Uganda [ 19 , 65 ] and in the sub-Saharan Africa region [ 66 ] in the past 10 years. Water samples were collected monthly from 27 sites used by the communities for household purposes that included drinking. Water samples were then tested to determine the vital physicochemical parameters. The water samples were collected from lakes, rivers, springs, ponds and an irrigation canal that were located in the lake basins of the five African Great Lakes in Uganda. In one site, water was also collected from a nearby drainage channel and tested for V. cholerae [ 22 ] and physicochemical parameters. However, because the channel was not used for drinking the results were omitted in this article. Water samples were analysed to determine the pH, temperature, dissolve oxygen, conductivity and turbidity. The study sites were located in the districts of Kampala and Kayunga in central region of Uganda; Kasese and Buliisa districts in western Uganda; Nebbi and Busia districts in northern and eastern Uganda respectively. The study sites were the same as for the simultaneous bacteriological V. cholerae detection study [ 22 ] and are shown in Fig.  1 .

Map showing the location of Uganda, the study districts, major surface water sources and the study sites, February 2015 – January 2016. The blue shades are the African Great Lakes and their basins. (Map generated by ArcGIS version 10.2 [licenced] and assembled using Microsoft Office PowerPoint, Version 2016 [licenced] by the authors)

Rural-urban categorization of the study sites

The study sites were categorized as urban if they were found in Kampala district (the Capital City of Uganda) or rural if they were in the other five remote study districts (Kasese, Kayunga, Busia, Nebbi and Buliisa).

Identification of the study sites and water testing procedures

The sites for water testing were identified with the guidance of the local communities and after direct observation by the study team. Geo-coordinates of the sites were taken at the beginning of the study to ensure that subsequent water collection and measurements were done on water from specific points. Two water collection sites were selected on each of the African Great Lakes in Uganda. The selected sites were in different locations but within the communities with a history of cholera outbreaks in the previous 10 years prior to the study period. For each selected lake point, a site was also selected on a river, a spring and a pond located within the area and being used by the communities for domestic purposes that included drinking and preparation of food. A total of 27 sites, two of which were from each of the five lakes were selected and the water tested. The number of sites on each lake and their locations are shown in Additional file  1 .

Water samples were collected and tested monthly for 12 months by the research assistants who were health workers with background training in microbiology or environmental health. The research assistants received training on water collection and testing from a water engineer. The physicochemical parameters were measured by use of the digital meters namely the Hach meter HQ40d and digital turbidity meter.

Water samples were collected in five-litre containers, three litres were processed for V. cholerae detection by Polymerase Chain Reaction (PCR) test as previously described [ 67 ]. Vibrio cholerae Non O1/Non O139 pathogens were frequently detected in the water samples during the study period [ 22 ]. While the three litres of water were being processed for V. cholerae detection [ 22 ], the rest of the water (2 l), were simultaneously used for the onsite measurement of temperature, pH, conductivity and dissolved oxygen. The Hach meters , HQ40d used in the study, had three electrodes that were calibrated before each monthly testing according to the manufacturers’ manual [ 68 ]. The Hach meter calibrations were done using three specific standard buffer solutions that were for pH, dissolved oxygen and conductivity respectively. Turbidity (total suspended solids or water clarity) was measured using a turbidity meter according to previously published methods [ 49 ]. In addition, the research assistants were provided with Standard Operating Procedures (SOPs) and supervised monthly by the investigators before and during each scheduled monthly measurements.

Data management, analysis and statistical tests

Data were collected, entered, cleaned and stored in the spreadsheet. Errors in the recorded readings were removed using the correct records retrieved from the Hach meters’ HQ40d internal memory. Stata statistical package version 13 was used to analyse the data. Data were analysed to generate means and standard error of the mean for pH, temperature, dissolved oxygen (DO), conductivity (CD) and turbidity. Data were presented in the form of tables and graphs. Comparison for variations between the water samples were carried out using One-Way Analysis of Variance (ANOVA) test. Samples with significant One-Way ANOVA test were subjected to Turkey’s Post Hoc test to establish which of the variables were statistically significant.

The map was created using ArcGIS software, Version 10.2, licenced (ESRI, Redlands, California, USA). The graphs and figures were produced using Microsoft Excel and PowerPoints, Version 2016 (Microsoft, Redmond, Washington, USA). The administrative shapefiles used to create the map were obtained from open access domain, the Humanitarian Data Exchange: https://data.humdata.org/ . In order to generate the study locations on the map, Global Positioning System (GPS) coordinates for the study sites were converted to shapefiles that were combined with the administrative shapefiles corresponding to the locations.

A total of 318 water samples were tested from 27 sites as follows; lake water 40.9%, (130/318), rivers water 26.4% (84/318), ponds water 17.9% (57/318), spring water 11.0% (35/318) and canal water 3.8% (12/318).

Test results for the lake water collected at the fish landing sites (FLS)

The mean physicochemical test results for pH, temperature, dissolved oxygen, conductivity and turbidity are shown in Table  1 .

The mean physicochemical water characteristics of most of the sites were within the WHO recommended water safety range except for turbidity. Few sites had pH and dissolved oxygen outside the WHO recommended safety range.

Monthly variations of the lake water physicochemical characteristics

There were monthly variations in the physicochemical parameters between the water from the lake sites overtime. Most of the sites had steady pH overtime for the first half of the study period (February – August 2015). Thereafter, the pH reduced slightly during the second half (September, 2015 – January, 2016) of the study period. The highest pH fluctuations were in the months of October – December, 2015. The widest change in pH within the same site was observed at Gaaba Fish landing site, Lake Victoria basin, Kampala district.

There were differences in water temperature on the same lake but at different test sites. These differences were detectable mostly in the months of April, 2015. The lowest and highest water temperatures were both recorded on Lake Edward (Kasese district) at Kayanzi fish landing site of 18.9 °C and at Katwe FLS of 34  ° C in the period between April – August, 2015. Fluctuations in the dissolved oxygen were detectable throughout the study period. Kalolo Fish landing site on Lake Albert, Buliisa district showed the widest fluctuations in dissolved oxygen with the highest value of 10.73 mg/L and the lowest of 2.5 mg/L.

Most test sites had small conductivity fluctuations except for Panyimur and Kalolo both of which were located on Lake Albert in Nebbi and Buliisa districts These districts had high water conductivity fluctuations with arrange of 267.1 μS/cm – 2640 μS/cm at Kalolo (Buliisa district) FLS and 296 μS/cm – 2061 μS/cm at Panyimur (Nebbi district). Water turbidity for the majority of the sites changed overtime. Kahendero fish landing site (Lake George, Kasese district) had the highest turbidity which was most noticeable in the months of October 2015 to January 2016. Majanji fish landing site (Lake Victoria, Busia district) had the lowest and most stable water turbidity. Monthly variations of the lake water physicochemical parameters are shown in Fig.  2 .

Monthly variations of lake water physicochemical characteristics (pH, temperature, dissolved oxygen, conductivity and turbidity), February 2015 – January 2016: Part a ) water pH variations; Part b ) water temperature variations; Part c ) water dissolved oxygen; Part d ) water conductivity variations; Part e ) water turbidity variations

River water physicochemical parameter test results

The mean physicochemical characteristics of water from the seven rivers studied are shown in Table  2 .

There were variations in the mean pH, temperature, dissolved oxygen and conductivity between study sites on the rivers. However, these mean parameter variations were in WHO acceptable drinking water safety limit except for River Lubigi, Kampala district which had mean dissolved oxygen below the recommended WHO range. At one time (February, 2015) River Lubigi had dissolved oxygen of 0.45 mg/L. The river water turbidity for all the test sites were above that recommended by WHO of less than 5NTU.

Monthly variations of the river water physicochemical characteristics

Monthly variations in the water physicochemical characteristics of the seven river test sites are shown in Fig.  3 .

Monthly variations of the physicochemical characteristics of river water, February 2015 – January 2016: Part a ) water pH variations; Part b ) water temperature variations; Part c ) water dissolved oxygen variations; Part d ) water conductivity variations; Part e ) water turbidity variations

There were variations in the water physicochemical parameters between rivers and within the same river overtime. Most rivers showed fluctuations of water pH and temperature. Some rivers such as R. Nyamugasani and R. Lhubiriha both in Kasese district had wide temperature fluctuations. River Mobuku (Kasese district) had the lowest water temperature recorded over the study period. Fluctuations in dissolved oxygen were highest in R. Lubigi (Kampala district), Lake Victoria basin. Dissolved oxygen for R. Lubigi was below the recommended level of more than 5 mg/L for most of the study period. Seasonal variations of water dissolved oxygen were also more noticeable in R. Lubigi than the rest of the river sites. Relatively more dissolved oxygen was found during the rainy seasons (March – July, 2015, first rainy season and September – December, 2015, second rainy season) than in dry season.

There were small variations in the water conductivity in the majority of the rivers. Wide fluctuations in conductivity were observed for water samples of R, Lubigi (Kampala district). River Nyamugasani (Kasese district, Lake Edward basin) had steady but higher conductivity than all the other rivers. There were variations in turbidity within the same river overtime and between the different rivers. River Sio (Busia district) had the highest and the widest turbidity variations during the study period.

Water test results for the springs and ponds

The mean physicochemical characteristics of spring and pond water are shown in Table  3 .

The mean physicochemical characteristics of water from the springs and ponds showed variations between the sites. The majority of site means values were within the WHO accepted pH range. Two sites, Wanseko pond (Buliisa, district, Lake Albert basin) and Katanga spring (Kampala district, Lake Victoria basin) had mean water pH below the recommended WHO drinking water acceptable range at the acidic level of 5.73 and 6.19 respectively. Forty percent (40%, 2/5) of the ponds and 33% (1/3) of the springs had mean dissolved oxygen below the recommended WHO level. The ponds with the low dissolved oxygen were found within Lake Albert basin. Among the springs, Katanga spring (Kampala district, L. victoria basin) had mean dissolved oxygen that was below the WHO recommended level of 5 mg/L. Conductivities of the spring water were 89.81–3276.36 μS/cm and for ponds 55.99–3280.83 μS/cm. For both the springs and the ponds the differences between the lowest and the highest conductivities were wide.

Monthly variations of the springs and ponds water physicochemical characteristics

The monthly variations of spring and pond water physicochemical characteristics are shown in Fig.  4 .

Monthly variations of the physicochemical characteristics of the spring and pond water, February 2015 – January 2016: Part a ) water pH variations; Part b ) water temperature variations; Part c ) dissolved oxygen variations; Part d ) conductivity variations and Part e ) water turbidity variations

There were variations in the water physicochemical characteristics of the spring and the pond water overtime. The variations in water (springs and ponds) were also present between the different sites. The springs had small monthly variations of the water physicochemical parameters while the ponds had wide variations. Mughende pond (Kasese district) had the highest pH for most of the study period. Katanga spring (Kampala district) had the lowest pH compared to other springs during the study period. Kibenge spring (Kasese district) had higher temperature than the rest of the two springs (Katanga spring, Kampala district and Nyakirango spring, Kasese district). Most springs and ponds had slight fluctuations in dissolved oxygen except for Mughende pond (Kasese district). Most springs and ponds except for Panyimur pond (Nebbi district) had small monthly fluctuations in water conductivity. Kibenge spring and pond (both located in Kasese district) had higher conductivity compared to the rest of the springs or ponds. Mughende spring and pond were outliers with higher conductivity than the rest of the water sites. There were variations in water turbidity with months for both the springs and the ponds. Apart from Mughende pond (Kasese district), the rest of the springs and ponds showed variations that had two peaks, the first peak (May – August, 2015) and the second peak (November – January, 2016).

Test results of the other surface water sources: Mobuku irrigation canal water

Mobuku irrigation canal water, water diverted from Mobuku River for irrigation purposes by the Mobuku irrigation scheme was tested because the local communities were using this water for domestic purposes including drinking. Apart from water turbidity which was above the WHO recommended standard of 5NTU, the rest of the water physicochemical parameters (pH, temperature, dissolved oxygen and conductivity) were in the WHO acceptable range as follow: pH of 7.93 ± Standard Error (SE) of 0.23, temperature of 26.57 °C ± SE of 1.25 °C, dissolved oxygen of 6.38 mg/L ± SE of 0.18 mg/L, conductivity of 69.06 ± SE of 2.57) and turbidity of 28.68 ± SE of 9.06NTU.

Monthly variations of physicochemical characteristics of Mobuku irrigation canal water

There were monthly variations in water physicochemical characteristics of Mobuku irrigation canal. The water pH and dissolved oxygen showed two peaks each. The first peak was in March – May, 2015 and the second peak, August – November, 2015. The variations of the Mobuku irrigation canal monthly water physicochemical parameters over the study period is shown in Fig.  5 .

Monthly variations of the physicochemical characteristics of Mobuku irrigation canal water, February 2015 – January 2016: Part a ) water pH variations; Part b ) water temperature variations; Part c ) dissolved oxygen variations; Part d ) conductivity variations and Part e ) water turbidity variations

Results of statistical tests for the differences within sites overtime and between sites

One-Way ANOVA test.

There were no statistically significant differences within most of the study sites except for sites on the lakes and the rivers where the pH and temperature differences were statistically significantly within sites overtime. Statistically significant differences in the water physicochemical characteristics were observed between sites (all p -value < 0.05) as indicated in the additional file  2 .

Turkey’s post hoc test

There were statistically significant differences for all water physicochemical parameters for both the lake and river sites. For instance, Lake Edward had both the highest temperature (34 °C, May, 2015) which was registered at Katwe FLS (Kasese district) and the lowest temperature (18.9 °C, April, 2015) which was recorded at Kayanzi FLS (Kasese district). The results of the comparison of the physicochemical parameters of the various lake and river sites are shown in Table  4 .

Similarly, comparison of the springs or pond water showed statistically significant differences for most (80% of the total comparison) of the water parameters (pH, temperature, dissolved oxygen and conductivity) apart from the water turbidity. Turkey’s post Hoc test results for the comparison of springs and pond water physicochemical parameters are shown in Table  5 .

This study showed that water for drinking and domestic purposes from the surface water sources and springs in cholera affected communities/districts of Uganda were not safe for human use in natural form. The water samples from the water sources in the study area did not meet the WHO drinking water quality standards in terms of the important physicochemical parameters. In addition, all the surface water sources and the springs tested had turbidity above the WHO recommended level of 5NTU yet the same water were used for domestic purposes including drinking in the natural form by the households. The study also found variations in the other physicochemical parameters (pH, temperature, dissolved oxygen and conductivity) between study sites on the same lake and between the different water sources.

While the majority of the water sources had mean water physicochemical characteristics (excluding turbidity) in acceptable range, few water sources, mainly the sites on Lake George, including the springs and ponds had pH and dissolved oxygen outside the recommended WHO ranges. These water sources that did not meet the WHO drinking water standards could expose the users to harmful effects of unsafe drinking water including waterborne diseases such as cholera. The present study findings of high water turbidity if due to algae bloom could encourage pathogen persistence and infection spread, including V. cholerae bacteria [ 40 , 41 ] resulting in ill-health and cholera epidemics. In addition, the high water turbidity complicates water disinfection as it gives rise to significant chlorine demand [ 53 ]. The increased chlorine demand can be costly and difficult to ensure constant availability for disinfection of water since Uganda and several other developing countries need and receive supplementary donor support [ 69 ].

In regard to temperature, dissolved oxygen and conductivity, the majority of the surface water sources and springs tested met the recommended WHO drinking water standards. However, a few water sources such as River Lubigi in Kampala district had mean dissolved oxygen below the recommended WHO drinking water standards. Therefore, in order to ensure universal access to safe drinking water, the water sources that had vital physicochemical parameters outside the WHO drinking water range could be targeted for further studies.

There were statistically significant differences in the water physicochemical characteristics between the different sites and sources (lakes, rivers, springs and ponds). Despite these differences, the required approaches to ensure safe water access to the communities may not differ across sites. First and foremost, all sites and water types will need measures that reduce the high water turbidity to WHO acceptable levels. Secondly, in few instances, such as the water sources with pH in acidic range (Katanga spring in Kampala district, Lake Victoria Basin and Wanseko pond in Buliisa district, lake Albert basin) in addition to requiring further studies to identify the causes of the low pH (acidity), such water sources may also require the use of water treatment methods that neutralize the excess acidity [ 54 ]. Furthermore, since acidity is usually associated with increased solubility of toxic heavy metals (lead, arsenic and others) [ 34 ], testing such water for metallic contamination may be required. Heavy metal contamination of water causes ill-health due to chronic exposure which is cumulative and manifest late for correction to be done [ 70 ].

The findings of this study also highlight the differences in water quality between the urban surface water sources and springs (Kampala district) and the rural surface sources and springs (other study districts – Kasese, Kayunga, Busia, Nebbi and Buliisa) The water sources that met the WHO recommended drinking water quality standards [ 53 ] were mostly the rural springs and the rivers. However, these differences between the rural and the urban water sources do not alter the required approaches to ensure access to safe water which is by promoting measures that reduce the high water turbidity in combination with water disinfection to remove the pathogens. The relatively good quality of rural water sources compared to the urban ones could have been due to availability of plenty of vegetation in rural setting that filtered the water along the way downstream and possibly low level of pollution from industrial inputs in rural areas than in urban areas [ 71 , 72 ].

In relation to cholera outbreaks in the study communities, naturally, the physicochemical conditions for survival of V. cholerae O1 occur in an estuarine environment and other brackish waters [ 73 , 74 ]. In such circumstances, the favourable physicochemical conditions for V. cholerae isolation are the high water turbidity [ 49 ] and temperature of above 17 °C [ 43 ]. Interestingly, all the surface water sources and the springs tested had favourable physicochemical characteristics for the survival of V. cholerae in terms of these two parameters (high water turbidity and temperature of above 17 °C). Furthermore, two lakes sites (Kahendero FLS and Hamukungu FLS, Lake George, Kasese district) had also favourable mean pH for the survival of V. cholerae of 9.03 ± 0.17 and 9.13 ± 0.23 respectively. Favourable pH for V. cholerae survival in waters of Lake George was previously documented in the same area [ 23 ]. Hence, the frequent cholera outbreaks [ 19 , 20 , 21 , 24 ] in the study area could be attributed to both the favourable physicochemical water characteristics and use of unsafe water.

There were wide variations in conductivity between water sources and within the same source overtime. High water conductivities were recorded in the months of January to March 2015 (dry season), possibly due to high evaporation which increased the concentration of electrolytes present in water. Likewise, two rivers namely. River Lubigi (Kampala district) and Nyamugasani (Kasese district) had higher mean conductivities of 460.51 ± 57.83 μS/cm and 946.08 ± 3.63 μS/cm respectively than for typically unpolluted river of 350 μS/cm [ 75 ]. Consequently, given that the two rivers flow through areas of heavy metal mining (copper and cobalt mines in Kasese district by Kilembe Mines Limited and Kasese Cobalt Company Limited) and industrial activities (Kampala City), it is possible for the high water conductivity to be due to the heavy metal contamination as previously documented in drinking water in South-western Uganda [ 62 ] and Kampala City [ 61 ]. Thus, specific studies are required on water from the two rivers to determine the true cause of the high conductivity and to guide mitigation measures.

Hence, more efforts are required to promote safe water access in Uganda to attain the WHO cholera elimination target [ 25 ] and SDG 6 by 2030 since 26% (36/135) of mean physicochemical water tests did not meet WHO drinking water quality standards [ 53 ]. These findings together with those of the previous studies which demonstrated the presence of pathogenic V. cholerae in the same water sources [ 22 , 23 , 76 ] should guide stakeholders to improve access to safe water in the Great Lakes basins of Uganda holistically. Thus, measures such as promotion of use of safe water (using water disinfection), health education, sanitation improvement and hygiene promotion that address both the water bacteriological contents and physicochemical parameters should be considered in both the short and medium terms. However, long term plan to increase access to safe water by construction of permanent safe water treatment plants and distribution systems (pipes) should remain a top priority.

In the short and intermediate period, focusing on the measures that reduce water turbidity and disinfection of water (to kill microorganisms) should be prioritized so as to facilitate progress towards attainment of SDGs and cholera elimination in the study area. The basis for such prioritization lies in the fact that high water turbidity raises water temperature and prevents the disinfection effects of chlorine on water. These in return promote survival of the microorganisms and consequently cholera and other waterborne disease outbreaks. Furthermore, though boiling of water is feasible and recommended through technical guidelines [ 26 ] since it addresses both turbidity and kills the micro-organisms, it has issues of poor compliance due to lack of firewood which is the main cooking energy source in these communities [ 70 ]. Therefore, alternative safe water provision targeting reduction of high water turbidity and removal of microorganism by special filters such as decanting and sand filters and flocculation agents which do not need heat energy should be promoted [ 77 , 78 ]. Also, there is a need to explore the use of solar energy (solar water purifiers) [ 79 ] in these communities given their location in the tropics where sunshine is plenty. In the minority of situations, in addition to use of above methods to make water safe, there may be a need to employ different approaches of water purification depending on the water source. For example the water sources with lower or higher than recommended pH [ 53 ] (Wanseko pond, Hamukungu and Kahendero FLS on L. George), use of water treatment reagents that are affected by pH such as chlorine tablets should be reevaluated.

In additional to disinfection and turbidity corrective measures for all the water that were studied, each of the springs in the study area (Katanga in Kampala district and Nyakirango and Kibenge springs in Kasese district) will also need a sanitary survey (a comprehensive inspection of the entire water delivery system from the source to the mouth so as to identify potential problems and changes in the quality of drinking water) [ 80 ]. The findings of the sanitary survey should then guide the medium and long term interventions for water quality improvement in areas served by targeted springs. The following are some of the interventions that could be carried out after a sanitary survey: provision of a screen to prevent the entrance of animals, erecting a warning signs, digging of a diversion ditch located at the uphill end to keep rainwater from flowing over the spring area, establishment of an impervious barrier (a clay or a plastic liner) to prevent potential contaminants from entering into the water or and others measures described in the handbook for spring protection [ 81 ].

Furthermore, as a stopgap measure while access to safe water is scaled up, the communities in the study area should be protected from cholera using Oral Cholera Vaccines [ 82 ]. Protection of these communities is necessary since this study shows that favorable conditions for cholera propagation/transmission are present in the water in the study area. The favorable conditions that were documented in this study included the high water turbidity which makes it difficult to disinfect water [ 53 ] and the water temperature of above 17 °C which speeds up the multiplication of pathogens [ 43 ].

In addition, there were some other important study findings that were not fully understood. For example, some water sources (Kibenge spring and pond (located in Kasese district, western Uganda) had extreme vital physicochemical values for both conductivity and water temperature relative to the rest of above 40 °C and 3000 μS/cm respectively. It is possible that the extreme values were due to geochemical effects documented in water sources around Mount Rwenzori [ 83 ]. However, since there was copper and cobalt mining in Kasese district, high water conductivity could have been due to chemical contamination. Similarly, River Lubigi, Kampala district (central Uganda) had very low dissolved oxygen of less than 1 mg/L during some months (for example in January 2015, dissolved oxygen of 0.45 mg/L) which could have been due to organic pollutants from the communities in Kampala City [ 84 ] that used up the oxygen in the water. Also, Wanseko pond (Lake Albert basin, Buliisa district) had low pH of 4.84 in February 2015. Such water with low pH have the potential to increase the solubility of heavy metals some of which make water harmful when consumed [ 85 ]. Therefore, further studies will be required to better understand such extreme values.

Strength and limitations of this study

This study had several strengths. First, the longitudinal study design that employed repeated measurements of water physicochemical characteristics from the same site and source. This design reduced the likelihood of errors that could arise from one-off measurements seen in cross-sectional study designs resulting in increased validity of the study findings. Second, the inclusion of a variety of the water sources from which drinking and domestic water were collected namely, lakes, rivers, ponds, springs and a canal from different regions of Uganda made the findings representative of the water sources in study districts. Third, use of robust equipment, Hach meters, HQ40d [ 68 ] which automatically compensated for the weather changes (corrected for possible confounders and biases) for the parameters that had effect on each other such as raising water temperature impacting on the water conductivity and dissolved oxygen. Forth, purposive selection of the districts with frequent cholera outbreaks, an important waterborne disease that is targeted for elimination locally within Uganda and globally by WHO [ 25 ]. This meant that the findings had higher potential for used by stakeholders targeting to improve access to safe water and those for cholera prevention.

