Research ArticleWater Sources Quality in Urban Slum Settlement along theContaminated River Basin in Indonesia Application ofQuantitative Microbial Risk Assessment

Sri Y Irda Sari 1 Deni K Sunjaya1 Hana Shimizu-Furusawa2 Chiho Watanabe2

and Ardini S Raksanagara1

1Department of Public Health Faculty of Medicine Padjadjaran University Bandung Indonesia2Department of Human Ecology School of International Health Graduate School of Medicineampe University of Tokyo Tokyo Japan

Correspondence should be addressed to Sri Y Irda Sari italatifyahoocom

Received 16 April 2018 Revised 18 July 2018 Accepted 12 August 2018 Published 18 September 2018

Academic Editor Sina Dobaradaran

Copyright copy 2018 Sri Y Irda Sari et al(is is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Fecal contamination in water sources is still found globally especially in urban slum areas of mid-low income countries Fecalcontamination as an indicator of low levels of hygiene and sanitation practices as well as poor management of drinking watersupply might increase the risk of waterborne diseases in developing countries like Indonesia (is study aimed to assess quality ofall water sources in one of the urban slum settlements along a contaminated river basin in Indonesia A cross-sectional survey wasconducted during the period of August to October 2015 Water samples were taken with simple random sampling fromhouseholds in urban slum areas along the Cikapundung river basin in the center of Bandung city Indonesia Water samples(n 379) from 199 households and 15 common wells were tested for microbiological contamination and 61 samples of groundwater sources and river were tested for selected heavy metal contamination Annual risk of infection from all water sources wascalculated using the quantitative microbial risk assessment Tap water distribution was poor in this slum area Most of the dugwells and half of refill bottled water were contaminated Estimated highest annual risks of infection due to fecal contaminationwould be caused by dug well and spring water since majority of the households did not use septic tank and disposed human wastedirectly to the river Improvement in point-of-use water treatment and storage is essential to prevent risk of waterborne diseasesand tap water should be more accessible and affordable in urban slum areas (e integrated monitoring system to control thequality of refill bottled water production is one of the many essential issues to be prioritized

1 Introduction

Water sanitation and hygiene (WaSH) are prerequisite tohuman health and development since clean water is es-sential for humanrsquos daily living especially for drinking waterMillions of people in developing countries still have noaccess to adequate and safe water supply (e number ofpeople without access to safe water in urban areas increasessharply in developing countries as a result of rapid urbani-zation much of which occurred in peri-urban and slum areassince the last decade [1] (e United Nations has projecteda rapid population growth in urban areas between 2000 and2030 suggesting that 6 out of 10 people will be living in cities(erefore accessible and adequate safe drinking water and

sanitation in urban areas particularly for urban poor dwellersshould be prioritized by policy makers to decrease the risk ofwater-related diseases [2]

Fecal contamination in water sources an indicator forpoor sanitation and hygiene is still found around the worldespecially in slum areas of mid-low income countries [3]Diarrhea or gastroenteritis is among the main causes ofhealth problems 15 million deaths were caused by diarrheain 2012 and 280000 were caused by poor sanitation [4] InIndonesia diarrhea is common among infants and childrenContact and ingestion of unsafe water lack of water supplypoor personal and domestic hygiene and inadequate de-velopment and management of water resourceswater sys-tems are known as risk factors of diarrhea in Indonesia [5]

HindawiJournal of Environmental and Public HealthVolume 2018 Article ID 3806537 7 pageshttpsdoiorg10115520183806537

Bandung city a densely populated area is the capital cityof West Java Province (e local water company that isresponsible for tap water distribution in Bandung city onlysupplies 4691 of the public need for clean water theremaining 53 have to find other safe water sources on theirown However the quality of tap water from the local watercompany was poor according to the report from the healthoffice that revealed only 1333 from 210 samples had goodquality (e lack of local water supply service has forced thelower class to find alternative water sources which areusually underground water consisting mostly ofboreholewells with mechanized pumping and dug wells(ese conditions will surely increase safe water demand inBandung city [6]

Taman Sari subdistrict is one of the slum areas in thecenter of Bandung city with poor coverage for safe waterhigh-reported diarrhea cases and high population density(is slum area is part of the priority for a development projecttargeting urban slum areas in 5 large cities in IndonesiaTaman Sari subdistrict is located right on the Cikapundungriver basin Cikapundung River is the main river among 15rivers which cross the city and empties into Citarum RiverCikapundung River has been heavily contaminated byhousehold waste and latrine disposal from settlement alongthe riverbanks while Citarum River in the south part of thecity contains industrial waste contamination

Surveillance of water source quality especially micro-biology parameters is required to prevent further con-tamination Quality is normally assessed against bothmicrobial indicators and chemical parameters although themicrobial quality is the most important aspect from publichealth perspective because epidemic outbreaks caused bysome pathogenic organisms can be very fast [7] WHOguidelines for drinking water quality recommend ensuringthe safety of drinking water supplies by development andimplementation of risk management strategies to controlhazardous constituents in water [8] (is study aimed toassess the quality of various water sources used by urbanslum dwellers along one of the contaminated river basins toinform key players in the water sector to improve waterquality in regards to public health protection

2 Materials and Methods

(is study was an observational research with cross-sectional design which was conducted from August toOctober 2015 (e study population was all the householdsin all RW (Rukun Warga community association) along theCikapundung river basin in Taman Sari subdistrict Sampleswere selected by simple random sampling from the list oftotal households in that area (n 1734) Minimal sampleswere calculated using sample size estimations for a singleproportion with alpha 5 and power 80 Informed consentwas done prior to sample collection and ethical approval wasobtained from the Ethical Committee in the Faculty ofMedicine Padjadjaran University

In all selected households all type of water sources werecollected including raw and drinking water sources Watersamples from the field were collected using sterile plastic and

then stored inside a cooler box before being transported to thelaboratory afterward laboratory processing was done within6ndash8 hours after retrieval Water samples from ground waterand tap water were 10x diluted (or 100x if the water wasvisibly cloudy) using sterile physiological saline solutionBacterial identification was conducted by a membrane fil-tration technique using the nitrocellulose membrane filter(47mm in diameter pore size 045 μmMerck Millipore) andChromocult Coliform agar as culture media (ChromocultColiform agar from Merckreg) One hundred milliliters of thediluted sample was then filtered through membranes andplaced on media Water samples from drinking water such asbottled water and refill bottled water were not diluted 100mlof the water sample was directly filtered through the mem-brane After that culture media was incubated at 37degC for 24hours until colonies formed (e sample was reported E coli-positive if a purple-bluish-coloured colony was found Co-liform bacteria-containing samples were reported if a red-coloured-colony was found E coli andColiform bacteria wereidentified by colony counting expressed in colony-formingunits (CFU) per 100ml water sample Raw water was de-termined as contaminated if the sample showsgt50CFU100ml based on the Indonesian guideline for cleanwater and drinking water should contain 0CFU100mlColiform and E Coli in the sample

Identification of microbiology parameters was con-ducted in the Laboratory of Microbiology and ParasitologyFaculty of Medicine Padjadjaran University Sixty-onewater samples from ground water sources and rivers wereselected to be tested for heavy metal contamination (ischemical examination was conducted using ICP-MS (In-ductively Coupled Plasma Mass Spectrometry) which hasgreater speed precision and sensitivity compared to atomicabsorption spectroscopy ICP-MS is capable to detect metalsand several nonmetals at concentrations as low as one part in1015 (part per quadrillion ppq) on noninterfered low-background isotopes by ionizing the sample with in-ductively coupled plasma and then using a mass spec-trometer to separate and quantify those ions (e validationwas prepared by the certified reference material ldquoNIST1643eTrace Element in Waterrdquo using Agilent 7500ce ICP-MS(istest was done in the Department of Human Ecology Schoolof International Health the University of Tokyo Japan

(e data were further analysed using the quantitativemicrobial risk assessment (QMRA) approach in order toidentify the risk of infection from various water sources byfocusing on the microbiological quality of water sourcesEquations that were used in this study are as follows

d V times c (1)

PI 1minus 1 +d

N501113888 11138891113890 1113891

minusα

(2)

Pannual 1minus 1minusPinfection( 1113857365

(3)

In Equation (1) d is ingested dose per day V is volume ofwater consumed per day and c is concentration of micro-organism in water (e volume of water consumed per day is

2 Journal of Environmental and Public Health

defined as 11 liter per person as derived from the previousstudy [9] In Equation (2) PI is the probability of infections tooccur α is the parametric slope andN50 is the average dose tocause an infection (E coli N50 86times107 α 01778) InEquation (3)Pannual is the probability of annual infection andPinfection is the calculated daily infection [10 11]

3 Results

31 Socio-Demographic Characteristics A total of 199households were surveyed with a total of 379 water samplesfrom various water sources from each household including15 common dug wells Characteristics of the respondentsfrom the households are described in Table 1 Almost one-third of the households in this slum area were in the status ofrented or shared house and 161 were using shared orcommon latrine About 231 of the head of family werejobless and 261 had low education status Tap water wasnot equally distributed in the whole area therefore about377 of the household were likely to use groundwaterMostly the drinking water source was from bottled watereither refill or branded bottled water while some householdskeep boiling the raw water sources from ground water or tapwater for their drinking water (e river along this area hadbeen acknowledged as giant septic tank since most of thehouseholds preferred to dispose the human waste from theirlatrine directly to the river

Comparation of monthly expenditure for daily living isshown in Table 2 (e average for all monthly expendituresamong slum dwellers was USD 2796 (1 USD IDR 13000)with food as the biggest expenditure (29) however themeanexpenditure for tapdrinking water took only a small portion(22) from the total expenditure (is expenditure was usedfor paying the tap water usage and buying the refill or brandedbottled water for daily consumption Households that still boilthe raw water also spend 23 of the monthly expenditure forgas fuel intended for cooking and boiling water Othermonthly expenditure such as for smoking groceries trans-portation and education is bigger compared to the expen-diture for tapdrinking water supply

32 Quality of Water Sources Figure 1 illustrates microbi-ological quality of various types of water sources used byslum dwellers(e type of raw water varies from tap water togroundwater (spring dug well and borehole)(ese types ofraw water were used as clean water for daily activities such ascooking bathing and washing and also being used as thesource of drinking water after boiling Households that donot use their raw water for drinking would buy bottledrefillbottled water as drinking water source Percentage ofcontaminated dug well is higher compared to the otherwater sources Furthermore half of refill bottled water wascontaminated and 3 out of 7 spring water which were usedas the source of drinking water found to be contaminated

Table 3 shows some heavy metal parameters two dif-ferent standard solutions ranged from 2 to 50 ppb was usedto validate the measured values which were compared tothe certified value In Table 3 the mean of the heavy metalconcentrations was below the Indonesian guideline limit

for clean water (water which is used for hygiene andsanitation purposes) and WHO guideline for drinkingwater except for aluminium in river water Besides that theresult revealed that there were 10 dug wells and 2 boreholeswith concentration of manganese exceeding 500 ppbManganese is known as one of the abundant metals in theearthrsquos crust and usually occurs together with iron Ironand manganese are essential trace elements in humannutrition and even no health-based guideline value isproposed for iron in drinking water (ese metals how-ever will affect taste and appearance [8]

33 Quantitative Microbial Risk Assessment Using Beta-Poisson model as application of QMRA the probabilityof infection can be calculated by incorporating the fore-known values and the average dose of Coliform and fecalColiform into Equation (2) Table 4 suggests the probability

Table 1 Characteristics of respondents

Characteristics (n 199) n ampe house statusOwner 145 728Rented 25 125Shared 29 147Head of family jobNo job 46 231Civil servant 7 35Business 102 512Employee 44 222Head of family highest educationElementary 52 261Junior high 27 135Senior high 94 477University 26 127Type of raw water sourcesTap water 103 517Tap water + ground water 14 71Dug-well 48 239Borehole 27 138Unprotected spring 7 35Type of potable water sourcesBoiling raw water 66 332Refill bottled water 76 382Branded bottled water 57 286Distance of ground water sources to the river (n 110)lt2 meters 12 1092ndash10 meters 31 28211ndash20 meters 11 1021ndash50 meters 21 191gt50 meters 35 318Type of human disposal wasteSeptic tank 7 35Sewerage from city system 4 2River 182 915Hole in backyard 6 3Ownership of the latrineOwner 167 839Sharing with other house 19 95Use of common toilet 13 66

