Background: Access to safe drinking water is essential for health. Monitoring access to drinking water focuses on water supply type at the source, but there is limited evidence on whether quality differences at the source persist in water stored in the household.

Objectives: We assessed the extent of fecal contamination at the source and in household stored water (HSW) and explored the relationship between contamination at each sampling point and water supply type.

Methods: We performed a bivariate random-effects meta-analysis of 45 studies, identified through a systematic review, that reported either the proportion of samples free of fecal indicator bacteria and/or individual sample bacteria counts for source and HSW, disaggregated by supply type.

Results: Water quality deteriorated substantially between source and stored water. The mean percentage of contaminated samples (noncompliance) at the source was 46% (95% CI: 33, 60%), whereas mean noncompliance in HSW was 75% (95% CI: 64, 84%). Water supply type was significantly associated with noncompliance at the source ( p < 0.001) and in HSW ( p = 0.03). Source water (OR = 0.2; 95% CI: 0.1, 0.5) and HSW (OR = 0.3; 95% CI: 0.2, 0.8) from piped supplies had significantly lower odds of contamination compared with non-piped water, potentially due to residual chlorine.

Conclusions: Piped water is less likely to be contaminated compared with other water supply types at both the source and in HSW. A focus on upgrading water services to piped supplies may help improve safety, including for those drinking stored water.

Citation: Shields KF, Bain RE, Cronk R, Wright JA, Bartram J. 2015. Association of supply type with fecal contamination of source water and household stored drinking water in developing countries: a bivariate meta-analysis. Environ Health Perspect 123:1222–1231;  http://dx.doi.org/10.1289/ehp.1409002

Address correspondence to K.F. Shields, The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 148 Rosenau Hall, CB #7431, Chapel Hill, NC 27599-7431 USA. Telephone: (734) 649-3295. E-mail: kshields@email.unc.edu

We thank the Howard W. Odum Institute for Research in Social Science at the University of North Carolina, Chapel Hill, for help with the statistical methods. We also thank M. Fisher and K. Downs for their helpful comments on drafts of this paper.

This work was supported by the Water Working Group of the WHO/UNICEF (World Health Organization and United Nations Children’s Fund) Joint Monitoring Programme (JMP) for Water Supply and Sanitation ( http://www.wssinfo.org ) and by the WHO ( http://www.who.int ). The funders had no role in study design, data collection and analysis, or decision to publish.

The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of UNICEF, the WHO, or UNC.

J.B. is a member of the Water Working Group and is an unpaid advisor to both the WHO and UNICEF. The other authors declare they have no actual or potential competing financial interests.

Received: 25 July 2014 Accepted: 6 May 2015 Advance Publication: 8 May 2015 Final Publication: 1 December 2015

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