There were also some study limitations. First, though the study identified the favourable conditions (higher than recommended mean water turbidity and temperature of above 17 °C) for cholera in the study area, we could not report on causal-effect relationship between V. cholerae and the parameters studied. Vibrio cholera e pathogens were detected by use of multiplex Polymerase Chain Reaction (PCR). The results for PCR test were interpreted as positive or negative for V. cholerae O1, O139, non O1, and non O139 [ 22 ]. These data were not appropriate for establishment of causal-effect relationship Therefore, further studies using appropriate methods are recommended to establish such relationships.

Second, during some months of the study, water samples could not be obtained from some sources especially the ponds that had dried up during the dry season. The drying up reduced the number of samples collected from these points. However, since the months without water were few compared to the entire study period, the impact of the missing data could have been minimal.

Third, water samples were only tested for the five key physicochemical water characteristics, Vital Signs [ 32 ] however, there are many other parameters that effect survival and health of living things namely, nitrates, copper, lead, fluoride, phosphates, arsenic and others. Studies are therefore required to provide more information on these other parameters not addressed by the current study.

The study showed that surface and spring water for drinking and other domestic purposes in cholera prone communities in Great Lakes basins of Uganda were unsafe in terms of vital physicochemical water characteristics. These water sources had favourable physicochemical characteristics for transmission/propagation of waterborne diseases, including cholera. All test sites (100%, 27/27) had temperature above 17 °C that is suitable for V. cholerae survival and transmission and higher than the WHO recommended mean water turbidity of 5NTU. In addition, more than a quarter (27%) of lake sites and 40% of the ponds had pH and dissolved oxygen outside the WHO recommended range of 6.5–8.5 and less than 5 mg/L respectively. These findings complement bacteriological findings that were previously reported in the study area which found that use of this water increased their vulnerability to cholera outbreaks [ 22 ]. Therefore, in order for Uganda to attain the WHO cholera elimination and the United Nations SDG 6 target by 2030, stakeholders (the Ministry of Water and Environment, the local governments, Ministry of Health development partners and others) should embrace interventions that holistically improve water quality through addressing both physicochemical and biological characteristics. Furthermore, studies should be conducted to generate more information on the other physicochemical parameters not included in this study such as detection of the heavy metal contamination.

Availability of data and materials

The datasets generated and/or analysed during the current study are available in the Mendeley Data repository, https://doi.org/10.17632/57sw2w23tw.1 . The cholera incidence data used to identify the study area were from Uganda Ministry of Health and the district (Kasese, Busia, Nebbi, Buliisa and Kayunga) weekly epidemiological reports.

Abbreviations

Analysis of Variance

Conductivity

Central Public Health Laboratories

Dissolved Oxygen

Delivery of Oral Vaccines Effectively

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Acknowledgements

The authors are grateful to the following: the district teams and the communities in Kasese, Kampala, Nebbi, Buliisa, Kayunga and Busia districts for the cooperation and support; the Ministry of Health, Makerere University School of Public Health, Dr. Asuman Lukwago, Dr. Jane Ruth Aceng and Prof. AK. Mbonye for technical guidance. The authors are grateful to Dunkin Nate from John Hopkins University for training of the field teams on water sampling and testing. The authors also thank Ambrose Buyinza Wabwire and to Damari Atusasiire for the support in creating the map and statistical guidance respectively. Special thanks to the laboratory teams in the district hospitals; CPHL (Kampala) and John Hopkins University (Maryland, USA) for carrying out the water tests.

This study was funded by the Bill and Melinda Gates Foundation, USA, through John Hopkins University under the Delivering Oral Vaccine Effectively (DOVE) project. (OPP1053556). The funders had no role in the implementation of the study and in the decision to publish the study findings.

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Godfrey Bwire, Henry Komakech & Christopher Garimoi Orach

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David A. Sack, Amanda K. Debes, Malathi Ram & Christine Marie George

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GB, DAS, AKD and CGO conceived the idea. GB, CGO, AKD, MR, HK, AK, TO and CMG conducted the investigation. MR, HK and TO carried out data curation. MR, HK, GB, DAS, CMG, AKD and AK analysed data. GB, DAK, AKD, CGO, MR, AK, TO and CMG wrote the first draft. All authors read and approved the final manuscript.

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This study was approved by the Makerere University School of Public Health Institution Review Board (IRB 00011353) and the Uganda National Council of Science and Technology. Cholera data used in selection of the water bodies and study communities were aggregated disease surveillance data from the Ministry of Health with no personal identifiers. The laboratory reports on the water sources found contaminated during the study period were shared immediately with the district team to ensure that preventive measures were instituted to protect the communities. In addition, the communities served by such water sources were educated on water treatment/purification (filtration, boiling, chlorination, use of Waterguard ).

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Supplementary information

Additional file 1..

The number and the type of water sources in each of the lake basins in cholera prone communities of Uganda that were enrolled in the study, February 2015 – January 2016.

Additional file 2.

One Way ANOVA test results for the differences within the study sites overtime (February 2015 – January 2016) and between sites.

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Bwire, G., Sack, D.A., Kagirita, A. et al. The quality of drinking and domestic water from the surface water sources (lakes, rivers, irrigation canals and ponds) and springs in cholera prone communities of Uganda: an analysis of vital physicochemical parameters. BMC Public Health 20 , 1128 (2020). https://doi.org/10.1186/s12889-020-09186-3

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Research Article

Community perceptions and practices on quality and safety of drinking water in Mbarara city, south western Uganda

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualization, Writing – review & editing

Roles Methodology, Supervision, Validation, Visualization, Writing – review & editing

Roles Conceptualization, Methodology, Project administration, Supervision, Validation, Visualization, Writing – review & editing

Affiliation Faculty of Science, Mbarara University of Science and Technology, Mbarara, Uganda

Roles Conceptualization, Data curation, Investigation, Methodology, Project administration, Supervision, Validation, Visualization, Writing – review & editing

• Abaasa N. Catherine, 
• Savino Ayesiga, 
• Godfrey Zari Rukundo, 
• Julius B. Lejju, 
• Frederick Byarugaba, 
• Imelda K. Tamwesigire

• Published: May 30, 2023
• https://doi.org/10.1371/journal.pwat.0000075
• Peer Review
• Reader Comments

Availability of clean drinking water is a universal human right. The quality of water differs across communities. When the quality is good, community members are the primary beneficiaries but they are also the first ones to experience the consequences of deteriorating quality of water. In most communities, the inhabitants are able to tell if their drinking water is safe and of quality basing on organoleptic properties. The community perceptions and practices about safety and quality of drinking water are informed by their attitudes and levels of knowledge about water quality. This study aimed to assess community perceptions and practices on quality and safety of drinking water in Mbarara city, south western Uganda. A qualitative study was conducted between May and July 2022. Six focus group discussions among community members and four Key informant interviews with stakeholders in the water service were conducted. Data was analysed basing on predetermined themes of: 1) perceived quality of water 2) perceived factors associated with water quality 3) practices related to water quality and 4) perceived solutions for improving water safety and quality. Drinking water safety and quality in Mbarara city is perceived as not good, dirty, salty and limited in supply and the water sources are shared with animals. The poor quality of drinking water is due to poor waste disposal, poor treatment, poor maintenance of systems, flooding, political interference, deficiency in city planning, increase in population growth and water hyacinth. Sensitizing the communities, community participation, proper water treatment and surveillance and monitoring are solutions to ensuring provision, use and maintenance of safe and quality drinking water in Mbarara city.

Citation: Catherine AN, Ayesiga S, Rukundo GZ, Lejju JB, Byarugaba F, Tamwesigire IK (2023) Community perceptions and practices on quality and safety of drinking water in Mbarara city, south western Uganda. PLOS Water 2(5): e0000075. https://doi.org/10.1371/journal.pwat.0000075

Editor: Eugene Appiah-Effah, Kwame Nkrumah University of Science and Technology, GHANA

Received: October 31, 2022; Accepted: April 29, 2023; Published: May 30, 2023

Copyright: © 2023 Catherine et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: To ensure confidentiality of participants’ information as agreed up on during Ethical approval and Consent Process, qualitative interview transcripts’ file is only visible to the direct research team or through Mbarara University of Science and Technology Research Ethics Committee, P.O. Box 1410 Mbarara, Tel: +256-48-543-3795, Fax: +256-48-542-0782, E-mail: [email protected] , [email protected] since they are not publically available.

Funding: The corresponding author who happens to be the PI for this study CNA received research support as part of Faculty Research Support from Faculty of Medicine, Mbarara University of Science and Technology (MUST). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: NWSC, National Water and Sewerage Cooperation; NEMA, National Environment Management Authority; UBOS, Uganda Bureau of Statistics; WASH, Water, sanitation, and hygiene

Introduction

Safe and quality water is defined as one free from any harmful chemicals and pathogenic agents such as Coliform bacteria, Escherichia coli and coliphages that affect its palatability as well as human livelihood [ 1 , 2 ]. According to the United Nations Sustainable Development Goal 6, “water sustains life, but safe clean drinking water defines civilization” [ 3 ]. Drinking water should be adequate, reliable, clean, accessible and acceptable to communities as a human right to live healthy lives [ 4 ]. There is evidence that steps aimed at providing safe water services have fairly increased, but its safety is uncertain [ 5 ]. Most households in low and middle income countries lack sufficient safe and quality freshwater (physical scarcity). In other countries there is abundant freshwater of unknown quality hence communities supplement improved water supplies with unimproved water or multiple sources that may not be safe for human consumption because it is expensive to ensure adequate supply of safe and quality water [ 6 , 7 ]. Safe drinking water” is water from an “improved water source,” that include household connections, public standpipes, boreholes, protected dug wells, protected springs and rainwater collections and it should not represent any significant risk to health over a lifetime of consumption [ 8 , 9 ]. Assessment of water quality is subjective and is based on beliefs, cognition, geographic location of the water source, socio economic characteristics, the experience of the user and information provided by local media [ 10 ].

Community members are the primary beneficiaries of quality and safe water and they are the first to experience the consequences of the deteriorating water quality when known or suspected to be unsafe for human consumption due to regulatory problems and lack of support [ 11 ]. They evaluate the safety and quality of drinking water using its organoleptic properties like taste, smell, colour and clarity as well as presence of litter and sanitary conditions around the drinking water source [ 12 ]. These perceptions are however useful and help to complement scientific measurements hence supporting water management policies [ 13 ]. Community participation in water and sanitation is one of the prominent global indicators used to assess the achievement of water-related sustainable developmental goals [ 12 ]. In addition, public acceptability of drinking water is one of the world health organization guidelines for drinking water quality [ 14 ].

Communities’ perception of the quality of drinking water is informed by health risk perception, perceived control, past experience, trust on water service provider, influence of impersonal and interpersonal information like media and peers, contextual factors, colour, taste of the water, appearance and demographic variables [ 15 , 16 ]. However, these perceptions are influenced by sociocultural, sociodemographic, and personal experiences and are shaped by service satisfaction, confidence in local and national authorities, selection of the water source as well as beliefs in human control of environment issues and formal and informal flow of information [ 17 ]. Community perceptions and practices of health risks related to drinking water are associated with drinking water, the persistence of these health problems and the level of awareness of the problem. Perception of the need for quality water drives the need to practice activities at the source, during transportation or storage and handling practices that will ensure the safety and quality of water as well as the use and storage of this God given resource [ 18 ]. Water quality concerns like water scarcity, lack of awareness and knowledge of ’safe’ collection, handling and storage of water, inadequate sanitation services and/or unhygienic practices exist in communities. In addition; water quality attributes like taste, colour, smell, litter and presence of feacal matter in and around the water source as well as education, age, number of years a person has lived in the community, presence of visible aspects of water pollution and water source catchment area encroachment influence community members’ perception on the quality and safety of drinking water [ 19 ]. These water quality concerns when left unresolved for long may lead to community perceptions of health risk and prompt community practices that may be dangerous to their health like use of chemicals or using alternative sources of water such as unprotected open wells, use of unprotected buckets left outside on the ground [ 20 ]. Through a dialogue with government, drinking water service providers, and community members’ perceptions of the quality of drinking water and associated health benefits and risks inform community practices to maintain water quality [ 11 ]. Understanding community beliefs and behaviours is critical for water resource management, monitoring, and creating drinking water quality standards [ 11 ]. Anecdotal evidence reveals that the quality and safety of drinking water in Mbarara city do not meet World Health Organization criteria for drinking water quality. Thus, the purpose of this study was to explore community members’ perceptions and practices about the quality and safety of drinking water. Results of this study provides community members’ perceptions, practices and perceived solutions to improve and maintain safe and quality drinking water in Mbarara City, South Western Uganda.

Materials and methods

Ethics statement.

Administrative clearance was obtained from District, city, parish, National water and sewerage cooperation and Ministry of water, lands and Environment authorities. The protocol was reviewed and approved by Mbarara University of Science and Technology Institutional Review Committee (MUST-2021-39), and National Council of Science and Technology (HS1469ES). Permission was obtained from the district, local council leaders and household heads especially for water harvest tanks before commencement of data collection. Written informed consent was obtained from every participant before participating in the interviews and discussions.

This study was conducted in Mbarara city, south western Uganda. Mbarara city is the commercial and administrative capital of Mbarara district in south western Uganda. Mbarara city is located 270 kilometres, by road, southwest of the capital city, Kampala. Mbarara district lies between coordinates 00 36 48 S, 30 39 30 E and covers an area of 1,778.4 square kilometres. It has a population of 91867 [ 21 ]. Mbarara city receives an average annual rainfall of 1200 mm with two rainy seasons during the months of September-December and February-May. Temperature ranges between 17°C to 30°C, humidity of 80–90%. The topography is a mixture of fairly rolling and sharp hills and mountains, shallow valleys and flat land. Mbarara city is provided, operated and maintained with safe water supply technologies and sanitation facilities to all communities of the city. Mbarara district recorded an increase in access to safe and clean water from 45% in 2000 to about 63% in the villages and 65% for the municipality in 2007. The safe water coverage is 65.9% in the rural areas and 95.7% in the urban, while accessibility to safe water lies between 29% and 95% [ 22 ].

Participant recruitment and description

This study was a cross sectional study employing qualitative techniques. Purposive sampling was employed to recruit participants for the key informant interviews and focus group discussions. Four (4) key informants were recruited from the District water office, National Environment Management Authority (NEMA), Ministry of Water, Lands and environment and National water and sewerage cooperation (NWSC) based their knowledge, expertise and experience with water safety and quality in Mbarara city. The key informants were water quality control managers and policy makers. Eighty- four (84) community members from six (6) villages/cells (Kaburangiire, Nyarubanga, Rubiri, Lugazi, Katebe and Katukuru) of Mbarara city were recruited for focus group discussions (FGDs). FGDs participants were residents of the selected villages who were consumers of the water from various water sources. Evidence has shown that people who reside and work near water sources are more likely to be concerned about the quality and safety of drinking water [ 23 ]. Both male and females across the different age groups that met the inclusion criteria of being community members in the six selected villages or water service providers in Mbarara city irrespective of their gender and socio economic status were recruited to gain a diversity of perceptive and variability with in the community. We did not collect information on the years of residency. We assumed that persons who had lived in the neighborhood for a longer period of time were better knowledgeable about the safety and quality of water in Mbarara. The participants in the Focus Group Discussions were chosen by the local chairman of the village. The six focus group discussions were constituted by senior inhabitants of the neighborhood who owned homes and had lived in those homes with their families for a long time, also known as "abataka," which literally means "permanent residents of the village."

Data collection

Local leaders as gatekeepers to the community were used to recruit FGD participants and fix dates and time for the discussions. Written informed consent was obtained from all research participants. The consent forms, focus group discussion and Key Informant interview guides were translated into Runyankore-Rukiga the language spoken and well understood in the study area. Discussion / Interview guides were used to collect data from key informants and FGDs between May and June 2022. The key study questions included: 1. What is your perception of the quality and safety of drinking water from sources in your community. 2. In your own view, who/what do you think is responsible for the quality and safety of drinking water you have described? 4. At family and community level, what has been done to ensure that drinking water in your community is of quality and is safe? 5. At family, community level, district/ as stakeholders what you done to ensure quality and safety of drinking water from drinking water sources in the community? These questions were elaborated on with more probing questions. AC conducted the interviews together with NP as a note taker and AT did the recording of the interviews and discussion. Each focus group was comprised of 14 participants. Extra effort was made to ensure an equal number of males and females constituted the focus group discussions.

The interviews and focus group discussions with the participants were conducted at a private location at the convenience of the different participants at the time agreed upon with the study team. The interviews were recorded with a Sony audio recorder and field notes were taken. Participants were not paid for participating in the study but time was compensated as was stipulated in the consent form. The interviews lasted between 60 and 90 minutes. The interviews were transcribed and those in Runyankole-Rukiga translated into English and back translated to Runyankole-Rukiga to ensure that what was recorded in Runyankole-Rukiga is what was captured in the English version of the transcript. Interview data was supplemented with field notes captured during the different interview and discussion sessions. One interview/ focus group discussions was conducted per day.

Data analysis and interpretations

Data analysis started with listening to the audio recordings alongside the field notes at the end of each day’s interview/ discussion session. They were transcribed sequentially on the daily basis by CA, NP and OJ which helped in giving a deeper insight into the inquiry during the data collection process in line with the study objectives. The data was transcribed by Research Assistant [ 24 ] and checked by CA and OJ. Data analysis was done through different stages of familiarization with data and dual coding was employed. CA, OJ and ACD independently read through the transcripts and identified emerging themes and manually identified corresponding quotes by highlighting them with different colors per theme. Data management from interviews and focus group discussions were analyzed differently and merged in one codebook by incorporating data from audio recordings, verbatim notes and nonverbal observations during the interview and discussion processes. A codebook with sections for parent themes, sub themes, description and illustrative quotes was developed from emerging themes. Using the four predetermined themes, indicative thematic analysis was done by analyzing statements from participants, identifying commonalities and developing sub themes. The same data was entered into Atlas Ti 7.5. Using the themes, each transcript was re-analyzed to reveal the best corresponding quotes. The same process was done for key informant interviews and focus group discussions data.

Findings from this study reveal the community perceptions and practices of community members and stakeholders on the quality of drinking water in Mbarara city, south western Uganda. The results are from Four (4) key informant interviews and six Focus Group Discussions from stakeholders and community members in Mbarara city. A total of 28 males and 56 females constituted the interviews and discussions. Participant quotes are presented to support the findings. Four themes were identified, Community perceptions on the quality and safety of drinking water, factors responsible for the quality of drinking water, community perceived solution for safe and quality drinking water and community practices for safe and quality drinking water as well as several subthemes as shown in Table 1 .

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https://doi.org/10.1371/journal.pwat.0000075.t001

Community member’s perception on the quality and safety of drinking water from sources in their community

We explored community members’ perceptions on the quality and safety of drinking water in selected villages in Mbarara city. We asked the community members about their perception on the quality and safety of their drinking water from the different drinking water sources in their villages. They gave a wide range of perceptions regarding the different drinking water sources. Generally, they indicated that the drinking water from different drinking water sources is not good, dirty and tasted salty. They believe that the quality is generally lacking since it is contaminated with human waste, cow dung, always changes in colour, it sediments on settling and the water sources are communally used and shared in some cases shared with animals. The supply on taps is unpredictable while boreholes suffer serious mechanical problems and are usually out of use and for some long period of time.

To be honest, our water is bad since we share it with animals, dumping cow dung in it, and we also use it for cooking and bathing and the problem is that we do not know which water is fit for consumption and how it looks like because we think good water is pure white, which you may discover is not actually good, so we do not know which one is good and we cannot avoid water from the well even taps are few and used by a small number of people; most of us go to the well (FGD II). We have a borehole, but the water cannot be used for cooking or bathing. Nothing good comes from that borehole, unless you wish to mix the soil for making bricks. Even when you wash your hands, they turn black. So in Kaburangire, we have a water problem, and even the rust they mentioned is there, so that is the type of water we have, and the borehole is now not operational ( FGD III ).

Similarly, a participant was noted to have said:

The safety and quality of drinking water is not all that bad because we follow world health drinking water standard regulations, but at times you find that the sources are contaminated when you are not aware, and we can face a challenge because this water that passes underground can be contaminated with anything, let us talk about boreholes, even a tap. Knowing that taps are sometimes passing through sewerage areas, someone can cut it and start getting water back flow ( KII IV ).

In addition, to the poor quality of drinking water, the participants reported that the supply is not constant

It comes and goes, and when it returns, it is different from what we had before it disappeared, and even when you put it in your mouth, you can feel the difference, and later, when it settles, a lot of sediments appear, which raises the concern on the quality (FGD IV).

Community member’s perceived factors responsible for the quality and safety of water in their community

Communities attribute the poor quality and safety of drinking water from sources in their communities to the growing population in the city.

Mbarara’s population is growing rapidly because, as a new city, there is scramble for resources. There are a lot of issues and of course as national water, we cannot meet the demands at the moment and people are opting for other sources (KII I). Because of the rising population, garbage is deposited everywhere, rendering our water unfit for human consumption (FGD IV).

There is a lot of garbage volume and residents live in congested homesteads with no provision for waste disposal. They resort to throwing their waste in River Rwizi at night.

Waste management is poor, and everyone dumps wherever they please; laws are in place, but they are not followed; personnel exist to execute laws, but when you try to do what is right, they will claim that you are interfering with voters ( KII II ). Sometimes you see someone on a boda boda (motorcycle) and you think that he is carrying luggage, and for those of us who walk at night, he reaches the bridge and stops for a while and dumps garbage into the river, thus we live by God’s grace. For example, someone may have garbage in the house and when she wakes up in the morning, she goes with it and throws it in the river because she has nowhere to put it, but those ditches will undoubtedly help us, so in your research, you should coordinate with the government to put emphasis on landlords digging up ditches for their tenants ( FGD I ).

The toilet facilities are few and unhygienic making residents to resort to other options like open defecation, using polythene bags and plastic bottles for their excreta which is dumped /poured in the garbage bins or trenches. Some landlords open their toilets to empty directly in River Rwizi.

We have seen that pollution is from domestic wastes, people opening their latrines anyhow, so everything ends up in the system, which means you cannot rule out the drainage system, so we simply urge people to connect to national water because we know it is safe (KII I).

Participants believe that national water and sewerage cooperation is not treating the water they supply for use or does not treat the water properly. They believe that sometimes they use poor quality chemicals which remain as residues in the water as it is supplied.

You go to get water and find that it is really River Rwizi water that is very brown in color and I don’t know what causes that because I believe they treat it and how come it is dirty as if it was not treated and even after boiling it and putting it down to settle, you find those brown things on the bottom so that water is not good and those who drink it without boiling it will get sick (FGD VI).

Other participants noted that drinking water is treated before it is availed for use but however attributed the poor quality of water accessed to the location of the consumer.

People who live in valleys have a higher chance of receiving dirty water because that is where settlement takes place and everything settles where there is a valley and you find that people who are in valleys have issues with water so the people at the end have a higher chance of receiving dirty water but we always put mitigation measures, for example, we encourage regular flashing of our systems. There are planned sessions every three months sometimes we conduct unplanned system flashing, which is done after getting complaints ( KII III ).

Participants believe that the safety and quality of drinking water is affected by poor maintenance of water systems. Once the water gets to the individual consumers, the overhead tanks are dirty since they are never or rarely cleaned. National water and sewerage cooperation is using old dysfunctional water systems (pipes) that have never been changed from the time they were installed and sometimes lack enough chemicals for treatment.

They are also not cleaning their tanks on a regular basis. Sincerely speaking, people do not wash their tanks for 3–4 years, the tank is just there, there are lizards, bird droppings, monkeys playing on it, and people are unaware of its effect, but people keep saying that national water gives us bad water because people are not sensitized, this is because our duty ends at your tap beyond your tap, it is your responsibility ( KII III ). We have ancient pipes. I believe these pipes are 72 years old, making them incredibly old, and you can detect water pollution from those old pipes since they wear out over time. We might not recognize if the problem has occurred, but with this next project, we are replacing all of them ( KII III ).