Journal of Environmental and Public Health 3

of occurrence of fecal Coliform infection in all types of watersources tested Meanwhile the probability of infection isused to calculate the annual probability using Equation (3) asshown in Table 4 USEPA limits the annual probability valueby 10minus4 per person yet Haas et al and Blumental et al statedthat the annual probability can be tolerated until 10minus3 perperson or more depending on dierent conditions of thecountry in which studies are conducted [11 13] Currentlythe tolerated range of the annual infection probability hadnot been determined in Indonesia Table 4 describes theannual probability of infection due to consumption of dugwells and spring water sources in urban slum areas in thestudy site that exceeds the tolerated limit

4 Discussion

Since this slum area is located in the city center tap waterconnection is available but only half of the households use

tap water as their main water source other dwellers useground water sources (borehole or dug-well) and springSome of the community still use common dug wellsparticularly those who stay in rented or shared housesthese types of houses usually do not have their own latrineinside their house therefore residents use common toiletsas the consequences One common dug-well is usuallyused by 3ndash5 houses however in certain locations it can beused by more than 20 houses One household might usemore than one type of water source sometimes people usetap water and also have dug-wellborehole as a secondarywater source

Interestingly for drinking water sources more than halfof the communities (668) prefer to choose bottled watereither rell or branded bottled water while the others stillboil tap or ground water Rell bottled water is more popularcompared to bottled water from branded company amongthe slum dwellers Rell bottled water is provided by waterrell stations and the consumers should bring their ownwater container which is commonly a 19-liter plastic bottleSome of them buy rell bottled water because of practicalityreason and due to the price that is three times cheapercompared to branded bottled water [14] Monthly expen-diture for tapdrinking water is smaller compared to otherexpenditures this might be because slum dwellers prefer toboil their raw water or choose rell bottled water

Due to limitations of capability from the local govern-ment company that is responsible for distributing tap waterto all parts of the city tap water is not always distributed 24hours a day and sometimes only a few days a week and only2-3 hours at midnight Lack of sucient volume of rawwatersources low capability of water treatment production anda high percentage of leakage in the distribution systemcontribute to the problem of low-tap water coverage inBandung city At the national scale the water loss due toleakage in piping systems reported ranges between 25 and30 in metropolitan cities and 30ndash35 in smaller cities[15ndash17]erefore people prefer to use groundwater such asdug wells or boreholes as their main water sources e riverbasin area is located in the lowest level consequently it isquite easy to get water from ground water and spring which

Table 2 Monthly expenditure in households

Monthly expenditure (USD) (n 199) Min-max Meanplusmn SD Proportion from total expenditure ()Food 59ndash4615 126plusmn 78 29Smoking 14ndash208 318plusmn 26 73Rent house (n 21) 06ndash192 363plusmn 423 84Health 01ndash169 144plusmn 258 33Education 05ndash5385 428plusmn 76 10Taxinsurance 02ndash269 184plusmn 47 42Communication 04ndash115 134plusmn 14 3Grocery 07ndash154 174plusmn 21 4Transportation 07ndash231 23plusmn 32 53Services (maiddriver) (n 12) 154ndash1385 605plusmn 365 14Electricity 15ndash92 18plusmn 176 41Tapdrinking water 1ndash58 97 plusmn 94 22Gas fuel 15ndash61 10 plusmn 9 23Others 02ndash185 4plusmn 17 29

0 20 40 60 80 100

Bottled water

Refill bottled water

Tap water

Borehole

Dug well

Spring

Used as clean water not contaminated Used as clean water contaminated Used as drinking water not contaminated Used as drinking water contaminated

()

Figure 1 Percentage of contaminated clean and drinking waterfrom various water sources

4 Journal of Environmental and Public Health

are also available in some spots However in this slum areaalmost all (91) of the households have no septic tanks anddispose their human and domestic waste directly to the riverand it causes high risk of contamination to their groundwater sources

Coliform bacteria existed in all types of water sourcesespecially in unprotected dug wells and springs even almostall of unprotected springs are contaminated Coliformcontamination may be caused due to contamination origi-nated from latrines without a septic tank surrounding thewater source It is quite interesting that bottled water ispopular among slum dwellers however we found that halfof refill bottled water was contaminated mostly by Coliform(is fact is quite important to be considered that the qualityof refill bottled water might not be appropriate in the waterrefill station or recontamination happened in the householdsseeing as hygiene and sanitation is the substantial problem inthe slum area Previous studies reported that the quality ofrefill bottled water was not fully supervised and 25ndash40were still not suitable as drinking water [9 18 19] In thisstudy only 8 out of 50 bottled water were still contaminatedcompared to other studies in Iran that found no contami-nation of Coliform in bottled water but still positive forHeterotrophic Plate Counts (HPCs) [20 21]

Tap water in developed country should be potable andnot contaminated by ColiformEColi however in manydeveloping countries even the local government treat thetap water before distribute it ussualy the consumer shouldboil the tap water before use as drinking water (e previousstudy from the decentralized municipal desalination plan inIran showed that even the mean value of physical andchemical parameters complied with the regulation limit but10 of HPC samples in the outlet and 14 of samples in thedistribution network did not comply with standard [22 23](is study showed that half of tap water found to be con-taminated in household distribution this recontamination

might be due to some factors such as leakage in the main orhousehold distribution system low pressure along the pipedistribution and not fully continuous water flow Worstsanitation and hygiene condition in the household distri-bution also contribute to this contamination definitely

(e location of this slum area is in the city center and faraway from the industrial area (erefore there is no heavymetal concentration found High concentration offerrumiron in ground water sources is due to the geologicalcharacteristic of the earthrsquos crust in Bandung city [24] (ereis no health-based guideline value for iron in drinking waterhowever high concentration of iron might cause manyesthetical effects due to staining laundry and ceramic as wellas high turbidity and colouring the water Commonly slumdwellers simply use the conventional filtration method tominimize the iron concentration

Analysis using QMRA contains three steps the first isa health-hazard identification followed by an exposure as-sessment and then a risk characterization In the hazardidentification phase the catchment-to-consumer systemdescription the selection of index pathogen and the se-lection of hazardous events were elaborated AlthoughQMRA was previously intended to be applied for a specificpathogen completing a QMRA for every pathogen that maybe transmitted by water would be challenging [25] thusmicroorganism indicators are used instead In this study thetotal Coliform and fecal Coliform were observed as indicatorbacteria in water because nonspecific diarrhea is the mostcommon type of waterborne disease reported in outpatientprimary health centers in Indonesia

(e last step of QMRA is the risk characterization whichaims to integrate the exposure information with dose-responseanalysis to obtain overall risk estimates High contamination indug wells and springs in urban slum areas is associated withpoor hygiene and sanitation due to the small number ofhouseholds that use septic tanks(e community is accustomed

Table 4 (e risk of infection due to consumption of various types of water sources

Type of watersource

Concentration of fecalColiform (CFU100ml)

Dose of consume fecal Coliform(CFUpersonday) (Equation (1))

Probability of infection cause byfecal Coliform (Equation (2))

Annual probability(Equation (3))

Bottled water 025 281 058times10minus8 021times 10minus5

Refill bottled water 246 2709 560times10minus8 204times10minus5

Tap water 135 1486 307times10minus8 112times10minus5

Borehole 167 1834 379times10minus8 138times10minus5

Dug well 136667 1503334 3107times10minus8 11279times10minus5

Spring 60 660 1364times10minus8 497times10minus5

Table 3 Heavy metal concentrations from all types of water sources

Concentration in nggr (meanplusmn SD)Al Mn Cu As Pb

Borehole (n 22) 5plusmn 5 187plusmn 287 45plusmn 52 05plusmn 02 02plusmn 04Dug well (n 38) 47plusmn 79 368plusmn 497 34plusmn 76 05plusmn 05 02plusmn 05Spring (n 1) 7 36 14 01 0River (n 1) 1374 552 47 08 12Indonesian guideline for clean water 200 500 1000 50 50WHO guideline for drinking water 200 500 1000 10 10

Journal of Environmental and Public Health 5

to disposing human waste directly to the riverbank by usingclosedopen pipes Safe excreta disposal is also critical as a firstbarrier to disease transmission (erefore the reduction ofmorbidity and mortality from infectious diarrheal diseasesrequires improvements in the quality and availability of waterexcreta disposal and general personal and environmentalhygiene Proper water treatment is extremely important toprevent infection from consuming contaminated drinkingwater Since half of refill bottled water did not fulfill thestandard the annual probability of having infection fromrefilled bottled water as potable water is higher compared to tapwater and borehole as raw water (is fact demonstrates thatthe possibility of recontamination during transportation orinappropriate cleaning methods of the storage among urbanslum dwellers is high(e previous study by Sima et al showedthat the usage of water from community-scale water refillstations can reduce the risk of childhood diarrhea [26] but ifthe quality of refill water is not properly monitored thecommunity will have risk of consume unstandardized drinkingwater Lack of government control on the quality of refill waterstation production is also an important factor subsequently theimplementation of an integrated monitoring system for bottledwater production is urgently needed

41 Limitation of the Study In this study the calculation ofthe annual probability of infection was calculated from rawwater therefore we cannot compare the risk of potablewater between boiling water and bottled water Heavy metalcontamination was tested only from ground water sourcesand limited only for selected parameters

5 Conclusions

Although the infection probability in bottled water tapwater and borehole is tolerable the presence of Coliformand fecal Coliform in both potable and raw water sourcessuggest that measures should be undertaken to reduce therisk of infection (e higher probability of infection in dugwells and spring water sources suggests that proper watertreatment should be proposed prior to consumption asdrinking water An improvement in the distribution net-works of tap water is crucial to reduce the risk of waterbornediseases (e integrated monitoring system to control thequality of refill bottled water production is one of the manyessential issues to be prioritized

Data Availability

(e data used to support the findings of this study areavailable from the corresponding author upon request

Disclosure

(is study was part of research entitled ldquoRisk Assessment onDrinking Water Source of Urban Slum Area in Cika-pundung River Basin in Bandung Municipalityrdquo which wasconducted in the Department of Public Health Faculty ofMedicine Padjadjaran University in collaboration withDepartment of Human Ecology School of International

Health Graduate School of Medicine (e University ofTokyo Japan

Conflicts of Interest

(e authors declare that there are no conflicts of interestregarding the publication of this paper

Acknowledgments

(is research was funded by the Ministry of ResearchTechnology and Higher Education of Indonesia under theInternational Research Collaboration and Scientific Publi-cation grant (is articlersquos publication is supported by theUnited States Agency for International Development(USAID) through the Sustainable Higher Education Re-search Alliance (SHERA) Program for Universitas Indo-nesiarsquos Scientific Modeling Application Research andTraining for City-centered Innovation and Technology(SMART CITY) Project (Grant no AID-497-A-1600004Sub-Grant no IIE-00000078-UI-1) We appreciate thesupport and cooperation of Ahyani Raksanagara MD Headof Bandung Health Office and all enumerators from thePrimary Health Centre in Salam and Taman Sari during thesurvey We also thank all the laboratory staff members fromthe Laboratory of Microbiology and Parasitology Faculty ofMedicine Padjadjaran University for all their hard work

References

[1] World Health Organization Monitoring Water and Sanita-tion for EvidencendashBased Policy and Intervention WaterSanitation Hygiene and Health Department of Public Healthand Environment WHO Geneva Switzerland 2010

[2] United Nations Water and Cities Facts and Figures UNndashWater Decade Programme on Advocacy and Communication(UNWndashDPAC) United Nations San Francisco CA USA2010

[3] J Wolf A PrussndashUstun O Cumming et al ldquoSystematicreview assessing the impact of drinking water and sanitationon diarrhoeal disease in low and middle income settingssystematic review and metandashregressionrdquo Tropical Medicine ampInternational Health vol 19 no 8 pp 928ndash942 2014

