Assessment of microbiological quality of sachet-packaged drinking water in Western Nigeria and its

public health significance

Intro

The microbiological quality of drinking water has attracted great attention worldwide because of implied
public health impacts. Sachet-packaged drinking water is very common in Nigeria.

Unsafe water, poor sanitation and hygiene have been reported to rank third among the 20 leading risk
factors for health burden in developing countries, including Nigeria.

Contamination of water, either directly or indirectly, by human or animal excreta and the micro-
organisms contained in faeces is known to contribute to acquisition of disease by consumers.

Various opportunistic pathogens that occur naturally in the environment may cause disease in humans.
Those at greatest risk of infection are infants and young children,

In such individuals, drinking water containing large numbers of opportunistic pathogens can
occasionally produce infections. Examples of such opportunistic agents are Pseudomonas aeruginosa,
Klebsiella sp., Aeromonas sp. and certain slow-growing mycobacteria.

Objective: To assess the microbiological quality of sachet-packaged drinking water in Western Nigeria
and its impact on public health.

Study design: Cross-sectional microbiological testing.

Methods: Ninety-two sachet-packaged water samples were analysed for microbiological and metal
qualities. Total bacterial and coliform counts were determined, and the presence of Escherichia coli, an
important water quality indicator, was tested. The level of conformity of the water processors with the
guidelines of Nigerias quality regulatory agency was also determined.

Results: Varying levels of microbial contamination were recorded in samples from the different sampling
locations. The total bacteria count ranged between 2.86 and 3.45 log colony-forming units (cfu)/ml. The
highest coliform count recorded was 1.62 log cfu/ml. Faecal coliform E. coli was detected in one sample
from Oke-Iho and one sample from Okaka, representing 2.2% of total samples. Lead and manganes were
not found in any of the samples. However, iron was detected and the highest iron concentration (0.10
mg/ l) was detected in samples from Ikorodu. The bacteria that were identified from the water samples
included E. coli, Pseudomonas aeruginosa, Enterobacter aerogenes, Klebsiella sp., Proteus vulgaris,
Alcali-genes faecalis, Bacillus cereus, Staphylococcus aureus, Streptococcus lactis, Aeromonas sp. and
Micrococcus luteum. Many of the water processors did not comply with the guidelines of the quality
regulatory agency.

Conclusions: Some of the sachet-packaged samples of drinking water were of poor quality. The results
indicate a need for Nigerias quality regulatory agency to take appropriate measures in safeguarding
public health.

The public health effects of water and sanitation

in selected West African countries

P. Alagidede a,*

, A.N. Alagidede

The Millennium Development Goals (MDG 7c) calls for halving

the proportion of the world's population without sustainable

access to safe drinking water and basic sanitation by the end

of 2015. According to the World Health Organisation (WHO)1

the drinking water target was met in 2010, five years ahead

of schedule. However, there are still over 700 million people

worldwide who do not have access to improved drinkingwater. Even with improved access, evidence
shows that there

are significant inequalities between rural and urban access to

improved water2 and the quality and cost of access to water is

not appropriately reflected in the reported statistics.3 In terms

of sanitation, open defecation continues to be the norm for

most developing countries and the data suggest that about 2.5

billion people in developing countries lack access to improved

sanitation facilities.6

As time draws closer to the expiration date set for the

MDG's it is imperative to re-examine the targets for water

and sanitation and put the search light on countries that

have shown the worst performance under MDG 7c. The

inability of the six West African countries (Chad, Niger,

Nigeria, Mauritania, Sierra Leone and Togoc

) to meet the
target for MDG 7c by 2015 naturally leads to a plethora of

questions: was this target too much for these countries?

What factors account for the poor trend observed in the

data? Is there any chance that these countries will be able to

achieve the target of halving the proportion of the population

without access to safe drinking water and basic sanitation

even if the target year was shifted beyond 2015? Answers to

these questions require a thorough look at the patterns in

the two indicators. This article attempts to identify the

countries that have failed to meet both the target for safe

drinking water and basic sanitation and also examine the

public health concerns in terms of diseases these countries

are dealing with in relation to these two factors. The article

constructs forecasts and addresses some policy concerns

that can help arrest the poor performance in relation to

MDG 7c.

The rest of the article is organized as follows: methodology;

analysis of the trends in water and sanitation in the selected

West Africa countries and provides forecasts; analysis of the

risk of the current rate of improvement in the two indicators

and points to some specific water and sanitation related dis-

eases that may pose a threat to the health care systems of

the countries under consideration; and the last section con-

cludes and offers some policy directions for improving the

state of water and sanitation in the selected West African

countries.

Methods

The methodology is based on analysis of the time series pat-

terns of water and sanitation indicators for the six West Af-
rican countries that performed poorly on the two MDGs. The

data used throughout the article is drawn from the World

Development Indicators (WDI) of the World Bank, and the

World Health Organisation Joint Monitoring Programme

(WHO JMP) and WaterAid Africa Wash Map. The UN MDG

7c set the target of 75% access to improved water and

sanitation to be achieved by 2015. Using this as our bench-

mark, we estimated the potential number of years required to

attain at least 75% improvement in basic sanitation and water.

For example, if it took Nigeria 14 years to move from 54.8%

improved access to water in 2000 to 65.7% in 2014 (see Fig. 1),

how long will it take Nigeria to reach the MDG target of 75%

access to water, all things remaining the same? It turns out

that Nigeria achieved improved coverage of 10.9% between

2000 and 2014 (65.7e54.8 14 10.9). Extrapolating, our calcula-

tions indicate that Nigeria would require 9.3% extra coverage

to reach 75% from the current 65.7%. And this would take

approximately 11 years (i.e. in the year 2025) at the current

level of progress. The results are shown in Table 1 for all

countries.