Participants reported a deficiency in city planning. Most buildings are not built according to city authorities’ plan. Factories and industries are constructed in water catchment areas with no permits and a provision for their waste disposal hence ending up in dumping their waste inappropriately that ends up in water catchment areas and water sources. These illegal developments are hard to regulate and monitor because of political interference.

We will not evict a factory near the river because there are so many industries along this river here, and when we look at the analysis we have been doing, we find that some samples taken at night have a different water quality than those taken during the day because we suspect that a lot of things are dumped there at night ( KII III ). We no longer listen to technical experts; instead, we listen to politicians, which is driving our people to regress to the early 1960s. Let us prevent political involvement, and since there is a political hand somewhere, people construct factories anywhere even in water catchment areas, making it difficult for us to intervene. Hence, we consider our integrity, I believe there is much we can avoid ( KII II ).

River Rwizi which is the main source of drinking water in Mbarara city has been covered by water hyacinth. The weed has covered the biggest part of the river, it has led to reduction in water volume, it traps garbage deposited in the river and makes pumping of water for treatment hard and costly.

This weed in the River Rwizi called water hyacinth, it collects and traps polythene bags and bottles, and their contents slowly leak into the water, thus I believe they are to blame for the polluted water we drink these days, and you may find that some individuals use it the way it is ( FGD I ).

Community member’s practices for safe and quality drinking water

Water rationing is employed where some areas receive water at night while others during the day to make sure that at least all communities have water per day. Communities are encouraged to have overhead tanks to ensure a continuous supply of water.

We practice water rationing, in which we decide to give water to one zone during the day and another during the night. We make sure everyone has access to water. We encourage people to get overhead tanks because residents in Mbarara get water via direct lines, so if there is no water on a certain day, overhead tanks might be of help ( KII III ).

Participants revealed that there are laws in place to ensure water catchment areas are protected and not encroached on for human activities. Any developments along water catchment areas must be evaluated for impact assessment and must receive permission inform of permits that clearly stipulates what activity is going to take place and for how long and their waste disposal and environment protection and conservation plan.

We have legislation in place, such as the National Environmental Act, which serves as a foundation for all environmental concerns, including the preservation of all water resources. We have national wetland, river bank, and lake shores management in place for the preservation of water sources, and as part of our mandate, we aim to engage communities and stakeholders in the conservation of water sources, and the battle is still ongoing ( KII IV ). Surface water abstraction permit, ground water abstraction permit, water discharge permit, construction permit, there are quite a few and for surface water permit, the main idea is that issuing a permit is to ensure that water is available for all not just some because they all need water so if we allow individuals, and you know individuals are selfish by nature, one can decide to take all the water excluding others so one needs to tell our department based on what they want ( KII I ).

Participants revealed that National water and Sewerage Corporation engages in both internal and external quality control measures to ensure that the drinking water supplied for human consumption is safe and of quality.

We sample together and then discuss the results. They also audit, and now we are going to audit so that if one group is not speaking the truth, another group will. I believe that with that level of transparency, we can perform those system checks and, at the end of the day, compare the data ( KII III ).

Community members have put in place security controls around water sources, the water sources are faced to stop animals from drinking from sources meant to supply drinking water for human consumption, they encourage community members not to send young children to fetch water hence minimising defecating and swimming in drinking water sources.

We have attempted to secure the water in our wetland so that when children go to get water from there, they do not defecate in the area surrounding our water and that cows that go to our water source do not go close the water that we fetch for drinking, which is what we do with our wetland. We make sure that when someone fetches, she/he ensures that the tap is properly closed and that children do not go there to play on the borehole/tap so that we can protect it ( FGD III ).

Water service providers ensure that drinking water supplied for use by communities is treated and is safe and of recommended quality of drinking water for supply to communities. The communities boil the water, sieve it, cover it, use clean water collection vessels, allow it to sediment, and use the supernatant and sometimes use safeguard to treat their drinking water before use.

For safety, I believe that for national water and sewerage cooperation, safety is maintained through treatment to address specific issues such as microbiology nuclei and all that, as well as disinfection, so the water is disinfected, and then there is the aspect of filtration to remove these other suspended materials, so there is this deliberate effort to treat the water so that it meets the standards that we require. So there is an effort in terms of personnel and resources, and the entire site has the idea in mind that this water must be treated to this acceptable standard, so the safety is guaranteed (KII IV) . We boil water, especially when it comes to drinking, and then we filter it to limit the level of contamination since after boiling, there is some dirt that remains on the bottom ( FGD II ).

Communities have a vast number of alternative sources of drinking water that range from, open wells, protected springs, boreholes, gravity flow, and tap water and rain harvest tanks. They use an alternative source depending on what they want to use the water for and the availability, accessibility, safety and quality of water.

We can choose to utilize rain water since we have been spoiled by taps, and as a result, one can build a house without a gutter. Collecting rain water would also help, but the problem is that once collected, one person dips a cup to fetch water and another person brings a jug, making it unsafe, but it would be one of the best ways because that water is free, and I feel like if I could get a crest tank and put it on my house to harvest clean water, could it be a solution and once I get it, I get period to wash it and by the time water enters into that tank I make sure there is a sieve to prevent large things from entering the tank, and once the water is finished, you cleanse the tank and boil water from that tank for drinking ( FGD II ).

Community members have resorted to putting to use the overgrowing garbage and plastic volume to use. Garbage and plastics are being collected and used to make brickets. Plastics are collected and recycled into other accessories like beads and mats.

Organic and inorganic plastics are separated for possible recycling since we cannot do away with this because as a country, we still need jobs, so how can we have these jobs without damaging the environment and River Rwizi ( FGD II ). For example , we make bricks from garbage , so if a person is aware that garbage is important and will benefit from it , he or she will take responsibility , and the responsible companies will come and pick it up . However , people should also be aware of which rubbish has value so that one knows the exact amount he is likely to receive ( FGD VI ) .

Community member’s perceived solutions to ensure safe and quality of water

Participants believe that engaging stakeholders in the catchment area on water source protection guidelines and the need to alert communities/stakeholders in case of contamination, and enforcing laws through political leaders can help ensure safe and quality water to the communities.

When the catchment is not proper, all of these will come down, so when we go to individuals, we must be aware that when certain things are not done correctly, one suffers, and when someone is not aware that chemicals for agriculture once sprayed, such chemicals will come back to me, so those people are not aware. So that is the information we are talking about, the safety of water and how this safety is important to all of us, not just you and me, but all of us, and even the people outside there, because otherwise, we would be treating the symptoms rather than the core cause of the problem ( KII I ).

Participants believe that community sensitisation on the need for safe and quality drinking water will help greatly in changing the mind set of communities.

Sensitization, that is it, the community may not be aware of pollutants rods and, major contaminants of water, so they need to come up with an approach of sensitization in our communities about the dangers of drinking contaminated water by informing the communities that if you use contaminated water, it affects them like getting water borne diseases, so that they can come to understand that they must protect the water sources (KII I). When you go to the villages in these town councils, you will see what I mean, you will see everywhere is garbage and so on, so sometimes we apply law and sometimes you can find a leader in the village does not have a latrine, does not have anything to use for sanitation, you find somebody’s compound is full of funny things and is a leader, so those are the things, but we will keep on community sensitization. Even if we lack resources, we will continue to educate the community, and those who wish to spread the word will go out and improve their surroundings ( FGD II ).

There is need to educate communities to create awareness and ensure that there are buffer zones in water catchment areas.

Awareness has been raised through educating communities and limiting development around waterways. NEMA regulates all projects where it is not possible; NEMA has not authorized any developments beside water resources, and when they are permitted, limitations are imposed. When we look at the River Rwizi, we tried to engage a number of stakeholders, including encroachers along the river basins, so that they can vacate and the buffer is well protected, and when the buffer is well protected, it means that the water is fine. We have also engaged industrialists in managing the effluents coming from their industries, so that the water released from the manufacturing processes is treated before it is discharged into the river, and even before it is discharged into the river ( KII IV ).

Participants believe that following guidelines set to ensure safe and quality drinking water is key to in maintaining safe and quality drinking water.

We must adhere to the drinking water guidelines. What is the distance from the latrine to the water source, sometimes people come and start cultivating near the water sources, so some meters are required from the water source, and even the water source itself has some meters’ standard like 50 by 50 so that if there is run off, it should not filtrate easily into the water source, so after putting the measures at the source, we know that that source is ok ( KII II ).

Participants believe that most factors that affect the safety and quality of water in Mbarara city are due to the behaviour and mind set of community members. National water and sewerage cooperation tries its level best to supply safe and quality drinking water at the recommended standard for home use not at the bottled water standard. Most communities access this resource through illegal connections that makes the cost of supply and maintenance expensive for the service provider thereby making it expensive for the consumer. Communities are aware that the water available for use needs to be boiled before drinking it but for personal reasons like lack of firewood, ignorance and time, they resort to drinking it half boiled or unboiled. City authorities have put in place provisions for waste disposal but communities continue to dispose waste as they wish.

We have a lot of pollution from industrial developments, as well as problems with improper waste management, all of which end in our waters. Leaving that aside, we have a number of illegal construction and illegal activities that are taking place outside of the 100-meter zone that is the protection zone along the river, thus ending up in the river, so the quality of water is not up to date due to poor waste disposal, population growth, and direct influent discharge from industries that is not even treated, and all of that ends up in our water sources ( KII IV ). Individuals illegally connect to the water supply, and we have many such incidents in Mbarara, largely from private plumbers. Connection is also important since someone will connect you where the settlement is and where they do not encourage consumers to be connected, but you will find individuals connecting illegally ( KI III ). We would be boiling the water, but most of the time we do not have enough money to buy charcoal because it is expensive, and sometimes you can have food but you cannot cook because you do not have charcoal, so there is no charcoal to boil water, so most people drink it without boiling it, which has caused typhoid infections. People have been talking about someone who just grabs a cup, pours directly from a jerrican, and drinks ( FGD I ).

To ensure safe and quality drinking water, there is need for collaboration between communities and water service providers. The community needs to be engaged and encouraged to participate in activities aimed at ensuring stable and sustainable supply and use of safe and quality drinking water. There is need to set up community water committees, catchment management committees and school sanitation committees through which information pertaining the use and maintenance of safe and quality water and practices to ensure proper use and maintenance of safe and quality water are shared between communities and water service providers.

we normally have the water user committees to check whoever gets water but they also have a challenge themselves. There is need to make committee on sanitation to ensure things like toilets, hand washing facility, abcd are introduced in the community so that they can reduce the risks and if someone comes from the toilet, there should be a jerrican and soap on the toilet to wash hands so those are the measures we are putting up but I told you that is a behavioural change strategy with its many challenges ( K II IV ). We have not gone to the household level, but we have managed to get to catchment organizations, which are made up of many stakeholders, including local governments, so from local governments, we establish a committee of that catchment organization called the catchment management committee. The organization is comprised of structures that comprise the executive arm, which meets to address issues. There are many entities in that catchment management committee, such as district local government, which brings on board district water officials, chief administrative officers, and LC 5 (Local council) chairpersons ( KII I ).

Participants believe treating drinking water from drinking water sources in Mbarara city at supply system level with chemicals and at home with safeguard will greatly help in improving the quality and safety. This could be by providing chemicals to help in home treatment of drinking water and general treatment of water before it is supplied for use on the taps. There is need to mechanically remove the water weeds/plants, clear bushes around water sources and regularly cleaning the open wells.

Water, in my opinion, should be collected in tanks and then purified at various treatment stations before being released. But my heart continues telling me that maybe National Water and Sewerage Corporation obtains water from a source and store it in tanks, but they don’t treat it before distributing it, or the tanks aren’t washed on a regular basis, or the treatment they use is insufficient. You are aware that in Uganda, less treatment can be used than is recommended, which cannot be sufficient for effective water treatment (FGD II). For safety, I believe that national water and sewerage cooperation maintains safety through water treatment to address specific issues such as microbiological nuclei. Water is disinfected, and there is also the issue of filtration to remove these other suspended things, so there is a concerted effort to clean the water so that it meets the acceptable standards we require. There is constant monitoring to verify that these criteria are met, including the availability of persons and resources to ensure that this water is treated to appropriate levels and that safety is ensured ( KII I ).

Participants suggest that water service providers should ensure that the water they supply is safe and of quality. They should put provisions in place to ensure that the quality is maintained throughout the supply chain by routine monitoring and surveillance and ensuring that any pitfalls are addressed in a timely manner.

I believe that National Water and Sewerage Company should take the time to walk around and observe what is going on, not only to appear to collect their money but also to learn about the kind of water they supply. There is a need for communities to set aside time to meet with individuals and discuss what to do, like we are doing now, and we also know if the problem is here or there. They do not have that time they only come when they want their money but I think giving time to people is also crucial. They should visit different locations since the water may be polluted in some locations but clean in others ( FGD II ).

Participants believe that so many factors contribute to ensuring safe and quality drinking water supply. It is these same factors if not properly addressed that will lead to deterioration of water quality. By engaging stakeholders, it is a great step towards provision and sustaining clean, safe and quality water. Stakeholders should provide community with feasible solutions, keep the process in check and hence the safety and quality of drinking water is achieved and maintained.

We are executing a project in Rubanda, Kabale, Ntungamo, and Rukiga where they are attempting to engage with people to preserve water in their farmland in order to maintain it for a longer period of time. But when it is running, it runs a way with soil and they see that some diseases are becoming prevalent and they start asking themselves that they never used to get these diseases so where are they coming from not knowing that it is due to mishandling some aspects of the environment such as hormonal birth control measures and when we shared those things they understood ( KII I ). We have national wetland, river bank, lake beaches management in place for water source protection, and as part of our mandate, we attempt to engage communities and stakeholders in water source conservation and protection, and the struggle is still ongoing ( KII III ).

This study explored community perceptions and practices about drinking water quality and safety from various water sources in Mbarara, Uganda. We wanted to know what community members thought about the quality of water drawn from drinking water sources, what is responsible for the quality, what they do to ensure the drinking water is safe and of good quality, and what possible solutions there are to ensure the water is safe and of good quality. The findings show that populations in Mbarara, south western Uganda, regard the quality of drinking water drawn for use as poor, dirty, tastes salty, and is generally unsafe for human use, as well as being limited in supply to communities.

Community member’s perceptions of the quality and safety of drinking water

Based on the color, taste, and presence of physical pollutants, community members perceive the safety and quality of drinking water to be poor, dirty, and salty. This perspective was echoed by members of the community and key informants. They believe that the safety and quality of drinking water is poor and that it does not meet established standards for human consumption, yet they continue to consume it since it is the only water available to them. Similarly, a study by Apecu and co-authors on quality of water sources in South-western Uganda using the compartment bag test (CBT) found out that most of the water sources in the study areas were not fit for human consumption without prior treatment [ 25 ]. This is odd given that this is a city neighbourhood where social services should be of higher quality. This however is not unique to Mbarara city alone since the World Health Organization estimates that 2 billion people lack safely managed services, including 1.2 billion with basic services, 282 million with limited services, 367 million using unimproved sources, and 122 million drinking surface water, when the United Nations Sustainable Development Goal6 is to ensure universal access to water and sanitation by 2030 [ 26 ]. In addition, without point-of-use treatment systems, at least four billion people worldwide do not have access to clean drinking water or are under the impression that it is unsafe to drink [ 27 ]. This is owing to increased water demand, reduced water supplies, and increased water pollution as a result of tremendous population and economic expansion. In many underdeveloped nations’ urban areas, badly polluted little water sources are widely used [ 28 ]. Contamination concerns are considerable in urban areas due to increased population. Yet, because most populations in urban areas cannot afford the expense of a treated water system and lack access to infrastructure, their sense of quality relies on modest water systems or various sources to supply their drinking water demands [ 29 ]. In addition, perceptions of worsening water quality have been observed all across the world, in both rich and developing nations, and ’Thousands have survived without love, not one without decent water quality [ 30 ]. It should be emphasized that the types, magnitudes, and extents of water quality concerns vary from country to country, and even from region to region within a country. This might be the result of uneven growth, accessibility, and water demands. Issues may be resolved via trust, political will, and social will, albeit the methods vary depending on the region of the country. It should be noted that; trust enables water delivery businesses to achieve both social and commercial benefits [ 31 ].

Community member’s perceived factors responsible for safety and quality of water

According to the findings of this study, the poor drinking water quality in Mbarara city is mostly attributable to improper waste management, poor water treatment, poor system maintenance, political interference, population increase, and water hyacinth. Some variables do not remain constant throughout time. These factors are not static, but instead vary over time. Some of these factors are human made while others are beyond the communities’ control. Issues such as flooding and water cost fluctuate between wet and dry seasons; changes in the water supply; changes in the community’s/family’s ability to maintain quality, household income, and level of awareness within a given community [ 32 ]. Similarly, to our study, the decline in water quality is caused by increased demand for water, reduced water supplies, and increased water pollution as a result of dramatic population and economic growth [ 33 ]. This is due to the discharge of essential pollutants from anthropogenic activities such as industrial applications (solid/liquid wastes, chemical compounds, mining activities, spills, and leaks), urban development (municipal wastes, land use practices, and others), and agricultural practices (pesticides and fertilizers) that affect the safety and quality of water in urban communities [ 34 ]. There are other key pollutants emitted by natural processes that contribute to climate change, natural catastrophes, geological causes, soil matrix, and hyporheic exchange in the aquatic environment, all of which might have a detrimental impact (e.g. Endocrine disruptions, DNA damage, cancerogenicity). These elements, together with rising temperatures, accelerated remobilisation processes, and hormone pollution, have a greater impact and may disrupt natural environmental equilibrium. It should be noted that, as indicated in this study, greater population expansion frequently coincides with the demand for more food and food production, forcing communities to encroach on water catchment areas for agriculture [ 35 ]. Because of the requirement for improved yields on a short plot of land, fertilizers and crop insecticides are used indiscriminately. These changes in land-use/land-cover (LULC) pattern degrade water quality. This is due to the interdependence of population and economic growth, as well as water consumption, resources, and pollution, all of which contribute to water shortage [ 36 ]. Moreover, population growth leads to deforestation to support agricultural development and urban expansion in Mbarara city, necessitating the need for water quality protection to meet urgent human requirements while also ensuring the long-term quality of water resources. There is a lot of garbage produced in the midst of economic issues, making it hard to properly dispose of or pay for proper disposal through structured public services, resulting in waste buildup. Occasionally garbage is dumped in available water sources or catchment areas. This not only affects the quality of drinking water, but it also raises the cost of treated water since more sophisticated procedures are used to assure that the water supplied to communities is treated and of the required standard. A study to investigate the impact of drinking water quality and sanitation on child health: Evidence from rural Ethiopia demonstrated that uncontaminated stored drinking water and safe child stool disposal are related with 18 and 20 percentage point decreases in child diarrhoea rates, respectively [ 37 ].

To ensure that drinking water from sources in Mbarara city is safe and of quality for use, as well as available and accessible in quantity, service providers use a holistic approach, water rationing, changing chemicals as often as possible depending on the quality of water available for treatment, and the water treatment process is quality controlled internally at National Water and Sewerage Corporation facility treatment centers and externally at Uganda National Bureau of Standards. National environment Management Authority issues permits for any developments that would result in waste to be dumped in River Rwizi or any developments close to the water catchment areas. This can be traced to the fact that, National water and sewerage cooperation, through their service accelerated program has created awareness for the need and maintenance of safe and quality water through radio talk shows, school health sanitation program and in churches. The communities, on the other hand, ensure that bushes are cleared around water sources, that adults and children in company of adults have access to these sources, that overhead tanks are installed and maintained, and that drinking water is boiled. This is crucial in increasing the availability, accessibility, and appropriate quantity of quality and safe drinking water since they are a primary measure for preventing different water-borne infections, poisoning, disease outbreaks, and human deaths in urban settings [ 38 ]. A healthy population is critical for health and long-term socioeconomic growth. Clean drinking water is a crucial component of Primary health care and plays an important role in poverty alleviation, hence boosting economic growth [ 24 ]. Due to the exponential growth in water demand and the decrease in usable freshwater due to various climate, environmental, and anthropogenic events, rain water harvesting has become a useful practice because it is inexpensive and low risk if the roof catchment, collection system, and storage are well maintained [ 39 ]. Similar to the findings of this study, there is a need to better understand social factors such as governance and increased understanding of diverse physical and social influences that lead to a more comprehensive understanding, knowledge, and need for clean, safe, and quality water, as well as water security, which is defined as a reliable and adequate supply of safe and quality water to support humans and ecosystems at all times [ 40 ]. Furthermore, there is a need to raise awareness about the need of clean, safe, and high-quality drinking water, as well as the necessity for other government stakeholders to work together to enhance water quality for improved health [ 41 ]. As a result, there should be a continuous extensive water quality monitoring program of drinking water sources across urban areas and their adjacent settings to guarantee population health and environmental balance [ 42 ]. However, this requires policymakers and managers to use Artificial Neural Networks (ANNs) and risk analysis techniques to predict water quality because such predictions indicate the level of risk (low, moderate, or high) to the inhabitants, allowing for the implementation of preventive measures to avoid illness or disease outbreaks. This can be achieved through engaging in socio-hydrological research and data analysis to help improve the current understanding and management of the quantity and quality society dynamics for drinking water quality and safety [ 40 ].

Community member’s perceived solutions for safe and quality of water

The participants in this study feel that stakeholder involvement, community awareness, establishing catchment plan rules and regulations, water treatment and maintenance, surveillance, and monitoring might all assist to improve and maintain the quality and safety of drinking water in Mbarara. This is due to an increasing number of people turning to alternative sources of drinking water, such as rainwater harvesting, to reduce their environmental footprint, because rainwater harvesting (RWH), while not economically feasible, provides protection against damage caused by increasing precipitation frequency and intensity [ 43 ]. Similarly, Anjana and colleagues in India advocated training people on drinking water treatment methods, sanitation, and hand washing habits since participants believed their drinking water was pure and didn’t need any further treatment [ 44 ]. Furthermore, an Ochilova and colleagues study recommended the need for rational use and protection of water resources, as well as ensuring and guaranteeing citizens’ right to a favorable natural environment, as well as helping to protect land, subsoil, forests, flora and fauna, atmospheric air, natural resources, and improving healthy family life [ 45 ]. There is a need to connect rural and urban areas. The two communities are mutually reliant. Water streams come from rural communities to feed water to urban cities; food production is mostly done in rural communities but is consumed in both rural and urban areas. The rural people should be given policy attention to the ecosystem services that rural areas provide, and the rural area’s ecology should be conserved for long-term service delivery, reducing the need to farm in water catchment areas that exist in already overcrowded urban areas [ 46 ]. Most importantly, there is a need to invest in implementing sustainable technologies for future water supply and sanitation because the amount of time and money spent by developed, developing, and underdeveloped countries on water investments, operation, and maintenance has changed dramatically in recent decades [ 47 ].

Strengths and limitations of the study

The findings of this study represent the perspectives and opinions of community members and stakeholders in Mbarara City’s water provision and maintenance. The study’s main strength is the unanimity in their thoughts and beliefs. Our capacity to interact with communities and stakeholders in water service supply to investigate their perceptions and practices about the safety and quality of drinking water is our strength. Key informants in this study were water service providers; this may have worked against us since they were afraid to completely voice their ideas and opinions for fear of acting against the expectations of their employers. Nonetheless, we ensured all of our participants of anonymity and confidentiality during the informed consent procedure. We acknowledge that this study presents views and opinions of communities and stakeholders in the water service provision and maintenance in Mbarara city.

Residents in Mbarara perceive the quality of drinking water drawn for use as not good, dirty and salty, and generally unfit for human consumption and limited in supply to communities. Increased population expansion and accompanying human activities, political intervention, flooding, and deficiencies in water treatment, supply, and management are all contributing to poor quality of drinking water in Mbarara city. The service providers use water rationing, offer permits for developments in the city and most importantly in water catchment areas, the water is treated and the water supply system is quality controlled both internally and externally, water sources are protected from contamination by clearing bushes and fencing, and alternative sources are used to supply drinking water in the event of suspected contamination.

