Review Journal

Global Health Journal

Disusun untuk memenuhi tugas mata kuliah Kesehatan Global

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Nama : Dian Ekawaty Mohamad
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PROGRAM STUDI MAGISTER KESEHATAN MASYARAKAT

PASCASARJANA UNIVERSITAS NEGERI GORONTALO

TAHUN 2023
 Global Health Journal 6 (2022) 204–211

Contents lists available at ScienceDirect

Global Health Journal

journal homepage: https://www.keaipublishing.com/en/journals/global-health-journal/

RESEARCH ARTICLE

Hygiene, sanitation facility, and assessment of drinking water quality in

the schools of Chattogram city, Bangladesh
Md. Zobaidul Alam∗, Abdullah Al Mukarrom
Department of Microbiology, University of Chittagong, Chattogram 4331, Bangladesh

a r t i c l e i n f o a b s t r a c t
Article history: Objective: This study is designed to evaluate the microbiological safety concern of drinking water of the 50 schools
Received 6 April 2022 of Chattogram city, Bangladesh, and to investigate the sanitation and hygiene conditions of the schools, which
Received in revised form 28 September 2022
are directly related to the health of thousands of students.
Accepted 27 December 2022
Methods: In this study, pour plate method used for total viable count (TVC), most probable number (MPN)
Available online 30 December 2022
method used for the total coliform count (TCC) and fecal coliform count (FCC), and four selective media used to
Keywords: isolate pathogenic bacteria from drinking water samples, and then identified by using morphological, cultural,
Pour plate method and biochemical tests. To investigate the water, sanitation, and hygiene conditions a structured questionnaire
Hygiene and sanitation
was used.
Most probable number
Results: A total of 46% samples were found above the acceptable limit (> 500 CFU/ml) for TVC count, 52% sam-
Schools
Chattogram city ples had coliform, and 28% samples had fecal coliform, which exceeded the WHO guideline value. We categorized
50 studied schools into five groups and found the highest TVC (67%) and TCC (83%) in the water samples of city
corporation schools. E. coli, Salmonella, Shigella, Enterobacter, Citrobacter, Klebsiella, and Yersinia were isolated
and identified from drinking water samples. In most schools, drinking water reservoirs were found impure and
contaminated by various bacteria. In government primary schools, a toilet is used by 143 students, whereas in pri-
vate English medium schools, a toilet is used by 30 students and found clean. Hand-washing soap was supplied
in only 14% of government primary schools, but 100% in private English medium schools.
Conclusion: Our findings suggest that drinking water in most of the schools was found contaminated by pathogens.
Poor hygiene, sanitation, and contaminated drinking water seem responsible for different kinds of diseases. More-
over, this study indicates the necessity for raising awareness about drinking water, hygiene, and sanitation facil-
ities of schools, which should monitor at regular intervals.

1. Introduction
Safe drinking water is a basic requirement for human life.1 Clean
drinking water is essential for normal body functions and good health.2
A major concern for human health is to drink microbiologically safe
drinking water, especially for growing children because hazardous mi-
crobes may contaminate drinking water. To improve human health, wa-
ter, sanitation, and hygiene (WASH) facilities such as the provision of
safe drinking water, enhance sanitation facilities, and increase hand-
washing facilities with soap.3 Children who suffer a water-related ill-
ness, with poor health remain in a disadvantaged position, reduces
learning abilities, and indirectly affect schooling through absenteeism
may result in attention deficits and early dropout.4
Many schools and households lack adequate and safe WASH ser-
vices in low- and middle-income countries (LMICs) like Bangladesh.5,6
United Nations International Children’s Emergency Fund reported in
2007, only 51% of schools in LMICs had adequate water and 45% had
access to sanitation facilities.7 In LMICs, 1.5–2 million children die each
year from WASH-related diseases and many more are weakened by ill-
ness, pain, and discomfort.8 In children below the age of five years
the majority of deaths occur, the burden of disease among school chil-
dren is considerable. Soap for handwashing is rarely found in schools
in these settings. The use of sanitation facilities, without water and
soap for handwashing, may put students at a higher risk of exposure to
pathogens.9
Young children have not fully acquired immunity against some
pathogens like pathogenic E. coli which may result in serious outcomes
including hemolytic uremic syndrome.10 School-aged children spend
too many hours in and around school facilities, as a result, close moni-
toring is necessary to improve the school environment. So, schools are
a high-risk environment for students and need to ensure a safe water
supply from a reliable source.11

∗
Corresponding author: zobaid@cu.ac.bd.