[4] R Bain R Cronk J Wright H Yang T Slaymaker andJ Bartram ldquoFecal contamination of drinking-water in low andmiddle income countries a systematic review and meta-analysisrdquo PLoS Medicine vol 11 no 5 article e1001644 2014

[5] B Haryanto and S Sutomo ldquoImproving access to adequatewater and basic sanitation services in Indonesiardquo Reviews onEnvironmental Health vol 27 no 4 pp 159ndash162 2012

[6] Bandung Health Office Annual Report of Bandung HealthOffice Bandung Health Office Bandung Indonesia 2012

[7] S T Odonkor and J K Ampofo ldquoEscherichia coli as anindicator of bacteriological quality of water an overviewrdquoMicrobiology Research vol 4 no 1 p 2 2013

[8] World Health Organization Guidelines for Drinking-WaterQuality WHO Geneva Switzerland 4th edition 2011

[9] S Putri N Anindrya and S M Barti ldquoApplying quanitativemicrobial risk assessment in household drinking watersources a case study of Ujungberung Subdistrict Bandungrdquo inProceedings of the 5th Environmental Technology and

6 Journal of Environmental and Public Health

Management Conference on Green Technology towards Sus-tainable Environment Bandung Indonesia November 2015

[10] S Petterson R Signor N Ashbolt and D Roser QMRAMethodology University of New South Wales Sydney NSWAustralia 2006

[11] C N Haas J B Rose and C P GerbaQuantitative MicrobialRisk Assessment Wiley New York NY USA 1999

[12] United State Environmental Protection Agency QuantitativeMicrobial Risk Assessment to Estimate Illness in FreshwaterImpacted by Agricultural Animal Sources of Fecal Contami-nation Quantitative Microbial Risk Assessment to EstimateIllness in Freshwater Impacted by Agricultural Animal Sourcesof Fecal Contamination Office of Water Washington DCUSA 2010

[13] U J Blumental D D Mara A Peasey G Ruiz-Palacios andR Stott ldquoGuidelines for the microbiological quality of treatedwastewater used in agriculture recommendation for revisingWHO guidelinesrdquo Bulletin of the World Health Organizationvol 78 no 9 pp 1104ndash1116 2000

[14] L C Sima andM Elimelech ldquoMore than a drop in the bucketdecentralized membrane-based drinking water refill stationsin southeast asiardquo Environmental Science and Technologyvol 47 no 14 pp 7580ndash7588 2013

[15] N Ardhianie ldquoWater privatisation in Indonesiardquo inReclaiming Public Water Achievements Struggles and Visionsfrom Around the World Transnational Institute and Corpo-rate Europe Observatory and Operator Performance December2005 B Balanya B Brennan O Hoedeman S Kishimotoand P Terhorst Eds Jakarta Water Supply Regulatory Body(JWSRB) Jakarta Indonesia 2005 httpwwwjakartawaterorgengindexphp

[16] D Hall and E Lobina Pipe Dreams the Failure of the PrivateSector to Invest in Water Services in Developing CountriesPSIRUWorld Development Movement London UK 2006

[17] A A Kurniati ldquoQuality of refill drinking water in greaterJakarta in 2010rdquo Health Sciences Indonesia vol 2 no 2pp 77ndash80 2011

[18] G Howard and O Schmoll ldquoWater safety plans risk man-agement approaches for the delivery of safe drinking-waterfrom groundwater sourcesrdquo in Protecting Groundwater forHealth Managing the Quality of Drinking-Water SourcesO Schmoll Ed pp 431ndash463 World Health OrganizationGeneva Switzerland 2006

[19] M Iqbal A Nastiti and B S Muntalif ldquoImproved but notalways safety a microbial water quality analysis in BandungPeri urban householdsrdquo in Proceedings of the 5th Environ-mental Technology and Management Conference on GreenTechnology towards Sustainable Environment BandungIndonesia November 2015

[20] G Medema and N Ashbolt ldquoQMRA its value for riskmanagementrdquo 2017 httpwwwcamramsuedudocumentsQMRA_ frameworkpdf

[21] S F Elham D Sina and H Roughayeh ldquoChemical microbialand physical evaluation of commercial bottled drinking waterin Bushehr city Iranrdquo Fresenius Environmental Bulletinvol 24 no 11A pp 3836ndash3841 2015

[22] M Zazouli G M Safarpour A Veisi and P HabibkhanildquoBacterial contamination in bottled water and drinking waterdistribution network in Semnan 2012rdquo Journal of Mazan-daran University of Medical Sciences vol 22 no 1 pp 151ndash159 2013

[23] N K Vahid D Sina S Farshid et al ldquo(e role of decen-tralized municipal desalination plants in removal of physicalchemical and microbial parameters from drinking water

a case study in Bushehr Iranrdquo Journal of Water Sanitationand Hygiene for Development vol 8 no 2 pp 325ndash339 2018

[24] R Alireza S Farshid D Sina K Mozhgan and N K VahidldquoMicrobial chemical and physical properties of drinkingwater in Bushehr distribution network systemrdquo Desalinationand Water Treatment vol 65 pp 208ndash214 2017

[25] S Sudarningsih B Satria R Rizky et al ldquoVariations in theconcentration of magnetic minerals and heavy metals insuspended sediments from Citarum river and its tributariesWest Java Indonesiardquo Geosciences vol 7 no 3 p 66 2017

[26] L C Sima M M Desai K M McCarty and M ElimelechldquoRelationship between use of water from community-scalewater treatment refill kiosks and childhood diarrhea inJakartardquo American Journal of Tropical Medicine and Hygienevol 87 no 6 pp 979ndash984 2012

Journal of Environmental and Public Health 7

defined as 11 liter per person as derived from the previousstudy [9] In Equation (2) PI is the probability of infections tooccur α is the parametric slope andN50 is the average dose tocause an infection (E coli N50 86times107 α 01778) InEquation (3)Pannual is the probability of annual infection andPinfection is the calculated daily infection [10 11]

3 Results

31 Socio-Demographic Characteristics A total of 199households were surveyed with a total of 379 water samplesfrom various water sources from each household including15 common dug wells Characteristics of the respondentsfrom the households are described in Table 1 Almost one-third of the households in this slum area were in the status ofrented or shared house and 161 were using shared orcommon latrine About 231 of the head of family werejobless and 261 had low education status Tap water wasnot equally distributed in the whole area therefore about377 of the household were likely to use groundwaterMostly the drinking water source was from bottled watereither refill or branded bottled water while some householdskeep boiling the raw water sources from ground water or tapwater for their drinking water (e river along this area hadbeen acknowledged as giant septic tank since most of thehouseholds preferred to dispose the human waste from theirlatrine directly to the river

Comparation of monthly expenditure for daily living isshown in Table 2 (e average for all monthly expendituresamong slum dwellers was USD 2796 (1 USD IDR 13000)with food as the biggest expenditure (29) however themeanexpenditure for tapdrinking water took only a small portion(22) from the total expenditure (is expenditure was usedfor paying the tap water usage and buying the refill or brandedbottled water for daily consumption Households that still boilthe raw water also spend 23 of the monthly expenditure forgas fuel intended for cooking and boiling water Othermonthly expenditure such as for smoking groceries trans-portation and education is bigger compared to the expen-diture for tapdrinking water supply

32 Quality of Water Sources Figure 1 illustrates microbi-ological quality of various types of water sources used byslum dwellers(e type of raw water varies from tap water togroundwater (spring dug well and borehole)(ese types ofraw water were used as clean water for daily activities such ascooking bathing and washing and also being used as thesource of drinking water after boiling Households that donot use their raw water for drinking would buy bottledrefillbottled water as drinking water source Percentage ofcontaminated dug well is higher compared to the otherwater sources Furthermore half of refill bottled water wascontaminated and 3 out of 7 spring water which were usedas the source of drinking water found to be contaminated

Table 3 shows some heavy metal parameters two dif-ferent standard solutions ranged from 2 to 50 ppb was usedto validate the measured values which were compared tothe certified value In Table 3 the mean of the heavy metalconcentrations was below the Indonesian guideline limit

for clean water (water which is used for hygiene andsanitation purposes) and WHO guideline for drinkingwater except for aluminium in river water Besides that theresult revealed that there were 10 dug wells and 2 boreholeswith concentration of manganese exceeding 500 ppbManganese is known as one of the abundant metals in theearthrsquos crust and usually occurs together with iron Ironand manganese are essential trace elements in humannutrition and even no health-based guideline value isproposed for iron in drinking water (ese metals how-ever will affect taste and appearance [8]

33 Quantitative Microbial Risk Assessment Using Beta-Poisson model as application of QMRA the probabilityof infection can be calculated by incorporating the fore-known values and the average dose of Coliform and fecalColiform into Equation (2) Table 4 suggests the probability

Table 1 Characteristics of respondents

Characteristics (n 199) n ampe house statusOwner 145 728Rented 25 125Shared 29 147Head of family jobNo job 46 231Civil servant 7 35Business 102 512Employee 44 222Head of family highest educationElementary 52 261Junior high 27 135Senior high 94 477University 26 127Type of raw water sourcesTap water 103 517Tap water + ground water 14 71Dug-well 48 239Borehole 27 138Unprotected spring 7 35Type of potable water sourcesBoiling raw water 66 332Refill bottled water 76 382Branded bottled water 57 286Distance of ground water sources to the river (n 110)lt2 meters 12 1092ndash10 meters 31 28211ndash20 meters 11 1021ndash50 meters 21 191gt50 meters 35 318Type of human disposal wasteSeptic tank 7 35Sewerage from city system 4 2River 182 915Hole in backyard 6 3Ownership of the latrineOwner 167 839Sharing with other house 19 95Use of common toilet 13 66

Journal of Environmental and Public Health 3

of occurrence of fecal Coliform infection in all types of watersources tested Meanwhile the probability of infection isused to calculate the annual probability using Equation (3) asshown in Table 4 USEPA limits the annual probability valueby 10minus4 per person yet Haas et al and Blumental et al statedthat the annual probability can be tolerated until 10minus3 perperson or more depending on dierent conditions of thecountry in which studies are conducted [11 13] Currentlythe tolerated range of the annual infection probability hadnot been determined in Indonesia Table 4 describes theannual probability of infection due to consumption of dugwells and spring water sources in urban slum areas in thestudy site that exceeds the tolerated limit

4 Discussion

Since this slum area is located in the city center tap waterconnection is available but only half of the households use

tap water as their main water source other dwellers useground water sources (borehole or dug-well) and springSome of the community still use common dug wellsparticularly those who stay in rented or shared housesthese types of houses usually do not have their own latrineinside their house therefore residents use common toiletsas the consequences One common dug-well is usuallyused by 3ndash5 houses however in certain locations it can beused by more than 20 houses One household might usemore than one type of water source sometimes people usetap water and also have dug-wellborehole as a secondarywater source

Interestingly for drinking water sources more than halfof the communities (668) prefer to choose bottled watereither rell or branded bottled water while the others stillboil tap or ground water Rell bottled water is more popularcompared to bottled water from branded company amongthe slum dwellers Rell bottled water is provided by waterrell stations and the consumers should bring their ownwater container which is commonly a 19-liter plastic bottleSome of them buy rell bottled water because of practicalityreason and due to the price that is three times cheapercompared to branded bottled water [14] Monthly expen-diture for tapdrinking water is smaller compared to otherexpenditures this might be because slum dwellers prefer toboil their raw water or choose rell bottled water

Due to limitations of capability from the local govern-ment company that is responsible for distributing tap waterto all parts of the city tap water is not always distributed 24hours a day and sometimes only a few days a week and only2-3 hours at midnight Lack of sucient volume of rawwatersources low capability of water treatment production anda high percentage of leakage in the distribution systemcontribute to the problem of low-tap water coverage inBandung city At the national scale the water loss due toleakage in piping systems reported ranges between 25 and30 in metropolitan cities and 30ndash35 in smaller cities[15ndash17]erefore people prefer to use groundwater such asdug wells or boreholes as their main water sources e riverbasin area is located in the lowest level consequently it isquite easy to get water from ground water and spring which

