Water Sachet Market Surveillance Water Quality, Packaging, and Brand Registration Survey - Accra Ghana

Abstract:
These data were collected to assess the relationship between sachet water quality, brand registration and neighbourhood deprivation. 118 sachet water samples were collected through a cross-sectional study, one for each brand sold by 66 vendors in four Enumeration Areas from high income and low income areas of Accra, Ghana noting major packaging details. Brand and manufacturer details on packaging were cross-referenced to regulatory records. All samples were tested for faecal indicator bacteria and selected physico-chemical parameters, though 6 samples were mislaid in the receiving laboratory.
Methodology:

Research Protocol:
To identify rich versus poor neighbourhoods, we developed a deprivation index for Enumeration Areas (EAs) in the Accra Metropolitan Area using 2010 population census data. Deprivation was measured via the first component derived from a principal components analysis of EA characteristics.  These were: proportion of illiterate population over 11 years, proportion of active population not working in professional, technical or managerial occupations, proportion of households without access to improved sanitation, piped domestic water to the dwelling, living in overcrowded conditions, lacking solid waste disposal, electric lighting and a computer or phone, renting, squatting or ‘perching’, and living in houses of inadequate construction. Based on a national rate of 20% detectable E. coli in point-of-sale sachet water in the 2012-13 Ghana Living Standard Survey (Wright et al., 2016a) and assuming a 20% difference in sachet contamination between rich and poor areas, we estimated that 118 samples would be required to detect 10% sachet contamination in least deprived EAs versus 30% contamination in those most deprived (with alpha=0.05 and 80% power). 
Fieldwork took place in two phases in February 2015 and September 2016.   Fieldwork for the first phase took place in four case study EAs within Accra, Ghana, in the Abeka and Pig Farm areas, two deprived neighbourhoods.  In the second phase, sampling was expanded to include a further 20 EAs in two wealthy neighbourhoods, East Legon and Roman Ridge areas, and additional EAs in Abeka and Pig Farm. All water vendors operating from fixed premises in and immediately surrounding each EA were mapped. All vendors operating from kiosks or shops were listed in and around each EA and eligible for the study. Street hawkers were excluded. In the first phase, 16 sachet vendors were selected from those listed as being closest to a set of randomly selected households with young children participating in a pilot intervention study (Wright et al., 2016b). After seeking informed consent, all 16 vendors in this first phase were asked about sachet procurement and subsequent storage, with observations made on each brand’s storage and a sample collected of each brand on sale. The form used to collect these data (‘sachet sample collection form’) is enclosed in this .zip file.
In the second phase, 50 vendors were selected using simple random sampling from the list of eligible vendors. After seeking informed consent from vendors, a sample sachet was collected of each brand on sale. Primary packaging characteristics were recorded via direct observation, including brands, producer addresses, the presence of a GSA kite mark, and FDA registration number. Storage and handling instructions, description of treatment processes, minimum durability (‘best before’) date, and any printed details of water chemical composition and price were also recorded. To measure packaging quality, the ‘feel’ of the packaging was assessed (following (Stoler et al., 2014)), as was the presence of blurred or poor colour quality printing or frayed heat-seals. 
Brand details and FDA registration numbers printed on primary packaging from both phases were then compared with records of products registered with the FDA (Ghana Food and Drugs Authority, 2015). Two researchers undertook this comparison independently, then reconciled any differences thereafter.
Laboratory analytical methods:
Samples were transported on ice to the Noguchi Memorial Institute laboratory within Accra and processed within 6 hours. The pour plate technique was used to enumerate heterotrophic bacteria in selected samples. After appropriate dilutions, aliquots were transferred to petri dishes and dilutions containing 25 and 250 colonies were counted and expressed as coliform forming units per millilitre (cfu/ml). Bacterial identification was achieved by using Brilliance E.coli/coliform selective agar. Briefly, after thorough mixing, 100ml of samples were filtered through a sterile filter paper with  0.45 µm pore diameter and filters removed and placed onto chromogenic agar CM1046 Brilliance E. coli ⁄ coliform selective agar (Oxoid Hampshire, UK), and incubated at 37 ºC for 24 hours.  The total number of purple ⁄ blue and pink (1–3 mm) colonies were regarded as confirmed total coliforms. Electrical conductivity was assessed using a portable hand-held water quality meter of model (HANNA H1 98129). For nitrates-nitrogen (NO3-N) levels in each sample were measured using Nitrate Powder Pillows in a direct reading Hach spectrophotometer Model DR. 2010. Chloride concentration was determined titrimetically by the Silver nitrate method (Eaton et al., 1995).  In the second phase, sachets were also weighed in the laboratory prior to testing.