https://doi.org/10.1016/j.glohj.2022.12.003
2414-6447/Copyright © 2023 People’s Medical Publishing House Co. Ltd. Publishing service by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Alam MZ and Mukarrom AA
Although some personal and community tube wells are found in the
Chattogram city, a large fraction of the people directly depends on Chat-
togram Water Supply Authority (CWASA). CWASA is supplying water to
meet only one-fourth of the total demand for water in the city through
its limited distribution network system.12 Surface water from the Halda
River and groundwater from deep tube wells at different locations of
the city are the main sources of CWASA. In Chattogram city, several
studies were carried out at different times to assess the drinking water
quality. Zuthi et al. reported that the people of Chattogram city are at
high risk due to microbial contamination of drinking water.13 In the
field research, they found cross-contamination due to pipeline leakage,
unauthorised connection with the main pipeline on the roadside, and
lack of maintenance of household storage and distribution systems.
In Chattogram city, there are several hundred schools and the total
number of students is up to several thousand. The quality of drinking
water provided by the schools and the availability of proper sanitation
and hygiene facilities are very important for students’ health and their
regular presence. But no studies were carried out before our work in
different schools of Chattogram city to assess the microbiological quality
of drinking water along with hygiene and sanitation of those schools.
This study aimed to understand the microbiological safety of drinking
water and also investigate the sanitation and hygiene conditions of the
schools of Chattogram city, which are directly related to the health of
thousands of school children.
2. Materials and methods
2.1. Sampling
The study was carried out in Chattogram city, which is a major
coastal seaport city and financial center in southeastern Bangladesh.
The city has a population of more than 2.5 million according to the
2011 census and making it the second-largest city in the country. The
city is located on the banks of the Karnaphuli River between the Chat-
togram Hill Tracts and the Bay of Bengal. Drinking water samples were
collected from different schools that were located in different parts of
Chattogram city.
A total of 50 drinking water samples were collected from 50 rep-
resentative schools in different areas of Chattogram city between July
2017 and Feb 2018. The schools were selected randomly and catego-
rized into: 14 government primary schools, 6 government high schools,
6 city corporation schools, 19 private Bengali mediums, and 5 private
English medium schools.
2.2. Samples collection, isolation, and identification of contaminants
All the sampling procedures were carried out according to the stan-
dard methods for the examination of water and wastewater.14 Two to
three drops of 3% sodium thiosulphate solution were added to the bot-
tles before sterilization for neutralizing the bactericidal effects of any
chlorine content present in the samples; samples were collected and
the bottles were preserved in a basket fitted with ice to limit bacterial
growth at 4–8°C, carried to the laboratory for analysis within 2‒4 h of
collection, and preserved at 4°C until analysis.
For the isolation of microbial contaminants from the drinking wa-
ter samples, four selective media were used like eosin methylene blue
(EMB) agar (for E. coli and other coliform groups of bacteria), xylose
lysine deoxycholate (XLD) agar (for Salmonella sp.), Salmonella-Shigella
(SS) agar (for Shigella sp.) and thiosulphate citrate bile salt (TCBS) agar
(for Vibrio sp.). Inoculums from TCC positive samples containing test
tubes were streaked on solidified EMB, XLD, SS, and TCBS agar plates.
After 24 h incubation at 37°C, grown colonies on the selective agar me-
dia were then transferred to nutrient agar slants and preserved for fur-
ther microscopic and biochemical characterization.15 The selected iso-
lates were then subjected to different staining and biochemical tests to
identify.
205
Global Health Journal 6 (2022) 204–211
2.3. Measures
2.3.1. Bacteriological quality testing of the samples
2.3.1.1. Total viable count (TVC). TVC was conducted by means of a
serial dilution agar plating method.16 In this method, one ml of water
sample was inoculated into nine ml of distilled water to get 10−1 dilu-
tion and then serially made up to 10−6 dilutions. One ml sample from
each dilution was dispensed in the sterilized petri plates and then melted
nutrient agar (about 45°C) was poured into each petri plate, mixed uni-
formly by rotating clockwise and anti-clockwise, and allowed to solidify.
Then the plates were incubated at 37°C for 24 h and 30–300 colonies
containing plates were only allowed for counting. The population of the
live microbial load can be estimated by this method, and the count rep-
resents the number of colony forming units per milliliter (CFU/ml) of
