I read the Chronicle story on 2 August warning the public on shit in sachet water. The story was attributed to a result of a 2017 survey that established that some sachet water products sold in Ghana are contaminated with fecal matter, raising questions about the regulation of the product.  

I explore this from scientific literature and further provide recommendations on how moringa could help manufacturers to deal with toxins.

Shit in Sachet Water: The Science

In this article, I present what researchers published over the years on the quality of sachet and bottled water in ghana.  The first study for instance was conducted by Obiri- Danso et al.(2003) to assess the microbiological quality of Ghanaian bottled and plastic-bagged drinking water sold on the streets of Metropolitan Kumasi, Ghana.  In this study, eight bottled, 88 factory-filled plastic sachets and 40 hand-filled hand-tied polythene-bagged drinking glasses of water were examined for the presence of heterotrophic bacteria total viable counts (TVCs), indicators of fecal contamination (total coliforms, fecal coliforms, and enterococci) and for lead, manganese, and iron.

Heterotrophic bacteria were found in all three types of water with TVCs per milliliter ranging from bottled water, factory-bagged sachet water and hand-filled hand-tied bagged water. None of the microbial indicators of fecal contamination were detected in bottled water, whereas 4.5% of the factory-bagged sachets contained total coliforms and 2.3% fecal coliforms, and 42.5% of the hand-filled hand-tied bags contained total coliforms, 22.5% fecal coliforms and 5% enterococci. Iron was found in all three types of drinking water but at concentrations well within the WHO recommendations. Lead and manganese were not detected. This study concluded that Ghanaian bottled water is of good microbiological quality but some factory-bagged sachet and hand-filled hand-tied polythene-bagged drinking water are of doubtful quality.

Also, Dodoo et al.(2005) assesses the quality of sachet water samples in the Cape Coast municipality of Ghana, random sampling procedures were used to collect 180 samples from 29 brands produced in the municipality from 1999 to 2004. For any particular year, each tested brand was sampled three times at intervals of not less than 2 weeks (usually monthly) between March to June. Forty-five percent (45%) of the brands subjected to bacteriological examination contained coliform bacteria for one sampling period or another during the period of investigation. The coliform contamination seemed to be more prevalent with some particular brands. Three out of seven brands examined in 2004 also recorded the presence of E. coli.  They had this to say: “In general, the high quality claimed for sachet waters could not be confirmed based on the measured Physico-chemical and bacteriological properties. The variable quality and in some cases, poor water quality observed, likely reflects the fact that the sachets are not always bagged under scrutinized sanitary conditions”.

One important study published in the Ghana Medical Journal by Kwakye-Nuako et al.(2007) for instance assesses the safety of sachet drinking water. In this study, twenty-seven different brands of 500ml sachet water samples randomly selected and purchased from various vendors in Accra were subjected to microscopic examinations to determine the presence of parasitic protozoa. The study was carried out between January and May 2005. The researchers found that seventy-seven percent of the samples contained infective stages of pathogenic parasitic organisms. Common pathogens identified include, Microsporidia sp (51.2%), Cryptosporidium parvum  (63.0%), Cyclospora cayetenensis (59.3%), Sarcocystis sp.  (66.7%). Rotifers (18.5%), and Charcoat Leyden crystals (44.4%). Ninety-three percent of the samples contained unidentified impurities/artifacts. 29.6% of the samples contained at least one type of parasite, 14.8% contained at least 2 types of parasites, 25.9% contained at least three types of parasites, while 29.6% contained four types of parasites. The study indicated the presence of contaminants of fecal and zoonotic origin in some of the sachet water examined. This has grim public health implications as the organisms identified can cause water-related diseases which have serious complications in children and adults, particularly immunocompromised individuals. Sachet water should be constantly monitored for its microbial quality.

Due to the many studies confirming bacteria in sachet water, Addo et al.(2009) found that current trends seem to suggest that sachet drinking water could be a route of transmission of diseases. In this study, the authors determine the bacteriological quality of sachet water sold in the Teshie-Nungua suburbs of Accra, Ghana, using simple random sampling procedures, 30 samples from 10 brands of sachet water were collected from hawkers/vendors in Teshie-Nungua (3 samples per brand). They found that Five (16.7 %) of the samples were Excellent, 5 (16.7%) were Satisfactory, 9 (30%) were Suspicious and 11 (36.7%) were Unsatisfactory.  Six samples were contaminated with fecal coliform and two of these, (P1 and P2) were from the same brand. Escherichia coli was also detected in two samples (P1 and P2) out of three samples from the same brand. The level of contamination could be due to inadequate treatment of water samples by the producers, improper use of filters, or post-production contamination.