Perspective and recommendation

We recommend a comprehensive approach to the provision, use, and management of drinking water sources. Policymakers and stakeholders should collaborate to increase knowledge, sensitization, and practices aimed at providing, using, and maintaining safe and high-quality drinking water from drinking water sources in Mbarara, south-western Uganda.

Acknowledgments

We thank all those who participated in this research project. We acknowledge the study participants and the Alex Tumusiime (AT) and Patience Nabaasa the study Research Assistants and Owokuhaisa Judith(OJ) who read through the transcripts and coded We acknowledge the reviewers who are going to review and provide constructive comments that will help perfect this manuscript.

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Home > Books > Water Challenges of an Urbanizing World

Safe Drinking Water: Concepts, Benefits, Principles and Standards

Submitted: 15 March 2017 Reviewed: 28 September 2017 Published: 21 March 2018

DOI: 10.5772/intechopen.71352

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Water is connected to every forms of life on earth. As a criteria, an adequate, reliable, clean, accessible, acceptable and safe drinking water supply has to be available for various users. The United Nation (UN) and other countries declared access to safe drinking water as a fundamental human right, and an essential step towards improving living standards. Access to water was one of the main goal of Millinium Development Goals (UN-MDGs) and it is also one of the main goal of the Sustainable Development Goals (SDGs). The UN-SDG goal 6 states that “Water sustains life, but safe clean drinking water defines civilization”. Despite these facts, there are inequalities in access to safe drinking water in the world. In some countries, sufficient freshwater is not available (physical scarcity); while in other countries, abundant freshwater is available, but it is expensive to use (economic scarcity). The other challenge is the increasing population of the world at an alarming rate, while the available freshwater resources almost remains constant. This chapter presents aspects of safe drinking water - background information, definition of water safety and access, benefits, principles and regulations, factors challenging the sustainable water supply and water quality standards and parameters.

• accessibility
• inequalities
• quality standards

Author Information

Megersa olumana dinka *.

• Department of Civil Engineering Sciences, Faculty of Engineering and the Built Environment, University of Johannesburg, South Africa

*Address all correspondence to: [email protected]

1. Introduction

Water covers more than two-thirds of the earth’s surface, but mostly salty and undrinkable. The available freshwater resource is only 2.7% of the available water on earth but only 1% of the available freshwater (in lakes, rivers and groundwater) is accessible. Most of the available freshwater resources are inaccessible because they are in the hidden part of the hydrologic cycles (deep aquifers) and in glaciers (frozen in the polar ice), which means safe drinkable water on earth has very small proportion (~3%) in the freshwater resources. Freshwater can also be obtained from the seawater by desalinization process. In some countries, sufficient freshwater is not available ( physical scarcity ). In some countries, abundant freshwater is available, but it is expensive to use ( economic scarcity ).

South Africa receives about 450 mm annual rainfall and is classified as a water-stressed country [ 1 , 2 ]. The available freshwater resource can sustain 80 million people only. Some African countries (Ethiopia, Congo and Papua New Guinea) have excess freshwater resources, but they are having water shortage due to economic reasons. Ethiopia, the second populous countries in Africa, is the water tower of east Africa due to the availability of abundant water (nine major river basins). However, the country is among the few countries in the world affected by chronic water problem. The water scarcity in the world is further aggravated by the reduced water quantity (or an increased water demands) due to population growth and the declining of water quality by pollution.

As a criterion, an adequate, clean and safe drinking water supply has to be available for various users [ 3 ]. There is no universally accepted definition of “safe drinking water.” Safe drinking water is defined as the water that does not represent any significant risk to health over a lifetime of consumption [ 4 ]. The safe drinking water must be delivered that is pure, wholesome, healthful and potable. Safe water is not necessarily pure, it has some impurities in it. It contains some traces of salts such as magnesium, calcium, carbonates, bicarbonates and others. The degree of purity and safety is a relative term and debatable. Clean/pure water has no minerals and it only contains H and O. According to the Monitoring organizations under the supervision of the Joint Monitoring Programme (JMP), “safe drinking water” is defined as water from an “improved water source,” which includes household connections, public standpipes, boreholes, protected dug wells, protected springs and rainwater collections. According to the same organization, “access to safe drinking water” is defined as the availability of at least 20 l per person per day from an “improved” source within 1 km of the user’s dwelling.

Safe drinking (potable) water is the water that can be delivered to the user and is safe for drinking, food preparation, personal hygiene and washing [ 3 ]. The water must meet the required (chemical, biological and physical) quality standards at the point of supply to the users [ 5 ]. Therefore, safe drinking water is a relative term, which depends on the standards and guidelines of a country; the standards set for the different quality parameters are different. The standard of WHO is not exactly the same as that of USA, Canada, European Commission, Russia, India, South Africa, Ethiopia, and so on. The term “safe” depends on the particular resistance ability of an individual. Water that is safe for drinking in some African countries might not be safe in European countries. Some African countries already developed resistance to some of the water-related diseases.

Safe drinking water is anonymously accepted as an international agenda and priority, which is evident from the MDGs and SDGs of the United Nations (UN) initiative and vision (MDGs 7 and SDGs 6). Despite the MDGs effort, still many people lack access to safe drinking water, even lack access to basic water. Globally, more than 1 billion people do not have access to safe drinking water. According to the Third World Academy of Sciences (TWAS) report [ 6 ], contaminated/dirty water is killing more people than cancer, AIDS, wars or accidents. Population of the world is increasing and the available freshwater resources almost remain constant. The number of people without access to safe drinking water is increasing. This is mostly related to the ever-increasing population growth in the developing countries and the inability (or unwillingness) of governments (local and national) to provide adequate water supply facilities in these countries [ 7 ].

2. Drinking water safety and access

2.1. access to safe drinking water.

Water is connected to every form of life on earth and is the basic human need, equally important as air. Water is connected to every aspect of human day-to-day activities directly or indirectly. At a basic level, everyone needs access to safe water in adequate quantities for drinking, cooking, personal hygiene and sanitation facilities that do not compromise health or dignity. Therefore, access to safe and dependable (clean and fresh) water is the fundamental/basic right of humans [ 8 ]. The UN and other countries declared that access to clean, safe drinking water is a basic human right, and an essential step toward improving living standards worldwide. Access to water was one of the main goals of UN-MDGs and it is also one of the main goals of the UN-SDGs. The South African constitution declares “ access to water and food for all ” as the main goal in the constitution following the 1998 National Water Act [ 9 ]. Despite these facts, still there are inequalities in access to safe drinking water in South Africa and in the world, the problem has more impacts on the poor, women and children. There are also inequalities within and among nations [ 6 ]. For instance, the population with access to safe drinking water in Congo was 77% for rural dwellers and 17% for rural dwellers by the year 2002 [ 6 ]. Inequalities in access to water and sanitation are morally unacceptable, but they are prohibited under international law [ 3 ].

Globally, it is estimated that 89% of people have access to water suitable for drinking [ 10 ]. According to UNDP [ 11 ] report, one out of six people do not have access to clean water, that is, about 1.1 billion people lack access to safe drinking water. In some countries, especially in Africa, almost half of the population do not have access to safe drinking water and hence, is afflicted with poor health [ 12 ]. The number of people without safe drinking water is more than the number reported by UNDP [ 11 ]. This is due to the fact that most of the water supply facilities initiated during the MDGs in developing countries are not functioning properly.

2.2. Benefits of safe drinking water

Water of satisfactory quality is the fundamental indicator of health and well-being of a society and hence, crucial for the development of a country. Contaminated water not only has the potential to pose immediate threat to human, but also can affect an individual productive rate [ 13 ]. According to the WHO [ 14 ] report, an estimated 1.1 billion people in the world drink unsafe water. Approximately 3.1% of the global annual death (1.7 million) and 3.7% of the annual burden (disability) (54.2 million) are caused by the use of unsafe water and lack of basic sanitation and hygiene.

Water provides a number of benefits and services for humans and the ecosystem. As reported by OECD [ 15 ], the benefit of water is not documented sufficiently, resulting in low political priority for water issues and in suboptimal levels of investment in water infrastructures. The same document also indicates that the benefit of water is mostly hidden in other technical documents. Most researchers have indicated that the benefit-cost ratio of access to water is more than 2, and in some cases, it can reach 7.0. In developing countries like Africa, the benefit-cost ratio of access to water is very high (more than 5:1 ratio) because it is related to every dimension of developmental activities (agriculture, energy, industry, etc.). In such areas, the return on investment in water services usually result in a substantial economic gains, estimated in the range of 5–28 USD per 1 USD [ 7 ]. In addition to the economic gains, water supply projects have technical, environmental and political gains. Water sector is interconnected with other development sectors (agriculture, energy, industry, etc.) and factors (social, economic, environmental, health, educational, legal and political) at local, national levels, regional and international levels [ 16 ]. In fact, access to safe water has a number of direct and indirect benefits related to health, education, poverty and environment. The UN World Water Development Report [ 7 ] indicated that there is a linkage or nexus between water and sustainable development, far beyond its social, economic and environmental dimensions. The report clearly indicated that access to safe water has a great role in addressing the developmental challenges, such as human health, food and energy security, urbanization and industrial growth, as well as climate changes. Especially, there is a strong nexus between water, food and energy [ 3 ].

The MDGs of the UN targeted to “ halve the population without access to safe drinking water and basic sanitation” in the period from 1990 to 2015. According to the report by WHO and UNICEF [ 17 ] through their Joint Monitoring Programme (JMP) for water supply and sanitation, about 2.3 billion people have gained access to an improved drinking water. The report indicates an impressive gain has been made in the past two decades, but much has to be done. The success of MDGs is even doubtful since many of developing countries, especially the poor are still struggling to get access to safe drinking water. As stated in Section 2.1, the number of people without access to safe drinking water is more than the value reported by the UN.

Research has shown that the majority of people without access to safe water are from developing nations [ 18 ]. This shows that many people in the developing world, especially Africa, still depend on unsafe water sources for daily water need and affected by chronic water problems and water-borne diseases. Millions of people die due to water-related diseases like cholera, diarrhea, malaria, dengue fever, and so on. Globally, water-borne diseases kill more than 25,000 people per day and about 5000 children die per day due to water-related diseases (mainly diarrhea) [ 12 ], most of them can be easily prevented. Diarrhea and related diseases kill about 1.8 million children every year, most of them are in developing countries [ 19 ]. It is also estimated that about 1.8 billion people drink water contaminated with Escherichia coli (indicator of fecal contamination) [ 20 ]. In many parts of the world, especially developing countries, water-borne diseases represent the leading cause of death. Thus, access to safe water means a reduction of water-related diseases. It is an opportunity for improved health because it reduces the outbreak of health hazards.

In cognizant to the benefits of water, the newly introduced ambitious Sustainable Development Goal (SDG) by UN in 2014 [ 21 ] considers water as one of the main developmental pillars under SDG 6. In fact, water was also one of the main goals of the UN-MDGs. The UN-SDG 6 states that “ Water sustains life but safe, clean drinking water defines civilization. ” The UN-SDG 6 recommended a dedicated SDG for water under five target areas such as (i) WASH, (ii) water resources, (iii) water governance, (iv) water quality and wastewater management and (v) water-related disasters. This indicates that the benefit-cost ratio of water is very high since it has social, economic, financial and environmental benefits. The benefit of water extends to other developmental activities/sectors such as health, education, agriculture and food production, energy, industry and other social and economic activities [ 7 ]. Therefore, achieving the UN’s SDG 6 seems very hard, especially in the poorest countries like Africa where there are lots of problems and challenges. It requires dramatic improvement to the quality of life and longevity [ 7 ]. If we declare that “access to clean safe drinking water is a basic human right, then providing the necessary education, infrastructure and support to ensure the success of SDG 6 is the responsibility of us all.” In developing countries, improving access to safe water requires the establishment of good governance [ 22 ].

3. Basic principles of safe drinking water supply

3.1. definition of terms.

There are basic standards, norms, criterion and indicators for safe drinking water. There are also policies, strategy and program under safe drinking water. These terms are well defined by Bos et al. [ 3 ]. Norm refers to the standard of development related to the large group of society. Criterion refers to the agreed norm or standard used for the decision. Indicator refers to the measured value of individual water quality parameters. Standard refers to the agreed target/threshold value established as an agreed target, which is set by an authority. There are various water quality standards and criteria in the world. Details of the water quality standards are provided under Section 5.3.

3.2. Water regulations and act

Water regulations are important for the provision of drinking water that is sufficient in quantity, safe, accessible, acceptable, affordable and reliable. Drinking water regulations include controlling of the water supply systems which are water source, water treatment, distribution, use, wastewater and gray water. Countries regulate drinking water differently depending on the quality of their water source. As stated earlier, different countries regulate drinking water differently depending on the quality of their water source.

In South Africa, water sources are monitored by the Department of Water and Sanitation (DWS). This was achieved by the implementation of the National Water Act (NWA) 36 of 1998 [ 9 ]. The purpose of the NWA is to ensure that the nation’s water resources are protected, used, developed, conserved, managed and controlled. Local authorities are responsible for the supply of water to residents. This was achieved by the implementation of the Water Services Act (WSA) 108 of 1997. WSA are established to provide the following services [ 9 ]: (1) ensuring the rights of access to basic water supply and sanitation; (2) setting national standards, norms and tariffs; (3) water service development plans; (4) prepare the regulatory framework for water service institutions and intermediaries; (5) establish and disestablish committee for water boards and water services and their powers and duties; (6) monitoring water services and intervention and (7) providing financial assistance to water service institutions.

As a criterion, an adequate, clean and safe drinking water supply has to be available for various users [ 3 ]. Moreover, water has to be accessible for all, including children, elders and disabled ones. Water availability refers to both sufficient quantities and reliability of service provisions. Adequacy refers to both the quality and quantity of water. Reliability refers to continuity of the service provision for the current and future generation, which is covered under the principle of sustainability, system robustness and resilience. Acceptability refers to esthetic value of water – the acceptable appearance, taste and odor of water. It is highly subjective parameter and largely depends critically on the perceptions of the local ecology, culture, education and experience and hence, there is no set clear and objective global acceptability standards. Accessibility to water refers to the accessibility to a reliable supply of water on a continuous basis close to the point of demand: within everyone’s reach: home, school, work, public places. It is related to the distance of water source from the point of demand (30 minutes walk or 0.2 km). That means the water has to be accessible for everyone, including children, elders and disabled ones. The detailed definition of the above water variables can be obtained from Bos et al. [ 3 ].

The role of a drinking water supplier is to provide adequate water for the community and prevent/mitigate risk of water contamination in different elements/points of water supply system such as source, treatment and distribution. They also should assure the delivery of a safe and esthetically pleasing drinking water to the consumer’s point. In general, the prevention, mitigation and elimination of water contamination are the responsibilities of water providers and regulators. Water regulations are also important for the provision of drinking water that is sufficient in quantity, safe, accessible, acceptable, affordable and reliable. Countries regulate drinking water differently depending on the quality of their water source. According to the WHO [ 23 ] and US Environmental Protection Agency [ 24 ], there are guidelines and principles that need to be followed for water to be considered fit for use. The guidelines are as follows: physical, microbial, chemical and radiological. The water quality standards for different countries are summarized under Section 6.1.

4. Potential factors challenging water supply systems

The water supply system (WSS) is a system of hydrologic and hydraulic components, including all buildings and installations, used to meet water requirement of industrial and population centers. It consists of capturing raw water, drainage basin, water capturing and transmission pipes, water treatment plants, treated water transfer pipes, drinking water adduction pipes, pumping stations and pumping, water storage tanks and water distribution networks to the consumers [ 25 , 26 , 27 ]. A conventional water supply system is a combination of complex subsystems, consisting of the water supply catchment, water storage reservoir, water treatment plant and water distribution network [ 26 ]. Water supply and distribution systems typically comprise a combination of source works, treatment facilities, service reservoirs, pumping stations, pipes, valves and so on [ 25 ].

4.1. Sustainable water supply and challenges

In the ambitious vision 2050 of the SDG, sufficient and safe water has to be available for all to support human’s basic needs and ecosystem integrity [ 7 ]. The sustainable development of the world largely depends on the sustainable development of water since other sectors are interrelated with water resources. It requires the progress of the three dimensions of the sustainable development (social, economic and environmental) [ 7 ]. Thus, the vision of SDGs (goal 6) for water requires management of the available water and related resources in an integrated, inclusive and participatory approach. Huge investment is highly needed for infrastructure, treatment plant systems and water recycling [ 29 ].

A WSS may face a number of challenges associated with many factors in provision of quality, efficient, reliable, resilient and sustainable water supply for the present and future generations. Rural areas are facing more financial and technical difficulties than urban areas. According to da Silva et al. [ 29 ], wealthier urban areas have more financial capacity and technical expertise than the poor rural communities to raise the capital needed for water infrastructure. Especially in rural areas with arid environment and great hydrologic variability, reliable and dependable WSS requires energy intensive infrastructure. A study made by Chung et al. [ 30 ] showed that robust optimization approach is a useful tool in reliable WSS design, under uncertainty, that prevents system failure at a certain level of risk.

Achieving the SDG requires huge capital investment and good governance , which is lacking in developing countries. Huge investment is highly needed for infrastructure, treatment plant systems and water recycling [ 28 ]. The sustainable development of water sector is affected by the sustainable development of the other sectors. Unsustainable developmental activities are greatly threatening the quantity and quality of renewable freshwater resources. Various driving forces are threatening the sustainability of WSS such as population increase at alarming rate, high rate of urbanization, significant land cover and climate change, the high demand for new energy supplies and poor governance. These driving factors are causing an increasingly frequent water shortage, floods and droughts, deleterious runoff, coastal hypoxia and depleted aquifers [ 28 ]. They have challenged the success of MDGs and will continue challenging the achievement of the newly set MDGs.

The other challenge of sustainable water supply is the lack of appropriate policies and programs that consider rural diversity. Small rural communities are the most vulnerable to water contamination. Furthermore, they struggle to secure the necessary funds for infrastructure necessary to improve water treatment and delivery systems, and thus fail to meet drinking water quality regulations. Community management is the tendency to provide water to rural areas worldwide. Despite the diversity of rural communities and their water supplies, policies tend to be uniform. A quantitative and qualitative study made in the Colombian Andes on four rural water supplies by considering aspects of infrastructure, training of human resources, revenue collection, water quality and post-construction support [ 31 ]. The study concluded that there is a need to design policies and programs that consider rural diversity to facilitate the sustainable water supply services. According to Kot et al. [ 32 ], policymakers have to align small communities with appropriate water quality goals by considering the contextual and cultural differences among rural communities.

In urban areas, the infrequent and insufficient application of adaptive capacity indicators in urban sustainable water supply systems has led to the challenge of dynamic and uncertain urban water supply systems. This condition is threatening the sustainability of urban water supply systems and raises concerns about the progress of urban water systems for variation and change [ 33 ]. As suggested by Spiller [ 33 ], future research should focus on developing methods and indicators that can define, evaluate and quantify adaptive capacity indicators under the three dimensions of sustainable development ( economic, environmental and technical ). Therefore, there is an urgent need to move toward the use of adaptive capacity indicators.

Moreover, there is an urgent need to move toward sustainable and resilient smart water grids in urban areas. Urban water supply systems are facing challenges of sustainability and resiliency, including water leaks, over-use, quality issues and response to drought and natural disasters [ 34 ]. Information and communications technology could help address these challenges through the development of smart water grids that network and automate monitoring and control devices [ 34 ]. While impressive progress has been made on technological elements (information and communication), the application of a smart water grid has received scant attention, especially in developing countries.

In fast-growing urban regions, water demand and supply modeling is extremely important. An accurate prediction of water demand plays a crucial role for water service providers in the planning, design and water utility asset management of drinking WSS. However, accurate prediction is always challenging due to the fact that predicting models require a simultaneous consideration of a number of factors affecting water demand and supply pattern. Some of the factors include climate changes, economic development, population growth, migration and consumer behavioral patterns [ 35 ].

4.2. Challenging factors for water supply systems

There are a number of factors challenging WSS. Some of the factors are aging infrastructure, water service provision thinking horizons, catchment (mountain)-specific issues, climate change, knowledge gaps with respect to present and future hydrology, accurate water demand prediction, land use/cover change, optimal operation of water supply systems, cost recovery, operating cost, water quality (water pollution), water scarcity, water leaks, low water pressure, over-use, response to drought and natural disasters, rapid urbanization, population growth, migration, demographic changes, economic development, consumer behavioral patterns, efficiency and reliability of a water supply system, self-sufficiency through use of alternative water sources, dynamic and uncertain urban water systems, complex dynamic human-environment coupled systems (non-holistic or siloed management), lack of adaptive capacity indicators to assess sustainability of water systems, scant attention of smart water grids (not supported by information and communications technology), lack of policies and programs that consider rural diversity and cultural differences and neglecting wastewater management are mentioned as challenges to water supply systems for provision of sustainable and reliable water services, which meet acceptable standards for present and future generations [ 14 , 25 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].

According to Berg and Danilenko [ 38 ], WSS has faced a number of global challenges in the twenty-first century. The major challenges are population growth, uncertain climate changes, socio-environmental issues, limited water resources, economic crises and continuous aging process. There are a number of problems associated with the continuous aging process, including low pressure, water loss and water quality deterioration [ 36 ]. The major challenges in the provision of safe water and sanitation on a global basis are [ 37 ]: (1) water contamination within distribution systems; (2) increasing water scarcity and shortages; (3) implementing innovative and low-cost sanitation systems; (4) providing sustainable water supply systems and sanitation for megacities; (5) reducing the disparities in access to water and sanitation and (6) developing financially feasible water and sanitation services.

Increasing urban water self-sufficiency: The main drivers for increased self-sufficiency were identified to be direct and indirect lack of water, constrained infrastructure, high-quality water demands and commercial and institutional pressures. Public water service providers should plan to achieve a high level of reliable, stable and dependable water supply, which can be achieved by combining alternative water supply systems with the conventional ones. A case study made by Rygaard et al. [ 39 ] demonstrated an increase in water self-sufficiency ratios to more than 80% when the conventional water supply was supplemented by water recycling, seawater desalination and rainwater harvesting. However, the study indicated that care should be made during the introduction of alternative freshwater sources since it may raise several challenges such as very high-energy requirements (> tenfold ) by the alternative techniques, appearance of trace contaminants in recycled wastewaters and the possible resistance from consumers due to the changes made to the drinking water system. The study concluded that despite the challenges, urban water self-sufficiency concepts in combination with conventional water resources are already helping to reach the goal of urban WSS.

Infrastructure development: Water services are in crisis or approaching crisis conditions due to the neglect of infrastructure, particularly underground water mains and sewers, largely because of political unwillingness to allow charges to be set high enough to achieve sustainable cost recovery. This is true in both developed and developing countries [ 43 ]. In developed countries, the solutions are relatively affordable; what is needed is the political commitment to take action. In developing countries, the situation is more serious due to a combination of neglect and rapidly growing urban populations. Without doubt, infrastructure is essential for sustainable water development. But infrastructure alone will not contribute to the improvement of the quality of life unless it is part of an overall framework: development, economic growth, social equity and environmental protection. As mentioned by the Nobel laureate Amartya Sen [ 45 ], “the absence of infrastructure has a pervasive influence on poverty, but at the same time is not a free-standing factor in lifting people from it.” Thus, the focus should be the use of physical infrastructure as a driver for sustainable development. But infrastructure development takes more time beyond the life of most governments. The thinking of water service providers has to be based on long-term horizons. In order to improve the accountability and social welfare of relatively low-income households, there is a need for more comprehensive frameworks (institutional, legal, regulatory, policy and management) than the existing ones at present [ 45 ]. Venkatachalam [ 47 ] suggested that improving the existing public water supply to a satisfactory level will improve the household’s willingness to pay because the willing households could reap significant benefits from the improved supply. This would help the government agencies to come out with an improved water tariff policy that will cover cost of investment and maintenance.

