Modeling Exposure to Fecal Contamination in Drinking Water due to Multiple Water Source Use

The Joint Monitoring Programme estimated that 71% of people globally had access to "safely managed" drinking water in 2017. However, typical data collection practices focus only on a household's primary water source, yet some households in low- and middle-income countries (LMICs) engage in multiple water source use, including supplementing improved water supplies with unimproved water throughout the year. Monte Carlo simulations and previously published data were used to simulate exposure to fecal contamination (as measured by E. coli) along a range of supplemental unimproved source use rates (e.g., 0-100% improved water use, with the remainder made up with unimproved water). The model results revealed a statistically significant increase in annual exposure to E. coli when individuals supplement their improved water with unimproved water just 2 days annually. Additionally, our analysis identified scenarios-realistic for the data set study setting-where supplementing with unimproved water counterintuitively decreases exposure to E. coli. These results highlight the need for evaluating the temporal dynamics in water quality and availability of drinking water sources in LMICs as well as capturing the use of multiple water sources for monitoring global access to safe drinking water.