The importance of domestic water quality management in the context of faecal–oral disease transmission

The deterioration of drinking water quality following its collection from a community well or standpipe and during storage in the home has been well documented. However, there is a view that post-supply contamination is of little public health consequence. This paper explores the potential health risk from consuming re-contaminated drinking water. A conceptual framework of principal factors that determine the pathogen load in household drinking water is proposed. Using this framework a series of hypotheses are developed in relation to the risk of disease transmission from re-contaminated drinking water and examined in the light of current literature and detailed field observation in rural Honduran communities. It is shown that considerable evidence of disease transmission from re-contaminated drinking water exists. In particular the type of storage container and hand contact with stored drinking water has been associated with increased incidence of diarrhoeal disease. There is also circumstantial evidence linking such factors as the sanitary conditions in the domestic environment, cultural norms and poverty with the pathogen load of household stored drinking water and hence the risk of disease transmission. In conclusion it is found that re-contaminated drinking water represents a significant health risk especially to infants, and also to those with secondary immunodeficiency.