{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:51:45Z","timestamp":1791921105463,"version":"4.3.4"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Expo Sci Environ Epidemiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A combined approach for studying water quality, attitudes, and practices is presented, focusing on urban low- and middle-income households in Chennai, India using reverse osmosis (RO) systems. Challenging the common assumption that in-home water treatment particularly RO fully resolves drinking water safety issues, this article presents one of the first empirical evaluations of the effectiveness of household-level filtration methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The study aims to assess the microbial safety of drinking water before and after household RO treatment and to understand how education and awareness influence household water and maintenance practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study involved surveys, water sampling, and data analysis, conducted by a multi-disciplinary team from Tel Aviv University, IIT Madras, and local partners. Water samples were collected before and after RO treatment from 216 households (262 samples total), and socio-demographic information, including education levels and water-use behavior, was analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The findings revealed that while RO systems reduce contamination, 31% of post-RO samples still contained\n                      <jats:italic>E. coli<\/jats:italic>\n                      , compared to 71% in untreated water. Furthermore, education levels were found to influence outcomes: 36% of post-RO samples from postgraduate respondents contained\n                      <jats:italic>E. coli<\/jats:italic>\n                      , versus 83% among those with lower education levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact Statements<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Empirical evaluation of RO system effectiveness in urban Chennai households.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            31% of post-RO household samples remained contaminated with\n                            <jats:italic>E. coli<\/jats:italic>\n                            .\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>RO systems reduce contamination but offer limited protection without maintenance.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Integrated survey and water testing reveal gaps in treatment efficacy perception.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Post-RO contamination linked to respondent education level and user practices.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41370-026-00911-5","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T14:32:40Z","timestamp":1778682760000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating household reverse osmosis systems for microbial safety: A case study from Chennai, India"],"prefix":"10.1038","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7756-2163","authenticated-orcid":false,"given":"Suzan","family":"Kagan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Hamilton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timor","family":"Lichtman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Skliarevskaia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonali","family":"Seth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanmayaa","family":"Nayak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shakked","family":"ben Giat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tohar","family":"Izikson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Belykh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Nellissery","family":"Lonappan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tabitha","family":"Durai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devendran","family":"Gokul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thalappil","family":"Pradeep","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadas","family":"Mamane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"911_CR1","volume-title":"Progress on household drinking water, sanitation and hygiene 2000\u20132020: five years into the SDGs","author":"World Health Organization, United Nations Children\u2019s Fund","year":"2021","unstructured":"World Health Organization, United Nations Children\u2019s Fund Progress on household drinking water, sanitation and hygiene 2000\u20132020: five years into the SDGs. Geneva: World Health Organization; 2021."},{"key":"911_CR2","doi-asserted-by":"publisher","first-page":"66","DOI":"10.2166\/washdev.2019.107","volume":"10","author":"A Geremew","year":"2020","unstructured":"Geremew A, Damtew YT. Household water treatment using adequate methods in sub-Saharan countries: evidence from 2013\u20132016 demographic and health surveys. J Water Sanit Hyg Dev. 2020;10:66\u201375. https:\/\/doi.org\/10.2166\/washdev.2019.107.","journal-title":"J Water Sanit Hyg Dev"},{"key":"911_CR3","first-page":"703","volume":"71","author":"M De Onis","year":"1993","unstructured":"De Onis M, Monteiro C, Akr\u00e9 J, Glugston G. The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on Child Growth. Bull World Health Organ. 