Urban water pricing ( cost recovery, affordability and water conservation ): Policymakers increasingly consider pricing as an important tool for cost recovery, affordability and water conservation to address water scarcity issues. However, implementing tariff reforms is often difficult in practice due to political factors and the absence of governance structures that can result in quality service provision. Additionally, institutional replication of successful water pricing policies has been difficult due to incomplete information and the contextual uniqueness of local institutions, politics and social relations. Water service provision thinking has to be based on long-term horizons. Infrastructure development takes time beyond the life of most governments. In those countries without such political continuity, there is a need for all political factions to agree on goals, policies and plans. It is unlikely that water can ever be separated from politics, but city political consensus must be attempted [ 53 ].

Climate change : Climate change is affecting the frequency of extreme weather events and hence increasing the uncertainty about water availability and reliability [ 50 ]. A properly planned, developed and managed infrastructure and related institutional capacities are required in order to buffer seasonal climatic variations and address water demand issues. More emphasis should be given to mountain-specific issues. Major priority areas include water governance for transboundary basins, cross-border information systems, establishing a knowledge base for mountain regions and sharing benefit between mountain and downstream communities [ 42 ].

Knowledge gaps: With respect to present and future, hydrology poses a serious constraint for infrastructure development. Changing hydrology will pose special challenges to the design, planning and management of infrastructure [ 42 ]. Land use influences raw surface water quality and treatment costs for drinking water supply [ 51 ]. Anthropogenic disturbances to the environment can compromise valuable ecosystem services, including the provision of potable water. These disturbances decrease water quality, potentially increasing treatment costs for producing drinking water.

Efficiency and reliability of a water supply system: Water inflow is among primary determinants of the successful functioning of the entire water supply system since it influences water storage. Developing an approach to assess the resilience of WSS under limited rainfall provides useful insights into effective system management [ 26 ]. For instance, understanding WSS resilience can support the identification of the minimum/threshold rainfall value by which WSS can maintain its operation without failure. It can also help to understand and identify the sensitivity of the WSS to a changing rainfall amount and distribution pattern. In this regard, the water service providers are well aware of the stability of WSS and know when the system experience a pressure or disruptive influences.

Challenges for water supply and Governance: Cities struggling to keep pace with population and demographic changes are not unique. According to a study conducted in Dublin [ 41 ], collectively there are combinations of factors that create an inordinately challenging situation for those attempting to plan for the city’s current and future water resources needs. Their main challenges related to topography, old infrastructure (the nineteenth century), population growth and development needs, water charges, climate change and water supply history.

5. Drinking water quality

5.1. definition and concepts.

Water is most fundamental in shaping the land and regulating the climate. It is one of the most important resources that profoundly influence life. Water quality is the most fundamental controlling factor when it comes to health and the state of diseases in both humans and animals. According to WHO report [ 23 ], about 80% of all the human diseases in human beings are caused by water.

Depending on the purpose of water quality analysis, water quality can be defined based on a set of biological, physical and chemical variable, which are closely linked to the water’s intended use. As a principle, drinking water is supposed to be free from harmful pathogens and toxic chemicals [ 3 ]. Contamination of freshwater (especially groundwater) sources is one of the main challenges currently faced by the South Africans, more especially in communities who depend almost exclusively on groundwater [ 52 ]. Groundwater is used for domestic, industrial and agricultural water supply in all four corners of the world. Therefore, the presence of contaminants in natural freshwater continues to be one of the most important environmental issues in many areas of the world, more especially in developing countries [ 53 ]. Once the groundwater is contaminated, its quality cannot be restored back easily, the best way is to protect it.

The concept and theory of water quality is very broad since it is influenced by many factors. Water quality is based on the intended uses of water for different purposes, that is, different water uses require different criteria to be satisfied. In water quality analysis, all of the accepted and unaccepted values must be clearly defined for each quality variable. If the quality variables meet the pre-established standards for a given use is considered safe for that use. When water fails to meet these standards, it must be treated if possible before use.

5.2. Description of water quality parameters

5.2.1. physical parameters.

Physical quality parameters are related to total solids content, which is composed of floating matter, settleable matter, colloidal matter and matter in solution. The following physical parameters are determined in water [ 12 ]:

Color : caused by dissolved organic materials from decaying vegetation or landfill leachate.

Taste and odor : can be caused by foreign compounds such as organic compounds, inorganic salts or dissolved gases.

Temperatures : the most desirable drinking water is consistently cool and does not have temperature fluctuation of more than a few degrees. Groundwater generally meets these criteria.

Turbidity : refers to the presence of suspended solid materials in water such as clay, silt, organic material, plankton, and so on.

5.2.2. Chemical parameters

The chemical constituents have more health concerns for drinking water than for the physical constituents. The objectionability of most of the physical parameters are based on esthetic value than health effects. But the main objectionability of some of the chemical constituents is based on esthetic as well as concerns for adverse health effects. Some of the chemical constituents have an ability to cause health problems after prolonged period of time [ 54 ]. That means the chemical constituents have a cumulative effect on humans. The chemical quality parameters of water include alkalinity, biological oxygen demand (BOD), chemical oxygen demand (COD), dissolved gases, nitrogen compounds, pH, phosphorus and solids (organic). Sometimes, chemical characteristics are evidenced by their observed reactions such as in laundering, redox reactions, and so on [ 12 , 54 ].

Below is a list of some of the chemical compounds and elements found in water:

Arsenic : occurs naturally in some geologic formation. It is mostly used in agricultural chemicals in South Africa. In drinking water, it has been linked to lung and urinary bladder cancer.

Chloride : most waters contain some chloride. The amount found can be caused by the leaching of industrial or domestic waters. Chloride should not exceed 100 mg/L in domestic water to be palatable.

Fluoride : is a natural contaminant of water. It is one of those chemicals given high priority by WHO [ 14 ] for their health effects on humans. High F in drinking water usually causes dental and skeletal fluorosis. Excessive F (>2 mg/L) causes a dental disease known as fluorosis (mottling of teeth), while regular consumption in excess may give rise to bone and skeletal fluorosis [ 12 ]. On the other hand, F < 2 mg/L causes dental cavities in children.

Zinc : is found in some natural waters, particularly in areas where zinc ore deposit have been mined. Though it is not considered detrimental to health, but it will impart a bad taste to drinking water.

Iron : small amounts of iron frequently are present in water because of the large amount of iron in the geologic materials. This will cause reddish color to water.

Manganese : naturally occurring manganese is often present in significant amounts in groundwater. Anthropogenic sources include discarded batteries, steel alloy production and agricultural products.

Toxic substances : generally classified as inorganic substances, organic substances and heavy metals. The toxic inorganic substances include nitrates (NO 3 ), cyanides (CN_) and heavy metals. These substances are of major health concern in drinking water. High NO 3 content can cause Methemoglobinemia in infants (“infant cyanosis” or “blue baby syndrome”); while CN can cause oxygen deprivation [ 12 ]. There are more than 120 toxic organic substances [ 24 ], generally exist in the form of pesticides, insecticides and solvents. These compounds produce health effects (acute or chronic). The toxic heavy metals are arsenic (As), barium (Ba), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg), selenium (Se) and silver (Ag) [ 12 ]. Like the organic substances, some of these substances are acute poisons (As and Cr) and others produce chronic diseases (Pb, Cd and Hg).

5.2.3. Biological parameters

Biological parameters are the basic quality parameters for the control of diseases caused by pathogenic organisms, which have human origin. Pathogenic organisms found in surface water include bacteria, fungi, algae, protozoa, plants and animals and viruses. Some of these disease-causing organisms (bacteria, fungi, algae, protozoa and viruses) are not identifiable and can only be observed microscopically. Microbiological agents are very important in their relation to public health and may also be significant in the modification of physical and chemical characteristics of water [ 12 ]. Water for drinking and cooking purposes must be free from pathogens. The greatest microbial risks are associated with consumption of water that is contaminated with human or animal feces. Feces can carry pathogenic bacteria, protozoa, helminthes and virus. Pathogens originating from feces are the principle concerns in setting health-based targets for microbial safety. Water-borne diseases are particularly to be avoided because of the capacity of result in the simultaneous infection of large number of people. While water can be a very significant source of infectious organisms, many of the diseases that may be waterborne may also be transmitted by other routes, including person-to-person contact, droplets and aerosols and food intake [ 54 ].

The techniques for comprehensive bacteriological test are complex and time consuming. Different tests have been developed to detect the relative degree of bacterial contaminations in terms of an easily defined quantity. There are two mostly used test methods widely used to estimate the number of microorganism of coliform groups ( Escherichia coli and Aerobacter aerogenes ). These include: total coliforms or E. coli , but the second one is found to be a better indicator of biological contamination compared to the first one [ 12 ].

5.3. Water quality standards

As presented in Section 3.1, standard is defined as a basis for judging the quality. A standard for drinking water quality is thus the reference that will ensure that the delivered water will not pose any threat or harm to human health. The water quality standard is the framework against which a water sample can be considered satisfactory or safe for use [ 54 ]. There are a number of standard guidelines for drinking purposes such as World Health Organization [ 54 ], Commission for European Union [ 55 ], U.S. Environmental Protection Agent [ 24 ], Environmental Canada [ 56 ], Russian Standard [ 57 ], Indian Standard [ 58 , 59 ], South African National Standard [ 60 ] and Ethiopian Standards [ 61 ]. Most developing and other developed countries use the WHO standards for drinking water [ 54 ]. Table 1 summarizes water quality guidelines of different countries.

Table 1.

Comparison of the different drinking water standards.

P – probability (%); HDL – highest desirable limit; MPL – maximum permissible limit; USEPA – United States Environmental Protection Agency; CEU – Commission of European Union; EC – Environmental Canada.

Sources: a WHO [ 54 ], b USEPA [ 24 ], c CEU [ 55 ], d UNESCO/WHO/UNEP [ 56 ], e Health Canada [ 57 ], f ISI [ 58 ] and BIS [ 59 ], g SANS [ 60 ], h ESA [ 61 ]. Note that the values indicated for the different standards other than WHO are the maximum permissible limits.

5.4. Water quality index

It is difficult to quantify the overall suitability of water for drinking based on the various guidelines presented in Table 1 . The interpretation of the various water quality parameters separately is usually a difficult task for general public as well as decision and policy makers. Therefore, the calculation of a general water quality index (WQI) is extremely important in order to communicate the quality of water in a better and understandable ways. There are different approaches of calculating WQI. In this section, a brief description has been provided for the weighted Arithmetic Water Quality Index Method proposed by Tiwari and Mishra [ 62 ] and adopted by others [ 63 , 64 , 65 , 66 , 67 ]. The quality rating (q i ), the sub-index (SI) [ 65 ] and the relative weights (Wi) are calculated using Eqs. (1) – (3) .

where V i and S i are the analytical and the standard value for the i th parameter, respectively, V o is the ideal value of the i th parameter in pure water (V o  = 0, except pH =7.0). The standard value is usually considered as the maximum permissible level set by WHO [ 10 , 14 , 54 ] or as per the standards for different countries presented in Table 1 . W i is the relative weights for various water quality parameters, assumed to be inversely proportional to the recommended standards for the corresponding parameters. w i is the unit weight of each parameter according to its relative importance in the overall quality of water for drinking purposes. The w i values are provided by Tiwari and Mishra [ 62 ], which depend on the number of parameters considered in the calculation of WQI. Note that the ∑W i should be equal to 1.

Finally, the overall WQI ( Eq. (4) ) is calculated for each of the water sources by aggregating the quality rating (q i ) linearly and taking their weighted mean.

WQI classes are as follows: 0–25 (excellent, grade A), 26–50 (good, grade B), 51–75 (poor, grade C), 76–100 (very poor, grade D), >100 (unfit for drinking, Grade E).

6. Conclusion

As water is a basic need for human life, access to clean, safe drinking water is a basic human right. As a criterion, an adequate, reliable, clean, acceptable and safe drinking water supply has to be available for various users. Moreover, everyone needs access to safe water in adequate quantities for drinking, cooking and personal hygiene and sanitation facilities that do not compromise health or dignity. Access to water is one of the most important catalysts given high priority by the UN for sustainable development. Despite these facts, there are inequalities in access to safe drinking water in the world. There are a number of factors challenging the sustainable WSS. Some of the factors are related to infrastructures (aging), clean water issues (quality, scarcity), natural factors (climate change, flood and drought), human factors (population growth, migration, demographic change, economic development, willingness to pay for water supply services, overuse), water management and delivery problems (pressure, leakages, lack of smart water meters, cost recovery, operation costs, etc.).

MDG fails to achieve its goal for access to safe water and sanitation. The chance for the success of the newly set SDG is also not different from that of MDGs, especially in some African countries. Some of the African leaders are reporting a false number of people with access to safe drinking water and sanitation to get a donation from the UN and using the donated money to buy weapons and use it to suppress the right of the people. In developing countries, improving access to safe water requires provision of good quality education and the establishment of good governance. Priorities should be given to the development of a democratic government and community empowerment.

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• 64. Asadi SS, Vappala P, Reddy AM. Remotely sensing and GIS techniques for evaluation of groundwater quality in municipal Corporation of Hydrabad (zone-V), India. International Journal of Environmental Research and Public Health. 2007; 4 (1):45-52
• 65. Ramakrishnaiah CR, Sadashivaiah C, Ranganna G. Assessment of water quality index for the groundwater in Tumkur Taluk, Karnataka State, India. E-Journal of Chemistry. 2009; 6 (2):523-530
• 66. Dinka MO. Analyzing the Extents of Basaka Lake Expansion and Soil and Water Quality Status of Matahara Irrigation Scheme, Awash Basin (Ethiopia). [dissertation]. Vienna, Austria: University of Natural Resources and Applied Life Sciences; 2010
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© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Drinking water quality in Indigenous communities in Canada and health outcomes: a scoping review

Lori e. a. bradford.

1 School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada

Lalita A. Bharadwaj

Udoka okpalauwaekwe, cheryl l. waldner.

2 Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada

Many Indigenous communities in Canada live with high-risk drinking water systems and drinking water advisories and experience health status and water quality below that of the general population. A scoping review of research examining drinking water quality and its relationship to Indigenous health was conducted.

The study was undertaken to identify the extent of the literature, summarize current reports and identify research needs.

A scoping review was designed to identify peer-reviewed literature that examined challenges related to drinking water and health in Indigenous communities in Canada. Key search terms were developed and mapped on five bibliographic databases (MEDLINE/PubMED, Web of Knowledge, SciVerse Scopus, Taylor and Francis online journal and Google Scholar). Online searches for grey literature using relevant government websites were completed.

Sixteen articles (of 518; 156 bibliographic search engines, 362 grey literature) met criteria for inclusion (contained keywords; publication year 2000–2015; peer-reviewed and from Canada). Studies were quantitative ( 8 ), qualitative ( 5 ) or mixed ( 3 ) and included case, cohort, cross-sectional and participatory designs. In most articles, no definition of “health” was given (14/16), and the primary health issue described was gastrointestinal illness (12/16). Challenges to the study of health and well-being with respect to drinking water in Indigenous communities included irregular funding, remote locations, ethical approval processes, small sample sizes and missing data.

Conclusions

Research on drinking water and health outcomes in Indigenous communities in Canada is limited and occurs on an opportunistic basis. There is a need for more research funding, and inquiry to inform policy decisions for improvements of water quality and health-related outcomes in Indigenous communities. A coordinated network looking at First Nations water and health outcomes, a database to store and create access to research findings, increased funding and time frames for funding, and more decolonizing and community-based participatory research aimed at understanding the relationship between drinking water quality and health outcomes in First Nations communities in Canada are needed.

Although Canada is recognized around the world for its natural wealth of fresh water ( 1 ), many Indigenous communities experience challenges to accessing safe drinking water. Literature suggests the water crisis in Indigenous communities is reflective of a host of unresolved matters that speak to issues of colonization, inequity, justice and institutional trends within governing and funding bodies in Canada ( 2 ).

Provincial water regulations do not apply to Indigenous communities. A complex tri-departmental federal structure consisting of Aboriginal Affairs and Northern Developmental Canada, Health Canada and Environmental Canada shares responsibility for safe delivery of drinking water. First Nations community leadership groups such as Chief and Councils must assume 20% of the costs for water infrastructure, and operations and maintenance, and are additionally tasked with monitoring water safety and ensuring the presence of trained operators. This complex governance structure has led to gaps in drinking water regulation in Indigenous communities across Canada. The Federal Government passed Bill S-8, the Safe Drinking Water for First Nations Act into law in 2013 as a means to address the regulatory gaps. It is unclear whether this Bill will significantly mitigate regulatory issues or lead to improvements in drinking water quality for Indigenous communities ( 3 ).

To Indigenous people, water is more than a commodity or a necessity for physical survival. In some Indigenous worldviews, water is considered a gift from the Creator, the lifeblood of Mother Earth and a spiritual resource that must be respected and kept clean ( 2 , 4 – 6 ). Government reports and assessments, as well as case-study reviews by non-profit organizations, highlight and identify imbalances in the provision of safe drinking water between Indigenous and non-Indigenous communities ( 7 – 9 ). Waterborne infections are more common in Indigenous communities compared to the national average, and 30% of Indigenous community water systems are described as “high risk.” Inequities in the provision and access to reliable and sustainable sources of drinking water leave Indigenous communities vulnerable to waterborne diseases, potential exposures to chemical contaminants and associated health effects. As of November, 2015, there were 138 Drinking Water Advisories (DWA) in effect in 94 First Nations communities across Canada, excluding British Columbia ( 1 , 10 ).

In 2005, Assembly of First Nations National Chief Phil Fontaine indicated that a first step in ensuring the health of Indigenous people and their communities was to address critical and urgent priorities such as safe drinking water on reserves. This scoping review on the nature and extent of academic and non-academic research on the topic of drinking water quality and Indigenous health was prompted by current reports on Indigenous health and the emergence of regulatory water policy. The results summarize documented challenges in access to safe drinking water for Indigenous communities in Canada, associated health issues (physical, psychological and social), methodological challenges and existing gaps in the literature ( 11 ). It is recognized that water security is an issue of both quality and quantity ( 12 ). This work focuses on aspects of water quality; however, there is an emerging body of research illustrating the effects of inadequate water quantity and resulting health outcomes in Indigenous communities in the north ( 13 , 14 ).

Investigation

The scoping review framework outlined by Arksey and O'Malley ( 15 ) and advancements by Pham et al. ( 16 ) were used. The steps included identification of the research question; identification of relevant articles and article selection; charting of the data; collating, summarizing and reporting of the results; and conducting a consultation exercise among the co-authors of this manuscript. The review process was summarized as sequential steps; however, the review process was not linear, some steps were repeated to ensure a comprehensive assessment of the literature. A scoping review was selected over a systematic review because the purpose was not to extract data, or formally assess the quality of studies and make specific conclusions, rather, the review sought to identify challenges faced by researchers and gaps in the literature ( 17 ).

The research question

A research team including a graduate student in public health, postdoctoral social scientist, toxicologist and epidemiologist was established. The team formulated the research questions, the overall study protocol and selection criteria for this review. The scoping review was guided by the questions: How do challenges (i.e. historical, social, political, cultural and environmental) associated with drinking water impact the health of Indigenous communities? And what gaps in the research are evident?

Data sources and search strategy

A comprehensive search strategy was designed with the assistance of a university librarian. Key search terms were developed and mapped with online databases prior to the article search. The initial search was carried out from 9 to 25 February 2015. Electronic databases that covered a wide range of disciplines were used initially, which include MEDLINE/PubMED (biomedical sciences, 2000 – present), Web of Science (multidisciplinary, 2000 – present), SciVerse Scopus (multidisciplinary 2000 – present) and Google Scholar. Search queries consisted of the keywords: Indigenous communities (and synonyms), drinking water, health and challenges tailored to the requirements of each database (see Table I ).

Keywords (with synonyms) and syntax used for literature search

A Google web search was also conducted using the search strings First Nations AND Drinking water AND Health AND Canada to identify grey literature. A decision to screen the first 100 hits from the Google search was made a priori, considering the time required to screen each article. This theory is based on evidence that further screening is unlikely to yield many more relevant articles. Additional websites were searched manually ( Table II ).

Additional websites used to identify grey literature for the scoping review

On 25 February 2015, an initial list of articles that met eligibility criteria was created from all articles identified during the initial scope ( Fig. 1 ). Subsequently, articles and their citations were manually searched to identify any additional articles for inclusion in the scoping review. Citations within articles were searched if they appeared relevant to the scoping review. This snowball technique was adopted to ensure a comprehensive and thorough search. Another search was carried out on 15 March 2015 using publisher's online search bars, in addition to the four bibliographic databases and other literature sources listed above. Eight months later, a second search was carried out again to ensure exhaustiveness. These searches applied the same search strings, keywords and date restrictions as shown in Table I .

PRISMA ( 21 ) flowchart of study selection process. OPHLA: Ontario Public Health Libraries Association. CPPC: Canadian Public Policy Collection. CIER: Center for Indigenous and Environmental Resources (see Table II ).

All citations, along with abstracts, were imported or manually entered into reference managers Endnote X7 ( 18 ) and Mendeley 13.8 ( 19 ). Associated full-text articles (FTAs) were thereafter added. Duplicates were removed manually after assembling citations.

Eligibility criteria and study selection

The scoping selection was limited to peer-reviewed documents from Canada subject to three inclusion criteria. The first criterion for inclusion involved keywords; peer-reviewed journal articles, theses, government and technical reports with the keywords (and synonyms as listed in Table I ) and combinations of these terms were selected. The second criterion was the timeframe of publication. Only papers published between the year 2000 and 2015 were selected. Finally, only English and English/French documents were selected for inclusion.

A two-stage process was used to assess the relevance of articles identified from the search. After the initial article collation and deduplication, articles were manually screened by checking their titles and abstracts for identified keywords. Thereafter, the FTAs with two or more keyword combinations were retrieved for further screening. The second stage involved reading all FTAs retrieved from the initial screening to identify articles that discussed issues related to drinking water quality in Indigenous communities, First Nations in Canada, health outcomes and other challenges to safe drinking water among Indigenous communities.

Data charting and summary

A Microsoft Access database ( 20 ) was used for data entry validation and coding. Data extracted from the selected articles included author(s), year of publication, title, design, type, location and type of Indigenous community. Other information extracted from the selected articles included summary of the findings, reported health outcomes, drinking water assessment and quality, associations and comparisons, recommendations and limitations. Articles were labelled by letter. The results below include proportions of articles with similar findings, as well as individually identified articles for reference (i.e. 12/16 articles were published in academic peer-reviewed journals; these included articles A–C, E, G, H and K–O).

Consultation exercises

At several intervals during the search and data inclusion phases, consultation exercises were conducted with the research team. Input on keyword selection, inclusion criteria and relevance of selections for each search strategy was provided during face-to-face and Email communications. Clarifications on methodological approach and tools were sought by the graduate student. The postdoctoral researcher conducted the second search, analysed data at the thematic level and provided direction on article summaries and tables.

Overview of selected studies

A total of 518 articles were retrieved from the overall search; 156 from the bibliographic search engines and 362 from grey literature. Following deduplication and relevance screening, 65 articles were found to meet the three first-level eligibility criteria (based on title and abstract). All 65 FTAs were reviewed for inclusion based on the second-level eligibility criteria (relevance to research question). Of the 65 FTAs, 49 articles did not meet the second-level eligibility criteria leaving a total of 16 articles for inclusion into the final scoping review.

The results section has three subsections beginning with the characteristics of the studies in the sample. Secondly, we report on methodological strengths and limitations of both the studies themselves and the sample as a whole. Thirdly, we explore the specific content of the studies, overall themes and gaps in research examining health outcomes and water in Indigenous communities.

Study characteristics

Descriptive summaries of study characteristics.

The general characteristics for the articles from the search are shown in Tables III and ​ andIV. IV . Most articles were published in academic journals (12/16), after the year 2010 (11/16) and had a mean study duration of 30 months. Two theses (F and P) and two government reports (I and J) also met the inclusion criteria. The documents ranged from 4 (N) to 129 pages (I).