Table 2 Monthly expenditure in households

Monthly expenditure (USD) (n 199) Min-max Meanplusmn SD Proportion from total expenditure ()Food 59ndash4615 126plusmn 78 29Smoking 14ndash208 318plusmn 26 73Rent house (n 21) 06ndash192 363plusmn 423 84Health 01ndash169 144plusmn 258 33Education 05ndash5385 428plusmn 76 10Taxinsurance 02ndash269 184plusmn 47 42Communication 04ndash115 134plusmn 14 3Grocery 07ndash154 174plusmn 21 4Transportation 07ndash231 23plusmn 32 53Services (maiddriver) (n 12) 154ndash1385 605plusmn 365 14Electricity 15ndash92 18plusmn 176 41Tapdrinking water 1ndash58 97 plusmn 94 22Gas fuel 15ndash61 10 plusmn 9 23Others 02ndash185 4plusmn 17 29

0 20 40 60 80 100

Bottled water

Refill bottled water

Tap water

Borehole

Dug well

Spring

Used as clean water not contaminated Used as clean water contaminated Used as drinking water not contaminated Used as drinking water contaminated

()

Figure 1 Percentage of contaminated clean and drinking waterfrom various water sources

4 Journal of Environmental and Public Health

are also available in some spots However in this slum areaalmost all (91) of the households have no septic tanks anddispose their human and domestic waste directly to the riverand it causes high risk of contamination to their groundwater sources

Coliform bacteria existed in all types of water sourcesespecially in unprotected dug wells and springs even almostall of unprotected springs are contaminated Coliformcontamination may be caused due to contamination origi-nated from latrines without a septic tank surrounding thewater source It is quite interesting that bottled water ispopular among slum dwellers however we found that halfof refill bottled water was contaminated mostly by Coliform(is fact is quite important to be considered that the qualityof refill bottled water might not be appropriate in the waterrefill station or recontamination happened in the householdsseeing as hygiene and sanitation is the substantial problem inthe slum area Previous studies reported that the quality ofrefill bottled water was not fully supervised and 25ndash40were still not suitable as drinking water [9 18 19] In thisstudy only 8 out of 50 bottled water were still contaminatedcompared to other studies in Iran that found no contami-nation of Coliform in bottled water but still positive forHeterotrophic Plate Counts (HPCs) [20 21]

Tap water in developed country should be potable andnot contaminated by ColiformEColi however in manydeveloping countries even the local government treat thetap water before distribute it ussualy the consumer shouldboil the tap water before use as drinking water (e previousstudy from the decentralized municipal desalination plan inIran showed that even the mean value of physical andchemical parameters complied with the regulation limit but10 of HPC samples in the outlet and 14 of samples in thedistribution network did not comply with standard [22 23](is study showed that half of tap water found to be con-taminated in household distribution this recontamination

might be due to some factors such as leakage in the main orhousehold distribution system low pressure along the pipedistribution and not fully continuous water flow Worstsanitation and hygiene condition in the household distri-bution also contribute to this contamination definitely

(e location of this slum area is in the city center and faraway from the industrial area (erefore there is no heavymetal concentration found High concentration offerrumiron in ground water sources is due to the geologicalcharacteristic of the earthrsquos crust in Bandung city [24] (ereis no health-based guideline value for iron in drinking waterhowever high concentration of iron might cause manyesthetical effects due to staining laundry and ceramic as wellas high turbidity and colouring the water Commonly slumdwellers simply use the conventional filtration method tominimize the iron concentration

Analysis using QMRA contains three steps the first isa health-hazard identification followed by an exposure as-sessment and then a risk characterization In the hazardidentification phase the catchment-to-consumer systemdescription the selection of index pathogen and the se-lection of hazardous events were elaborated AlthoughQMRA was previously intended to be applied for a specificpathogen completing a QMRA for every pathogen that maybe transmitted by water would be challenging [25] thusmicroorganism indicators are used instead In this study thetotal Coliform and fecal Coliform were observed as indicatorbacteria in water because nonspecific diarrhea is the mostcommon type of waterborne disease reported in outpatientprimary health centers in Indonesia

(e last step of QMRA is the risk characterization whichaims to integrate the exposure information with dose-responseanalysis to obtain overall risk estimates High contamination indug wells and springs in urban slum areas is associated withpoor hygiene and sanitation due to the small number ofhouseholds that use septic tanks(e community is accustomed

Table 4 (e risk of infection due to consumption of various types of water sources

Type of watersource

Concentration of fecalColiform (CFU100ml)

Dose of consume fecal Coliform(CFUpersonday) (Equation (1))

Probability of infection cause byfecal Coliform (Equation (2))

Annual probability(Equation (3))

Bottled water 025 281 058times10minus8 021times 10minus5

Refill bottled water 246 2709 560times10minus8 204times10minus5

Tap water 135 1486 307times10minus8 112times10minus5

Borehole 167 1834 379times10minus8 138times10minus5

Dug well 136667 1503334 3107times10minus8 11279times10minus5

Spring 60 660 1364times10minus8 497times10minus5

Table 3 Heavy metal concentrations from all types of water sources

Concentration in nggr (meanplusmn SD)Al Mn Cu As Pb

Borehole (n 22) 5plusmn 5 187plusmn 287 45plusmn 52 05plusmn 02 02plusmn 04Dug well (n 38) 47plusmn 79 368plusmn 497 34plusmn 76 05plusmn 05 02plusmn 05Spring (n 1) 7 36 14 01 0River (n 1) 1374 552 47 08 12Indonesian guideline for clean water 200 500 1000 50 50WHO guideline for drinking water 200 500 1000 10 10

Journal of Environmental and Public Health 5

to disposing human waste directly to the riverbank by usingclosedopen pipes Safe excreta disposal is also critical as a firstbarrier to disease transmission (erefore the reduction ofmorbidity and mortality from infectious diarrheal diseasesrequires improvements in the quality and availability of waterexcreta disposal and general personal and environmentalhygiene Proper water treatment is extremely important toprevent infection from consuming contaminated drinkingwater Since half of refill bottled water did not fulfill thestandard the annual probability of having infection fromrefilled bottled water as potable water is higher compared to tapwater and borehole as raw water (is fact demonstrates thatthe possibility of recontamination during transportation orinappropriate cleaning methods of the storage among urbanslum dwellers is high(e previous study by Sima et al showedthat the usage of water from community-scale water refillstations can reduce the risk of childhood diarrhea [26] but ifthe quality of refill water is not properly monitored thecommunity will have risk of consume unstandardized drinkingwater Lack of government control on the quality of refill waterstation production is also an important factor subsequently theimplementation of an integrated monitoring system for bottledwater production is urgently needed

41 Limitation of the Study In this study the calculation ofthe annual probability of infection was calculated from rawwater therefore we cannot compare the risk of potablewater between boiling water and bottled water Heavy metalcontamination was tested only from ground water sourcesand limited only for selected parameters

5 Conclusions

Although the infection probability in bottled water tapwater and borehole is tolerable the presence of Coliformand fecal Coliform in both potable and raw water sourcessuggest that measures should be undertaken to reduce therisk of infection (e higher probability of infection in dugwells and spring water sources suggests that proper watertreatment should be proposed prior to consumption asdrinking water An improvement in the distribution net-works of tap water is crucial to reduce the risk of waterbornediseases (e integrated monitoring system to control thequality of refill bottled water production is one of the manyessential issues to be prioritized

Data Availability

(e data used to support the findings of this study areavailable from the corresponding author upon request

Disclosure

(is study was part of research entitled ldquoRisk Assessment onDrinking Water Source of Urban Slum Area in Cika-pundung River Basin in Bandung Municipalityrdquo which wasconducted in the Department of Public Health Faculty ofMedicine Padjadjaran University in collaboration withDepartment of Human Ecology School of International

Health Graduate School of Medicine (e University ofTokyo Japan

Conflicts of Interest

(e authors declare that there are no conflicts of interestregarding the publication of this paper

Acknowledgments

(is research was funded by the Ministry of ResearchTechnology and Higher Education of Indonesia under theInternational Research Collaboration and Scientific Publi-cation grant (is articlersquos publication is supported by theUnited States Agency for International Development(USAID) through the Sustainable Higher Education Re-search Alliance (SHERA) Program for Universitas Indo-nesiarsquos Scientific Modeling Application Research andTraining for City-centered Innovation and Technology(SMART CITY) Project (Grant no AID-497-A-1600004Sub-Grant no IIE-00000078-UI-1) We appreciate thesupport and cooperation of Ahyani Raksanagara MD Headof Bandung Health Office and all enumerators from thePrimary Health Centre in Salam and Taman Sari during thesurvey We also thank all the laboratory staff members fromthe Laboratory of Microbiology and Parasitology Faculty ofMedicine Padjadjaran University for all their hard work

References

[1] World Health Organization Monitoring Water and Sanita-tion for EvidencendashBased Policy and Intervention WaterSanitation Hygiene and Health Department of Public Healthand Environment WHO Geneva Switzerland 2010

[2] United Nations Water and Cities Facts and Figures UNndashWater Decade Programme on Advocacy and Communication(UNWndashDPAC) United Nations San Francisco CA USA2010

[3] J Wolf A PrussndashUstun O Cumming et al ldquoSystematicreview assessing the impact of drinking water and sanitationon diarrhoeal disease in low and middle income settingssystematic review and metandashregressionrdquo Tropical Medicine ampInternational Health vol 19 no 8 pp 928ndash942 2014

[4] R Bain R Cronk J Wright H Yang T Slaymaker andJ Bartram ldquoFecal contamination of drinking-water in low andmiddle income countries a systematic review and meta-analysisrdquo PLoS Medicine vol 11 no 5 article e1001644 2014

[5] B Haryanto and S Sutomo ldquoImproving access to adequatewater and basic sanitation services in Indonesiardquo Reviews onEnvironmental Health vol 27 no 4 pp 159ndash162 2012

[6] Bandung Health Office Annual Report of Bandung HealthOffice Bandung Health Office Bandung Indonesia 2012

[7] S T Odonkor and J K Ampofo ldquoEscherichia coli as anindicator of bacteriological quality of water an overviewrdquoMicrobiology Research vol 4 no 1 p 2 2013

[8] World Health Organization Guidelines for Drinking-WaterQuality WHO Geneva Switzerland 4th edition 2011

[9] S Putri N Anindrya and S M Barti ldquoApplying quanitativemicrobial risk assessment in household drinking watersources a case study of Ujungberung Subdistrict Bandungrdquo inProceedings of the 5th Environmental Technology and

6 Journal of Environmental and Public Health

Management Conference on Green Technology towards Sus-tainable Environment Bandung Indonesia November 2015

[10] S Petterson R Signor N Ashbolt and D Roser QMRAMethodology University of New South Wales Sydney NSWAustralia 2006

[11] C N Haas J B Rose and C P GerbaQuantitative MicrobialRisk Assessment Wiley New York NY USA 1999

[12] United State Environmental Protection Agency QuantitativeMicrobial Risk Assessment to Estimate Illness in FreshwaterImpacted by Agricultural Animal Sources of Fecal Contami-nation Quantitative Microbial Risk Assessment to EstimateIllness in Freshwater Impacted by Agricultural Animal Sourcesof Fecal Contamination Office of Water Washington DCUSA 2010

[13] U J Blumental D D Mara A Peasey G Ruiz-Palacios andR Stott ldquoGuidelines for the microbiological quality of treatedwastewater used in agriculture recommendation for revisingWHO guidelinesrdquo Bulletin of the World Health Organizationvol 78 no 9 pp 1104ndash1116 2000

[14] L C Sima andM Elimelech ldquoMore than a drop in the bucketdecentralized membrane-based drinking water refill stationsin southeast asiardquo Environmental Science and Technologyvol 47 no 14 pp 7580ndash7588 2013

[15] N Ardhianie ldquoWater privatisation in Indonesiardquo inReclaiming Public Water Achievements Struggles and Visionsfrom Around the World Transnational Institute and Corpo-rate Europe Observatory and Operator Performance December2005 B Balanya B Brennan O Hoedeman S Kishimotoand P Terhorst Eds Jakarta Water Supply Regulatory Body(JWSRB) Jakarta Indonesia 2005 httpwwwjakartawaterorgengindexphp