the sample. The TVC was calculated according to the following formula:
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑐𝑜𝑙𝑜𝑛𝑖𝑒𝑠
Total viable count =
𝑉 𝑜𝑙𝑢𝑚𝑒 𝑝𝑙𝑎𝑡𝑒𝑑 × 𝑑𝑖𝑙𝑢𝑡𝑖𝑜𝑛 𝑓 𝑎𝑐𝑡𝑜𝑟
2.3.1.2. Total coliform and fecal coliform count. The most probable num-
ber (MPN) technique is a method for estimating the number of bacte-
ria in a food or water sample. In this technique, the microbial popu-
lation sizes in a liquid substrate are estimated. In this study, we used
MPN technique to estimate the presence of coliform by replicating liquid
broth growth in ten-fold dilutions.14 To ensure whether the water is safe
or not in terms of the coliform present, this method is most commonly
applied. It is actually a qualitative test, indicating only the presence
of coliform. For this test, three continuous stages like a presumptive
test, a confirmed test, and a completed test were carried through which
the presence of indicator organism E. coli is detected and confirmed by
using some key characteristics of them including lactose fermentation
with gas, green metallic sheen on Eosin methylene blue agar and by
Gram reaction. For fecal coliform count, MPN method was also used by
preparing 3 sets of test tubes containing lactose fermentation broth. Fe-
cal coliform is also called thermotolerant coliform as it can grow and
ferment lactose at an extended temperature (44 ± 0.5°C). All the test
tubes were incorporated with Durham’s tube for detection of gas for-
mation by fecal coliform bacteria and then incubated at 44 ± 0.5°C for
48 h. After incubation, gas formation in the Durham’s tube was observed
carefully and gas positive tubes were counted. The fecal coliform count
is then obtained by matching gas positive tubes in different dilutions
with the standard chart of MPN.
An MPN index number represents the MPN of bacteria in the original
sample based upon the statistical probability of the coincidence of mi-
croorganisms in each sample replicate. A 95% confidence interval repre-
sents a range of actual counts in a sample, whereby there is a 95% prob-
ability that any sample containing a number of microorganisms within
that range would yield the same result by MPN techniques. According
to WHO guidelines, drinking water can be divided into different risk
categories on the basis of the MPN index per 100 ml.
2.3.2. Inspection of the water, sanitation, and hygiene condition of the
schools
The water, sanitation, and hygiene conditions of the schools were
closely monitored by on-field observation as well as by filling a survey
questionnaire form. All the questions in the survey questionnaire were
regarding the water, sanitation, and hygiene facility of the schools. We
first explained the aim and objectives of our research to the school au-
thority, and after getting their permission, filled up the questionnaire
by interviewing a nominated school representative with his name and
other information and on-field observation.
2.4. Statistical analysis
STATA 15.0 (Stata Corp, Texas, US) was used for data analysis. Cat-
egorical variables were described by percentage. Mean ± standard de-
viation (𝑥̄ ± 𝑠) was carried out for normally distributed data.
Alam MZ and Mukarrom AA
Table 1
Determination of total viable count and total coliform count from the drinking water samples of different schools in Chattogram city.
TVC (CFU/ml,
Types of school 𝑥 ± 𝑠)
City corporation school 5 784.00 ± 10 353.07
Government high school 3 223.33 ± 5 756.71
Government primary school 1 780.79 ± 4 431.54
Private Bengali medium 5 818.74 ± 18 041.46
Private English medium 15 599.60 ± 20 837.98
TVC: total viable count; CFU: colony forming units; MPN: most probable number.
Table 2
Categorization of drinking water quality on the basis of MPN results (n = 50).
MPN index (per 100 ml) Risk level Total sample [n (%)]
0 No risk 24 (48.00)
1 to 10 Low 5 (10.00)
10 to 100 Intermediate 8 (16.00)
100 to 1 000 High 10 (20.00)
> 1 000 Very high 3 (6.00)
MPN: most probable number.
3. Results
3.1. Bacteriological analysis of the drinking water samples
3.1.1. Determination of total viable bacteria
The TVC denotes the total number of viable bacteria present in wa-
ter as well as the microbial load in the water.17 According to the United
States Environmental Protection Agency (USEPA), the standard limit of
the viable count in drinking water is < 500 CFU/ml. TVC of all 50 wa-
ter samples was performed and the results ranged from a minimum of
10 to a maximum of 79 000 CFU/ml (Table 1). A total of 23 (46%)
samples have a TVC count > 500 CFU/ml, which is above the accept-
able limit; meanwhile, 54% of samples are within the acceptable limit
(< 500 CFU/ml). Drinking water from seven schools had a very high
TVC count of >10 000 CFU/ml. From the comparative study of differ-
ent groups of school water, it is seen that more than 60% of the city
corporation schools and private English medium schools water have an
unacceptable limit of TVC. Among the five different groups of schools,
government high schools water contained the least unacceptable limit
of TVC (33%) (Table 1).
