Water bags as a potential vehicle for transmitting disease in a West African capital, Bissau Adriano A. Bordalo a,b, * and Ana Machado a,b a Laboratory of Hydrobiologyand Ecology, Institute of Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira, 228, 4050–313 Porto, Portugal; b Ciimar-Centre of Marine and Environmental Research, Porto, Portugal *Corresponding author: Tel: +351 220428181; Fax: +351 222062284; E-mail: bordalo@icbas.up.pt Received 22 November 2013; revised 17 April 2014; accepted 17 April 2014 Background: Street vendors of chilled packaged water have an increasing role in meeting the drinking water demand of people on the move in developing nations. Hygienic conditions can be questionable, and water quality screening scarce or non-existent. Methods: In order to ascertain the quality of the packaged water sold by street vendors in Bissau, the capital of the Western African country Guinea-Bissau, water bags were screened in 2011 and during the 2012 cholera outbreak for key physical, chemical and microbiological parameters. Results: Water used to fill the hand-filled hand-tied bags originated from communal tap water and melted ice. All samples (n¼36) were microbiologically contaminated, although levels showed a pronounced variability (e.g. 7–493 372 cfu 250 ml 21 for Escherichia coli). In 2012, the fecal contamination levels increased (p,0.05), and Vibrio cholerae was detected in all water bags obtained from the neighborhood where the outbreak started. Conclusion: Findings showed that all packaged water samples were unfit for human consumption and during the 2012 cholera outbreak represented a potential vehicle for the spread of the disease. The design of measures to decrease the risk associated to the consumption of highly contaminated chilled water is clearly required. Keywords: Africa, Cholera, Guinea-Bissau, Microbial water quality, Street vendors, Water bags Introduction In recent years the activities of street vendors have become a topical issue within the urban spaces of the developing world 1 where drinks, meals and snacks are consumed by millions of people. 2 In West Africa the availability of packaged water has expanded drinking water access. 3 Surprisingly, investigations dealing with the quality of packaged drinking water on sale in the streets have lagged and the few accessible references, e.g. from Ghana, Tanzania and Nigeria, report only on the microbiology of the water. 4–7 In Guinea-Bissau, one of the poorest countries in the world and periodically ravaged by civil unrest, the majority of the capital’s urban population withdraws water for daily needs from about 4500 shallow wells, 8 giving a ratio of 1 well per 100 inhabitants. The remaining urban dwellers have access to piped water through household or standpipe connections, although interrup- tions may last several weeks or months. In these cases, all population retrieves water from wells. As the economic situation slowly improves, lifestyles change and chilled packaged water street vending increases as a response to the demand from customers on the move. Unlike other areas in Africa, Asia and Latin America, water vendors in Bissau sell only chilled water bags and sachets of about 500 ml and not of the traditional 20 to 30 liter plastic drums commonly seen elsewhere. Indeed, the overall basic water requirements of the population are fulfilled from well water, leaving little space for door-to-door water vendors. The increased demand for chilled water bags but not bottled water by dwellers on the move is related to the prohibitive retail price of bottled water imported from Europe, the low cost and the portability of plastic bags and sachets, readily available when needed. This rather new activity in the country is unregu- lated and health authorities are unable to perform any quality monitoring of the water offered for sale due to the lack of infrastructures and resources. The main goal of this research was to assess for the first time the quality of the packaged water on sale on the streets of Bissau, the capital of Guinea-Bissau (West Africa). The investigation was carried out by analysis of microbial indicators (Escherichia coli, fecal coliforms, fecal enterococci and heterotrophic count) and key physical and chemical parameters, to ascertain if water bags are a potential vehicle for the spread of disease, including cholera, during an outbreak. # The Author 2014. Published by Oxford University Press on behalf of Royal Societyof Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. ORIGINAL ARTICLE Int Health 2015; 7: 42–48 doi:10.1093/inthealth/ihu056 Advance Access publication 27 August 2014 42 Downloaded from https://academic.oup.com/inthealth/article/7/1/42/2964828 by guest on 18 July 2022