Results

This section presents the results of our analysis of the pat-

terns observed in the data and the forecasts for attaining the

75% coverage of MDG 7c.

Fig. 1 shows the state of access to improved water for the

six countries for 2000 and 2014. While some effort has been

made in improved access to water, a lot remains to be done.

Only 46.8% of the population had access to improved water

sources in Sierra Leone in 2000. This has increased to 62.2% by

2014. Niger and Mauritania started at 42.1% and 40.4% in 2000

and only went up to 54% and 51.4% respectively by 2014. The

Sahelian regions experienced the slowest performance in

terms of access to improved water sources between 2000 and

2014.

If the target for water has been missed in the countries

under study, then the target for sanitation has been sorely

missed! If it is reasonable to attain the water target in a decade

or two from now, our analysis shows that with sanitation,

unless a big push takes place some countries would continue

to wallow in filth and squalor as shown in Fig. 2 and Table 1.

Fig. 2 shows that while four countries improved marginally

on sanitation, two countries retrogressed. Nigeria and Togo

are worse off now than they were in 2000. About 12.2% and

34% of the population had access to improved sanitation fa-

cilities in Togo and Nigeria respectively in 2000. In 2014, Togo

was at 11.2% while Nigeria was at 27%. A cursory look at this

indicator for the two countries depicts a precipitous decline

for Nigeria since the 2000s and some stagnation, interspersed

by declines in Togo. With the remaining four countries,

progress on sanitation has been very slow.

The MDG started in 2000, and expected to expire in 2015,

with the key benchmark of halving global poverty and

improvement in a host of social, environmental and health

indicators. MDG 7c which is under investigation in this article

set the target of 75% access to improved water and sanitation

coverage by December 2015. By the year 2000 all countries in

this study were below the target for both water and sanitation

(see Figs. 1 and 2) and by the end of 2014, just 12 months before

the MDGs expire, there was no indication that the West Afri-
can countries under study would achieve the targets. As

explained above, we constructed forecast to judge the per-

formance of each country against the benchmark and to

c These countries were specifically chosen because of the

availability of data for the analysis carried out in the article. The

countries in our sample represent the group that missed both the

water and sanitation targets. Thus we exclude countries that

achieved the water target. For example, Guinea Bissau, The

Gambia and Liberia can be candidate countries for this study;

however, there is no data on sanitation in the WaterAid Africa

Wash Map, hence their exclusion. depict the gap left to be filled and the required number of years

to attain the target if progress were to remain the same.

As shown in Table 1, it would take about 46 years for Chad

to attain the target coverage in 2060 at the current rate of

growth. Sierra Leone, Niger and Mauritania would attain the

target in 2030, 2038, and 2044 respectively.

The forecasts show that at the current levels of progress,

Nigeria and Togo would need a miracle to attain the sanitation

targets since these countries have not shown any improve-

ment since 2000. With the other countries it would take a big

push to get out of the trap of filth and squalor.

Conclusion

Access to improved water and sanitation continue to be a

challenge for many countries in the developing world. The

Millennium Development Goals attempted to fast track access

to these amenities by the world's poorest, particularly on ac-

count of the fact that growth and poverty alleviation cannot

take place in unclean environment, and more so because

these two factors are highly correlated with health care and

outcomes. We have argued in this article that six West African

countries: Nigeria, Niger, Chad, Togo, Sierra Leone, and

Mauritania have performed poorly on both indicators. While

access to improved water is not too far-fetched, improved

sanitation may continue to be an elusive pimpernel for these

countries unless a massive intervention is applied. One such

intervention could come through the awareness of the

importance of water in the economic growth process and the

role of sanitation in ensuring a healthy and sound populace.

Water and sanitation have public good elements. We

argued that the main bottleneck to widening access to

improved water was the poor supply system, run down

infrastructure and large scale provision of water by state

owned enterprises. This paradigm has persisted with disas-

trous consequences. Efforts to move beyond state dominance

in water provision are thus a possibility that should be

explored. Already, many countries have engaged private

companies in the water sector, and a number of public-private

partnerships have emerged in Sub-Saharan Africa. For the

countries under study, injecting more private participation

while regulating efficiently could ameliorate the problem of

lack of access to improved water sources. In the past, natural

monopolies emerged in the water sector because of the huge

initial capital outlays that were required to set up urban and

rural water systems. However, ingenious financial engineer-

ing through capital markets could overcome this hurdle in

recent times for many countries seeking to diversify states

role in water provision. Given the profit motive, private com-

panies may inject the needed discipline in the market place

while maintaining adequate supply of water. The problem of

waste collection and disposal could follow similar lines. Pri-

vatised waste systems should be explored. Job creation

through waste collection and disposal on a small, medium to

large scale basis is certainly a treasured way to reducing filth

in rural and urban areas. In the case of open defecation, public

education on its effect should go hand in hand with the

provision of adequate toilet facilities in rural and urban areas.

This further requires that building and construction laws

should be amended to mandate the inclusion of improved

toilet facilities in residential and commercial buildings. Self-

help projects to build wholesome but affordable toilet facil-
ities should be encouraged, while communal cleaning days

should be observed in both rural and urban areas. Above all

decentralizing water and sanitation systems, coupled with

reform of state owned water and sewerage companies could

complement the current role of NGOs and other donor related

support in improving the water and sanitation indicators.