{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:13:32Z","timestamp":1793142812029,"version":"4.5.0"},"reference-count":40,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,10,3]]},"abstract":"<jats:p>Poor drinking water quality is one of the main causes of acute diarrheal disease in developing countries. The study investigated the relationship between fecal contamination of hands, stored drinking water, and source waters in India. We further evaluated the environmental and behavioral factors associated with recontamination of water between collection and consumption. The bacterial contamination, that is, <jats:italic>Escherichia coli<\/jats:italic> (log<jats:sub>10<\/jats:sub> most probable number per two hands), found on mothers\u2019 hands (mean = 1.11, standard deviation [SD] = 1.2, <jats:italic>N<\/jats:italic> = 152) was substantially higher than that on their children younger than 5 years (mean = 0.64, SD = 1.0, and <jats:italic>N<\/jats:italic> = 152). We found a low level of <jats:italic>E. coli<\/jats:italic> (&lt; 1 per 100 mL) in the source water samples; however, <jats:italic>E. coli<\/jats:italic> contamination in stored drinking water was above the recommended guidelines of the World Health Organization. The study also found that <jats:italic>E. coli<\/jats:italic> on hands was significantly associated with <jats:italic>E. coli<\/jats:italic> in the stored drinking water (<jats:italic>P<\/jats:italic> &lt; 0.001). Moreover, <jats:italic>E. coli<\/jats:italic> was positively associated with gastrointestinal symptoms (odds ratio 1.42, <jats:italic>P<\/jats:italic> &lt; 0.05). In the households with elevated levels (&gt; 100 <jats:italic>E. coli<\/jats:italic>\/100 mL) of fecal contamination, we found that 43.5% had unimproved sanitation facilities, poor water handling practices, and higher diarrheal incidences. The water quality deterioration from the source to the point of consumption is significant. This necessitates effective interventions in collection, transport, storage, and extraction practices when hand\u2013water contact is likely to occur. These findings support the role of hands in the contamination of stored drinking water and suggest that clean source water does not guarantee safe water at the point of consumption.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0819","type":"journal-article","created":{"date-parts":[[2018,7,31]],"date-time":"2018-07-31T07:00:54Z","timestamp":1533020454000},"page":"889-898","source":"Crossref","is-referenced-by-count":27,"title":["Drinking Water Safety: Role of Hand Hygiene, Sanitation Facility, and Water System in Semi-Urban Areas of India"],"prefix":"10.4269","volume":"99","author":[{"given":"Arti","family":"Kundu","sequence":"first","affiliation":[{"name":"School of Veterinary Medicine, One Health Institute, University of California, Davis, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woutrina A.","family":"Smith","sequence":"additional","affiliation":[{"name":"School of Veterinary Medicine, One Health Institute, University of California, Davis, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Harvey","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, School of Medicine, University of California, Davis, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Wuertz","sequence":"additional","affiliation":[{"name":"Department of Civil and Environmental Engineering, University of California, Davis, California;"},{"name":"Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore;"},{"name":"School of Civil and Environmental Engineering, Nanyang Technological University, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"J Nat Sci Biol Med","first-page":"24","article-title":"Diarrheal diseases among children in India: current scenario and future perspectives","volume":"6","author":"Lakshminarayanan","year":"2015"},{"key":"b2","series-title":"Lancet Glob Health","first-page":"E172","article-title":"Accelerated progress to reduce under-5 mortality in India","volume":"1","author":"Bhan","year":"2013"},{"key":"b3","series-title":"PLoS Med","first-page":"e1001644","article-title":"Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis","volume":"11","author":"Bain","year":"2014"},{"key":"b4","series-title":"Int J Hyg Environ Health","first-page":"29","article-title":"Quantifying tap-to-household water quality deterioration in urban communities in Vellore, India: the impact of spatial assumptions","volume":"220","author":"Falconi","year":"2017"},{"key":"b5","series-title":"Int J Hyg Environ Health","first-page":"473","article-title":"Water contamination in urban south India: household storage practices and their implications for water safety and enteric infections","volume":"207","author":"Brick","year":"2004"},{"key":"b6","series-title":"Am J Trop Med Hyg","first-page":"759","article-title":"Point-of-use interventions to decrease contamination of drinking water: a randomized, controlled pilot study on efficacy, effectiveness, and acceptability of closed containers, Moringa oleifera, and in-home chlorination in rural south India","volume":"82","author":"Firth","year":"2010"},{"key":"b7","series-title":"Soc Sci Med","first-page":"41","article-title":"Switching to sanitation: understanding latrine adoption in a representative panel of rural Indian households","volume":"188","author":"Coffey","year":"2017"},{"key":"b8","series-title":"Am J Trop Med Hyg","first-page":"499","article-title":"Rethinking indicators of microbial drinking water quality for health studies in tropical developing countries: case study in northern coastal Ecuador","volume":"86","author":"Levy","year":"2012"},{"key":"b9","series-title":"Int J Environ Health Res","first-page":"273","article-title":"Water quality deterioration: a study of household drinking water quality in rural Honduras","volume":"14","author":"Trevett","year":"2004"},{"key":"b10","series-title":"Water Sci Technol Water Supply","first-page":"400","article-title":"Deterioration in water quality from supply chain to household and appropriate storage in the context of intermittent water supplies","volume":"11","author":"Elala","year":"2011"},{"key":"b11","series-title":"J Water Health","first-page":"145","article-title":"Is fecal contamination of drinking water after collection associated with household water handling and hygiene practices? 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