[16] D Hall and E Lobina Pipe Dreams the Failure of the PrivateSector to Invest in Water Services in Developing CountriesPSIRUWorld Development Movement London UK 2006

[17] A A Kurniati ldquoQuality of refill drinking water in greaterJakarta in 2010rdquo Health Sciences Indonesia vol 2 no 2pp 77ndash80 2011

[18] G Howard and O Schmoll ldquoWater safety plans risk man-agement approaches for the delivery of safe drinking-waterfrom groundwater sourcesrdquo in Protecting Groundwater forHealth Managing the Quality of Drinking-Water SourcesO Schmoll Ed pp 431ndash463 World Health OrganizationGeneva Switzerland 2006

[19] M Iqbal A Nastiti and B S Muntalif ldquoImproved but notalways safety a microbial water quality analysis in BandungPeri urban householdsrdquo in Proceedings of the 5th Environ-mental Technology and Management Conference on GreenTechnology towards Sustainable Environment BandungIndonesia November 2015

[20] G Medema and N Ashbolt ldquoQMRA its value for riskmanagementrdquo 2017 httpwwwcamramsuedudocumentsQMRA_ frameworkpdf

[21] S F Elham D Sina and H Roughayeh ldquoChemical microbialand physical evaluation of commercial bottled drinking waterin Bushehr city Iranrdquo Fresenius Environmental Bulletinvol 24 no 11A pp 3836ndash3841 2015

[22] M Zazouli G M Safarpour A Veisi and P HabibkhanildquoBacterial contamination in bottled water and drinking waterdistribution network in Semnan 2012rdquo Journal of Mazan-daran University of Medical Sciences vol 22 no 1 pp 151ndash159 2013

[23] N K Vahid D Sina S Farshid et al ldquo(e role of decen-tralized municipal desalination plants in removal of physicalchemical and microbial parameters from drinking water

a case study in Bushehr Iranrdquo Journal of Water Sanitationand Hygiene for Development vol 8 no 2 pp 325ndash339 2018

[24] R Alireza S Farshid D Sina K Mozhgan and N K VahidldquoMicrobial chemical and physical properties of drinkingwater in Bushehr distribution network systemrdquo Desalinationand Water Treatment vol 65 pp 208ndash214 2017

[25] S Sudarningsih B Satria R Rizky et al ldquoVariations in theconcentration of magnetic minerals and heavy metals insuspended sediments from Citarum river and its tributariesWest Java Indonesiardquo Geosciences vol 7 no 3 p 66 2017

[26] L C Sima M M Desai K M McCarty and M ElimelechldquoRelationship between use of water from community-scalewater treatment refill kiosks and childhood diarrhea inJakartardquo American Journal of Tropical Medicine and Hygienevol 87 no 6 pp 979ndash984 2012

Journal of Environmental and Public Health 7

of occurrence of fecal Coliform infection in all types of watersources tested Meanwhile the probability of infection isused to calculate the annual probability using Equation (3) asshown in Table 4 USEPA limits the annual probability valueby 10minus4 per person yet Haas et al and Blumental et al statedthat the annual probability can be tolerated until 10minus3 perperson or more depending on dierent conditions of thecountry in which studies are conducted [11 13] Currentlythe tolerated range of the annual infection probability hadnot been determined in Indonesia Table 4 describes theannual probability of infection due to consumption of dugwells and spring water sources in urban slum areas in thestudy site that exceeds the tolerated limit

4 Discussion

Since this slum area is located in the city center tap waterconnection is available but only half of the households use

tap water as their main water source other dwellers useground water sources (borehole or dug-well) and springSome of the community still use common dug wellsparticularly those who stay in rented or shared housesthese types of houses usually do not have their own latrineinside their house therefore residents use common toiletsas the consequences One common dug-well is usuallyused by 3ndash5 houses however in certain locations it can beused by more than 20 houses One household might usemore than one type of water source sometimes people usetap water and also have dug-wellborehole as a secondarywater source

Interestingly for drinking water sources more than halfof the communities (668) prefer to choose bottled watereither rell or branded bottled water while the others stillboil tap or ground water Rell bottled water is more popularcompared to bottled water from branded company amongthe slum dwellers Rell bottled water is provided by waterrell stations and the consumers should bring their ownwater container which is commonly a 19-liter plastic bottleSome of them buy rell bottled water because of practicalityreason and due to the price that is three times cheapercompared to branded bottled water [14] Monthly expen-diture for tapdrinking water is smaller compared to otherexpenditures this might be because slum dwellers prefer toboil their raw water or choose rell bottled water

Due to limitations of capability from the local govern-ment company that is responsible for distributing tap waterto all parts of the city tap water is not always distributed 24hours a day and sometimes only a few days a week and only2-3 hours at midnight Lack of sucient volume of rawwatersources low capability of water treatment production anda high percentage of leakage in the distribution systemcontribute to the problem of low-tap water coverage inBandung city At the national scale the water loss due toleakage in piping systems reported ranges between 25 and30 in metropolitan cities and 30ndash35 in smaller cities[15ndash17]erefore people prefer to use groundwater such asdug wells or boreholes as their main water sources e riverbasin area is located in the lowest level consequently it isquite easy to get water from ground water and spring which

Table 2 Monthly expenditure in households

Monthly expenditure (USD) (n 199) Min-max Meanplusmn SD Proportion from total expenditure ()Food 59ndash4615 126plusmn 78 29Smoking 14ndash208 318plusmn 26 73Rent house (n 21) 06ndash192 363plusmn 423 84Health 01ndash169 144plusmn 258 33Education 05ndash5385 428plusmn 76 10Taxinsurance 02ndash269 184plusmn 47 42Communication 04ndash115 134plusmn 14 3Grocery 07ndash154 174plusmn 21 4Transportation 07ndash231 23plusmn 32 53Services (maiddriver) (n 12) 154ndash1385 605plusmn 365 14Electricity 15ndash92 18plusmn 176 41Tapdrinking water 1ndash58 97 plusmn 94 22Gas fuel 15ndash61 10 plusmn 9 23Others 02ndash185 4plusmn 17 29

0 20 40 60 80 100

Bottled water

Refill bottled water

Tap water

Borehole

Dug well

Spring

Used as clean water not contaminated Used as clean water contaminated Used as drinking water not contaminated Used as drinking water contaminated

()

Figure 1 Percentage of contaminated clean and drinking waterfrom various water sources

4 Journal of Environmental and Public Health

are also available in some spots However in this slum areaalmost all (91) of the households have no septic tanks anddispose their human and domestic waste directly to the riverand it causes high risk of contamination to their groundwater sources

Coliform bacteria existed in all types of water sourcesespecially in unprotected dug wells and springs even almostall of unprotected springs are contaminated Coliformcontamination may be caused due to contamination origi-nated from latrines without a septic tank surrounding thewater source It is quite interesting that bottled water ispopular among slum dwellers however we found that halfof refill bottled water was contaminated mostly by Coliform(is fact is quite important to be considered that the qualityof refill bottled water might not be appropriate in the waterrefill station or recontamination happened in the householdsseeing as hygiene and sanitation is the substantial problem inthe slum area Previous studies reported that the quality ofrefill bottled water was not fully supervised and 25ndash40were still not suitable as drinking water [9 18 19] In thisstudy only 8 out of 50 bottled water were still contaminatedcompared to other studies in Iran that found no contami-nation of Coliform in bottled water but still positive forHeterotrophic Plate Counts (HPCs) [20 21]

Tap water in developed country should be potable andnot contaminated by ColiformEColi however in manydeveloping countries even the local government treat thetap water before distribute it ussualy the consumer shouldboil the tap water before use as drinking water (e previousstudy from the decentralized municipal desalination plan inIran showed that even the mean value of physical andchemical parameters complied with the regulation limit but10 of HPC samples in the outlet and 14 of samples in thedistribution network did not comply with standard [22 23](is study showed that half of tap water found to be con-taminated in household distribution this recontamination

might be due to some factors such as leakage in the main orhousehold distribution system low pressure along the pipedistribution and not fully continuous water flow Worstsanitation and hygiene condition in the household distri-bution also contribute to this contamination definitely

(e location of this slum area is in the city center and faraway from the industrial area (erefore there is no heavymetal concentration found High concentration offerrumiron in ground water sources is due to the geologicalcharacteristic of the earthrsquos crust in Bandung city [24] (ereis no health-based guideline value for iron in drinking waterhowever high concentration of iron might cause manyesthetical effects due to staining laundry and ceramic as wellas high turbidity and colouring the water Commonly slumdwellers simply use the conventional filtration method tominimize the iron concentration

Analysis using QMRA contains three steps the first isa health-hazard identification followed by an exposure as-sessment and then a risk characterization In the hazardidentification phase the catchment-to-consumer systemdescription the selection of index pathogen and the se-lection of hazardous events were elaborated AlthoughQMRA was previously intended to be applied for a specificpathogen completing a QMRA for every pathogen that maybe transmitted by water would be challenging [25] thusmicroorganism indicators are used instead In this study thetotal Coliform and fecal Coliform were observed as indicatorbacteria in water because nonspecific diarrhea is the mostcommon type of waterborne disease reported in outpatientprimary health centers in Indonesia

(e last step of QMRA is the risk characterization whichaims to integrate the exposure information with dose-responseanalysis to obtain overall risk estimates High contamination indug wells and springs in urban slum areas is associated withpoor hygiene and sanitation due to the small number ofhouseholds that use septic tanks(e community is accustomed

Table 4 (e risk of infection due to consumption of various types of water sources

Type of watersource

Concentration of fecalColiform (CFU100ml)

Dose of consume fecal Coliform(CFUpersonday) (Equation (1))

Probability of infection cause byfecal Coliform (Equation (2))

Annual probability(Equation (3))

Bottled water 025 281 058times10minus8 021times 10minus5

Refill bottled water 246 2709 560times10minus8 204times10minus5

Tap water 135 1486 307times10minus8 112times10minus5

Borehole 167 1834 379times10minus8 138times10minus5

Dug well 136667 1503334 3107times10minus8 11279times10minus5

Spring 60 660 1364times10minus8 497times10minus5

Table 3 Heavy metal concentrations from all types of water sources

Concentration in nggr (meanplusmn SD)Al Mn Cu As Pb

Borehole (n 22) 5plusmn 5 187plusmn 287 45plusmn 52 05plusmn 02 02plusmn 04Dug well (n 38) 47plusmn 79 368plusmn 497 34plusmn 76 05plusmn 05 02plusmn 05Spring (n 1) 7 36 14 01 0River (n 1) 1374 552 47 08 12Indonesian guideline for clean water 200 500 1000 50 50WHO guideline for drinking water 200 500 1000 10 10

Journal of Environmental and Public Health 5

to disposing human waste directly to the riverbank by usingclosedopen pipes Safe excreta disposal is also critical as a firstbarrier to disease transmission (erefore the reduction ofmorbidity and mortality from infectious diarrheal diseasesrequires improvements in the quality and availability of waterexcreta disposal and general personal and environmentalhygiene Proper water treatment is extremely important toprevent infection from consuming contaminated drinkingwater Since half of refill bottled water did not fulfill thestandard the annual probability of having infection fromrefilled bottled water as potable water is higher compared to tapwater and borehole as raw water (is fact demonstrates thatthe possibility of recontamination during transportation orinappropriate cleaning methods of the storage among urbanslum dwellers is high(e previous study by Sima et al showedthat the usage of water from community-scale water refillstations can reduce the risk of childhood diarrhea [26] but ifthe quality of refill water is not properly monitored thecommunity will have risk of consume unstandardized drinkingwater Lack of government control on the quality of refill waterstation production is also an important factor subsequently theimplementation of an integrated monitoring system for bottledwater production is urgently needed

41 Limitation of the Study In this study the calculation ofthe annual probability of infection was calculated from rawwater therefore we cannot compare the risk of potablewater between boiling water and bottled water Heavy metalcontamination was tested only from ground water sourcesand limited only for selected parameters

