Combining sanitary inspection and water quality data in western Uganda: Lessons learned from a field trial of original and revised sanitary inspection forms

Risk assessment for drinking water systems combines sanitary inspections (SI) and water quality testing and is critical for effectively managing the safety of these systems. SI forms consist of question sets relating to the presence of potential sources and pathways of contamination specific to different types of water points, piped distribution systems, and household collection and storage practices. As part of the revision to the Guidelines for Drinking-water Quality (GDWQ), the World Health Organization (WHO) is updating the suite of SI forms to reflect and include the most recent technical and scientific information available. This paper reports the results from a field pilot of a selection of published and revised SI forms and water quality testing in the municipality of Bushenyi-Ishaka, Uganda. We collected data from 45 springs, 61 taps from piped distribution systems, and 129 household storage containers filled with water from those springs and taps. The median total risk scores, according to the revised forms, for spring, tap, and household practices were 36, 53, and 33%, respectively, with higher percentages indicating greater risk. The median Escherichia coli concentrations of spring, tap, and household storage systems were 17, <1, and 7 CFU/100 mL, respectively. We found that increased questioning in the revised SI forms do not necessarily translate to a higher total risk. There is potential for misinterpretation of terminology in the revised SI forms and occasional redundancy of concepts. For the revised SI form for springs, we suggest specific text changes to reduce potential bias. We recommend that users of SI forms receive training in their use and be familiar with their locale. Furthermore, the revised SI forms may need to be adapted in accordance with the local context.