3.1.2. Determination of total coliform and fecal coliform count
TCC includes aerobic and facultatively anaerobic, Gram-negative,
non-spore-forming bacilli capable of growing in the presence of rela-
tively high concentrations of bile salts by fermenting lactose with the
production of acid or aldehyde within 24 h at 35‒37°C. In this study, the
values for total coliform ranged from a minimum of zero to a maximum
of > 2 400 MPN/100 ml (Table 2). Among the 52% coliform contami-
nated waters, 6% waters were at very high risk, 20% were at high risk,
16% at intermediate risk, and 10% at low risk.
Total coliform serves as an indicator of the cleanliness and integrity
of storage facilities and distribution networks. This data reveals that
thousands of students who drink water every day during their school
time in school are subjected to different levels of health risk. By compar-
ing the coliform contamination rates among different groups of schools,
it is revealed that the highest rate (83.33%) of coliform contamination
was found in the drinking water of city corporation schools, whereas
government primary schools showed the lowest rate (35.71%) (Table 1).
Among the 50 samples, we found that 14 samples (28%) were contam-
inated with fecal coliform, and 72% with non-fecal coliform.
3.2. Isolation and identification of the bacterial isolates
Different types of bacterial contaminants were identified from wa-
ter samples of different schools and then confirmed by microscopic,
cultural, and biochemical tests. After 24 h of incubation at 37°C, dark
Global Health Journal 6 (2022) 204–211
TVC above acceptable MPN index (/100 ml, Contamination
range (%) 𝑥 ± 𝑠) by coliform (%)
66.67 53.5 ± 129.25 83.33
33.33 7.5 ± 348.75 50.00
42.86 0.0 ± 12.25 35.71
42.11 4.0 ± 150.00 57.89
60.00 0.0 ± 93.00 40.00
colonies with a green metallic sheen on EMB agar, on XLD agar red with
black center or entirely black colonies, from SS agar colorless colonies,
and from TCBS agar yellow and green colonies were picked, purified by
further streaking (Fig. 1). A total of 52 bacterial isolates were gathered
from different selective media. These isolates were then subjected to
staining and different biochemical tests to identify the bacterial strain.
Bacterial isolates were identified up to the genus level by comparing
with the standard description given in Bergey’s Manual of Determinative
Bacteriology, 8th ed.18
In this study, seven types of bacteria were isolated from drinking
water samples. Enterobacter sp. (27%), and E. coli (18%) were the domi-
nant bacteria in most of the samples. Other bacteria such as Citrobacter
sp. (14%), Salmonella sp. (14%), Klebsiella sp. (11%), Shigella sp. (11%),
and Yersinia sp. (5%) were detected in varying percentages (Fig. 2). One-
third of the drinking water samples collected from government high
schools, government primary schools, and city corporation schools were
contaminated with E. coli. Yersinia sp. was only identified in the water
sample of private Bengali medium schools. Water samples of private En-
glish medium schools were found contaminated only with Klebsiella sp.
and Enterobacter sp. (Table 3).
3.3. Water, sanitation, and hygiene facilities at the schools
3.3.1. Sources of drinking water at school
Five types of drinking water sources were used in different types
of schools in Chattogram city (Fig. 3). From this study, it is seen that
32% (16/50) of schools used unpurified tap water as drinking water,
and in some schools, it was stored in a tank that is suitable for bacterial
growth.
Purified tap water was used by 28% (14/50) of the school as a drink-
ing water source. Purified water may contain bacteria due to an im-
proper purification system. In 12% (6/50) of the schools, jar water was
used as a drinking water source. Municipal supply water was used by
14% of the schools as a drinking water source. In 14% (7/50) of schools,
deep tubewell water was directly used as a source of drinking water,
where we found two samples were contaminated with coliform bacte-
ria.
In this study, we found only 24% (12/ 50) schools had a water treat-
ment facility in the school. Among them, only two schools are pro-
vided with water purification systems from non-government develop-
ment organizations such as WaterAid Bangladesh and Dushtha Shasthya
Kendra.
3.3.2. Sanitation facilities at school
In the survey questionnaire, the sanitation facilities of all 50 schools
were recorded by on-field observation and carefully monitored their
cleanliness. In government primary schools, 143 students can be able
to use only one toilet, which is not hygienic for their health. In pri-
vate English medium schools, toilets were found to be cleaner and in
good condition, and a smaller number of students can use one toilet
(30 persons per one toilet). Besides this, government high, private Ben-
gali medium, and city corporation schools, 115, 106, and 96 students
respectively, use only one toilet (Fig. 4).
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Alam MZ and Mukarrom AA Global Health Journal 6 (2022) 204–211

