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Bacterial Indicators of Risk of Diarrhoeal Disease from Drinking-Water in the Philippines


Moe, Christine L.; Sobsey, Mark D.; Samsa, Gregory P.; & Mesola, Virginia (1991). Bacterial Indicators of Risk of Diarrhoeal Disease from Drinking-Water in the Philippines. Bulletin of the World Health Organization, 69(3), 305-317.


Inadequate measures of water quality have been used in many studies of the health effects associated with water supplies in developing countries. The present 1-year epidemiological-microbiological study evaluated four bacterial indicators of tropical drinking-water quality (faecal coliforms, Escherichia coli, enterococci and faecal streptococci) and their relationship to the prevalence of diarrhoeal disease in a population of 690 under-2-year-olds in Cebu, Philippines. E. coli and enterococci were better predictors than faecal coliforms of the risk of waterborne diarrhoeal disease. Methods to enumerate E. coli and enterococci were less subject to interference from the thermotolerant, non-faecal organisms that are indigenous to tropical waters. Little difference was observed between the illness rates of children drinking good quality water (less than 1 E. coli per 100 ml) and those drinking moderately contaminated water (2-100 E. coli per 100 ml). Children drinking water with greater than 1000 E. coli per 100 ml had significantly higher rates of diarrhoeal disease than those drinking less contaminated water. This threshold effect suggests that in developing countries where the quality of drinking-water is good or moderate other transmission routes of diarrhoeal disease may be more important; however, grossly contaminated water is a major source of exposure to faecal contamination and diarrhoeal pathogens.


Reference Type

Journal Article

Year Published


Journal Title

Bulletin of the World Health Organization


Moe, Christine L.
Sobsey, Mark D.
Samsa, Gregory P.
Mesola, Virginia