Evaluation of the drinking water parameters in primary and secondary schools located in the Gaziantep Province Center

The term ‘drinking water’ refers to water that is safe for consumption, devoid of pathogenic microorganisms and toxic substances, and contains minerals in a balanced manner. Access to clean potable water is essential to public health (Güler 2012). From various standpoints, school-age children constitute a distinct population concerning public health. School environmental health practices become more critical as school-age children spend a significant portion of their day at school, and the influence of environmental factors on individual health and success levels is evident. Throughout this process, children maintain their growth and development, and the preventive measures implemented or disregarded during this period will have enduring impacts on their subsequent lives (Güler & Akın 2012). As per the data from the joint program of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), 29% of schools worldwide are deemed to have inadequate drinking water services, impacting a total of 546 million school children (World Health Organization 2022). Given the prevailing global circumstances, it is clear that deficiencies exist in the provision of clean and safe drinking water in educational institutions. In the context of drinking water inspections, schools are not routinely subjected to sampling. In light of this information, it is thought that laboratory evaluation of drinking water in schools may be necessary. This study aimed to assess the parameters of drinking water in primary and secondary schools in the city center of Gaziantep. The investigation focused on identifying the drinking water source and management practices in primary and secondary schools within the province. It also evaluated the availability of healthy drinking water for school students using collected samples. It was evaluated whether there was a difference between the central districts in access to healthy drinking water.

The study population consisted of 519 primary and secondary schools located in the Şahinbey, Şehitkamil, and Oğuzeli districts of Gaziantep Province, all affiliated with the Provincial Directorate of National Education. The Provincial Directorate of National Education granted institutional permission. This epidemiological study was conducted cross-sectionally. Based on the power analysis, it was concluded that the ‘minimum sample size’ is 54. The sample selection process involved weighing the districts in the sample based on their weight in the universe and using a random numbers table. The sample consisted of 60 schools, with 24 (40.0%) located in the Şahinbey district, 32 (53.3%) in Şehitkamil, and 4 (6.7%) in Oğuzeli. Two bottles were used to collect drinking water samples from the schools – one for chemical testing and the other for microbiological testing. The samples were appropriately obtained within the designated period of 21/04/2022–25/05/2022 and were subsequently delivered to the laboratory for analysis, ensuring adherence to cold chain conditions. The analysis was conducted at the Public Health Laboratory, which is affiliated with the Gaziantep Provincial Health Directorate and accredited by TÜRK-AK under Accreditation # AB-1502-T, per TS/EN ISO17025 standards. The parameters of color, odor, turbidity, pH, electrical conductivity, ammonium, aluminum, iron, Escherichia coli, coliform bacteria, and enterococci–fecal streptococci were evaluated (Ministry of Health 2005).

The data collection sheet comprised a questionnaire consisting of 15 inquiries pertaining to the general information of the schools. The researcher obtained answers to these inquiries through direct, in-person interviews with the school administrators. Analysis of the data was carried out using the SPSS 22.0 software package. Descriptive statistics were computed using numerical values, percentages, mean with standard deviation, and median with interquartile range. The variables were compared using Chi-square, Mann–Whitney U, and Kruskall–Wallis tests. The significance level of the statistics was deemed acceptable at p < 0.05. The Gaziantep University Clinical Research Ethics Committee approved the research under decision number 2021/326.

The key attributes of the involved schools are outlined in Table 1. Of the total, 60% (n = 36) comprised primary schools, while 40% (n = 24) were secondary schools. In addition, 65% (n = 39) were in urban areas, while 35% (n = 21) were in rural areas. The primary drinking water source was mains in 91.7% (n = 55) of the schools, whereas the other sources (wells) were used in 8.3% (n = 5) of the schools.