Fig. 1. Identified bacterial contaminants from water samples by cultural tests. (A) Dark colonies with green metallic sheen on EMB agar; (B) Green colonies on
TCBS agar; (C) Red colonies with black center on XLD agar; (D) Whitish colonies on SS agar.
EMB: eosin methylene blue; TCBS: thiosulphate citrate bile salt; XLD: xylose lysine deoxycholate; SS: Salmonella-Shigella.

Fig. 2. Percentage of different types of bacteria detected from the drinking water samples.
Table 3
Water samples of different types of schools were found to be contaminated with bacteria (%).

Bacteria City corporation school Government high school Government primary school Private Bengali medium Private English medium

E. coli 34 34 32 10 0
Salmonella sp. 16 34 14 12 0
Shigella sp. 0 16 16 16 0
Enterobacter sp. 16 16 26 22 20
Citrobacter sp. 34 0 18 26 0
Klebsiella sp. 0 0 16 16 40
Yersinia sp. 0 0 0 6 0

3.3.3. Handwashing facilities at school
Proper handwashing is a must to keep away from pathogenic mi-
crobes. So, handwashing soap and clean water is necessary to reduce
the spread of diseases among students and keep them healthy. In this
study, we found that 100% of private English medium schools pro-
vide soap in the basin for handwashing after the toilet, and 50% of
government high schools, city corporation schools, and private Ben-
gali medium schools do not provide handwashing soap after toilet. We
also found very shocking information that only 14% of government pri-
mary schools provide handwashing soap to the children after the toilet
(Fig. 5).

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Alam MZ and Mukarrom AA Global Health Journal 6 (2022) 204–211

Fig. 3. Drinking water sources which are used in the schools of Chattogram city.

Fig. 4. Average number of users per toilet in different types of schools.

Fig. 5. Percentage of the provision of soap for hand-washing in the toilet of different types of schools.

4. Discussion
The safety and quality of drinking water are always a major con-
cern of public health, especially in developing countries. In this study,
50 different schools in the Chattogram city were selected randomly to
investigate the water supply, sanitation, hygiene conditions, and assess
the quality of drinking water of these schools. The schools were differ-
ent from each other according to their number of students, grade level,
student’s gender, etc.
In this study, TVC count > 500 CFU/ml were found in 46% sam-
ples and < 500 CFU/ml (acceptable limit) were found in 54% sam-
ples. This finding is in accordance with the findings of Chowdhury
et al. and other studies.19-21 Ahmed et al. found that 63.5% of sam-
ples exceeded the WHO drinking water quality limits.22 So, from this
study it is clear that 23 schools (> 500 CFU/ml) require more im-
proved purification systems to ensure the quality of drinking water
otherwise contaminated water may cause serious illness and associ-
ated mortality.23-25 TVC was found (1.5 × 102–1.6 × 104) CFU/ml
in the drinking jar water of Chattogram city.26 TVC count of drink-
ing water may vary from < 1 to > 104 CFU/ml, which is known to
be influenced by water pH, temperature, residual chlorine, and incor-
porable organic matter contents.27 Most of the water samples of pop-
ular restaurants in Sylhet city are significantly contaminated by TVC
bacteria.28 Molla et al. found that among 42 supply water samples
in Chattogram city, 19 were contaminated that crossed the acceptable
limit.29

