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Cited by 68Fecal contamination and water qualityFood Safety and HygieneWater Treatment and Disinfection

A Systematic Review and Meta-Analysis of Fecal Contamination and Inadequate Treatment of Packaged Water

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Williams, Ashley R., Bain, Robert E. S., Fisher, Michael B., Cronk, Ryan, Kelly, Emma R., Bartram, Jamie·2015·PLOS ONE
DOI 10.1371/journal.pone.0140899PMC PMC4624706
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Abstract

BACKGROUND: Packaged water products provide an increasingly important source of water for consumption. However, recent studies raise concerns over their safety. OBJECTIVES: To assess the microbial safety of packaged water, examine differences between regions, country incomes, packaged water types, and compare packaged water with other water sources. METHODS: We performed a systematic review and meta-analysis. Articles published in English, French, Portuguese, Spanish and Turkish, with no date restrictions were identified from online databases and two previous reviews. Studies published before April 2014 that assessed packaged water for the presence of Escherichia coli, thermotolerant or total coliforms were included provided they tested at least ten samples or brands. RESULTS: A total of 170 studies were included in the review. The majority of studies did not detect fecal indicator bacteria in packaged water (78/141). Compared to packaged water from upper-middle and high-income countries, packaged water from low and lower-middle-income countries was 4.6 (95% CI: 2.6-8.1) and 13.6 (95% CI: 6.9-26.7) times more likely to contain fecal indicator bacteria and total coliforms, respectively. Compared to all other packaged water types, water from small bottles was less likely to be contaminated with fecal indicator bacteria (OR = 0.32, 95%CI: 0.17-0.58) and total coliforms (OR = 0.10, 95%CI: 0.05, 0.22). Packaged water was less likely to contain fecal indicator bacteria (OR = 0.35, 95%CI: 0.20, 0.62) compared to other water sources used for consumption. CONCLUSIONS: Policymakers and regulators should recognize the potential benefits of packaged water in providing safer water for consumption at and away from home, especially for those who are otherwise unlikely to gain access to a reliable, safe water supply in the near future. To improve the quality of packaged water products they should be integrated into regulatory and monitoring frameworks.

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  • Most included studies tested point-of-sale or consumption samples, and there are few studies examining the safety of conditions under which sachet water is produced.

    “Most included studies tested point-of-sale or consumption samples, and there are few studies examining the safety of conditions under which sachet water is produced.”

    From Characteristics of packaged water production facilities in Greater Accra, Ghana: implications for water safety and associated environmental impacts (2020) · cites this paper as Williams et al. 2015

    Results > Study characteristics (page not provided) reports that 60% of included studies collected point-of-sale samples, versus 9% that collected samples from manufacturers. The Discussion says few studies examined quality along the supply chain in detail. These passages support the sampling imbalance, but do not establish how many studies examined the safety of sachet-water production conditions specifically. (LLM, conf=0.82)

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  • Systematic review evidence concerning faecal indicator bacteria in packaged water suggests low contamination prevalence.

    “Systematic review evidence concerning faecal indicator bacteria in packaged water suggests low contamination prevalence (Williams et al.  ).”

    From Characteristics of packaged water production facilities in Greater Accra, Ghana: implications for water safety and associated environmental impacts (2020) · cites this paper as Williams et al. 2015

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12 of the 200 references couldn’t be matched to a known paper.

Research works printed but not linked: 27

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Authors
Williams, A. R., Bain, R. E. S., Fisher, M. B., Cronk, R., Kelly, E. R., & Bartram, J.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • United Nations Children's Fund (US)
Corresponding author
Bartram, Jamie
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2015-10-27
Volume
10
Issue
10
Pages
e0140899
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0140899
PMC
PMC4624706
OpenAlex
W1854018898
Cited by
68
References
200
Citations by year
2026: 3 · 2025: 8 · 2024: 10 · 2023: 6 · 2022: 10 · 2021: 7 · 2020: 6 · 2019: 5 · 2018: 6 · 2017: 5 · 2016: 2
FWCI
0.36
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • University of North Carolina at Chapel Hill
  • National Institute of Environmental Health Sciences (T32ES007018)
Topics
  • Physical Sciences › Environmental Science › Water Science and Technology › Fecal contamination and water quality
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Food Safety and Hygiene
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Water Treatment and Disinfection
Keywords
bottled water, fecal contamination, Escherichia coli, fecal coliforms, total coliforms, microbiological water quality, low- and middle-income countries
MeSH terms
Escherichia coli, Feces, Humans, Water Microbiology, Product Packaging, Water Quality, Drinking Water

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