Summary of articles included in scoping review (n=16)

General attributes of publications included in the scoping review (n=16)

Twelve papers described participating communities as including First Nations (12/16; A, B, F–I and K–P), three described drinking water-related health issues among Inuit communities (C–E) and one government document reviewed the effects of drinking water on health as perceived by 11 First Nation, Inuit and Métis grandmothers from several different Canadian provinces (O) ( Table III ).

Terminology used to describe drinking water quality in Indigenous communities was fairly consistent among the identified articles ( Table IV ). Two papers used both terms “drinking water” and “safe drinking water” interchangeably; two used “safe drinking water,” while most (11/16) of reviewed articles used the term “drinking water” alone. A definition of health was suggested in two articles and focused on either a well-managed relationship with water and the “life force” (J) or eating uncontaminated foods and maintaining emotional well-being of families and communities (M). In the remaining articles, health was not defined (11/16) or a citation was provided to another source (3/16).

Reported methods

The methodological characteristics of reviewed articles are summarized in Table V . Eight studies used a quantitative approach, while five were qualitative, and three used mixed methods ( Table V ). A variety of study designs were employed including community-based participatory research methodologies (5/16) case studies (4/16), cross-sectional studies (3/16), cohort studies (3/12) and theoretical research (1/16).

Methodological characteristics of publications included in the scoping review (n=16)

In the following section, we describe four methodologically diverse studies.

One community-based participatory research project gathered information on the nature, availability, utilization, perceptions and attitudes of community drinking water sources in both three Ontario and one Saskatchewan First Nation communities using an in-person household survey tool (B). Results indicated that risk perceptions differ by province on water source, health concern for tap water consumption, likelihood of reporting illness from tap water and spending more money on bottled water.

A cross-sectional study was conducted to assess perceptions of water quality, safety and changes over time as well as incidence and frequency of DWA in two First Nation communities (I). The study involved the collection of household surveys and interviews from over 900 residents of First Nations communities and 706 residents of other small communities off reserve with the aim of exploring how these communities felt about the safety of their water since the implementation of the First Nations Water and Wastewater Action Plan. Results indicated that residents of First Nations reserves are less confident about their water source, household water supply and overall water safety than non-reserve populations.

A retrospective cohort study on First Nations reserves in British Columbia (O) assessed the prevalence of hepatitis A among residents in these areas and its association with drinking water. Results indicated that increased hepatitis A incidence was associated with greater numbers of persons per housing unit. Further inspection as to the relationship with water and wastewater services was not suggested as data were insufficient to infer relationships.

A case-study example in our sample included a look at multiple dimensions of water insecurity, impacts on health and how they relate to policy changes in Inuit communities in Black Tickle, Labrador (C). Open-ended interviews with community leaders and elders, as well as focus groups with community members explored water use patterns, water quality, community health and coping strategies. The results included a local perspective defining the attributes of current health, social and political water-related issues in the communities. All major water sources were also tested for microbiological, chemical and physical contaminants and found concern with levels of disinfectant by-products and turbidity.

Reported data collection tools

The articles in the sample reported using questionnaires and survey instruments (A, B, E, I, N, O and P); literature reviews and case reports (C, F and H); community workshops/document analysis (K); focus groups and open-ended interviews (D, J and M); and on-site water testing (L) as primary tools ( Table III ). Primary data were gathered in most articles (11/16) ( Table V ). The number of communities that were part of these studies ranged from 1 (C, K and L) to 56 (N); however, research for the study with the most communities was focused on the water systems at each location. The largest community level study with primary data included information from 750 people in six communities (A).

Secondary data were used in four articles (including one that also collected primary data) including counts of gastrointestinal-related clinic visits obtained from health clinic records, weather and water quality results (E, F, G, O) ( Table V ). Two articles did not include primary data; rather, they included programme evaluations and source water protection planning outcomes with no reported primary data (D and H).

Methodological strengths and limitations of the sample

Quantitative and mixed methods articles were examined for response rates where applicable, and risks for biases ( Table III ). For example, in a cohort study on the incidence of gastroenteritis in three Indigenous communities in British Columbia and the source water characteristics (O), biases and limitations were reported as selection bias, blinding and mixed water sources. Selection bias was minimized by random sampling of community clusters. Failure to blind study participants and lack of pre-screening of participants may have skewed the results of the incidences of illness. Unreported use of mixed water sources (bottled, tap and raw) made it difficult to make conclusions about source water and gastrointestinal illness, and underreporting of symptoms and the accuracy of reporting were other limitations to the study (O).

Selection bias was prominent among the studies; 4/8 quantitative studies reported selection biases due to language barriers (I), inadequate sampling and missing data (F, I, N and P), and the use of convenience sampling (I). In the mixed methods studies, 2/3 reported problems including participant's misinterpreting concepts such as risk (E) and having inadequate time to complete study tools (P). Further quantitative and mixed study concerns included poor record keeping on population statistics (B), and non-blinding, demographic and pre-screening errors for study subjects made it difficult to draw conclusions (O and P). Of the other quantitative and mixed methods studies (5/11), the lack of reporting of limitations demonstrates inadequate reflection and questionable strength of conclusions.

Considered as a whole, the sample undertook at least one investigation in each of seven provinces and three territories, missing three Atlantic Provinces. Ten articles reported that a barrier to establishing the quality of water on reserve was the access to sources for testing (A, C, F, G, I, L, M, N, O and P). Due to inconsistent delivery of water (i.e. funding shortages, and weather in remote locations meant that in some instances trucks could not delivery water), the unreported use of varied water sources meant that thorough sampling of water sources for quality testing and linking to health outcomes was not possible (8/12 reporting water quality assessment). Over 3,200 individuals were surveyed across 84 First Nation communities and 68 water systems were tested, in comparison with an estimated total of 3,100 Indigenous reserves in Canada ( 34 ).

During the analyses, we inferred further researcher limitations including access, longitudinal effects, cultural biases and language biases which were not reported in the quantitative and mixed methods studies. The lack of available baseline and prior data, longitudinal research, reliable data on source water quality, and incidence of illness or disease meant that no trends or relationships in our sample of articles could be established on water provision and quality, and health outcomes on First Nations reserves in Canada from the reported samples. At best, the quantitative sample gave unsystematic evidence for challenges in discovering relationships among water and health in First Nations reserves in Canada.

Among the qualitative studies, three concerns were reported. The first related to conditions resulting in poor drinking water quality. Uncertain water provision and poor economic conditions, which exacerbate management and infrastructural challenges in communities, were reported as a major limitation to qualitative research (i.e. the interview results would change if conducted at a different point in time because of the uncertain water situation) (D, J and M). Secondly, researchers also indicated that communication and related socio-political dimensions among the Chief and Council and local people affected the results because of the inherent mistrust of “outsiders” gathering data on reserves (D). Thirdly, there was also scrutiny towards reductionist examinations of drinking water quality, which needed dispelling before interviews and focus groups were started (D and M).

Further limitations are evident. Small sample sizes and difficulty finding acceptable definitions for key terms (i.e. gastrointestinal illness, safe drinking water and health) were reported in studies using interviews and focus groups (D and J). A noted limitation is the application of frameworks (capacity measurement, programme evaluations and source water protection practices) developed for non-Indigenous communities in First Nations reserves (D). We could only ascertain that at least 11 grandmothers from First Nations across Canada (J) and an unreported number of elders, youth and local harvesters from Ontario (M) were interviewed or participated in focus groups among the sample. Only one article reported using a decolonizing approach (M).

Thematic analysis and study findings

The findings of reviewed articles were grouped under the following key themes: (a) drinking water quality, (b) health outcomes and (c) challenges to accessing safe drinking water. Results for each are summarized below.

Drinking water quality

Drinking water quality was evaluated qualitatively (i.e. asking perceptions) in seven articles (five purely qualitative articles, plus two mixed methods articles; Tables III and ​ andV). V ). Quantitative measures of water quality (tested against established standards), including turbidity, biological (total coliform, E. coli most commonly), physical or other chemical contaminations (free chlorine residuals), were assessed in seven articles, while mixed methods studies frequently reported both measured water quality indicators and community perceptions. For example, results in a perceived under-funded potable water-dispensing unit (PDWU) in an Inuit community in Newfoundland and Labrador indicated quantitatively high levels of E. coli and qualitatively a low perception of water safety and trust of the PDWUs (C). Residents in the community had a strong distrust in the PDWU system due to animal activities around the PDWU sources. Two articles reported on specific pathogens that included bacteria ( Escherichia coli, Campylobacter jejuni, Shigella spp., Helicobacter pylori and Giardia lamblia ), viruses ( Hepatitis A ) and protozoa ( Cryptosporidium ) (L and O).

Qualitative measures of water quality were assessed in terms of risk perception in five other articles ( Table III ). Mixed results were found among First Nation community members when surveyed about their perceptions concerning health risks from tap water and bottled water (B, E and I). Risk perceptions for First Nations people were cautious in general, but differed by province, water source, health concerns for tap water consumption, likelihood of reporting illness from tap water, and money spent on bottled water (B, E, I, M and N). Residents of First Nations reserves were less confident about their water source, household water supply and overall water safety than non-reserve populations (B, E, I and N). Although some authors reported that participants disliked and did not trust the taste of chlorinated water (E and N), another reported that the addition of chemical treatment to water made community members feel safer (I).

Health outcomes associated with poor drinking water in Indigenous communities

A variety of concerns were reported about the health impacts or poor drinking water quality and are summarized in Table VI . All of the articles concluded with statements linking increased risk of negative health outcomes with poor drinking water quality. The most commonly stated health issues reported in relation to drinking water were gastrointestinal infections (12/16). The two next most commonly reported health issues (5/16) were skin problems (eczema and skin cancers) and birth defects. Other reported health problems included obesity, diabetes, hypertension, mental stress (anxiety and depression), heart diseases, liver diseases, kidney problems, neurological problems, immunopathology, cancers, thyroid conditions and infant mortality.

Health outcomes related to drinking water described in publications included in the scoping review (n = 16)

Source water is a key concern for heath determinants. One article reported a higher risk of iodine deficiency in First Nations men in Quebec who drank spring or tap water compared with those that drank more bottled water (A), while increased skin diseases were reported in First Nations communities with over-chlorination (F). Mercury, lead, arsenic and toxic pollutants like phenols, dioxins and polycyclic aromatic hydrocarbon contamination were a reported concern (F and M). Authors noted, however, that more research is needed to determine if higher rates of infant mortality, birth defects, developmental problems, cancers and other chronic conditions could be explained by community demographics. Diet, lifestyle, environmental factors and susceptible populations (infants, the elderly, pregnant women and people with co-existing health conditions) have been implicated in the literature ( 35 – 37 ).

Diabetes was a significant health concern among First Nations and Inuit people identified within the scoping review (C, F and P) and other work on diabetes prevalence ( 38 ). An increase of reliance on carbonated, sugary drinks (soda pop) sold relatively cheaper than bottled water in many communities was put forward as an explanation. Although the scoping review articles did not place much water-related emphasis on the prevalence of diabetes in First Nations, Métis and Inuit populations, they have a rate of diabetes 3–5 times higher than other Canadians ( 39 ).

In summary, some health outcomes have been connected to poor drinking water services in Indigenous populations; however, due to the limitations of the research, there was not sufficient information to evaluate the potential for causal relationships between the water quality and the reported health concerns.

Challenges to accessing safe drinking water

Most articles (14/16) described some limitations to accessing safe drinking water within Indigenous communities ( Table V ). A major limitation to safe drinking water in the sample was the remote location of reserves and traditional lands. Study participants reported using raw water (occasionally, to always) from local sources (springs, lakes, wells and opportunistic “bush” waters) (A, C, D, E, F, G, I, J, L, M, O and P). Others relied on trucked-in water which was uncertain (i.e. in poor weather, or without adequate funding and personnel, water was undelivered) (C, I and K). Other problems in accessing safe water in remote locations were the training and retaining of certified water operators (C, D, K, N and P). Training programmes were offered in distant urban areas with different governing systems (D). One study reported the difficulty in retaining personnel once trained, and in retaining personnel to complete training both because of the lack of nearby support personnel, such operators were on-call every day, and because of the fear of making mistakes while operating complex water systems (K).

The differences in cultural beliefs were also noted as a major challenge to safe drinking water (E, F, J, K, L, M and O). A participant is quoted in one article stating that Indigenous teachings indicated that water provides for both the hydration of the body and giving “spirit” in each drink. The participant pondered that “anything wrapped in plastic dies… Are we feeding our people dead water?” when asked about the community's use of bottled water (J, p. 20). The misunderstanding of the values of water and how Indigenous people relate to it meant that culturally inappropriate water programmes and communication barriers prevented consistent access to safe drinking water in the perspective of community members (K, L and M). One study shed light on how culturally engaging water projects increased knowledge and development of local adaptation strategies to support better health outcomes in Indigenous communities (D). Understanding cultural knowledge of water was, therefore, a challenge to accessing safe drinking water.

Finally, formal procedures for applying for government support for improved drinking water and research on water systems were a challenge reported in the sample (B, C, D, E, F, K and N). Communities felt constrained because of their dependence on the federal government for funding for water services (B, C, F, K and N). Funding cycles for both water service applications and research grants needed to be lengthened to allow communities to gain capacity and to allow researchers to complete ethics approval processes which are lengthy and conduct meaningful community-engaged projects which take time (C, D, E and K).

This scoping review utilized a systematic approach to explore the nature and extent of information on health issues associated with poor drinking water in Indigenous communities in Canada. The review found 16 relevant articles following a scope of an initial pool of 518 articles. The most striking observations in this review were the paucity of literature on the topic of water and health in Indigenous communities in Canada as well as the variation in the methodologies used to assess drinking water quality and perceptions of water and health in these communities. Only one article in the sample used a decolonizing approach. Given the recommendations of the Truth and Reconciliation Commission, governments, researchers and Indigenous communities are in need of new approaches and improved relationships to move forward on issues of health and safe drinking water. Nevertheless, the findings validated previous reports describing inequalities related to the quality of drinking water and associated key health outcomes in Indigenous communities in Canada.

Contamination of water by microbial pathogens was the most commonly discussed direct risk to health and verifies research on drinking water quality and health outcomes in other contexts ( 38 , 40 ). There is no national surveillance system for the systematic collection of waterborne disease outbreak data ( 41 ), but recent studies described 288 recorded outbreaks of infectious disease related to drinking water in Canada over a 27-year period until 2001 ( 40 , 42 ). The scoping review articles revealed that the overall number of gastrointestinal infections in Indigenous communities was 26 times greater than the rest of Canada, and cases are more likely to go underreported due to different perceptions of risk and health ( 7 – 9 ). High incidences of other health outcomes are linked through a variety of processes to access to high-quality water (i.e. Hepatitis A and diabetes). Of particular concern were toxic pollutants in the water and their effects on children and the elderly. Lack of source water protection, governance role confusion, remote locations and unpredictable weather changes, malfunctioning water distribution systems, human error, cultural considerations and poor funding were put forth as root causes in our sample. Research on synergistic effects among anthropogenic pollutants, source water characteristics and existing diseases in populations of Indigenous people in Canada, however, is sparse.

Differences in the conceptualization of health, safe water and risk among researchers and participants were brought forward in the articles. The two articles that provided explanation of health from the participants’ point of view described health as a well-managed relationship with water (the life-force); and about eating uncontaminated foods, and emotional well-being. These concepts are very different from public agency definitions (i.e. health as the absence of chronic or infectious diseases, and injuries) ( 43 ) and are worth investigating so that researchers and participants alike are working towards the same thing. Similar misalignment of researcher and Indigenous definitions of education, housing and research designs has recently been put forward in the literature ( 44 – 47 ). Given the logistical challenges associated with conducting health and drinking water research with Indigenous communities, we expect that the growing body of research in this field will continue to use similar colonizing approaches, scientific definitions and non-Indigenous community standards against which quality of water and health outcomes are monitored. Enhancing Nation-to-researcher communications about the use of decolonizing research approaches is one way forward to improving the salience and legitimacy of drinking water and health research in Indigenous communities in Canada, and translating findings into public health policies that work for Indigenous people.

There are significant gaps in the knowledge of health outcomes related to drinking water in Indigenous communities. There are no longitudinal, systematic studies of drinking water and Indigenous communities across Canada. No fully agreed on indicators of drinking water safety have been catalogued or evaluated on a systematic basis, and for which researchers could create a database or link to health outcome data. Confusion exists on reserves as to whether illnesses such as gastrointestinal illnesses are related to drinking water, and there is a problem with underreporting potential drinking water-related illnesses. More could be done to educate reserve populations on potential waterborne illnesses and steps to reporting them, and to ensure health care and drinking water records are being maintained. There are no studies that focus on drinking water and health of children in Indigenous communities. Given the recognition that many adult health problems originate in childhood, these studies are acutely necessary.

To move forward on ameliorating the conditions of drinking water and health outcomes in Indigenous populations in Canada, we suggest the following recommendations that emerged from the scoping review:

• Build a coordinated network of researchers, communities, representative organizations and government agencies to conduct large cross-sectional and longitudinal studies examining the relationships between drinking water and health outcomes in Indigenous communities in Canada.
• Develop a database and management system for collating information on health outcomes related to drinking water in Indigenous populations. This can be co-created (see e.g. 48–50) to include indicators and data sets derived from multiple knowledge systems and must do so in an ethical and respectful way. Clear definitions of concepts (i.e. safe drinking water, health and risk) from Indigenous worldviews should be developed as a part of this process.
• Encourage funding agencies to put together a special call for interdisciplinary work on safe drinking water quality and quantity and health outcomes in Indigenous contexts across a variety of platforms to encourage immediate and longer-term projects targeting needs as discovered in this scoping review (i.e. widespread water quality data and content analysis of health records for “suspected” water-related illnesses on reserves as well as examining source water protection issues, community perceptions of risk and health; and policy mapping).
• Create funding opportunities to develop capacity within Indigenous communities to monitor and report drinking water safety and health outcomes and to implement strategies for ameliorating barriers and challenges to safe drinking water access.

This scoping review is indicative that there is a critical need for academics to work together with Indigenous communities to understand conditions on reserve that impact drinking water quality and health outcomes and to identify solutions. Barriers and challenges exist for the communities, but also for researchers attempting to better understand the inequality. Overall, the number of studies was very small; however, the studies reported reflected a broad range of research designs and data types.

Unsatisfactory drinking water systems are common in Indigenous communities. While some research is emerging, much of the information reported to date relies heavily on data that are subject to bias as well as a number of other important reporting limitations. Future research efforts should focus on improving communications and cultural understanding, as well as increasing the numbers of communities and participants per community. Greater sample sizes are necessary to better understand the heterogeneity in experiences both within and among communities. There is a need for community-based participatory research that also applies best practices for collecting and analysing observational data when the objective is to evaluate causal associations, such as the questions raised about the impact of water quality on chronic disease in some of the studies included in this review. A step forward to improving conditions of safe drinking water would be to recognize that research must not just be credible, but also action oriented.

Acknowledgements

The authors recognize the support of our funders: Canadian Institute of Health Research – 2010-11-08 Operating Grant: Population Health Intervention Research/Operating Grant: Population Health Intervention Research, Global Institute for Water Security, and the Saskatchewan Health Research Foundation.

Conflict of interest and funding

The authors declare no conflict of interest in the funding or activities involved in this research project.

Water Quality & Drinking Water Treatment Exploratory Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

The New York City Water Report

Water treatment plant configuration, steps involved in the water treatment.

This reflective report analyses New York City’s drinking water quality and the treatment process. The paper identifies the contaminants in New York City water and analyzes these contaminants through a broad spectrum approach.

The fluoride contaminant violated the maximum requirement level in the New York drinking water. The fluoride content of 2.2 mg/L in this water is almost double the concentration level of 1.0mg/L as situated by the New York City Health Code.

The calcium contaminant was very close to violating the maximum contaminant levels in the New York City drinking water. The concentration of calcium contaminant was recorded at 5.3 mg/L against an average of between 4.4 and 6.7 mg/L.

Contaminant detected: Nitrate

Water in its natural source is often subject to fecal contamination, primarily derived from processes of decomposition of organic nitrogenous material present in water.

While ammonia (ammonium) and nitrites indicate an organic contamination, there are several harmless contaminants present in water such iron and calcium among others. The diagram below represents a typical water treatment plant summarizing the processes involved in water treatment.

Schematic water treatment diagram

Step 1: Screening

The raw water is passed through a sieving screen to eliminate relatively large pieces of foreign material such as rocks, leaves, and sticks. At this stage, Potassium permanganate chemical may be used when the raw water has traces of algal bloom.

Step 2: Coagulation

This involves passing the raw water into a coagulation tank where visible particles that remained after the screening stage are separated and channeled to an ejection tank for farm use.

Step 3: Sedimentation

The water is then moved to a special tank that is designed to allow for any remaining particle in the water to patch up at the base of the sediment tank.

Step 4: Filtration

The dual media in the filtration tank consisting of anthracite and sand ensures that all the visible pollutants are eliminated.

Step 5: Disinfection

Regulated amount of chlorine is passed into the water to inactivate any pathogens that might have passed through the previous steps. At this stage, controlled quantity of fluoride ingredient is added to the disinfected water to reduce incidences of tooth discoloration and decay upon use of this water.

Step 6: Storage and distribution

The fully treated water is then channel to storage tanks for a while before being distributed to the final user.

Water treatment is carried out by using special purification equipments that measured the 4 parameters of contamination (nitrates, phosphates, chlorides and sulfur). However, the concentration of each parameter detected varies due to the conditions and flow of water from its source. There are significant differences between the parameters, pH, temperature and dissolved oxygen in different water sources.

• Vitamin D, Round up Glyphosate, Nicotine and Sodium Nitrate Toxicity
• Fluoride-Containing Varnishes Development and Application in Dentistry
• Acid Rain Investigation: Problem and Hypothesis
• The Renewable and Non-renewable Electricity Sources
• Electricity Production and Consumption in the US
• Demand for Energy. Energy Sources
• Vulnerability of World Countries to Climate Change
• Aquatic Life in Indiana
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2019, July 8). Water Quality & Drinking Water Treatment. https://ivypanda.com/essays/water-quality-drinking-water-treatment/

"Water Quality & Drinking Water Treatment." IvyPanda , 8 July 2019, ivypanda.com/essays/water-quality-drinking-water-treatment/.

IvyPanda . (2019) 'Water Quality & Drinking Water Treatment'. 8 July.

IvyPanda . 2019. "Water Quality & Drinking Water Treatment." July 8, 2019. https://ivypanda.com/essays/water-quality-drinking-water-treatment/.

1. IvyPanda . "Water Quality & Drinking Water Treatment." July 8, 2019. https://ivypanda.com/essays/water-quality-drinking-water-treatment/.

Bibliography

IvyPanda . "Water Quality & Drinking Water Treatment." July 8, 2019. https://ivypanda.com/essays/water-quality-drinking-water-treatment/.

There are many options for what to drink , but water is the best choice for most people who have access to safe drinking water. It is calorie-free and as easy to find as the nearest tap.

Water helps to restore fluids lost through metabolism, breathing, sweating, and the removal of waste. It helps to keep you from overheating, lubricates the joints and tissues, maintains healthy skin, and is necessary for proper digestion. It’s the perfect zero-calorie beverage for quenching thirst and rehydrating your body.

How Much Water Do I Need?

Water is an essential nutrient at every age, so optimal hydration is a key component for good health. Water accounts for about 60% of an adult’s body weight. We drink fluids when we feel thirst, the major signal alerting us when our body runs low on water. We also customarily drink beverages with meals to help with digestion. But sometimes we drink not based on these factors but on how much we think we should be drinking. One of the most familiar sayings is to aim for “8 glasses a day,” but this may not be appropriate for every person.