208
Alam MZ and Mukarrom AA
More than 60% of the city corporation schools and private English
medium schools water have an unacceptable limit of TVC. On the con-
trary, 33% of government high school water contained the least unac-
ceptable limit of TVC. TVC count >10 000 CFU/ml were found in the
drinking water of seven schools. It is a matter of concern that four of the
samples were unpurified tap water but the remaining three were purified
by boiling. Improper boiling or unclean reservoir may be the reason be-
hind the high TVC of the boiling waters. So, care should be taken while
using boiling as a purification system for drinking water. Although high
TVC measurements have not been found to correlate with illness inci-
dence and no outbreaks, but indicate favorable conditions for bacterial
re-growth.
In drinking water, the presence of coliform indicates contamination,
the potential risk of the presence of pathogenic organisms. The absence
of coliform is evidence of bacteriologically safe drinking water and col-
iform is more resistant to water than the pathogenic bacteria of intestinal
origin.30 According to WHO and Bangladesh EQS (Environmental qual-
ity standard), the TCC and FCC should be zero per 100 ml of drinking
water.31 In this study, 20% of waters were at high risk, and 6% of waters
were at very high risk among the 52% coliform contaminated waters.
We also found more than 83% waters of the city corporation school
were contaminated with coliform. This result is in concurrence with the
findings of Parvez et al. which were carried out in different educational
institutions in Tangail municipality where 80% of the drinking water
samples were found contaminated with coliform.32 Molla et al. showed
that 57.1% of samples were above the acceptable limit for total coliform
count and 47.61% were for fecal coliform count.29
By comparing both the TVC and TCC data, it is revealed that the
drinking waters of city corporation schools were found worse than oth-
ers in both criteria; as a result, it needs immediate and effective control
measures. A number of factors might be involved in the contamination
of drinking water, e.g., lack of water treatment facility, storage in unhy-
gienic reservoirs, lack of budgets to set improved water supply systems,
etc.
We found that 28% of water samples were contaminated with fecal
coliform and 72% with non-fecal coliform. Talukdar studied 175 tap
water samples of Dhaka city and found that 80% of their water samples
were contaminated with fecal coliform.33 In Chattogram city, contami-
nation of fecal coliform was found in the water supplied by CWASA.13
Water samples of all the popular restaurants in Sylhet city were con-
taminated by fecal coliform.28 Moreover, water supplied by Dhaka
WASA was found highly contaminated with fecal coliforms in Basabo
(2.8‒103 CFU/100 ml), in Sobujbag (5.2‒106 CFU/100 ml), in Shagun
Bagichaa, and Mohammadpur (5.0‒103 CFU/100 ml).34
Seven types of bacteria like Enterobacter sp., E. coli, Citrobacter sp.,
Salmonella sp., Klebsiella sp., Shigella sp., and Yersinia sp. were detected
at varying percentages. Among them, Enterobacter sp and E. coli were
the dominant bacteria in most of the samples. This finding is in partial
accordance with the finding of other works.20 , 21 , 26 , 35-39 Islam et al. re-
ported that 50% of mineral water, 87.5% of filtered water, and 100% of
tap water samples were exceeded the drinking water guideline value of
WHO.19 Microorganisms like E. coli (60%), Klebsiella sp. (40%), Enter-
obacter sp. (20%), Pseudomonas sp. (70%), Proteus sp. (10%), and Staphy-
lococcus sp. (40%) were detected in tap water.36 Pathogenic organisms
such as Salmonella sp., Shigella sp., E. coli, and Vibrio cholerae are also
present in the study samples.29 All these pathogens are responsible for
gastrointestinal problems with the symptoms of diarrhea, nausea, vomit-
ing, fever, abdominal pain, etc., and are also the major etiological agents
of many waterborne outbreaks.40
From the on-field observation, it was found that drinking water stor-
age tanks were unclean and kept in an unprotected condition. Untreated
water may contain a variable number of bacteria such as Klebsiella, En-
terobacter, E. coli, Pseudomonas and this may cause a variety of gastroin-
testinal diseases including diarrhea, dysentery, typhoid, etc.19 , 35 , 39 , 41
209
Global Health Journal 6 (2022) 204–211
In this study, we found that unpurified water sources contain Shigella,
Salmonella, Citrobacter, E. coli, Enterobacter, Klebsiella and Yersinia which
supports above studies.
In purified tap water, Shigella, Salmonella, Citrobacter, E. coli, and
Enterobacter were detected. In the filtered water, E. coli was detected
by Chowdhury et al. which partially supports this result.21 During stor-
age in households, point-of-use contamination of drinking water is very
common and is a major factor in the deterioration of drinking water
quality where the source water quality is relatively good.42-44 In jar wa-
ter, Klebsiella, Salmonella, Citrobacter, E. coli, Enterobacter were detected.
Mina et al. worked on jar water and identified Micrococcus, Pseudomonas,
E. coli, Enterobacter, Aeromonas, Bacillus, Cardiobacterium, Corynebac-
terium, Lactobacillus, Clostridium, Klebsiella which support our results.26
E. coli was found in 98% jar water and the samples were collected from
24 points in the capital city Dhaka.45 So, jar water is most likely to be
hazardous for the students health. In this study, E. coli, Shigella, Kleb-
siella, Citrobacter, Salmonella, and Yersinia were detected in the munici-
pal supply water. In a different study, municipal supply water and tube-
well water was found contaminated by coliform bacteria.13 , 46-48 In an-
other study, high numbers of pathogenic bacteria like Salmonella sp.,
Shigella sp., Aeromonas sp., Vibrio sp., Listeria sp., Pseudomonas sp., and
Staphylococcus sp. were found in the municipal supply water.36
