ArticleThe American journal of tropical medicine and hygiene2012
Rethinking indicators of microbial drinking water quality for health studies in tropical developing countries: case study in northern coastal Ecuador.
Article in The American journal of tropical medicine and hygiene, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 57 citations in OpenAlex.
- Coliform bacteria as indicators of diarrheal risk in household drinking water: systematic review and meta-analysis.PloS one · 2014Pooled it
- Effectiveness of the Hydrogen Sulfide Test as a Water Quality Indicator for Diarrhea Risk in Rural Bangladesh.The American journal of tropical medicine and hygiene · 2017Trial
- A stepped wedge, cluster-randomized trial of a household UV-disinfection and safe storage drinking water intervention in rural Baja California Sur, Mexico.The American journal of tropical medicine and hygiene · 2013Trial
- Latrine surface contamination and hygiene practices in rural Nepal: implications for diarrhoeal diseases and urinary tract infections.Journal of water and health · 2026Article
- Comparing the Power of Low vs High-Precision Methods for MeasuringACS ES&T water · 2025Article
- Bacterial community assessment of drinking water and downstream distribution systems in highland localities of Ecuador.Journal of water and health · 2024Article
- Fecal indicators and antibiotic resistance genes exhibit diurnal trends in the Chattahoochee River: Implications for water quality monitoring.Frontiers in microbiology · 2022Article
- Drinking Water Quality and Public Health in the Kathmandu Valley, Nepal: Coliform Bacteria, Chemical Contaminants, and Health Status of Consumers.Journal of environmental and public health · 2022Article
- Determining the microbial and chemical contamination in Ecuador's main rivers.Scientific reports · 2021Article
- Measuring Environmental Exposure to Enteric Pathogens in Low-Income Settings: Review and Recommendations of an Interdisciplinary Working Group.Environmental science & technology · 2020Review
- Human fecal contamination of water, soil, and surfaces in households sharing poor-quality sanitation facilities in Maputo, Mozambique.International journal of hygiene and environmental health · 2020Article
- Household-stored drinking water quality among households of under-five children with and without acute diarrhea in towns of Wegera District, in North Gondar, Northwest Ethiopia.Environmental monitoring and assessment · 2018Article
- Drinking Water Safety: Role of Hand Hygiene, Sanitation Facility, and Water System in Semi-Urban Areas of India.The American journal of tropical medicine and hygiene · 2018Article
- Microbial Indicators and Environmental Relationships in the Umhlangane River, Durban, South Africa.Open life sciences · 2018Article
- Article
- FRNA Bacteriophages as Viral Indicators of Faecal Contamination in Mexican Tropical Aquatic Systems.PloS one · 2017Article
- Seasonality of water quality and diarrheal disease counts in urban and rural settings in south India.Scientific reports · 2016Article
- Microbiological Contamination of Drinking Water Associated with Subsequent Child Diarrhea.The American journal of tropical medicine and hygiene · 2015Article
- "Improved" But Not Necessarily Safe: An Assessment of Fecal Contamination of Household Drinking Water in Rural Peru.The American journal of tropical medicine and hygiene · 2015Article
- Spatial Variability ofWater · 2015Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
Abstract
To address the problem of the health impacts of unsafe drinking water, methods are needed to assess microbiologic contamination in water. However, indicators of water quality have provided mixed results. We evaluate five assays (three for Escherichia coli and one each for enterococci and somatic coliphage) of microbial contamination in villages in rural Ecuador that rely mostly on untreated drinking water. Only membrane filtration for E. coli using mI agar detected a significant association with household diarrheal disease outcome (odds ratio = 1.29, 95% confidence interval = 1.02-1.65 in household containers and odds ratio = 1.18, 95% confidence interval = 1.02-1.37) in source samples. Our analysis and other published research points to the need for further consideration of study design factors, such as sample size and variability in measurements, when using indicator organisms, especially when relating water quality exposure to health outcomes. Although indicator organisms are used extensively in health studies, we argue that their use requires a full understanding of their purposes and limitations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.