5 Conclusions

Although the infection probability in bottled water tapwater and borehole is tolerable the presence of Coliformand fecal Coliform in both potable and raw water sourcessuggest that measures should be undertaken to reduce therisk of infection (e higher probability of infection in dugwells and spring water sources suggests that proper watertreatment should be proposed prior to consumption asdrinking water An improvement in the distribution net-works of tap water is crucial to reduce the risk of waterbornediseases (e integrated monitoring system to control thequality of refill bottled water production is one of the manyessential issues to be prioritized

Data Availability

(e data used to support the findings of this study areavailable from the corresponding author upon request

Disclosure

(is study was part of research entitled ldquoRisk Assessment onDrinking Water Source of Urban Slum Area in Cika-pundung River Basin in Bandung Municipalityrdquo which wasconducted in the Department of Public Health Faculty ofMedicine Padjadjaran University in collaboration withDepartment of Human Ecology School of International

Health Graduate School of Medicine (e University ofTokyo Japan

Conflicts of Interest

(e authors declare that there are no conflicts of interestregarding the publication of this paper

Acknowledgments

(is research was funded by the Ministry of ResearchTechnology and Higher Education of Indonesia under theInternational Research Collaboration and Scientific Publi-cation grant (is articlersquos publication is supported by theUnited States Agency for International Development(USAID) through the Sustainable Higher Education Re-search Alliance (SHERA) Program for Universitas Indo-nesiarsquos Scientific Modeling Application Research andTraining for City-centered Innovation and Technology(SMART CITY) Project (Grant no AID-497-A-1600004Sub-Grant no IIE-00000078-UI-1) We appreciate thesupport and cooperation of Ahyani Raksanagara MD Headof Bandung Health Office and all enumerators from thePrimary Health Centre in Salam and Taman Sari during thesurvey We also thank all the laboratory staff members fromthe Laboratory of Microbiology and Parasitology Faculty ofMedicine Padjadjaran University for all their hard work

References

[1] World Health Organization Monitoring Water and Sanita-tion for EvidencendashBased Policy and Intervention WaterSanitation Hygiene and Health Department of Public Healthand Environment WHO Geneva Switzerland 2010

[2] United Nations Water and Cities Facts and Figures UNndashWater Decade Programme on Advocacy and Communication(UNWndashDPAC) United Nations San Francisco CA USA2010

[3] J Wolf A PrussndashUstun O Cumming et al ldquoSystematicreview assessing the impact of drinking water and sanitationon diarrhoeal disease in low and middle income settingssystematic review and metandashregressionrdquo Tropical Medicine ampInternational Health vol 19 no 8 pp 928ndash942 2014

[4] R Bain R Cronk J Wright H Yang T Slaymaker andJ Bartram ldquoFecal contamination of drinking-water in low andmiddle income countries a systematic review and meta-analysisrdquo PLoS Medicine vol 11 no 5 article e1001644 2014

[5] B Haryanto and S Sutomo ldquoImproving access to adequatewater and basic sanitation services in Indonesiardquo Reviews onEnvironmental Health vol 27 no 4 pp 159ndash162 2012

[6] Bandung Health Office Annual Report of Bandung HealthOffice Bandung Health Office Bandung Indonesia 2012

[7] S T Odonkor and J K Ampofo ldquoEscherichia coli as anindicator of bacteriological quality of water an overviewrdquoMicrobiology Research vol 4 no 1 p 2 2013

[8] World Health Organization Guidelines for Drinking-WaterQuality WHO Geneva Switzerland 4th edition 2011

[9] S Putri N Anindrya and S M Barti ldquoApplying quanitativemicrobial risk assessment in household drinking watersources a case study of Ujungberung Subdistrict Bandungrdquo inProceedings of the 5th Environmental Technology and

6 Journal of Environmental and Public Health

Management Conference on Green Technology towards Sus-tainable Environment Bandung Indonesia November 2015

[10] S Petterson R Signor N Ashbolt and D Roser QMRAMethodology University of New South Wales Sydney NSWAustralia 2006

[11] C N Haas J B Rose and C P GerbaQuantitative MicrobialRisk Assessment Wiley New York NY USA 1999

[12] United State Environmental Protection Agency QuantitativeMicrobial Risk Assessment to Estimate Illness in FreshwaterImpacted by Agricultural Animal Sources of Fecal Contami-nation Quantitative Microbial Risk Assessment to EstimateIllness in Freshwater Impacted by Agricultural Animal Sourcesof Fecal Contamination Office of Water Washington DCUSA 2010

[13] U J Blumental D D Mara A Peasey G Ruiz-Palacios andR Stott ldquoGuidelines for the microbiological quality of treatedwastewater used in agriculture recommendation for revisingWHO guidelinesrdquo Bulletin of the World Health Organizationvol 78 no 9 pp 1104ndash1116 2000

[14] L C Sima andM Elimelech ldquoMore than a drop in the bucketdecentralized membrane-based drinking water refill stationsin southeast asiardquo Environmental Science and Technologyvol 47 no 14 pp 7580ndash7588 2013

[15] N Ardhianie ldquoWater privatisation in Indonesiardquo inReclaiming Public Water Achievements Struggles and Visionsfrom Around the World Transnational Institute and Corpo-rate Europe Observatory and Operator Performance December2005 B Balanya B Brennan O Hoedeman S Kishimotoand P Terhorst Eds Jakarta Water Supply Regulatory Body(JWSRB) Jakarta Indonesia 2005 httpwwwjakartawaterorgengindexphp

[16] D Hall and E Lobina Pipe Dreams the Failure of the PrivateSector to Invest in Water Services in Developing CountriesPSIRUWorld Development Movement London UK 2006

[17] A A Kurniati ldquoQuality of refill drinking water in greaterJakarta in 2010rdquo Health Sciences Indonesia vol 2 no 2pp 77ndash80 2011

[18] G Howard and O Schmoll ldquoWater safety plans risk man-agement approaches for the delivery of safe drinking-waterfrom groundwater sourcesrdquo in Protecting Groundwater forHealth Managing the Quality of Drinking-Water SourcesO Schmoll Ed pp 431ndash463 World Health OrganizationGeneva Switzerland 2006

[19] M Iqbal A Nastiti and B S Muntalif ldquoImproved but notalways safety a microbial water quality analysis in BandungPeri urban householdsrdquo in Proceedings of the 5th Environ-mental Technology and Management Conference on GreenTechnology towards Sustainable Environment BandungIndonesia November 2015

[20] G Medema and N Ashbolt ldquoQMRA its value for riskmanagementrdquo 2017 httpwwwcamramsuedudocumentsQMRA_ frameworkpdf

[21] S F Elham D Sina and H Roughayeh ldquoChemical microbialand physical evaluation of commercial bottled drinking waterin Bushehr city Iranrdquo Fresenius Environmental Bulletinvol 24 no 11A pp 3836ndash3841 2015

[22] M Zazouli G M Safarpour A Veisi and P HabibkhanildquoBacterial contamination in bottled water and drinking waterdistribution network in Semnan 2012rdquo Journal of Mazan-daran University of Medical Sciences vol 22 no 1 pp 151ndash159 2013

[23] N K Vahid D Sina S Farshid et al ldquo(e role of decen-tralized municipal desalination plants in removal of physicalchemical and microbial parameters from drinking water

a case study in Bushehr Iranrdquo Journal of Water Sanitationand Hygiene for Development vol 8 no 2 pp 325ndash339 2018

[24] R Alireza S Farshid D Sina K Mozhgan and N K VahidldquoMicrobial chemical and physical properties of drinkingwater in Bushehr distribution network systemrdquo Desalinationand Water Treatment vol 65 pp 208ndash214 2017

[25] S Sudarningsih B Satria R Rizky et al ldquoVariations in theconcentration of magnetic minerals and heavy metals insuspended sediments from Citarum river and its tributariesWest Java Indonesiardquo Geosciences vol 7 no 3 p 66 2017

[26] L C Sima M M Desai K M McCarty and M ElimelechldquoRelationship between use of water from community-scalewater treatment refill kiosks and childhood diarrhea inJakartardquo American Journal of Tropical Medicine and Hygienevol 87 no 6 pp 979ndash984 2012

Journal of Environmental and Public Health 7

are also available in some spots However in this slum areaalmost all (91) of the households have no septic tanks anddispose their human and domestic waste directly to the riverand it causes high risk of contamination to their groundwater sources

Coliform bacteria existed in all types of water sourcesespecially in unprotected dug wells and springs even almostall of unprotected springs are contaminated Coliformcontamination may be caused due to contamination origi-nated from latrines without a septic tank surrounding thewater source It is quite interesting that bottled water ispopular among slum dwellers however we found that halfof refill bottled water was contaminated mostly by Coliform(is fact is quite important to be considered that the qualityof refill bottled water might not be appropriate in the waterrefill station or recontamination happened in the householdsseeing as hygiene and sanitation is the substantial problem inthe slum area Previous studies reported that the quality ofrefill bottled water was not fully supervised and 25ndash40were still not suitable as drinking water [9 18 19] In thisstudy only 8 out of 50 bottled water were still contaminatedcompared to other studies in Iran that found no contami-nation of Coliform in bottled water but still positive forHeterotrophic Plate Counts (HPCs) [20 21]

Tap water in developed country should be potable andnot contaminated by ColiformEColi however in manydeveloping countries even the local government treat thetap water before distribute it ussualy the consumer shouldboil the tap water before use as drinking water (e previousstudy from the decentralized municipal desalination plan inIran showed that even the mean value of physical andchemical parameters complied with the regulation limit but10 of HPC samples in the outlet and 14 of samples in thedistribution network did not comply with standard [22 23](is study showed that half of tap water found to be con-taminated in household distribution this recontamination

might be due to some factors such as leakage in the main orhousehold distribution system low pressure along the pipedistribution and not fully continuous water flow Worstsanitation and hygiene condition in the household distri-bution also contribute to this contamination definitely

(e location of this slum area is in the city center and faraway from the industrial area (erefore there is no heavymetal concentration found High concentration offerrumiron in ground water sources is due to the geologicalcharacteristic of the earthrsquos crust in Bandung city [24] (ereis no health-based guideline value for iron in drinking waterhowever high concentration of iron might cause manyesthetical effects due to staining laundry and ceramic as wellas high turbidity and colouring the water Commonly slumdwellers simply use the conventional filtration method tominimize the iron concentration

Analysis using QMRA contains three steps the first isa health-hazard identification followed by an exposure as-sessment and then a risk characterization In the hazardidentification phase the catchment-to-consumer systemdescription the selection of index pathogen and the se-lection of hazardous events were elaborated AlthoughQMRA was previously intended to be applied for a specificpathogen completing a QMRA for every pathogen that maybe transmitted by water would be challenging [25] thusmicroorganism indicators are used instead In this study thetotal Coliform and fecal Coliform were observed as indicatorbacteria in water because nonspecific diarrhea is the mostcommon type of waterborne disease reported in outpatientprimary health centers in Indonesia

(e last step of QMRA is the risk characterization whichaims to integrate the exposure information with dose-responseanalysis to obtain overall risk estimates High contamination indug wells and springs in urban slum areas is associated withpoor hygiene and sanitation due to the small number ofhouseholds that use septic tanks(e community is accustomed

Table 4 (e risk of infection due to consumption of various types of water sources

Type of watersource

Concentration of fecalColiform (CFU100ml)

Dose of consume fecal Coliform(CFUpersonday) (Equation (1))

Probability of infection cause byfecal Coliform (Equation (2))

Annual probability(Equation (3))

Bottled water 025 281 058times10minus8 021times 10minus5

Refill bottled water 246 2709 560times10minus8 204times10minus5

Tap water 135 1486 307times10minus8 112times10minus5

Borehole 167 1834 379times10minus8 138times10minus5

Dug well 136667 1503334 3107times10minus8 11279times10minus5

Spring 60 660 1364times10minus8 497times10minus5

Table 3 Heavy metal concentrations from all types of water sources

Concentration in nggr (meanplusmn SD)Al Mn Cu As Pb

Borehole (n 22) 5plusmn 5 187plusmn 287 45plusmn 52 05plusmn 02 02plusmn 04Dug well (n 38) 47plusmn 79 368plusmn 497 34plusmn 76 05plusmn 05 02plusmn 05Spring (n 1) 7 36 14 01 0River (n 1) 1374 552 47 08 12Indonesian guideline for clean water 200 500 1000 50 50WHO guideline for drinking water 200 500 1000 10 10