In this study, we found that the sanitation facilities of most schools
were insufficient depending on the total number of students present in
a school. It was also found that the condition of most of the schools toi-
lets was poor and dirty. Among the five types of schools, toilet facilities
of government primary schools were one toilet per 143 students, which
was really insufficient and unhygienic. On the contrary, in private En-
glish medium schools, 30 students can able to use one toilet, which was
found clean and sufficient for the students. Globally, 66% of schools had
a basic sanitation service.49 Using dirty toilets can cause infections such
as strep throat, gastrointestinal viruses, mold, hepatitis A and flu.50 In
a report on schools, it was found that many children avoid school for
the dirty toilet.51 In worldwide, insufficient quantity of drinking water,
inadequate sanitation, and unimproved hygiene account for 7% of the
global burden of disease and 19% of child mortality.52 In many low-
and middle-income countries, insufficient sanitation and unsafe fecal
sludge management threaten public health through fecal contamination
in the environment.53 , 54 So, these schools should improve their san-
itation facilities to reduce different types of diseases that are caused
by improper sanitation systems and to improve children’s presence at
school.
To ensure good health and keep away from pathogenic microbes
proper hand washing is necessary. The lack of handwashing soap and
clean water can increase the spread of diseases among students. The risk
of diarrheal disease can be reduced by 42% to 47% if hands are properly
washed with soap.55 In this study, we found only 14% of government
primary schools provided handwashing soap after the toilet but in pri-
vate English medium schools, handwashing soap was provided on the
basins of all toilets. Though it is very necessary for primary school chil-
dren to wash hands after the toilet because their immune system is very
poor and remain in the risky zone of different diseases. Contaminated
hands can cause different gastrointestinal infections such as salmonel-
losis and respiratory infections such as influenza. Gastrointestinal and
respiratory infections can cause serious complications, especially for
young children, the elderly, or those with a weakened immune system.56
Globally, 53% of schools had a basic hygiene service in 2016 among
them only 11% had handwashing facilities but no soap available and
36% of schools had no hand washing service. Over 850 million children
lacked a basic service, either had a limited or no hand washing service
at their school.49 It is estimated that millions of school days are lost
each year due to diarrhea or other illnesses.57 Intensive handwashing
promotion at schools significantly reduces absenteeism due to diarrhea,
respiratory infections, and conjunctivitis.9 , 58 , 59
Alam MZ and Mukarrom AA
5. Conclusion
Safe and quality drinking water is always an essential component of
human life. In this study, we found that 52% of samples were contam-
inated with coliform, and 28% with fecal coliform. A total of 46% of
samples have a TVC count (> 500 CFU/ml) which is above the accept-
able limit. The presence of high TVC, TCC, and FCC in drinking water
in the study area indicates a positive correlation between water qual-
ity and health; students of these schools are more vulnerable to health
risks. This result also indicates the limited concern of the school author-
ity to provide safe drinking water in school. Seven types of pathogenic
bacteria like Enterobacter sp. (27%), E. coli (18%), Citrobacter sp. (14%),
Salmonella sp. (14%), Klebsiella sp. (11%), Shigella sp. (11%), and Yersinia
sp. (5%) were isolated, indicate the necessity of effective treatment pro-
cesses and closely monitor the water sources at regular intervals. In most
of the schools, the ratio between the number of students and the toilet
was found insufficient and unclean. After the toilet, most of the school
students washed their hands without soap, as a result, they may carry co-
liform and fecal coliform bacteria which results in water-borne diseases.
So, our results clearly suggest improving the sanitation and hygiene fa-
cilities of those schools within a short period of time.
Though this study seems crucial for the present situation, we were
able to collect samples from 50 schools due to some limitations, includ-
ing limited available funds, obstacles to get easy access to schools, etc.
We only collected samples from those schools that were willingly agreed
to test water samples or provide the relevant information. We are hop-
ing to continue our ongoing project to reveal more information regard-
ing this health issue of the school-going students. Also, in this study,
we identified the organisms at the genus level using selective media,
morphological, cultural, and biochemical tests, but in the future, we are
planning to use the molecular technique to identify the organisms at the
species level in a concrete manner. Finally, we hope that this study will
add an important impact on the public health-related decision-making
process.
Acknowledgements
The authors become grateful to the Department of Microbiology be-
cause this research was done in the laboratory of the Department of Mi-
crobiology, University of Chittagong, Bangladesh. Also, thanks to the
school authority for their cooperation and became agreed to supply
drinking water samples for this research.
CRediT author statement
Md. Zobaidul Alam: Conceptualization, Methodology, Formal anal-
ysis, Data curation, Visualization, Supervision, Writing – original draft,
Writing – review & editing. Abdullah Al Mukarrom: Investigation, For-
mal analysis, Data curation, Writing – original draft.
Competing interests
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
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Resume
Kebersihan, fasilitas sanitasi, dan penilaian kualitas air minum di
sekolah di kota Chattogram, Bangladesh