1993;71:703\u201312.","journal-title":"Bull World Health Organ"},{"key":"911_CR4","unstructured":"World Health Organization. Levels and trends in child malnutrition. Geneva: World Health Organization; 2021."},{"key":"911_CR5","first-page":"129","volume":"2","author":"I Akuffo","year":"2013","unstructured":"Akuffo I, Cobbina S, Alhassan E, Nkoom M. Assessment of the quality of water before and after storage in the Nyankpala community of the Tolon-Kumbungu District, Ghana. Int J Sci Technol Res. 2013;2:129\u201334.","journal-title":"Int J Sci Technol Res"},{"key":"911_CR6","doi-asserted-by":"publisher","first-page":"14","DOI":"10.2166\/wrd.2017.172","volume":"8","author":"J Lahnsteiner","year":"2018","unstructured":"Lahnsteiner J, Van Rensburg P, Esterhuizen J. Direct potable reuse \u2013 a feasible water management option. J Water Reuse Desal. 2018;8:14\u201328. https:\/\/doi.org\/10.2166\/wrd.2017.172.","journal-title":"J Water Reuse Desal"},{"key":"911_CR7","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1007\/s00267-011-9692-6","volume":"48","author":"A Saylor","year":"2011","unstructured":"Saylor A, Prokopy LS, Amberg S. What\u2019s wrong with the tap? Examining perceptions of tap water and bottled water at Purdue University. Environ Manage. 2011;48:588\u2013601. https:\/\/doi.org\/10.1007\/s00267-011-9692-6.","journal-title":"Environ Manage"},{"key":"911_CR8","doi-asserted-by":"publisher","DOI":"10.1016\/j.desal.2023.116831","volume":"565","author":"MA Al-Obaidi","year":"2023","unstructured":"Al-Obaidi MA, Alsarayreh AA, Bdour A, Jassam SH, Rashid FL, Mujtaba IM. Simulation and optimisation of a medium scale reverse osmosis brackish water desalination system under variable feed quality: energy saving and maintenance opportunity. Desalination. 2023;565:116831. https:\/\/doi.org\/10.1016\/j.desal.2023.116831.","journal-title":"Desalination"},{"key":"911_CR9","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1080\/10934521003772386","volume":"45","author":"SK Park","year":"2010","unstructured":"Park SK, Hu JY. Assessment of the extent of bacterial growth in reverse osmosis system for improving drinking water quality. J Environ Sci Health A Tox Hazard Subst Environ Eng. 2010;45:968\u201377. https:\/\/doi.org\/10.1080\/10934521003772386.","journal-title":"J Environ Sci Health A Tox Hazard Subst Environ Eng"},{"key":"911_CR10","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1080\/19443994.2014.928804","volume":"55","author":"D Zhao","year":"2015","unstructured":"Zhao D, Yu S. A review of recent advance in fouling mitigation of NF\/RO membranes in water treatment: pretreatment, membrane modification, and chemical cleaning. Desalin Water Treat. 2015;55:870\u201391. https:\/\/doi.org\/10.1080\/19443994.2014.928804.","journal-title":"Desalin Water Treat"},{"key":"911_CR11","doi-asserted-by":"publisher","first-page":"109","DOI":"10.2166\/wh.2003.0013","volume":"1","author":"TF Clasen","year":"2003","unstructured":"Clasen TF, Bastable A. Faecal contamination of drinking water during collection and household storage: the need to extend protection to the point of use. J Water Health. 2003;1:109\u201315. https:\/\/doi.org\/10.2166\/wh.2003.0013.","journal-title":"J Water Health"},{"key":"911_CR12","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1001\/jama.1995.03520360062040","volume":"273","author":"ED Mintz","year":"1995","unstructured":"Mintz ED, Reiff FM, Tauxe RV. Safe water treatment and storage in the home: a practical new strategy to prevent waterborne disease. JAMA. 1995;273:948\u201353. https:\/\/doi.org\/10.1001\/jama.1995.03520360062040.","journal-title":"JAMA"},{"key":"911_CR13","first-page":"1","volume":"91","author":"R Lindskog","year":"1988","unstructured":"Lindskog R, Lindskog P. Bacteriological contamination of water in rural areas: an intervention study from Malawi. Trop Med Int Health. 1988;91:1\u20137.","journal-title":"Trop Med Int Health"},{"key":"911_CR14","doi-asserted-by":"publisher","first-page":"3832","DOI":"10.1021\/acsestwater.4c00164","volume":"4","author":"R Ramesh","year":"2024","unstructured":"Ramesh R, Frank E, Padmavilochanan A, Barda Y, Eldar I, Wolf H, et al. Reliable water quality monitoring by women in low-resource communities. ACS ES&T Water. 2024;4:3832\u201341. https:\/\/doi.org\/10.1021\/acsestwater.4c00164.","journal-title":"ACS ES&T Water"},{"key":"911_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.envdev.2023.100862","volume":"46","author":"V Ajith","year":"2023","unstructured":"Ajith V, Fishman R, Yosef E, Edris S, Ramesh R, Suresh RA, et al. An integrated methodology for assessment of drinking-water quality in low-income settings. Environ Dev. 2023;46:100862. https:\/\/doi.org\/10.1016\/j.envdev.2023.100862.","journal-title":"Environ Dev"},{"key":"911_CR16","unstructured":"Bureau of Indian Standards. Drinking water specification (IS 10500). New Delhi: Bureau of Indian Standards; 2012."