Journal of Environmental and Public Health 5

to disposing human waste directly to the riverbank by usingclosedopen pipes Safe excreta disposal is also critical as a firstbarrier to disease transmission (erefore the reduction ofmorbidity and mortality from infectious diarrheal diseasesrequires improvements in the quality and availability of waterexcreta disposal and general personal and environmentalhygiene Proper water treatment is extremely important toprevent infection from consuming contaminated drinkingwater Since half of refill bottled water did not fulfill thestandard the annual probability of having infection fromrefilled bottled water as potable water is higher compared to tapwater and borehole as raw water (is fact demonstrates thatthe possibility of recontamination during transportation orinappropriate cleaning methods of the storage among urbanslum dwellers is high(e previous study by Sima et al showedthat the usage of water from community-scale water refillstations can reduce the risk of childhood diarrhea [26] but ifthe quality of refill water is not properly monitored thecommunity will have risk of consume unstandardized drinkingwater Lack of government control on the quality of refill waterstation production is also an important factor subsequently theimplementation of an integrated monitoring system for bottledwater production is urgently needed

41 Limitation of the Study In this study the calculation ofthe annual probability of infection was calculated from rawwater therefore we cannot compare the risk of potablewater between boiling water and bottled water Heavy metalcontamination was tested only from ground water sourcesand limited only for selected parameters

5 Conclusions

Although the infection probability in bottled water tapwater and borehole is tolerable the presence of Coliformand fecal Coliform in both potable and raw water sourcessuggest that measures should be undertaken to reduce therisk of infection (e higher probability of infection in dugwells and spring water sources suggests that proper watertreatment should be proposed prior to consumption asdrinking water An improvement in the distribution net-works of tap water is crucial to reduce the risk of waterbornediseases (e integrated monitoring system to control thequality of refill bottled water production is one of the manyessential issues to be prioritized

Data Availability

(e data used to support the findings of this study areavailable from the corresponding author upon request

Disclosure

(is study was part of research entitled ldquoRisk Assessment onDrinking Water Source of Urban Slum Area in Cika-pundung River Basin in Bandung Municipalityrdquo which wasconducted in the Department of Public Health Faculty ofMedicine Padjadjaran University in collaboration withDepartment of Human Ecology School of International

Health Graduate School of Medicine (e University ofTokyo Japan

Conflicts of Interest

(e authors declare that there are no conflicts of interestregarding the publication of this paper

Acknowledgments

(is research was funded by the Ministry of ResearchTechnology and Higher Education of Indonesia under theInternational Research Collaboration and Scientific Publi-cation grant (is articlersquos publication is supported by theUnited States Agency for International Development(USAID) through the Sustainable Higher Education Re-search Alliance (SHERA) Program for Universitas Indo-nesiarsquos Scientific Modeling Application Research andTraining for City-centered Innovation and Technology(SMART CITY) Project (Grant no AID-497-A-1600004Sub-Grant no IIE-00000078-UI-1) We appreciate thesupport and cooperation of Ahyani Raksanagara MD Headof Bandung Health Office and all enumerators from thePrimary Health Centre in Salam and Taman Sari during thesurvey We also thank all the laboratory staff members fromthe Laboratory of Microbiology and Parasitology Faculty ofMedicine Padjadjaran University for all their hard work

References

[1] World Health Organization Monitoring Water and Sanita-tion for EvidencendashBased Policy and Intervention WaterSanitation Hygiene and Health Department of Public Healthand Environment WHO Geneva Switzerland 2010

[2] United Nations Water and Cities Facts and Figures UNndashWater Decade Programme on Advocacy and Communication(UNWndashDPAC) United Nations San Francisco CA USA2010

[3] J Wolf A PrussndashUstun O Cumming et al ldquoSystematicreview assessing the impact of drinking water and sanitationon diarrhoeal disease in low and middle income settingssystematic review and metandashregressionrdquo Tropical Medicine ampInternational Health vol 19 no 8 pp 928ndash942 2014

[4] R Bain R Cronk J Wright H Yang T Slaymaker andJ Bartram ldquoFecal contamination of drinking-water in low andmiddle income countries a systematic review and meta-analysisrdquo PLoS Medicine vol 11 no 5 article e1001644 2014

[5] B Haryanto and S Sutomo ldquoImproving access to adequatewater and basic sanitation services in Indonesiardquo Reviews onEnvironmental Health vol 27 no 4 pp 159ndash162 2012

[6] Bandung Health Office Annual Report of Bandung HealthOffice Bandung Health Office Bandung Indonesia 2012

[7] S T Odonkor and J K Ampofo ldquoEscherichia coli as anindicator of bacteriological quality of water an overviewrdquoMicrobiology Research vol 4 no 1 p 2 2013

[8] World Health Organization Guidelines for Drinking-WaterQuality WHO Geneva Switzerland 4th edition 2011

[9] S Putri N Anindrya and S M Barti ldquoApplying quanitativemicrobial risk assessment in household drinking watersources a case study of Ujungberung Subdistrict Bandungrdquo inProceedings of the 5th Environmental Technology and

6 Journal of Environmental and Public Health

Management Conference on Green Technology towards Sus-tainable Environment Bandung Indonesia November 2015

[10] S Petterson R Signor N Ashbolt and D Roser QMRAMethodology University of New South Wales Sydney NSWAustralia 2006

[11] C N Haas J B Rose and C P GerbaQuantitative MicrobialRisk Assessment Wiley New York NY USA 1999

[12] United State Environmental Protection Agency QuantitativeMicrobial Risk Assessment to Estimate Illness in FreshwaterImpacted by Agricultural Animal Sources of Fecal Contami-nation Quantitative Microbial Risk Assessment to EstimateIllness in Freshwater Impacted by Agricultural Animal Sourcesof Fecal Contamination Office of Water Washington DCUSA 2010

[13] U J Blumental D D Mara A Peasey G Ruiz-Palacios andR Stott ldquoGuidelines for the microbiological quality of treatedwastewater used in agriculture recommendation for revisingWHO guidelinesrdquo Bulletin of the World Health Organizationvol 78 no 9 pp 1104ndash1116 2000

[14] L C Sima andM Elimelech ldquoMore than a drop in the bucketdecentralized membrane-based drinking water refill stationsin southeast asiardquo Environmental Science and Technologyvol 47 no 14 pp 7580ndash7588 2013

[15] N Ardhianie ldquoWater privatisation in Indonesiardquo inReclaiming Public Water Achievements Struggles and Visionsfrom Around the World Transnational Institute and Corpo-rate Europe Observatory and Operator Performance December2005 B Balanya B Brennan O Hoedeman S Kishimotoand P Terhorst Eds Jakarta Water Supply Regulatory Body(JWSRB) Jakarta Indonesia 2005 httpwwwjakartawaterorgengindexphp

[16] D Hall and E Lobina Pipe Dreams the Failure of the PrivateSector to Invest in Water Services in Developing CountriesPSIRUWorld Development Movement London UK 2006

[17] A A Kurniati ldquoQuality of refill drinking water in greaterJakarta in 2010rdquo Health Sciences Indonesia vol 2 no 2pp 77ndash80 2011

[18] G Howard and O Schmoll ldquoWater safety plans risk man-agement approaches for the delivery of safe drinking-waterfrom groundwater sourcesrdquo in Protecting Groundwater forHealth Managing the Quality of Drinking-Water SourcesO Schmoll Ed pp 431ndash463 World Health OrganizationGeneva Switzerland 2006

[19] M Iqbal A Nastiti and B S Muntalif ldquoImproved but notalways safety a microbial water quality analysis in BandungPeri urban householdsrdquo in Proceedings of the 5th Environ-mental Technology and Management Conference on GreenTechnology towards Sustainable Environment BandungIndonesia November 2015

[20] G Medema and N Ashbolt ldquoQMRA its value for riskmanagementrdquo 2017 httpwwwcamramsuedudocumentsQMRA_ frameworkpdf

[21] S F Elham D Sina and H Roughayeh ldquoChemical microbialand physical evaluation of commercial bottled drinking waterin Bushehr city Iranrdquo Fresenius Environmental Bulletinvol 24 no 11A pp 3836ndash3841 2015

[22] M Zazouli G M Safarpour A Veisi and P HabibkhanildquoBacterial contamination in bottled water and drinking waterdistribution network in Semnan 2012rdquo Journal of Mazan-daran University of Medical Sciences vol 22 no 1 pp 151ndash159 2013

[23] N K Vahid D Sina S Farshid et al ldquo(e role of decen-tralized municipal desalination plants in removal of physicalchemical and microbial parameters from drinking water

a case study in Bushehr Iranrdquo Journal of Water Sanitationand Hygiene for Development vol 8 no 2 pp 325ndash339 2018

[24] R Alireza S Farshid D Sina K Mozhgan and N K VahidldquoMicrobial chemical and physical properties of drinkingwater in Bushehr distribution network systemrdquo Desalinationand Water Treatment vol 65 pp 208ndash214 2017

[25] S Sudarningsih B Satria R Rizky et al ldquoVariations in theconcentration of magnetic minerals and heavy metals insuspended sediments from Citarum river and its tributariesWest Java Indonesiardquo Geosciences vol 7 no 3 p 66 2017

[26] L C Sima M M Desai K M McCarty and M ElimelechldquoRelationship between use of water from community-scalewater treatment refill kiosks and childhood diarrhea inJakartardquo American Journal of Tropical Medicine and Hygienevol 87 no 6 pp 979ndash984 2012

Journal of Environmental and Public Health 7

to disposing human waste directly to the riverbank by usingclosedopen pipes Safe excreta disposal is also critical as a firstbarrier to disease transmission (erefore the reduction ofmorbidity and mortality from infectious diarrheal diseasesrequires improvements in the quality and availability of waterexcreta disposal and general personal and environmentalhygiene Proper water treatment is extremely important toprevent infection from consuming contaminated drinkingwater Since half of refill bottled water did not fulfill thestandard the annual probability of having infection fromrefilled bottled water as potable water is higher compared to tapwater and borehole as raw water (is fact demonstrates thatthe possibility of recontamination during transportation orinappropriate cleaning methods of the storage among urbanslum dwellers is high(e previous study by Sima et al showedthat the usage of water from community-scale water refillstations can reduce the risk of childhood diarrhea [26] but ifthe quality of refill water is not properly monitored thecommunity will have risk of consume unstandardized drinkingwater Lack of government control on the quality of refill waterstation production is also an important factor subsequently theimplementation of an integrated monitoring system for bottledwater production is urgently needed

41 Limitation of the Study In this study the calculation ofthe annual probability of infection was calculated from rawwater therefore we cannot compare the risk of potablewater between boiling water and bottled water Heavy metalcontamination was tested only from ground water sourcesand limited only for selected parameters

5 Conclusions

Although the infection probability in bottled water tapwater and borehole is tolerable the presence of Coliformand fecal Coliform in both potable and raw water sourcessuggest that measures should be undertaken to reduce therisk of infection (e higher probability of infection in dugwells and spring water sources suggests that proper watertreatment should be proposed prior to consumption asdrinking water An improvement in the distribution net-works of tap water is crucial to reduce the risk of waterbornediseases (e integrated monitoring system to control thequality of refill bottled water production is one of the manyessential issues to be prioritized

Data Availability

(e data used to support the findings of this study areavailable from the corresponding author upon request

Disclosure

(is study was part of research entitled ldquoRisk Assessment onDrinking Water Source of Urban Slum Area in Cika-pundung River Basin in Bandung Municipalityrdquo which wasconducted in the Department of Public Health Faculty ofMedicine Padjadjaran University in collaboration withDepartment of Human Ecology School of International

Health Graduate School of Medicine (e University ofTokyo Japan

Conflicts of Interest

(e authors declare that there are no conflicts of interestregarding the publication of this paper