General recommendations

• The National Academy of Medicine suggests an adequate intake of daily fluids of about 13 cups and 9 cups for healthy men and women, respectively, with 1 cup equaling 8 ounces. [1] Higher amounts may be needed for those who are physically active or exposed to very warm climates. Lower amounts may be needed for those with smaller body sizes. It’s important to note that this amount is not a daily target, but a general guide. In the average person, drinking less will not necessarily compromise one’s health as each person’s exact fluid needs vary, even day-to-day.
• Fever, exercise, exposure to extreme temperature climates (very hot or cold), and excessive loss of body fluids (such as with vomiting or diarrhea) will increase fluid needs.
• The amount and color of urine can provide a rough estimate of adequate hydration. Generally the color of urine darkens the more concentrated it is (meaning that it contains less water). However, foods, medications, and vitamin supplements can also change urine color. [1] Smaller volumes of urine may indicate dehydration, especially if also darker in color.
• Alcohol can suppress anti-diuretic hormone, a fluid-regulating hormone that signals the kidneys to reduce urination and reabsorb water back into the body. Without it, the body flushes out water more easily. Enjoying more than a couple of drinks within a short time can increase the risk of dehydration, especially if taken on an empty stomach. To prevent this, take alcohol with food and sips of water.
• Although caffeine has long been thought to have a diuretic effect, potentially leading to dehydration, research does not fully support this. The data suggest that more than 180 mg of caffeine daily (about two cups of brewed coffee) may increase urination in the short-term in some people, but will not necessarily lead to dehydration. Therefore, caffeinated beverages including coffee and tea can contribute to total daily water intake. [1]

Keep in mind that about 20% of our total water intake comes not from beverages but from water-rich foods like lettuce, leafy greens, cucumbers, bell peppers, summer squash, celery, berries, and melons.

Aside from including water-rich foods, the following chart is a guide for daily water intake based on age group from the National Academy of Medicine:

Preventing Dehydration: Is Thirst Enough?

As we age, however, the body’s regulation of fluid intake and thirst decline. Research has shown that both of these factors are impaired in the elderly. A Cochrane review found that commonly used indicators of dehydration in older adults (e.g., urine color and volume, feeling thirsty) are not effective and should not be solely used. [3] Certain conditions that impair mental ability and cognition, such as a stroke or dementia, can also impair thirst. People may also voluntarily limit drinking due to incontinence or difficulty getting to a bathroom. In addition to these situations, research has found that athletes, people who are ill, and infants may not have an adequate sense of thirst to replete their fluid needs. [2] Even mild dehydration may produce negative symptoms, so people who cannot rely on thirst or other usual measures may wish to use other strategies. For example, aim to fill a 20-ounce water bottle four times daily and sip throughout the day, or drink a large glass of water with each meal and snack.

Symptoms of dehydration that may occur with as little as a 2% water deficit:

• Confusion or short-term memory loss
• Mood changes like increased irritability or depression

Dehydration can increase the risk of certain medical conditions:

• Urinary tract infections
• Kidney stones
• Constipation  

Like most trends of the moment, alkaline water has become popular through celebrity backing with claims ranging from weight loss to curing cancer. The theory behind alkaline water is the same as that touting the benefits of eating alkaline foods, which purportedly counterbalances the health detriments caused by eating acid-producing foods like meat, sugar, and some grains.

From a scale of 0-14, a higher pH number is alkaline; a lower pH is acidic. The body tightly regulates blood pH levels to about 7.4 because veering away from this number to either extreme can cause negative side effects and even be life-threatening. However, diet alone cannot cause these extremes; they most commonly occur with conditions like uncontrolled diabetes, kidney disease, chronic lung disease, or alcohol abuse.

Alkaline water has a higher pH of about 8-9 than tap water of about 7, due to a higher mineral or salt content. Some water sources can be naturally alkaline if the water picks up minerals as it passes over rocks. However, most commercial brands of alkaline water have been manufactured using an ionizer that reportedly separates out the alkaline components and filters out the acid components, raising the pH. Some people add an alkaline substance like baking soda to regular water.

Scientific evidence is not conclusive on the acid-alkaline theory, also called the acid-ash theory, stating that eating a high amount of certain foods can slightly lower the pH of blood especially in the absence of eating foods supporting a higher alkaline blood pH like fruits, vegetables, and legumes. Controlled clinical trials have not shown that diet alone can significantly change the blood pH of healthy people. Moreover, a direct connection of blood pH in the low-normal range and chronic disease in humans has not been established.

BOTTOM LINE: If the idea of alkaline water encourages you to drink more, then go for it! But it’s likely that drinking plain regular water will provide similar health benefits from simply being well-hydrated—improved energy, mood, and digestive health

Is It Possible To Drink Too Much Water?

There is no Tolerable Upper Intake Level for water because the body can usually excrete extra water through urine or sweat. However, a condition called water toxicity is possible in rare cases, in which a large amount of fluids is taken in a short amount of time, which is faster than the kidney’s ability to excrete it. This leads to a dangerous condition called hyponatremia in which blood levels of sodium fall too low as too much water is taken. The excess total body water dilutes blood sodium levels, which can cause symptoms like confusion, nausea, seizures, and muscle spasms. Hyponatremia is usually only seen in ill people whose kidneys are not functioning properly or under conditions of extreme heat stress or prolonged strenuous exercise where the body cannot excrete the extra water. Very physically active people such as triathletes and marathon runners are at risk for this condition as they tend to drink large amounts of water, while simultaneously losing sodium through their sweat. Women and children are also more susceptible to hyponatremia because of their smaller body size.

Fun Flavors For Water  

Infused water

Instead of purchasing expensive flavored waters in the grocery store, you can easily make your own at home. Try adding any of the following to a cold glass or pitcher of water:

• Sliced citrus fruits or zest (lemon, lime, orange, grapefruit)
• Crushed fresh mint
• Peeled, sliced fresh ginger or sliced cucumber
• Crushed berries

Sparkling water with a splash of juice

Sparkling juices may have as many calories as sugary soda. Instead, make your own sparkling juice at home with 12 ounces of sparkling water and just an ounce or two of juice. For additional flavor, add sliced citrus or fresh herbs like mint.

TIP: To reduce waste, reconsider relying on single-use plastic water bottles and purchase a colorful 20-32 ounce refillable water thermos that is easy to wash and tote with you during the day. 

Are seltzers and other fizzy waters safe and healthy to drink?

BOTTOM LINE: Carbonated waters, if unsweetened, are safe to drink and a good beverage choice. They are not associated with health problems that are linked with sweetened, carbonated beverages like soda.

• Harvard T.H. Chan School of Public Health is a member of the Nutrition and Obesity Policy Research and Evaluation Network’s (NOPREN) Drinking Water Working Group. A collaborative network of the Centers for Disease Control and Prevention, the NOPREN Drinking Water Working Group focuses on policies and economic issues regarding free and safe drinking water access in various settings by conducting research and evaluation to help identify, develop and implement drinking-water-related policies, programs, and practices. Visit the network’s website to access recent water research and evidence-based resources.
• The Harvard Prevention Research Center on Nutrition and Physical Activity provides tools and resources for making clean, cold, free water more accessible in environments like schools and afterschool programs, as well as tips for making water more tasty and fun for kids.
• The National Academy of Sciences. Dietary References Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. https://www.nap.edu/read/10925/chapter/6#102 Accessed 8/5/2019.
• Millard-Stafford M, Wendland DM, O’Dea NK, Norman TL. Thirst and hydration status in everyday life. Nutr Rev . 2012 Nov;70 Suppl 2:S147-51.
• Hooper L, Abdelhamid A, Attreed NJ, Campbell WW, Channell AM, et al. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev . 2015 Apr 30;(4):CD009647.

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• Open access
• Published: 11 June 2024

Assessment of drinking water quality using Water Quality Index and synthetic pollution index in urban areas of mega city Lahore: a GIS-based approach

• Maria Latif 1   na1 ,
• Nimra Nasir 1 ,
• Rab Nawaz 1 , 2 ,
• Iqra Nasim 1   na1 ,
• Khawar Sultan 1 ,
• Muhammad Atif Irshad 1 ,
• Ali Irfan 3 ,
• Turki M. Dawoud 4 ,
• Youssouf Ali Younous 5 ,
• Zulkfil Ahmed 6 &
• Mohammed Bourhia 7  

Scientific Reports volume  14 , Article number:  13416 ( 2024 ) Cite this article

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Metrics details

• Environmental sciences

The aim of the present study was to assess the drinking water quality in the selected urban areas of Lahore and to comprehend the public health status by addressing the basic drinking water quality parameters. Total 50 tap water samples were collected from groundwater in the two selected areas of district Lahore i.e., Gulshan-e-Ravi (site 1) and Samanabad (site 2). Water samples were analyzed in the laboratory to elucidate physico-chemical parameters including pH, turbidity, temperature, total dissolved solids (TDS), electrical conductivity (EC), dissolved oxygen (DO), total hardness, magnesium hardness, and calcium hardness. These physico-chemical parameters were used to examine the Water Quality Index (WQI) and Synthetic Pollution Index (SPI) in order to characterize the water quality. Results of th selected physico-chemical parameters were compared with World Health Organization (WHO) guidelines to determine the quality of drinking water. A GIS-based approach was used for mapping water quality, WQI, and SPI. Results of the present study revealed that the average value of temperature, pH, and DO of both study sites were within the WHO guidelines of 23.5 °C, 7.7, and 6.9 mg/L, respectively. The TDS level of site 1 was 192.56 mg/L (within WHO guidelines) and whereas, in site 2 it was found 612.84 mg/L (higher than WHO guidelines), respectively. Calcium hardness of site 1 and site 2 was observed within the range from 25.04 to 65.732 mg/L but, magnesium hardness values were higher than WHO guidelines. The major reason for poor water quality is old, worn-out water supply pipelines and improper waste disposal in the selected areas. The average WQI was found as 59.66 for site 1 and 77.30 for site 2. Results showed that the quality of the water was classified as “poor” for site 1 and “very poor “ for site 2. There is a need to address the problem of poor water quality and also raise the public awareness about the quality of drinking water and its associated health impacts.

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Introduction.

One of the most important necessities for preserving human health is the availability of clean drinking water. Water is the most prevalent compound on the Earth surface and is a renewable resource that is necessary for life to exist. Unfortunately, the water will become increasingly scarcer as a result of population growth, urbanization, and climate change 1 . Industrial effluents are recognized as major contaminants in groundwater and sewer waters. Industries that release waste and effluents into water bodies without treatment have affected the environment, endangered human health, and disrupted aquatic ecosystems. Groundwater is contaminated with heavy metals and other pollutants due to the widespread dumping of industrial waste and effluents into water bodies without any kind of treatment or filtration. For the efficient treatment of water bodies, there are a variety of treatment technologies such as improved oxidation processes, phytoremediation, and nano-remediation 2 , 3 , 4 . Water resources in developing nations, such as Pakistan, are contaminated due to a number of industrial and human activities. People rely on heavily contaminated sources, like shallow wells and boreholes, for drinking water due to the insufficient water supply, which creates serious health hazards. In addition, these polluted water sources are unfit for residential use, which makes it even harder for communities to get access to clean and safe drinking water 5 .

Recent technological developments, such as chemical composition of pipelines, can occasionally result in the pollution of drinking water with biological, physical, and chemical pollutants. Improper or inadequate supply of drinking water poses a serious threat to public health. The water quality in most of the Pakistani cities is deteriorating rapidly 6 . Human health is greatly affected by the lack of access to sanitary facilities and clean water. Every year, the use of tainted water and inadequate sanitation systems cause around 2.2 million deaths among the population in poorer nations. The Sustainable Development Goals (SDGs) estimate that 1.2 billion people worldwide lack access to even the most basic services related to water. Remarkably, eight out of ten people live in rural regions without access to basic drinking water services, and nearly half of them live in Least Developed Countries (LDCs) 7 . Water-borne illnesses account for over 60% of infant mortality rates. In Pakistan's rural areas, around 90% of the population lacks access to clean drinking water 8 . The UNICEF research states that 12.6% of newborn deaths and 7% of fertility in Pakistan are connected to water-associated diseases, including as cholera, diarrhea, malaria, hepatitis, typhoid fever, dysentery, and giardiasis, and that between 20 and 40% of patients in the country’s hospitals suffer from these conditions. Every year in Pakistan, between 0.2 and 0.25 million children die from diarrhea. Every year, 10,000 people in Karachi die from kidney infections caused by contaminated drinking water 9 .

Industrial discharge can have a substantial impact on drinking water quality by bringing numerous pollutants into the environment, which in turn causes 82% of diseases like cholera, dysentery, and typhoid. Water bodies are primarily affected due to discharge of untreated or inadequately treated effluents that contain harmful pollutants such heavy metals, organic compounds, and excessive salt content. The safety and quality of drinking water resources are at stake because these pollutants have the ability to contaminate surface water and seep into groundwater sources. Inadequate management and elimination of industrial waste can result in enduring environmental deterioration and possible health risks for populations reliant on these water supplies 10 . An official survey conducted across 12 districts in Punjab indicated that around 79% of drinking water samples were contaminated, while 88% of drinking water in rural areas was contaminated due to sewage discharge, heavy metals, microorganisms, and industrial effluents 11 , 12 .

It is crucial to comprehend the spatial distribution of environmental features in order to evaluate the quality of drinking water. However, it can be expensive to monitor the water quality, particularly in big groundwater basins. Therefore, dependable and flexible gadgets will be required to solve such problems. Use of technologies like geographic information systems (GIS) facilitate spatial analysis, water quality monitoring, and support strategic planning and decision-making processes linked to water management. In the event of an emergency or outbreak of a waterborne disease, GIS can also help with real-time tracking, monitoring, and visualization of the impacted areas, the people at risk, and the resources that are available. GIS-generated interactive maps and visualizations can be used to make communities aware about water-related issues and to increase public understanding of potential hazards, sources, and quality of drinking water. Through the application of GIS technology, the drinking water quality of the entire region may be presented with fewer observations, which lowers costs and improves the overall effectiveness of water management and monitoring initiatives. Synthetic pollution index (SPI) and the water quality index (WQI) are among the most often used methods for classifying and reflecting the quality of the water and pollution risk in a given area. WQI and SPI have been utilized by researchers from several countries to evaluate the water quality in various places 13 , 14 .

The purpose of the present study was to evaluate the quality of the drinking water in the Gulshan-e-Ravi and Samanabad localities using the WQI and SPI. These areas are particularly ancient and are posing health risks including waterborne and microbial ailments like diarrhea and cholera, etc. Major reasons that lie behind the water pollution are industrial discharges, low groundwater levels, dumping, and old and worn-out metallic pipes. The study area i.e., Gulshan-e-Ravi, and some colonies of Samanabad zone has severe issue of water pollution. This can be observed in the form of common waterborn diseases rate. The key objectives of the present study are to identify the location points having high physico-chemical attributes by the GIS approach and to calculate the WQI and SPI of selected areas by determining the physico-chemical parameters in the water samples.

Materials and methods

The study was conducted in a densely populated city, Lahore, Punjab province, Pakistan. The longitude and latitude are 31.5204° N and 74.3587° E 15 . Study areas were Gulshan-e-Ravi and Samanabad town which are situated in the Samanabad zone of Lahore as shown in Fig.  1 . Lahore is located on the northeast side of the country having an international border (Wahga Border) with India. The northern part of the city is considered a walled city (old city). It is the provincial capital of Punjab. Pakistan’s second most populated city is Lahore with a population of more than 13 million. It is the 26th most populated city in the world 16 . The climate of Lahore is comprised of five seasons. Pakistan is fortunate to have these distinct seasons: summer, winter, autmn, spring, and monsoon. These unique weather patterns and seasons are important to Pakistan’s geographical circumstances. The hottest month of Lahore is June having a 38.2 °C average temperature, while the coldest month is January having a 12 °C average temperature. In monsoon months, maximum rainfall is observed 17 . According to the 2017 census, Lahore’s population is 11,126,285. During the past decades, the inhabitants of Lahore have grown extensively.

Map showing study areas with sampling sites.

Hydrogeological setting

Lahore aquifer, a 400-m-thick unconsolidated alluvial complex in Bari Doab, is a highly transmissive, 25–70 m/day hydraulic conductor in the south-flowing Indus River system. It is reported that there are two aquifers in the Lahore area, the shallow and deep, separated by an aquitard 18 . Despite the heterogeneous composition of the alluvial complex, groundwater occurs under water table conditions 19 . Another study found that the soil in the Lahore area is predominately composed of quartz, muscovite, and clinochlore as major minerals with small percentages of heavy minerals and can be classified as silty clay forming part of Pleistocene deposits 20 . The River Ravi is a major recharge source and controls the overall hydrological flow in the study area. The area is generally flat, sloping slightly to the south and southwest direction with a gradient of 0.3–0.4 m/km.

With respect to land cover/land use of study areas, Gulshan-e-Ravi, a predominantly residential area in Lahore, offers a diverse range of housing options, including multi-story apartment complexes and large-yard homes. Gulshan-e-Ravi, situated on the Ravi River’s eastern bank is characterized by alluvial soils and sedimentary deposits, making it ideal for farming. Gulshan-e-Ravi’s hydrogeological characteristics are impacted by the Ravi River’s proximity. Groundwater is a major source of water for residents, primarily accessible through boreholes and tube wells. The most dominant land use in the study area is residential with a densly populated housing setting that changed rapidly between the years 2000 to 2005 and 2010 to 2015 21 , 22 . The local geological characteristics and the depth of the groundwater table can affect both the quantity and quality of the water. However, Samanabad, an older and established residential area in Lahore, is predominantly urban with a mixture of modern constructions and narrow streets. It is located on alluvial plains with sedimentary layers, has rich, ideal soil for agriculture, despite decreased agricultural land due to urbanization, and its water source comes from groundwater.

Physico-chemical analysis

Drinking water samples were collected from 2 locations in Lahore i.e., Gulshan-e-Ravi and Samanabad, which are old urban areas of District Lahore, Pakistan. 25 water samples were collected from both areas. New plastic water bottles were used for sample collection to avoid any kind of contamination, along with proper care and labeling of bottles. Bottles were properly washed 2 to 3 times and dried before the sampling. Random sampling method was used to collect the water samples at various locations within the study areas during the months of August and September. Water quality parameters are significantly influenced by the monsoon season, characterized by heavy rainfall. This precipitation can lead to increased runoff from urban areas, potentially transporting pollutants into water bodies. Rising temperatures, agricultural practices, and the discharge of untreated wastewater further contribute to the complex interplay of factors affecting water quality during these months 23 .

A tap was run for 2–3 min before collecting a sample to help flush out stagnant water. The sample bottle was held below tap flow, filled to the specific line, and sealed. The sample bottle was then labled. Longitudes and latitudes were also recorded instantly. Numerous water quality parameters, including physical (temperature, turbidity, TDS) and chemical (pH, EC, DO, total hardness (TH), calcium (Ca +2 ) hardness, and magnesium (Mg +2 ) hardness) were determined in the laboratory. Temperature and pH were measured at the site of sample collection. All physico-chemical parameters were analyzed by following the standard methods of the American Public Health Organization (APHA) and the American Society for Testing and Materials (ASTM) as shown in Table 1 . These guidelines were followed throughout the examination process. This commitment to established standards not only ensures the accuracy and reliability of the data but also facilitates comparability with existing research, contributing to a more robust and credible assessment of groundwater quality. ArcGIS (10.8) software was used, employing the interpolation technique, to develop spatial maps for identifying the areas with polluted drinking water.

Total hardness (TH), Ca +2 hardness, and Mg +2 hardness were analyzed using the standard EDTA titration method. For total hardness, an ammonia buffer solution was prepared and added to a 50-water sample. A pinch of Erichrome Black-T was added and suddenly the color of the sample changed from transparent to wine red. Then it was titrated against EDTA present in the burette, the colour changed to dark blue. Total hardness was calculated by observing the initial and final burette readings by the following formula;

For calcium (Ca +2 ) hardness, 2 ml of 1 M NaOH (sodium hydroxide) solution was prepared and a few drops were added to the 50 ml of water sample with the help of a pipette. Then after stirring, a pinch of murexide (C 8 H 3 N 5 O 6 –2 ) was added to the water sample. After a little stirring, the sample watercolor was changed to a pink color. Then, it was titrated against the EDTA solution present in the burette, and the color was changed from pink to purple indicating the presence of calcium. Calcium hardness was calculated by following the formula;

Magnesium (Mg +2 ) hardness is calculated by the difference between total and calcium hardness by given following formula;

Water Quality Index (WQI)

The nine significant physico-chemical parameters were utilized for estimation of WQI from the study site to assess the quality of drinking water. WHO permissible values for drinking water were used to compare these parameters using the formula for calculating WQI 25 .

To analyze WQI, firstly relative weight ( W i ) was calculated using the given formula:

K was calculated using;

where, Wi is the unit weight factor, K is the proportional constant, Si is the standard permissible value of i th parameter.

The unit weight for all the chosen nine parameters with their standard values was calculated. A number that reflects the relative value of the given parameter in the contaminated water referring to its permissible standard value is the quality rating scale (Qi) and it was calculated using the formula;

where, Q i is the quality rating scale of i th parameter, V i is the estimated permissible value and S i is standard permissible value of i th parameter.

All the values of V o were taken as 0 for the drinking water, except for pH and DO i.e., 7.0 and 40 ppm. After finding w i and q i ,, both values were multiplied with each other by having w i q i and then it was divided with w i :

Then overall WQI was calculated;

WQI for water samples of both sites 1 and 2 was calculated using the Eq. ( 10 ). WQI generally ranges between good to poor category 26 . The water quality of the selected areas was classified into different categories using WQI, as given in Table 2 .

Calculation of synthetic pollution index (SPI) model

The derivation and calculation of SPI involves different steps given below 28 :

Step 1: Constant of proportionality ( Ki ):

Step 2: Weight coefficient ( Wi ):

Step 3: Synthetic pollution index (SPI):

where, Si is the threshold value for an i th physicochemical parameter as per WHO guidelines and n is the total number of water quality parameters considered for analysis. Based on SPI, the water quality is classified into five categories as shown in Table 3 ;

Results and discussion

Results from the present study revealed the significant variations in different physico-chemical parameters of sampling sites. Some of the water samples had paramters’ values below and some of them had above the WHO guidelines for drinking water.

Analysis based on physico-chemical parameters

The pH level of a solution indicates its alkalinity or acidity, determined by the concentration of hydrogen ions within the solution. Typically, the pH scale varies from 0 to 14. At 25 °C, the acidic aqueous solutions have a pH under 7. While basic or alkaline aqueous solutions have a pH above 7. Furthermore, a pH level of 7 at 25 °C is considered as “neutral”. As the H 3 O + ions concentration becomes equal to the OH – ions concentration in pure water. Strong bases may have a pH above 7 to 14, while strong acids have a pH of less than 7 to 0 29 . WHO guideline for pH of drinking water is 6.5 to 8.5. In this study, most of the water samples had pH between the range, as shown in Fig.  2 . Block 1 of site 1 (Gulshan-e-Ravi) average pH was slightly below the WHO guideline i.e., 5.87. While, Block 1 and 3 of site 2 (Samanabad) average pH was slightly above the guideline i.e., 8.54 and 8.66. Some of the areas in Blocks 1 and 3 had water contamination issues due to old and corrosive water pipelines. The blue color in the pH map indicates high pH values (alkaline) exceeding the WHO guidelines in the study sites figure. Most of the problem lies in acidic water compared to basic water which causes skin issues. Also, the human kidney system is considered to be the best filtration system to maintain the acid–base situation in the human body. And alkaline water has an advantage in improving gut health and lowering blood sugar levels 30 .

Concentration of physical parameters: Temperature ( a ), TDS ( b ), and Turbidity ( c ) in drinking water of selected areas of Lahore.

The temperature of the water is also important physical parameter for assessing water quality. Temperature can affect many other factors as well and it can alter chemical and physical properties of water 31 .

According to WHO, the standard temperature for drinking water should be between 20 and 25 °C. Both study sites had temperatures within range except for Block 3 of Site 1 and Block 1 of Site 2. Both values were slightly above the guideline and this might be mainly due to the sample collection season. The temperature map shows variations in the temperature of both study sites. The most significant temperature fluctuations are depicted in yellow (22–24 °C), followed by orange and then green. Areas exceeding WHO guidelines are presented in red color. High temperatures may increase the microbial activity and this can affect other parameters such as pH and electrical conductivity.