Ethical Approval: 
Free and informed consent of the participants or their legal representatives was obtained and the study protocol was approved by the appropriate Committees for the Protection of Human Participants [Noguchi Memorial Institute For Medical Research Institutional Review Board; Faculty of Social, Human and Mathematical Sciences Ethics Committee], by the University of Ghana, Greater Accra, Ghana, ref: 006/14-15 and 3 Sept 2014; University of Southampton, Hampshire, UK, ref: 12241, and 23 Sept 2014] .  
Details of data structure:
Data are provided as three files:
SachetWaterChemistry.dta: Results of physico-chemical testing of sachet samples.  Note that 6 samples from Phase 2 were mislaid by the receiving laboratory, so these records are missing from this file.
SachetWaterMicrobiology.dta: Results of microbiological testing of sachet samples; weights of sachet samples collected in Round 2. Note that 6 samples from Phase 2 were mislaid by the receiving laboratory, so these records are missing from this file.
SachetCollectionForm.dta: Point-of-sale, storage, packaging, and registration characteristics of sampled sachets.  The form used to record point-of-sale, storage and packaging characteristics is also enclosed as WaterSampleCollectionForm_v1.4.docx.  Brand names, producers and FDA registration numbers printed on packaging were compared by two researchers (WD and JW) with Food and Drugs Authority regulatory records (Ghana Food and Drugs Authority, 2015).  Following independent comparisons of these details, WD and JW then met to reconcile their interpretations, consolidating these into a single field.
Each file is a Stata .dta format file (version 13) and units of measurement and value labels are encoded within each variable in these files.  Information from sachetcollectionform can be linked to sachetwatermicrobiology and sachetwaterchemistry via unique combinations of vendor Id and brand name.  However, note that this is not possible for a subset of 24 samples from Phase 2, because of mis-recording of vendor IDs in the receiving laboratory.
Funding:
This research was funded by the UK Medical Research Council and Department for International Development under the Public Health Intervention Development programme (ref: MR/M008940/1: ‘Urban Drinking Water and Health Outcomes’).
References:
EATON, A., CLESCERI, L., GREENBERG, A. & FRANSON, A. 1995. Standard Methods for the Examination of Waste and Wastewater, Washington, D.C., American Public Health Association.
GHANA FOOD AND DRUGS AUTHORITY. 2015. Registered products [Online]. Accra: Ghana Food and Drugs Authority,. Available: http://www.fdaghana.gov.gh/index.php?option=com_fdasearch&Itemid=36 [Accessed 10/11/2015 2015].
STOLER, J., TUTU, R. A., AHMED, H., FRIMPONG, L. A. & BELLO, M. 2014. Sachet Water Quality and Brand Reputation in Two Low-Income Urban Communities in Greater Accra, Ghana. American Journal of Tropical Medicine and Hygiene, 90, 272-278.
WRIGHT, J., DZODZOMENYO, M., WARDROP, N. A., JOHNSTON, R., HILL, A., ARYEETEY, G. & ADANU, R. 2016a. Effects of Sachet Water Consumption on Exposure to Microbe-Contaminated Drinking Water: Household Survey Evidence from Ghana. International Journal of Environmental Research and Public Health, 13.
WRIGHT, J., DZODZOMENYO, M., FINK, G., WARDROP, N. A., ARYEETEY, G. C., ADANU, R. M. & HILL, A. G. 2016b. Subsidized Sachet Water to Reduce Diarrheal Disease in Young Children: A Feasibility Study in Accra, Ghana. American Journal of Tropical Medicine and Hygiene, 95, 239-246.