Penelitian Jurnal Kesehatan Global tentang kebersihan, fasilitas sanitasi, dan

kualitas air minum di sekolah-sekolah di kota Chattogram, Bangladesh. Penelitian
ini bertujuan untuk mengevaluasi keamanan mikrobiologis air minum dan
menyelidiki kondisi sanitasi dan kebersihan sekolah, yang berdampak langsung
pada kesehatan ribuan siswa.
Penelitian ini menyelidiki kondisi sanitasi dan kebersihan di 50 sekolah di
kota Chattogram dan menemukan bahwa terdapat variasi antar sekolah. Sekolah-
sekolah tersebut dikategorikan menjadi 14 sekolah dasar negeri, 6 sekolah
menengah negeri, 6 sekolah perusahaan kota, 19 sekolah menengah swasta bahasa
Bengali, dan 5 sekolah menengah swasta bahasa inggris. Studi ini mengevaluasi
kondisi pasokan air, sanitasi, dan kebersihan sekolah-sekolah tersebut. Rata-rata
jumlah pengguna per toilet dan persentase penyediaan sabun cuci tangan di toilet
juga dinilai. Namun penelitian ini tidak memberikan analisis rinci mengenai
variasi antar sekolah.

Bahan dan metode penelitian ini yaitu dengan mengumpulkan sampel air
dari 50 sekolah di kota Chattogram, Bangladesh, dan mengevaluasi keamanan
mikrobiologis air minum, serta kondisi sanitasi dan kebersihan sekolah. Prosedur
pengambilan sampel dilakukan sesuai dengan metode standar untuk pemeriksaan
air dan air limbah. Empat media selektif digunakan untuk mengisolasi kontaminan
mikroba dari sampel air minum. Kondisi air, sanitasi, dan kebersihan sekolah
dipantau secara ketat melalui observasi lapangan serta pengisian formulir survei.
Data dianalisis menggunakan perangkat lunak STATA 15.0. Variabel kategori
dijelaskan dengan persentase, dan mean ± standar deviasi (̄ 𝑥 ± 𝑠) dilakukan untuk
data yang berdistribusi normal. Ada beberapa bakteri patogen terdapat pada
sampel air minum, antara lain Salmonella sp., Shigella sp., E. coli, Vibrio
cholerae, Klebsiella, Enterobacter, Pseudomonas, Citrobacter, dan Yersinia.
Diantaranya adalah Enterobacter sp. dan E. coli merupakan bakteri dominan pada
sebagian besar sampel.

Penelitian ini menemukan bahwa kualitas mikrobiologis air minum di

sekolah-sekolah di kota Chattogram tidak memuaskan. Penelitian tersebut
mengidentifikasi beberapa kontaminan mikroba dalam sampel air minum, antara
lain total coliform, fecal coliform, E. coli, Salmonella spp., Shigella spp., Vibrio
cholerae, dan Pseudomonas aeruginosa. TVC (jumlah total yang layak) dan TCC
(jumlah total coliform) tertinggi terdapat pada sampel air sekolah perusahaan kota.
Studi ini juga menemukan bahwa kondisi sanitasi dan kebersihan sekolah belum
memenuhi standar yang ditetapkan. Studi ini menunjukkan bahwa peningkatan
fasilitas sanitasi dan kebersihan di sekolah-sekolah tersebut diperlukan untuk
menjamin kesehatan siswa yang bersekolah. Oleh karena itu, penelitian ini
menyimpulkan bahwa terdapat kebutuhan mendesak untuk meningkatkan kualitas
air minum, sanitasi, dan fasilitas kebersihan di sekolah-sekolah di kota
Chattogram untuk menjamin kesehatan siswa.