},{"key":"911_CR17","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.ijid.2017.09.021","volume":"66","author":"JS Park","year":"2018","unstructured":"Park JS, Kim JS, Kim SJ, Shin EK, Oh KH, Kim YH, et al. A waterborne outbreak of multiple diarrhoeagenic Escherichia coli infections associated with drinking water at a school camp. Int J Infect Dis. 2018;66:45\u201350. https:\/\/doi.org\/10.1016\/j.ijid.2017.09.021.","journal-title":"Int J Infect Dis"},{"key":"911_CR18","doi-asserted-by":"publisher","first-page":"446","DOI":"10.3390\/w10040446","volume":"10","author":"L Wang","year":"2018","unstructured":"Wang L, Zhang L, Lv J, Zhang Y, Ye B. Public awareness of drinking water safety and contamination accidents: a case study in Hainan Province, China. Water. 2018;10:446 https:\/\/doi.org\/10.3390\/w10040446.","journal-title":"Water"},{"key":"911_CR19","doi-asserted-by":"publisher","DOI":"10.1016\/j.watres.2021.117151","volume":"198","author":"Y Deng","year":"2021","unstructured":"Deng Y. Making waves: principles for the design of sustainable household water treatment. Water Res. 2021;198:117151. https:\/\/doi.org\/10.1016\/j.watres.2021.117151.","journal-title":"Water Res"},{"key":"911_CR20","doi-asserted-by":"publisher","DOI":"10.1016\/j.watres.2023.121098","volume":"251","author":"EFM Paz","year":"2024","unstructured":"Paz EFM, Raskin L, Wigginton KR, Kerkez B. Toward the autonomous flushing of building plumbing: characterizing oxidation-reduction potential and temperature sensor dynamics. Water Res. 2024;251:121098. https:\/\/doi.org\/10.1016\/j.watres.2023.121098.","journal-title":"Water Res"},{"key":"911_CR21","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.3390\/w14152401","volume":"14","author":"D Papciak","year":"2022","unstructured":"Papciak D, Domo\u0144 A, Zdeb M, Tch\u00f3rzewska-Cie\u015blak B, Konkol J, So\u010do E. Mechanism of biofilm formation on installation materials and its impact on the quality of tap water. Water. 2022;14:2401 https:\/\/doi.org\/10.3390\/w14152401.","journal-title":"Water"},{"key":"911_CR22","unstructured":"Rice EW, Baird RB, Eaton AD, Clesceri LS. Standard methods for the examination of water and wastewater. 22nd ed. Washington (DC): American Public Health Association; 2012."}],"updated-by":[{"DOI":"10.1038\/s41370-026-00974-4","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000}}],"container-title":["Journal of Exposure Science &amp; Environmental Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41370-026-00911-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41370-026-00911-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41370-026-00911-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:38:08Z","timestamp":1789796288000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41370-026-00911-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":22,"alternative-id":["911"],"URL":"https:\/\/doi.org\/10.1038\/s41370-026-00911-5","relation":{},"ISSN":["1559-0631","1559-064X"],"issn-type":[{"value":"1559-0631","type":"print"},{"value":"1559-064X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"13 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 April 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2026","order":6,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":7,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The original online version of this article was revised: In this article the author\u2019s name Mary Nellissery Lonappan was incorrectly written as Mary George.","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2026","order":9,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":10,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":11,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1038\/s41370-026-00974-4","URL":"https:\/\/doi.org\/10.1038\/s41370-026-00974-4","order":12,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"All methods reported in this manuscript were performed in accordance with the relevant guidelines and regulations. Ethical approval for this study was obtained from the Institutional Ethics Committee (IEC) of the Indian Institute of Technology Madras, India (Approval No. IEC\/2024-02\/PT\/16; valid from 21 June 2024 to 20 June 2027). The study was conducted in accordance with the Indian Council of Medical Research (ICMR) National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017). Informed consent to participate was obtained electronically at the beginning of each survey, and the survey was not continued unless consent was provided.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Ethics"}}]}}