# Fecal Contamination in Point of Use (POU) Drinking Water and Its Associated Factors in Ethiopia: Systematic Review and Meta‐Analysis; “Implications for SDG 6 and WASH Interventions”

## TL;DR

This study finds that over 65% of drinking water at the household level in Ethiopia is contaminated with feces, highlighting the need for better water, sanitation, and hygiene practices to meet global health goals.

## Contribution

The study provides the first pooled estimate of fecal contamination in POU drinking water in Ethiopia and identifies key associated factors.

## Key findings

- The pooled prevalence of fecal contamination in POU drinking water in Ethiopia is 65.02%.
- Unimproved sanitation and water sources significantly increase contamination risk.
- Household water treatment absence and unsafe handling practices are major behavioral risk factors.

## Abstract

Access to safe drinking water is a fundamental human right and a critical component of public health, particularly in developing countries like Ethiopia. This systematic review and meta‐analysis aimed to assess the prevalence of fecal contamination in Point of Use (POU) drinking water and identify its associated factors within the Ethiopian context, with implications for achieving sustainable development goal (SDG) 6 and enhancing water, sanitation, and hygiene (WASH) interventions.

A comprehensive search across multiple databases yielded 12 studies, encompassing 5285 drinking water samples. Funnel plot and I² test assessed publication bias and heterogeneity. The DerSimonian and Laird random‐effects model estimated the pooled prevalence of fecal contamination in POU drinking water. Eggers and Beggs tests evaluated the small study effect, while subgroup and sensitivity analyses identified sources of heterogeneity.

The overall pooled prevalence of fecal contamination in POU drinking water was found to be 65.02% (95% CI: 56.33, 73.72), with significant heterogeneity (I² = 98.13%, p < 0.001). Fecal contamination in POU drinking water was significantly associated with environmental factors such as unimproved sanitation facilities [3.07, 95% CI: 2.59, 3.54] and unimproved water sources [3.03, 95% CI: 1.73, 4.32]; behavioral factors such as absence of household (HH) water treatment practices [4.08, 95% CI: 2.71, 5.45], unsafe withdrawal methods from storage container [3.15, 95% CI: 2.37, 3.93], and prolonged storage of drinking water [3.27, 95% CI: 1.13, 5.41].

The findings underscore the urgent need for targeted interventions to improve water quality at the HH level, including education on safe water handling, effective treatment methods, and infrastructure improvements. These efforts are essential to mitigate the health risks associated with contaminated drinking water and to progress towards the SDGs in Ethiopia.