Stoler et al.(2013) examine basic bacteriologic indicators for 60 sachet water samples from two very low-income communities in Accra, Ghana, and explore the relationship between local perceptions of brand quality and bacteriologic quality after controlling for characteristics of the vending environment.  In this study, the researchers found no fecal contamination detected in any sample, and 82% of total heterotrophic bacteria counts were below the recommended limit for packaged water. Sachets from brands with a positive reputation for quality were 90% less likely to present any level of total heterotrophic bacteria after controlling for confounding factors. These results contrast with much of the recent sachet water quality literature and may indicate substantial progress in sachet water regulation and quality control.

This report is in agreement with a similar study by Osei et al.(2013) which determine the microbiological quality of different types of packaged drinking water available in Accra, Ghana. Sixty samples of sachet water and ten (PET) bottled water were randomly purchased from various locations in Accra. Bacteriological and parasitological analyses of the packaged (sachet and bottled) and tap water (as control) were done according to standard procedures.

Fifty-two out of 60 sachet water samples (86.7%) had bacterial levels well above the internationally recommended limits. For the bottled water, nine out of the ten (90%) were within the recommended limits. Two out of the five (40%) tap water samples (control samples) had above the recommended limits of 500 CFU/mL. While none of the bottled water samples showed the presence of protozoa, two out of the five tap water and 31 out of the 60 sachet water samples had a wide range of protozoa including rotifers. The findings indicate that while PET bottled water sold in Accra may be generally safe, the same cannot be said for the sachet water; since the study found its microbiological quality not significantly different from tap water.

Another study conducted in Tamale by  Duwiejuah et al.(2013)  examine the effect of storage on the quality of sachet-vended water produced in the Tamale Metropolis. Based on the findings of this study, it is recommended that Food and Drugs Authority and Ghana standard Board should ensure minerals concentrations of sachet water are improved to meet the general dietary requirement.

Also, in a study by Awuah et al.(2014) the quality of sachet and bagged water sold on the market was assessed to determine its suitability for consumption. Water quality analysis was performed on 50 brands of sachet water and 20 bagged water sampled randomly selected for the study.  Eighty-two percent (82%) of the sachet water samples and all the bagged water samples were found to be contaminated with either E. coli, Salmonella, other coliforms, and Enterobacteriaceae. The analysis revealed that even though most of the physicochemical parameters were satisfactory, the biological parameter was poor. These bacteria are capable of causing diseases like typhoid, cholera, and other gastrointestinal disorders thus posing a serious health risk to consumers.

Another study by Stoler et al.(2015)  tested a sample of 80 sachets purchased along two commercial transects in low-income neighborhoods of Accra, Ghana, for total coliforms (TC), fecal coliforms (FC), Escherichia coli (EC), total heterotrophic bacteria (THB), and Pseudomonas aeruginosa (PA), and examined the relationships between these indicators and brand reputation. Just 5% of samples tested positive for TC, and none tested positive for FC and EC, yet 41% of samples tested positive for PA. After controlling for one popular brand, a negative brand reputation was associated with both THB presence and the number of samples with THB but PA was found in brands of both positive and negative reputations and was only correlated with THB counts. The emergence of PA presents an opportunity for the re-evaluation of packaged water quality standards in a rapidly-globalizing, urban environment.

Mosi et al.(2018) also determine the microbiological quality of 41 brands of sachet water sampled in 16 districts across 5 regions in Ghana. The researchers examined the samples for the presence of total and fecal coliform ( Escherichia coli).  They found that the majority of the samples (56.09%) were excellent, 4.87% satisfactory and 14.63% suspicious. Ten samples (24.4%) were unsatisfactory. For the degree of fecal contamination, (85.56%) were satisfactory, four (9.76%) were suspicious, and two others (4.88%) were unsatisfactory. The contaminations observed could be attributed to poor sanitary conditions (during and/or after production) and the failure of some production facilities to adhere to standard manufacturing practices. Their data suggest that microbiological quality sachet water from some sources has not yet attained levels that make it pure and wholesome for consumption in many areas.

Another study by Aslan et al.(2020)  also assesses the microbiological quality of sachet water in 21 different brands in Ghana. They found Culturable total coliform was positive in 87% of the samples collected, where Escherichia coli colonies were absent. The analysis of quantitative polymerase chain reaction results indicated the presence of E. coli genes in 44.6% of the samples, with the highest concentration up to 3,166 CCE/100 ml. Microbial source tracking analyses showed that the source of E. coli genes did not originate from sewage contamination because the human-associated HF183 marker was not detected. Of the 175 samples tested, 71% did not mention any water treatment before filling the packages.  Their study shows an urgent need for increased regulation and standardized manufacturing of sachet water to ensure safe drinking water.