The TDS consists of inorganic salts including Ca +2 , Cl − , K+, Na+, Mg +2 , HCO 3 −1 , and SO 4 −2 and a few other small amounts of such organic contents, minerals or metals which are dissolved in a specific amount of water 32 . Higher levels of TDS affect the drinking water quality. According to a study 33 , TDS in drinking water shouldn’t be more than 500 mg/L or ppm. If it exceeds more than 600 or 1000 mg/L, it is not considered fit for drinking. TDS are mostly increased by industrial sewage, rocks, urban runoff, silt, and the use of fertilizers and pesticides. WHO guideline for TDS in drinking water is 600 mg/L. Site 1 samples had TDS within the WHO guideline with an average maximum value of 192.5 mg/L. While site 2 had serious issues regarding TDS in drinking water. Drinking water in 4 out of 5 blocks had TDS higher than the WHO guideline, as shown in Fig.  2 . The average highest value of TDS was 779 mg/L in Block 1 of site 2. While, 80% of site 2 water samples had TDS higher than guidelines, exceeding 1000 mg/L.

The management of groundwater for domestic and agricultural consumption requires a thorough qualitative assessment and a comprehensive understanding of spatial variation 34 , 35 , 36 . For this purpose, spatial distribution maps were also incorporated into this study as shown in Fig.  3 . The map of chemical parameters such as TDS indicates high TDS values exceeding WHO standards in Site 2 (yellow, orange, and red). The most of the water samples had TDS level between 472 and 672 mg/L in site 2 while, Site 1 had a TDS level within the permissible range of WHO standards which is indicated by blue color (137–305 mg/L), as shown in Tables 4 and 5 . High levels of TDS in drinking water and domestic use can lead to nausea, vomiting, dizziness, lung irritation, and rashes. While long term usage of such water can cause chronic health issues such as liver and kidney failures, cancer, weak immunity, nervous system disorders, and birth defects in newborn babies. Pakistan is facing health risks due to poor monitoring and maintenance, ranking as one of South Asia’s most water-polluted countries with urban areas contributing to increasing health and environmental issues 37 , 38 .

Water quality status map for Gulshan Ravi (Site 1) and Samanabad (Site 2): Temperature ( a ), Turbidity ( b ), and TDS ( c ) are visualized through a GIS-based map, illustrating the water quality conditions at both sites.

Turbidity is caused by suspended waterborne particles, including fine inorganic or organic substances, sediment, and microscopic organisms like algae, scattering of light, and cloudy or opaque appearance of water. These particles can consist of fine sediments like silt or clay, and various others. A low level of turbidity indicates high clarity of water, while a high level of turbidity indicates low clarity of water 39 . According to a study 40 , drinking water turbidity should be less than 5 NTU (Nephelometric Turbidity Unit). High levels of turbidity may not seem aesthetically clean and water is not fit for drinking purpose. Most of the samples were within the permissible range recommended by WHO that indicated that the water in these sites was clear. One case was detected in block 1 of site 2, which had a slight 1% high turbidity in water, still, it made the water cloudy. The highest turbidity issue was reported in both sites but especially in site 2 have a turbidity of more than 5 NTU. High turbidity can hinder disinfection issues in the water and it can lead to high growth of microorganisms such as parasites, bacteria, and viruses. Drinking water with high turbidity can cause nausea, diarrhea, cramps, and headaches especially in infants, as they are more prone to diseases. Other than those, the elderly and weak immunity people can also be affected by such problems. Also, it seems poor aesthetically 33 and people boil water before use in case of high turbidity of water.

A greater EC indicates that the groundwater is more enriched in the salts. For dissolved ionizable solid (Na, Ca, and Mg salts) concentrations and salinity, EC works as an indicator. Due to the effect of anthropogenic activities, more pollutants move into groundwater and hence, EC increases 41 , 42 . It is measured in micro-Siemens per centimeters (µS/cm) or milli-Siemens per centimeters (mS/cm). i.e., 1 mS = 1000 µS and 1 µS = 0.001 mS. WHO guideline for EC in drinking water rages from 200 to 800 µS/cm, while 800 µS/cm is the MPL for drinking water. Block 2 (849.8), 3 (814.4), and 5 (844.6) of site 1 had more EC than the standard. While in site 2, block 1 (877.6), 3 (897), and 4 (818) had high EC specifically block 3 had the highest one followed by block 2 of site 2 and then block 2 and 5 of site 1. The highest EC (> 800 µS/cm) was recorded in both sites which is indicated by the white and tea-pink color. High EC causes high corrosiveness in the water. EC has no direct health link but it can lead to other fluctuations in parameters like pH, total hardness, and TDS, which can cause minerals like the taste of water and health issues like skin problems and gut problems.

Dissolved oxygen (DO), necessary for aquatic life, can be negatively affected by the presence of organic material, agricultural runoff and leaching, industrial waste, and dissolved gases, with concentrations below 5.0 mg/L 32 . Sufficient DO is essential for water quality, higher levels of DO affect aquatic life and potentially corrode water pipes, while low levels indicate increased microbial activity. WHO guideline for drinking water DO is 6.5 to 8 mg/L or ppm. Almost every sample was within the range of standard. The permissible value of DO in water indicates that oxygen concentration is fine for drinking purposes. DO concentration of both sites was within the range of WHO guideline except for 2 to 3 sampling points of site 2. The reason might be some anthropogenic factors which increase temperature and hence microbial activity starts.

Total hardness indictaes the magnesium (Mg) and calcium (Ca) dissolved in the water, to measure the solubility of water for drinking purposes, local households, and some industrial applications credited to the occurrence of Ca +2 , Mg 2+ , Cl − , HCO 3 −1 , and SO 4 −2 . Specifically, alkaline earth metals Ca and Mg in dissolved form, play an important role in water hardness. It is measured in milligrams per liter (mg/L) of calcium carbonates by combining overall contents 32 .

Water having hardness below 75 mg/L is soft water, followed by 76 to 150 mg/L lies in moderately hard water, 151–300 mg/L is categorized as hard water and more than 300 mg/L is considered very hard water 43 . WHO guidelines for total hardness should be no more than 500 mg/L in drinking water. Block 5 of site 2 had the highest water hardness recorded in the study area. Overall, site 2 water samples were mostly in the very hard water category and in contrast with site 1, most of the samples were soft water and moderately hard. This indicates that site 1 samples were in the permissible range of WHO having good water quality while site 2 had hard water issue due to densely populated areas and old scaly waterpipes. According to a study 44 , effective management strategies are required to prevent groundwater contamination and pollution, primarily in monitoring wells, and ensure daily access to alternative water sources for the local population.

The majority of water hardness was observed in site 2 having light and dark pink colors. While site 1 had total hardness within range and was shown with light and dark blue color. Although water hardness is not a health concern, it can cause problems in the home while washing clothes, dishwashing, bathing, and making clothes stiff and rough. Sticky soap curd is formed when soap is utilized with hard water, this can cause hurdles while cleaning. Also, it causes psychological issues may happen when this type of situation happens. While bathing, when the soap curd sticks with the body it prevents the removal of bacteria or dirt from the body and this can cause irritation and allergic itching problems in humans. In addition, water hardness reduces water flow in pipelines and hence Ca +2 and Mg 2+ deposits in the pipelines ultimately require pipe replacement 45 .

The amount of dissolved calcium in the water is represented in mg/L or ppm (parts per million) of calcium carbonates. Limestone is the major source of Ca hardness in water. Also, calcium can react with Fe, Zn, P, and Mg while reducing the absorption of other minerals. WHO standard for Ca 2+ contents or hardness in drinking water is 60 to 120 mg/L. Whereas, 120 mg/L is the MPL for any drinking water. Ca 2+ contents in current study areas varied depending upon the location. Block 1 and 5 of site 2 had the highest Ca 2+ contents i.e., 123 and 118 mg/L, which exceeded the standard of WHO. Site 1 of the study area had Ca 2+ contents within the permissible range and the water was considered as soft as shown in Fig.  5 . Moderately high Ca hardness was observed in some areas of Site 2 (shown with dark blue color). While most of the water samples of both study sites were within range as shown in Fig.  4 . High Ca 2+ contents can weaken the bones; forms kidney stones and it also interfere with our brain and heart working. All of these problems can lead to hypercalcemia.

Concentration of selected chemical parameters: pH ( a ), EC ( b ), DO ( c ), Total Hardness ( d ), Calcium hardness ( e ), and Mg hardness ( f ) in drinking water of selected sites of Lahore.

The presence of high Mg 2+ in the form of SO 4 −2 and CO 3 −2 in drinking water is magnesium hardness. It is measured in mg/L or ppm. Dolomite is the major cause of magnesium hardness in water 46 . The WHO standard for Mg 2+ concentration in water is 50 mg/L. Most of the values in the current study site were in the permissible range, but a few like block 1 of site 1 and block 5 of site two had slightly higher Mg 2+ content in water as shown in Fig.  4 . This indicates that Mg 2+ deposits were present in the pipelines due to high sewage content. The map indicates a magnesium hardness trend in both areas. Some areas with dark purple values had high Mg hardness as compared to others with light colors. High Mg 2+ can cause hypermagnesemia, which causes renal failure resulting in the reduced ability to remove magnesium from the kidney. Bowel functions can also be disturbed by high Mg 2+ contents. The local hydrological setting controls water movement in the south and southwest directions towards the Ravi River. Soil–water contact enhanced the dissolution of minerals, enriching water with sodium and calcium concentration (Fig.  5 ), resulting in the rise of total dissolved salts. Mineral–water contact time brings salt concentration (~ 1000 mg/L) levels that render it unsuitable for some uses.

Water quality status map for Gulshan Ravi (Site 1) and Samanabad (Site 2). EC ( a ), pH ( b ) and TH ( c ), Calcium hardness ( d ), Mg hardness ( e ) and DO ( f ) are presented using a GIS map to illustrate the water quality conditions at both sites 1 and 2.

Analysis based on the WQI model

The Water Quality Index maps were developed using ArcGIS software (10.8) on the basis of selective physico-chemical parameters, classified as excellent, very good, good, poor, and very poor 47 as mentioned in Table 2 . The factors affecting the water quality include all the physico-chemical parameters that were used to examine the water quality. These factors play a key role in identifying the water quality of an area 48 . Basically, this study includes the determination of physiochemical parameters of drinking water in current study sites and their water quality parameters, as shown in Table 5 . Based on water quality factors, the WQI produces a single value that indicates the total water quality in a specific area. This is a composite indicator that combines the effects of many water quality parameters and suitability for drinking purposes 1 , 49 , 50 .

The WQI is a statistical tool that simplifies the analysis of complex groundwater data 51 . WQI of site 1 and site 2 was 59.66 and 77.3, respectively. Site 1 WQI lies in a “Poor” rating of water quality. Site 2 WQI lies in the “Very Poor” rating of WQI as shown in Fig.  6 which indicates that both areas either had some physiochemical parameters within range, but overall, the water quality rating is very poor and it poses a serious health threat to the residents of these areas. A comparative difference between both sites with the help of an interpolation map shows both areas were shown with dark colors which indicate poor and very poor water quality (Fig.  7 ). Findings of the current study regarding WQI are in line with a study conducted by 52 to check water quality in western Lahore which has poor WQI and is unfit for human consumption. The observed differences in water quality, ranging from poor to very poor, can be attributed to a myriad of factors. Conversely, areas with poorer water quality experience contamination from industrial discharges, low groundwater levels, dumping, and old and worn-out metallic pipes. To address these disparities and improve water quality in deteriorating areas like Samanabad and Gulshan Ravi in Lahore, comprehensive mitigation measures are essential like water monitoring, and community awareness on responsible water usage are potential interventions. Additionally, strategic urban planning and infrastructure development can play a pivotal role in preventing further degradation and fostering long-term improvements in water quality.

Comparison of average WQI for Gulshan Ravi (Site 1) and Samanabad (Site 2).

Spatial distribution map showing WQI of both site 1 Gulshan Ravi and site 2 Samanabad.

Analysis based on the SPI Model

The findings of the analysis of water samples for the purpose of determining the quality of drinking water and classifying it using SPI are compiled in Table 3 .

Based on the SPI model, water samples of both areas were identified as “very polluted” as the SPI value was more than 3 indicating that there is a high risk of contamination of drinking water in these areas.

Water quality issues prevailing in the study area are similar to those found in other big urban areas of Pakistan 53 . SPI of water samples collected from a selected areas of Karachi varied from 0.6 to 6.6 and no water sample was found to be suitable for drinking purposes.

The relationship between WQI and SPI models

The respective WQI and SPI model categories of water were correlated using regression analysis in order to determine a relationship between them. The relationship shows a strong correlation between both models showing the R 2 value is 1, as shown in Fig.  8 . A series of studies have demonstrated a strong regression analysis between water quality index (WQI) and synthetic pollution index (SPI) in drinking water quality. Other study found a significant positive correlation between WQI and SPI, indicating an increase in pollution load 54 . This was further supported by another research study 55 , that reported a fair correlation between the two indices in the lower stretch of river Ganga. The threat of heavy metal pollution in drinking water, with a significant impact from Pb contamination are explored 56 . A study further improved the prediction of WQI using machine learning regression models, with linear regression and ridge offering the best performance 57 . These studies collectively underscore the importance of monitoring and addressing synthetic pollution in drinking water.

Regression analysis of Water Quality Index and Synthetic Pollution Index.

The aim of the present study was to assess the quality of drinking water in two urban areas of Lahore using physico-chemical analysis, Water Quality Index (WQI), and the Specific Pollution Index (SPI). The findings revealed that in site 1 (Samanabad) had significant issues related to water quality, affecting primarily major residential colonies and blocks with elevated physico-chemical parameters suh as TDS, temperature pH, Ca +2 , Mg +2 , turbidity, etc. The major reasons for poor water quality are old water pipelines, rapid urbanization, toxic ingredients seepage, improper waste disposal, and low groundwater levels in these areas. Major parameters recorded that were above the WHO guidelines were EC, pH, TDS, and hardness. Although some parameters of both areas were within range as prescribed by WHO guidelines, WQI indicated that both areas had overall poor (59.66) and very poor (77.30) water quality ratings. WQI describes a greater number of variables using a single value that indicates the overall quality of water in a certain area. It is concluded that the water quality in both study areas was found unsuitable for drinking, emphasizing the need for prompt action by local authorities. Stricter management of industrial effluent, public education campaigns about water conservation, and the search for alternative water supplies should be the top priorities for remedial action. To reduce the risk of pollution, there is need of maintaining and modernizing sewage infrastructure, distribution networks, and provision of water treatment plants.

Data availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

The authors extend their appreciation to the Researchers Supporting Project number (RSP2024R197), King Saud University, Riyadh, Saudi Arabia. The authors acknowledge the Department of Environmental Sciences, The University of Lahore for providing technical support. Some part of the paper is extracted from the final year project of the second author of the paper. Thanks are also extended to the team at the analytical lab for providing the necessary facilities during this work.

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These authors contributed equally: Maria Latif and Iqra Nasim

Authors and Affiliations

Department of Environmental Sciences, The University of Lahore, Lahore, 54000, Pakistan

Maria Latif, Nimra Nasir, Rab Nawaz, Iqra Nasim, Khawar Sultan & Muhammad Atif Irshad

Faculty of Engineering and Quantity Surveying, INTI International University, 71800, Nilai, Negeri Sembilan, Malaysia

Department of Chemistry, Government College University Faisalabad, Faisalabad, 38000, Pakistan

Botany and Microbiology Department, College of Science, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia

Turki M. Dawoud

Evangelical College, BP 1200, N’Djamena, Chad

Youssouf Ali Younous

College of Resource and Civic Engineering, Northeast University, Shenyang, China

Zulkfil Ahmed

Laboratory of Biotechnology and Natural Resources Valorization, Faculty of Sciences, Ibn Zohr University, 80060, Agadir, Morocco

Mohammed Bourhia

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Contributions

Conceptualization, M.L. and R.N.; methodology, N.N. and I.N.; software, M.L. and K.S.; validation, M.A.I. and K.S.; formal analysis, A.I. and N.N.; investigation, N.N.; resources, A.I and K.S.; data curation, A.I. and N.N.; writing—original draft preparation, M.L.; writing—review and editing, R.N. and A.I.; visualization, MB; supervision, D.T.; project administration, Y.A.Y.

Corresponding authors

Correspondence to Rab Nawaz , Ali Irfan or Youssouf Ali Younous .

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Latif, M., Nasir, N., Nawaz, R. et al. Assessment of drinking water quality using Water Quality Index and synthetic pollution index in urban areas of mega city Lahore: a GIS-based approach. Sci Rep 14 , 13416 (2024). https://doi.org/10.1038/s41598-024-63296-1

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Published : 11 June 2024

DOI : https://doi.org/10.1038/s41598-024-63296-1

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Essay on Drinking Water

Students are often asked to write an essay on Drinking Water in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Drinking Water

Importance of drinking water.

Water is life’s essential ingredient. Our bodies are about 60% water. Drinking water keeps us hydrated, which is vital for our bodily functions.

Benefits of Drinking Water

Drinking water aids in digestion, nutrient absorption, and maintains body temperature. It also helps in flushing out toxins and keeps our skin healthy.

How Much Water to Drink?

Experts suggest drinking 8-10 glasses of water daily. However, this can vary based on physical activity and climate.

Drinking water is crucial for our health. So, let’s make a habit of consuming enough every day.

250 Words Essay on Drinking Water

The importance of drinking water.

Water is a fundamental element of life. Covering about 70% of the Earth’s surface, it’s also the primary component of the human body. However, the importance of drinking water extends beyond mere existence. It plays a vital role in our physical and mental health, and even in societal development.

Physiological Benefits

Water is the medium of all metabolic processes in the body. It aids in digestion, nutrient absorption, and waste elimination. It regulates body temperature, lubricates joints, and maintains skin health. Dehydration, on the other hand, can lead to fatigue, headaches, and impaired cognitive function.

Mental Health Implications

The brain is approximately 75% water. Hence, adequate hydration is necessary for optimal brain function. Studies suggest that even mild dehydration can affect mood, concentration, and memory. Furthermore, it can exacerbate symptoms of certain mental disorders.

Societal Relevance

Access to clean drinking water is a global concern. It’s not just about health, but also about social equality and economic growth. Water scarcity can lead to conflicts and migration, while waterborne diseases can cripple communities.

In essence, drinking water is not just a basic need, but a cornerstone of human health and societal progress. As we delve deeper into the intricacies of our bodies and societies, the importance of this clear, tasteless liquid becomes even more apparent. We must therefore strive for its conservation and equitable distribution, recognizing it as a critical component of our collective wellbeing.

500 Words Essay on Drinking Water

Introduction.

Water makes up about 60% of the human body, highlighting its role in maintaining bodily functions. It aids in digestion, nutrient absorption, and waste elimination. It also helps regulate body temperature, lubricate joints, and protect sensitive tissues. Dehydration, or the lack of adequate water in the body, can lead to serious health issues such as kidney stones, urinary tract infections, and even cognitive impairment.

Health Benefits of Drinking Water

Drinking sufficient water has numerous health benefits. It boosts skin health and beauty, flushing out toxins and promoting a clear complexion. It aids in weight loss by enhancing metabolism and suppressing appetite. Furthermore, it plays a crucial role in maintaining cardiovascular health by facilitating the flow of oxygen and nutrients in the blood.

Challenges of Water Scarcity

Sustainable water management.

Given the importance and scarcity of water, sustainable water management is imperative. It involves the efficient use of water resources, reducing waste, and promoting conservation. For instance, rainwater harvesting and wastewater treatment can provide alternative sources of water. Additionally, awareness campaigns can educate the public about the importance of water conservation and the dire consequences of wastage.

In conclusion, drinking water is a fundamental human need and a critical component of our health and wellbeing. However, water scarcity is a pressing issue that threatens our ability to meet this basic need. Therefore, it is crucial to prioritize sustainable water management, promoting water conservation, and ensuring equitable access to clean, safe drinking water for all. By doing so, we can safeguard our health and secure a sustainable future for generations to come.

If you’re looking for more, here are essays on other interesting topics:

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Make Your Note

The Big Picture - Drinking Water: Quality & Challenges

• 22 Nov 2019
• GS Paper - 2
• Management of Social Sector/Services
• Issues Arising Out of Design & Implementation of Policies

According to the Ministry of Consumer Affairs, Food and Public Distribution, Mumbai residents need not buy reverse osmosis (RO) water purifiers as samples of tap water collected from the Mumbai are compliant with the Indian standards for drinking water.

However, other metro cities of Delhi, Kolkata and Chennai failed in almost 10 out of 11 quality parameters tested by the Bureau of Indian Standards (BIS). Similar is the condition in the majority of other state capitals.

Nature of Water Crisis

• According to NITI Aayog's Composite Water Management Index 2018,  21 major cities (Delhi, Bengaluru, Chennai, Hyderabad and others) are racing to reach zero groundwater levels by 2020, affecting access for 100 million people.
• India ranks 120 among 122 countries on the Water Quality Index released by WaterAid.
• The national capital region of India is facing a double whammy, not only it harbours poor standards of air (air emergency) but poor water quality also.

Drishti Input:

• According to the data released by the World Resources Institute, India is ranked 13 th among the 17 most water-stressed countries of the world.
• According to the Ministry of Urban Development, 80% of India's surface water is polluted.
• This signifies India is going through Water emergency.

Causes of Poor Drinking Water Quality

• Chlorination only kills bacteria & other microorganisms but dissolved salts, alkalinity, toxic metals in water can't be eliminated by chlorination.
• Moreover, the water supply line & sewerage line running side by side.
• However, groundwater is severely contaminated by carcinogenic pollutants like Arsenic.
• Water is a state subject. This lead to the problem of coordination between Union, State and Local government.
• Rapid urbanization has led the unequal distribution of water, contamination/ depletion of local water bodies due to pollution.
• Sometimes the places from where water samples are collected, may not reflect the true state of water quality.

Effects of Poor Drinking Water

• Harmful health impacts: Nearly 70% of the diseases in India are waterborne. Therefore, poor water quality is a great health hazard.
• Economic cost: Poor drinking water will lead to a reduction in tourist inflow.
• Domino effect: Result of poor drinking water is the prime reason for the sale of plastic bottled drinking water. However, this bottled water gives rise to plastic pollution.
• Also, the RO water is deprived of essential minerals and salts.
• Social effect: With the given condition of the water crisis, it is less likely to fulfil the target of providing everyone with safe drinking water (Sustainable Development Goal number 6).

Way Forward

• This will increase involvement, sensitization & awareness of citizens, service providers and the government.
• This can make municipalities and other local bodies accountable.
• Pricing for water: Water can be priced for well-off sections of society so that proper maintenance cost should be recovered.
• Also, efforts should be made to find out the sites of continuation in the supply line.
• Technological solution: Up-gradation of the water treatment plant to remove toxic inorganic pollutants and dissolved solids.
• Therefore, rainwater harvesting should be encouraged to the maximum extent possible.
• Next step for Jal Jeevan mission: The government's effort to provide piped water to all rural households by 2024 under the Jal Jeevan mission, is a step in the right direction. However, providing quality piped water will be a big challenge.

Effect of soaking time of cocoa fruit peel and addition of citronella grass extract (Cymbopogon nardus) on quality characteristics of infused water from indonesian local resources for increasing body immune to face bad environment

• Lubis, M. M.
• Nurminah, M.
• Lubis, L. M.

Infused water is a form of modern processed food that is widely consumed by the public. Infused water drinks can be made from a variety of food ingredients. This infused water drink is made from cocoa pod skin and added citronella juice. This research was conducted to investigate the impact of soaking duration of cocoa fruit peel and the concentration of lemongrass extract on the characteristics of cocoa fruit peel infused water. This study used a factorial Completely Randomized Design method with two factors, namely the soaking time of cocoa fruit peel (P): (2 hours; 4 hours; 6 hours) and the concentration of citronella grass extract (S): (5%; 10%, 15%). Infused water drinks were then analyzed for color index (°Hue), pH, vitamin C levels, and antioxidant activity. The final result was that P3S3 treatment = 6 hours of soaking cocoa pod skin : 15% citronella grass extract was the best treatment of infused water.