Tables 3 and 4 present the laboratory results of the schools that were part of the study. Overall, laboratory results of 16.7% (n = 10) of the schools did not comply with the legislation. In all schools (n = 60), the results of physical parameters and chemical parameters such as conductivity, iron, ammonium, and aluminum values complied with national legislation. pH was found to be non-compliant in 1.7% (n = 1) of the schools. Concerning the microbiological parameters, non-compliance with the legislation was observed in 8.3% (n = 5) of the schools for E. coli values, 15% (n = 9) for coliform bacteria values, and 5% (n = 3) for enterococci and fecal streptococci values.

The distribution of laboratory results based on the school's geographical region is depicted in Table 5.

The map was marked to display the sample schools based on the results obtained.

Table 6 displays the distribution of key characteristics according to the school region. In both urban and rural areas, the mains are used as the drinking water source for 94.9 and 85.7% of schools, respectively. In urban schools, the percentage of canteens is 82.1%, whereas, in rural schools, it is 14.3%. When comparing schools in urban and rural areas, no statistically significant difference was observed in the parameters of drinking water source and the frequency of water cuts (p > 0.05). Urban schools demonstrated a significantly higher percentage of canteen availability and water sales (82.1%) compared to the rural group (14.3%) (p = 0.000). The percentage of having a backup water source was significantly higher in urban schools (69.2%) than the rural group (33.3%) (p = 0.005).

The evaluation of drinking water parameters in primary and secondary schools within a provincial center demonstrated in this study that a significant percentage of schools (91.7%) primarily relied on the mains for their drinking water supply. As per the research conducted by Jeffrey Ezennia et al., it was found that school-age children residing in low socioeconomic areas of the United States predominantly relied on school fountains and mains water as their primary source of drinking water (Ezennia et al. 2023). Thus, the significance of having drinking fountains and ensuring the availability of potable water in schools is elevated. Upon examining the studies in the literature, it is observed that the percentage of schools with access to tap water or an improved water source ranges from 56.0 to 98.6% (Turan 2008; Morgan et al. 2017, 2021; Çetinkaya et al. 2020; Ahmed et al. 2022; Oloruntoba et al. 2022; Poague et al. 2023). In our study and other studies within literature, the level of access to mains water falls short of the desired rate. Given the potential health implications associated with using tap water for drinking purposes, it is believed that all schools should have access to it, and any installations requiring maintenance should be replaced and consistently monitored.

The analysis revealed that 16.7% (n = 10) of the sampled schools violated national legislation. Compliance with legislation was assessed by evaluating the physical parameters in all 60 samples. Only one of the samples analyzed in our study exhibited pH non-compliance regarding chemical parameters. As per the national legislation, the absence of microbiological parameters like E. coli, coliform bacteria, and enterococci–fecal streptococcus is required in drinking water. These parameters act as indicators for fecal matter and comprise bacteria originating from the intestinal flora of either humans or animals. The detection of these bacteria in water samples signifies the presence of fecal contamination. In the studies reviewed in the literature, the rate of samples found to be inappropriate in terms of drinking water quality varies between 10 and 85% (Kandemir 2008; Avcı et al. 2014; Bora 2016; Tanas 2016; Morgan et al. 2017, 2021; Hung & Thi Cuc 2020; Murtaza et al. 2020; Cronk et al. 2021; Tuluk et al. 2021; Ahmed et al. 2022; Hossain et al. 2022).

The microbiological parameters were deemed non-compliant in our study and other studies referenced in the literature. Given the suitable conditions under which the samples were collected and transported to the laboratory, it can be inferred that the drinking water sources are contaminated with bacteriological elements rather than being attributed to the sampling and transportation methods. The audits conducted by relevant public institutions and academic examinations should be utilized to determine the reasons for this situation, with the ultimate goal of ensuring that the analysis results of all schools align with the legislation.

