Abstract:
Clean and plentiful water provides the foundation for prosperous communities.
Changing climate patterns are threatening lakes and rivers, while key sources of
drinking water are being overdrawn or tainted with pollution. Water can be
contaminated with fecal material due to inadequate protection of the source,
unhygienic practices of the community at the source and poor household handling
practices. Water contamination exuberate its potential for greatly transmitting variety
of enteric diseases. Escherichia coli is considered the most suitable index of fecal
contamination. Thermotolerant (TTC) E. coli in water is used to monitor the quality
of drinking water as well as disinfection indicators. Limited data exit in Kenya
qualifying the safety (both from harmful bacteria and disinfectant byproducts) of
drinking water for human consumption. In fact, with the poor water handling
strategies both at the sources and within households especially in rural and socioeconomically poor settings in Kenya calls for an urgent water quality survey to avert
the water born infections epidemic waiting to occur. With this urgency, this crosssectional study sought to determine the proportion of water (source and within the
household) in Kericho district contaminated by TTC as well as evaluated factors
associated with this contamination in the district. Water samples were collected
aseptically using sterile sampling containers. About 100 mL of the water sample was
collected and immediately analyzed for bacteriological qualities and physical
chemical properties (pH, temperature, turbidity, and free chlorine) on site using a
DelAgua water testing kit. Water source sampling (rivers, streams, or other surface
waters) involved drawing water from 30cm below the surface. Sampling from wells
and boreholes involved drawing water using a bucket and taking 100 mL into a
sterile container. Water samples were filtered through a 0.45 μ m pore size
membrane filter. Culture and multiplex polymerase chain reaction (PCR) techniques
were used to characterize TTCs. The disk diffusion method was used for antibiotic
susceptibility profiling of pathogenic E. coli. Structured questionnaire was adopted
from the WHO/UNICEF Joint Monitoring Programme which was used to gather
information related to water-extraction patterns, type of water transport, water
treatment methods, hygiene and sanitation related issues. A total of 103 households
consented and their household and source waters collected. Majority (30.1%) of the
households were located within the Kericho Township, (68.9%) were in the rural
locality, (95.1%) were female and (42.7%) were aged 21 to 30 years. The
respondents mean age was 21.59 years, the range (18–29 years) was the majority.
The main water source was river (36.9%) and only (33%) had piped or municipal
supply. Most (43.7%) of the households had drinking water source within their
premises while (13.6%) had to walk for 30 to 60 minutes to water source. Majority
60.2% of the household used clay pot for water storage; most of them (91.3%) did
not treat their drinking water. The majority (83.5%) drew drinking water by dipping
the cup into the water storage container. About (59.2%) did not wash their hands
before drawing water while (96.1%) of them rinsed the water drawing utensils. There
were 48/103 (46.6%) households whose drinking water was contaminated by
Thermotolerant coliform (TTC) levels of >10cfu/100ml. Five (10.4%) of these 48
TTCs were toxigenic E. coli including 2/5 (40%) Enteroaggregative E. coli (EAEC),
2/5 (40%) Enterotoxigenic E. coli (ETEC) and 1/5 (20%) Enteropathogenic E. coli
(EPEC). All of this pathogenic E. coli were resistant to commonly used antibiotics such as Cephalothin, Ampicillin, Tetracycline, Ampicillin/sulbactam and
Sulfamethoxazole/trimethoprim. Rural household locality (OR 2.01, 95% CI 1.09 to
4.12) and hand contact with drinking water during water withdrawal (OR 1.11, 95%
CI 1.11 to 3.39) increased the likelihood of water TTC contamination. However,
household whose main source of drinking water was from piped supply or from
municipal (OR 0.38, (95%) CI 0.16 to 0.91), washed their drinking water storage
containers (OR 0.58, 95% CI 0.31 to 0.99), washed hands before drawing drinking
water (OR 0.33, 95% CI 0.15 to 0.67), households whose total coliforms count was
less than 10 cfu/100ml (OR 0.45, 95% CI 0.26 to 0.81) and household water source
temperatures was between 15 to 20oC (OR 0.39, 95% CI 0.16 to 0.96) were less
likely to have household drinking water contaminated with TTC. This study shows
that significant number of household drinking water in this study were contaminated
with TTC including toxigenic multi-drug resistant E. coli. These strains are
associated with great mortality and morbidity especially among children and
immunocompromised population. The study recommends continuous monitoring of
both water sources and household for contamination and that water treatment of any
kind could reduce the level of TTC contamination. Further the study showed that by
improving on hygiene and protecting water source are simple implementable steps
household could adopt to improve the quality of drinking water in the district.