Case-control study of drinking water quality in Yemen

Background: Water, sanitation and hygiene (WASH) activities collapsed in Yemen due to the 2015 war, causing acute safe water shortage, poor sanitation and hygiene, and degraded microbial water quality. The cholera outbreaks in 2016/2017 triggered emergency WASH interventions to improve water quality and reduce cholera and other water-borne disease incidence. Aim: This study aimed to assess the microbial water quality in Sana'a, Yemen, following cessation of the WASH activities. Methods: We collected and analysed water samples in 2022 from 64 out of the 381 mini water purification plants that benefitted from WASH interventions in Sana'a in 2018, 2019 and 2020. Face-to-face interviews with representatives of each mini water purification plant were conducted alongside observatory evaluations. We compared results of the 2022 analyses with those of 2018, 2019 and 2020. We analysed our data using Microsoft Excel 2010 and descriptive statistics and presented the results in tables and charts. Results: By 2022, one year after suspending the WASH interventions, the purification system rating had decreased slightly from 87.4% to 84.1%, and the water safety requirements rating had decreased significantly from 78.1% to 62.1%, compared to the 2018-2020 values. This caused a nearly double value, from 15.1% to 31.3%, for the microbial pollution, confirming an inverse relationship between microbial pollution and both purification system and water safety requirements. Conclusion: The microbial water quality of the plants was degraded due to the cessation of the WASH programme. It is important to consider sustainability issues when designing and implementing WASH programmes to ensure that they achieve their goals. It is also crucial to monitor WASH activities rigorously and invest in raising awareness of WASH benefits among operators and community members so they can become effective partners in preventing contamination and water pollution. Keywords: Water quality, water pollution, water purification, water safety, WASH, Sana'a, Yemen