A more recent study by Amuah et al.(2021)  showed that vendors in Damongo, Northern Region, did not adhere to proper hygienic practices as ninety-four (94%) of them did not have health clearance, ninety (90%) did not frequently wash their receptacles for selling daily, and most of them stored and sold in unhygienic environments.  The majority of the producers violated Food and Drugs Authority Regulations. They found that total iron, total Heterotrophic Bacteria, Salmonella, Cl⁻, E. coli, and fecal and total coliforms were the controlling elements in the water. All the brands were below threshold limits based on the physical water assessment. However, enteric bacteria were observed in all the brands. The researchers suggest that besides sachet water contamination during production and transportation, vendors significantly impacted the quality of sachet water. Sensitization on proper hygienic practices for sachet water production and vending and routine assessment of the quality of sachet water produced or sold is recommended.

A larger recent study by Angnunavuri et al. (2022) published this August in the Science of The environment examined Six hundred (600) packages, consisting of sachet and bottled water, that were sampled from two high-end companies in Accra (Ghana) and stored through their shelf lives under an average room temperature of 30^oC. The results reported lower than regulated levels of electrical conductivity (163.66mg/L), alkalinity (39.67mg/L), and residual chlorine (<0.01mg/L) while the pH was generally within specification (6.5-7.7). All samples showed progressive biological contamination following the third week (sachet samples) and the sixth week (bottled water) of incubation. This study confirmed the presence of phthalates and pathogenic bacteria in the samples, at risk levels that require mitigation. 

Due to the public health threat of this, Dada (2015) wrote one letter to the editor of a peer-reviewed journal titled Reflections on ‘Microbiological quality of packaged water sold in Accra, Ghana. Panel and calling on the FDA to take measures to regulate sachet water producers in Ghana.

Take Home

Empirical studies have demonstrated that some sachet waters are unsafe for human consumption. However, they failed to mention the brands that are safe for the Ghanaian public. Probably, the manufacturers association in conjunction with the FDA should take measures to protect the public as the studies are worrying. 

Also,  from empirical studies, bottled waters have high-quality standards as compared to sachet water. Though water is life, unsafe water sold to the public is a huge public threat. For instance, (Dodoo et al. 2005; Kwakye-Nuako et al. 2007; Amuah et al. 2021) agree that we cannot say sachet water is safe for public consumption.

 (Addo et al. 2009; Mosi et al. 2018)also found bad practices by the producers are the cause of unhealthy sachets of water.  Interestingly, Amuah et al.(2021)  showed that vendors in Damongo, Northern Region, did not adhere to proper hygienic practices as ninety-four (94%) of them did not have health clearance, ninety (90%) did not frequently wash their receptacles for selling daily, and most of them stored and sold in unhygienic environments.  This is worrying!

Stoler et al.(2013) found Sachets from brands with a positive reputation for quality were 90% less likely to present any level of total heterotrophic bacteria after controlling for confounding factors.

The question is how do we know the good brands on the market? What markers should consumers look out for to check quality brands?

Well, Osei et al.(2013) recommend that consumers should opt for bottled water instead of sachet water.  Duwiejuah et al.(2013) advise the FDA and Standard Authority to work together to protect the public.

On disease correlation and unsafe water, Awuah et al.(2014) found that outbreaks of cholera and typhoid are linked to unsafe drinking sachet water. What makes this a worrying trend is that Stoler et al.(2015)  found some bacteria in both good and bad brands on the market. Interestingly, Aslan et al.(2020)  found that some sachet water contains bacteria as high as  87%. 

Finally, a more recent study by Angnunavuri et al. (2022) found bacteria from two high-end companies in Accra.  There are more studies policymakers could review to take measures on the state of sachet water in the Ghanaian market to protect the public.

Wayford

Manufacturers of both sachet and bottled could also benefit from moringa seeds. For instance, one study by Dube and Chingoma(2016) found that moringa seeds are used for water purification. They note that using moringa seeds with water helps impurities stick to the seeds so they can be removed, leaving behind better quality water that’s lower in toxins.

Salt also seems to bind to moringa, which is beneficial for producing fresh-tasting water. The researchers found that 0.2 grams of ground moringa seed can turn one liter of contaminated water into safe drinking water. This is due to the coagulating actions of certain ingredients in the plant that absorb bacteria.

The interesting thing is that moringa and seed pods are inexpensive, readily available, and may serve as a cost-effective means for the treatment of drinking water for domestic and commercial users in low and middle-income countries.

NB: Prof. Nyarkotey has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations to justify his write-ups. My articles are for educational purposes and do not serve as medical advice for diagnosis or treatment. I aim to educate and empower the general public to take control of their health by providing trustworthy or evidence-based scientific Natural Health Information and advocating for your right to make informed health decisions.

The writer is a Professor of Naturopathic Healthcare, President, Nyarkotey College of Holistic Medicine & Technology (NUCHMT)/African Naturopathic Foundation. E-mail: collegeofholisticmedicine@gmail.com. 

References

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