Acknowledgments

(is research was funded by the Ministry of ResearchTechnology and Higher Education of Indonesia under theInternational Research Collaboration and Scientific Publi-cation grant (is articlersquos publication is supported by theUnited States Agency for International Development(USAID) through the Sustainable Higher Education Re-search Alliance (SHERA) Program for Universitas Indo-nesiarsquos Scientific Modeling Application Research andTraining for City-centered Innovation and Technology(SMART CITY) Project (Grant no AID-497-A-1600004Sub-Grant no IIE-00000078-UI-1) We appreciate thesupport and cooperation of Ahyani Raksanagara MD Headof Bandung Health Office and all enumerators from thePrimary Health Centre in Salam and Taman Sari during thesurvey We also thank all the laboratory staff members fromthe Laboratory of Microbiology and Parasitology Faculty ofMedicine Padjadjaran University for all their hard work

References

[1] World Health Organization Monitoring Water and Sanita-tion for EvidencendashBased Policy and Intervention WaterSanitation Hygiene and Health Department of Public Healthand Environment WHO Geneva Switzerland 2010

[2] United Nations Water and Cities Facts and Figures UNndashWater Decade Programme on Advocacy and Communication(UNWndashDPAC) United Nations San Francisco CA USA2010

[3] J Wolf A PrussndashUstun O Cumming et al ldquoSystematicreview assessing the impact of drinking water and sanitationon diarrhoeal disease in low and middle income settingssystematic review and metandashregressionrdquo Tropical Medicine ampInternational Health vol 19 no 8 pp 928ndash942 2014

[4] R Bain R Cronk J Wright H Yang T Slaymaker andJ Bartram ldquoFecal contamination of drinking-water in low andmiddle income countries a systematic review and meta-analysisrdquo PLoS Medicine vol 11 no 5 article e1001644 2014

[5] B Haryanto and S Sutomo ldquoImproving access to adequatewater and basic sanitation services in Indonesiardquo Reviews onEnvironmental Health vol 27 no 4 pp 159ndash162 2012

[6] Bandung Health Office Annual Report of Bandung HealthOffice Bandung Health Office Bandung Indonesia 2012

[7] S T Odonkor and J K Ampofo ldquoEscherichia coli as anindicator of bacteriological quality of water an overviewrdquoMicrobiology Research vol 4 no 1 p 2 2013

[8] World Health Organization Guidelines for Drinking-WaterQuality WHO Geneva Switzerland 4th edition 2011

[9] S Putri N Anindrya and S M Barti ldquoApplying quanitativemicrobial risk assessment in household drinking watersources a case study of Ujungberung Subdistrict Bandungrdquo inProceedings of the 5th Environmental Technology and

6 Journal of Environmental and Public Health

Management Conference on Green Technology towards Sus-tainable Environment Bandung Indonesia November 2015

[10] S Petterson R Signor N Ashbolt and D Roser QMRAMethodology University of New South Wales Sydney NSWAustralia 2006

[11] C N Haas J B Rose and C P GerbaQuantitative MicrobialRisk Assessment Wiley New York NY USA 1999

[12] United State Environmental Protection Agency QuantitativeMicrobial Risk Assessment to Estimate Illness in FreshwaterImpacted by Agricultural Animal Sources of Fecal Contami-nation Quantitative Microbial Risk Assessment to EstimateIllness in Freshwater Impacted by Agricultural Animal Sourcesof Fecal Contamination Office of Water Washington DCUSA 2010

[13] U J Blumental D D Mara A Peasey G Ruiz-Palacios andR Stott ldquoGuidelines for the microbiological quality of treatedwastewater used in agriculture recommendation for revisingWHO guidelinesrdquo Bulletin of the World Health Organizationvol 78 no 9 pp 1104ndash1116 2000

[14] L C Sima andM Elimelech ldquoMore than a drop in the bucketdecentralized membrane-based drinking water refill stationsin southeast asiardquo Environmental Science and Technologyvol 47 no 14 pp 7580ndash7588 2013

[15] N Ardhianie ldquoWater privatisation in Indonesiardquo inReclaiming Public Water Achievements Struggles and Visionsfrom Around the World Transnational Institute and Corpo-rate Europe Observatory and Operator Performance December2005 B Balanya B Brennan O Hoedeman S Kishimotoand P Terhorst Eds Jakarta Water Supply Regulatory Body(JWSRB) Jakarta Indonesia 2005 httpwwwjakartawaterorgengindexphp

[16] D Hall and E Lobina Pipe Dreams the Failure of the PrivateSector to Invest in Water Services in Developing CountriesPSIRUWorld Development Movement London UK 2006

[17] A A Kurniati ldquoQuality of refill drinking water in greaterJakarta in 2010rdquo Health Sciences Indonesia vol 2 no 2pp 77ndash80 2011

[18] G Howard and O Schmoll ldquoWater safety plans risk man-agement approaches for the delivery of safe drinking-waterfrom groundwater sourcesrdquo in Protecting Groundwater forHealth Managing the Quality of Drinking-Water SourcesO Schmoll Ed pp 431ndash463 World Health OrganizationGeneva Switzerland 2006

[19] M Iqbal A Nastiti and B S Muntalif ldquoImproved but notalways safety a microbial water quality analysis in BandungPeri urban householdsrdquo in Proceedings of the 5th Environ-mental Technology and Management Conference on GreenTechnology towards Sustainable Environment BandungIndonesia November 2015

[20] G Medema and N Ashbolt ldquoQMRA its value for riskmanagementrdquo 2017 httpwwwcamramsuedudocumentsQMRA_ frameworkpdf

[21] S F Elham D Sina and H Roughayeh ldquoChemical microbialand physical evaluation of commercial bottled drinking waterin Bushehr city Iranrdquo Fresenius Environmental Bulletinvol 24 no 11A pp 3836ndash3841 2015

[22] M Zazouli G M Safarpour A Veisi and P HabibkhanildquoBacterial contamination in bottled water and drinking waterdistribution network in Semnan 2012rdquo Journal of Mazan-daran University of Medical Sciences vol 22 no 1 pp 151ndash159 2013

[23] N K Vahid D Sina S Farshid et al ldquo(e role of decen-tralized municipal desalination plants in removal of physicalchemical and microbial parameters from drinking water

a case study in Bushehr Iranrdquo Journal of Water Sanitationand Hygiene for Development vol 8 no 2 pp 325ndash339 2018

[24] R Alireza S Farshid D Sina K Mozhgan and N K VahidldquoMicrobial chemical and physical properties of drinkingwater in Bushehr distribution network systemrdquo Desalinationand Water Treatment vol 65 pp 208ndash214 2017

[25] S Sudarningsih B Satria R Rizky et al ldquoVariations in theconcentration of magnetic minerals and heavy metals insuspended sediments from Citarum river and its tributariesWest Java Indonesiardquo Geosciences vol 7 no 3 p 66 2017

[26] L C Sima M M Desai K M McCarty and M ElimelechldquoRelationship between use of water from community-scalewater treatment refill kiosks and childhood diarrhea inJakartardquo American Journal of Tropical Medicine and Hygienevol 87 no 6 pp 979ndash984 2012

Journal of Environmental and Public Health 7

Management Conference on Green Technology towards Sus-tainable Environment Bandung Indonesia November 2015

[10] S Petterson R Signor N Ashbolt and D Roser QMRAMethodology University of New South Wales Sydney NSWAustralia 2006

[11] C N Haas J B Rose and C P GerbaQuantitative MicrobialRisk Assessment Wiley New York NY USA 1999

[12] United State Environmental Protection Agency QuantitativeMicrobial Risk Assessment to Estimate Illness in FreshwaterImpacted by Agricultural Animal Sources of Fecal Contami-nation Quantitative Microbial Risk Assessment to EstimateIllness in Freshwater Impacted by Agricultural Animal Sourcesof Fecal Contamination Office of Water Washington DCUSA 2010

[13] U J Blumental D D Mara A Peasey G Ruiz-Palacios andR Stott ldquoGuidelines for the microbiological quality of treatedwastewater used in agriculture recommendation for revisingWHO guidelinesrdquo Bulletin of the World Health Organizationvol 78 no 9 pp 1104ndash1116 2000

[14] L C Sima andM Elimelech ldquoMore than a drop in the bucketdecentralized membrane-based drinking water refill stationsin southeast asiardquo Environmental Science and Technologyvol 47 no 14 pp 7580ndash7588 2013

[15] N Ardhianie ldquoWater privatisation in Indonesiardquo inReclaiming Public Water Achievements Struggles and Visionsfrom Around the World Transnational Institute and Corpo-rate Europe Observatory and Operator Performance December2005 B Balanya B Brennan O Hoedeman S Kishimotoand P Terhorst Eds Jakarta Water Supply Regulatory Body(JWSRB) Jakarta Indonesia 2005 httpwwwjakartawaterorgengindexphp

[16] D Hall and E Lobina Pipe Dreams the Failure of the PrivateSector to Invest in Water Services in Developing CountriesPSIRUWorld Development Movement London UK 2006

[17] A A Kurniati ldquoQuality of refill drinking water in greaterJakarta in 2010rdquo Health Sciences Indonesia vol 2 no 2pp 77ndash80 2011

[18] G Howard and O Schmoll ldquoWater safety plans risk man-agement approaches for the delivery of safe drinking-waterfrom groundwater sourcesrdquo in Protecting Groundwater forHealth Managing the Quality of Drinking-Water SourcesO Schmoll Ed pp 431ndash463 World Health OrganizationGeneva Switzerland 2006

[19] M Iqbal A Nastiti and B S Muntalif ldquoImproved but notalways safety a microbial water quality analysis in BandungPeri urban householdsrdquo in Proceedings of the 5th Environ-mental Technology and Management Conference on GreenTechnology towards Sustainable Environment BandungIndonesia November 2015

[20] G Medema and N Ashbolt ldquoQMRA its value for riskmanagementrdquo 2017 httpwwwcamramsuedudocumentsQMRA_ frameworkpdf

[21] S F Elham D Sina and H Roughayeh ldquoChemical microbialand physical evaluation of commercial bottled drinking waterin Bushehr city Iranrdquo Fresenius Environmental Bulletinvol 24 no 11A pp 3836ndash3841 2015

[22] M Zazouli G M Safarpour A Veisi and P HabibkhanildquoBacterial contamination in bottled water and drinking waterdistribution network in Semnan 2012rdquo Journal of Mazan-daran University of Medical Sciences vol 22 no 1 pp 151ndash159 2013

[23] N K Vahid D Sina S Farshid et al ldquo(e role of decen-tralized municipal desalination plants in removal of physicalchemical and microbial parameters from drinking water

a case study in Bushehr Iranrdquo Journal of Water Sanitationand Hygiene for Development vol 8 no 2 pp 325ndash339 2018

[24] R Alireza S Farshid D Sina K Mozhgan and N K VahidldquoMicrobial chemical and physical properties of drinkingwater in Bushehr distribution network systemrdquo Desalinationand Water Treatment vol 65 pp 208ndash214 2017

[25] S Sudarningsih B Satria R Rizky et al ldquoVariations in theconcentration of magnetic minerals and heavy metals insuspended sediments from Citarum river and its tributariesWest Java Indonesiardquo Geosciences vol 7 no 3 p 66 2017

[26] L C Sima M M Desai K M McCarty and M ElimelechldquoRelationship between use of water from community-scalewater treatment refill kiosks and childhood diarrhea inJakartardquo American Journal of Tropical Medicine and Hygienevol 87 no 6 pp 979ndash984 2012

Journal of Environmental and Public Health 7

Stem Cells International

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

MEDIATORSINFLAMMATION

of

EndocrinologyInternational Journal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Disease Markers

Hindawiwwwhindawicom Volume 2018

BioMed Research International

OncologyJournal of

Hindawiwwwhindawicom Volume 2013

Hindawiwwwhindawicom Volume 2018

Oxidative Medicine and Cellular Longevity

Hindawiwwwhindawicom Volume 2018

PPAR Research

Hindawi Publishing Corporation httpwwwhindawicom Volume 2013Hindawiwwwhindawicom

The Scientific World Journal

Volume 2018

Immunology ResearchHindawiwwwhindawicom Volume 2018

Journal of

ObesityJournal of

Hindawiwwwhindawicom Volume 2018

Hindawiwwwhindawicom Volume 2018

Computational and Mathematical Methods in Medicine

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Volume 2018Hindawiwwwhindawicom

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