Fecal contamination indicates the presence of pathogenic microorganisms, including bacteria, protozoa, viruses, fungi, and helminths in the water. Consumption of contaminated water can spread infectious diseases and water-borne epidemics, notably typhoid and cholera. Furthermore, the rise in water-borne infections will contribute to an augmentation of health-related expenditures. Our study revealed that, upon the assessment of schools that failed to comply with the legislation, only 1 out of 10 of these schools had appropriate microbiological parameters. The observation that most schools experiencing microbiological contamination are located within the same district implies the need to assess the district's infrastructure as well. It is crucial to ensure the dissemination of necessary information pertaining to this matter.

The pH parameter is the cause of non-compliance in one particular school. In Kandemir's study, which aimed to assess the activities of public health centers in Edirne, the chemical analysis results of drinking water samples collected from schools showed consistent appropriateness across the districts. Overall, evaluating the chemical analysis results for the samples was deemed appropriate. In just one district, the rate of chemical analysis results identified as unsuitable amounted to 10.0%. Nonetheless, the sampling rate was assessed as insufficient compared to the drinking water samples that were supposed to be obtained in that investigation (Kandemir 2008).

In a study by Murtaza et al. in Pakistani schools, all pH analysis results complied with the WHO data (Murtaza et al. 2020). In another study by Ahmed et al. in schools in Pakistan, all pH analysis results complied with the WHO data (Ahmed et al. 2022). In the study of Hung et al. evaluating drinking water parameters in Vietnamese schools, the rate of nonconformity of pH analysis results of the samples was determined to be 3.9% (Hung & Thi Cuc 2020). The pH non-compliance rate of the studies in the literature varies between 0 and 10%, similar to our study results.

When schools in urban areas were compared with schools in rural areas, although there was no statistically significant difference in drinking water source, the access rate to mains water was higher in urban areas (94.9 vs. 85.7%). In a study by Poague et al., in which 173,000 schools in Brazil were evaluated for drinking water, sanitation, and hygiene before and during the pandemic, it was determined that schools in urban areas had higher access rates to safe drinking water than those in rural areas, and private schools had higher access rates to safe drinking water than public schools (Poague et al. 2023). An evaluation of six African countries conducted by Morgan et al. found that the access rate to safe drinking water in rural schools ranged between 54.0 and 89.0% (Morgan et al. 2017). When examining the data from our study, it became evident that schools in rural areas were at a disadvantage compared to their urban counterparts. This result was primarily due to the lack of canteens, the limited availability of packaged water, and insufficient back-up water sources. Canteen and spare water source availability rates in rural schools were 14.3 and 33.3%, respectively. In comparison, urban schools exhibited rates of 82.1 and 69.2%.

Rural schools exhibited lower access rates to mains water, the reduced availability of alternative water sources, and the limited sale of packaged water in canteens, implying that rural schools face drawbacks in accessing safe drinking water. Access to mains water should be made available to all schools, with a particular emphasis on rural areas.

The aim should be to secure healthy drinking water for every school. Based on the evaluation of water parameters, it was determined that schools do not have adequate access to healthy drinking water. While schools in both urban and rural areas generally rely on tap water, it can be argued that rural schools face a disadvantage when it comes to accessing healthy drinking water, which can be mainly attributed to the absence of an alternative water source and the unavailability of packaged water sales in the canteen. The main issue concerning water relates to its microbiological properties. Urgent research efforts should be undertaken to identify the microbiological origin and address the issue, encompassing infrastructure management. The resolution to this issue can be achieved through inter-institutional collaboration. The National Education Directorate and the relevant municipalities must receive information and training regarding the health effects of the current situation, as per our research findings.

Ethical approval was obtained from the Gaziantep University Clinical Research Ethics Committee, and research permission was obtained from the Gaziantep Provincial Directorate of National Education.

All authors accept all conditions and publication rights.

The Gaziantep University Scientific Research Projects Management Unit funded this project under project number TF.UT.22.06.

Data cannot be made publicly available; readers should contact the corresponding author for details.

The authors declare there is no conflict.