Drinking Water Quality from Water Vending Machines in Selected Public Schools in Cebu City, Philippines

DOI: 10.21625/essd.v3iss1.253 Drinking Water Quality from Water Vending Machines in Selected Public Schools in Cebu City, Philippines Marchee Tabotabo-Picardal1, Emily May G. Rapirap2, Ofelia N. Barrientos3, Mary Jane B. Tura4, Arnulfo C. Sarnillo5, Adelaida L. Porol6, Rey A. Kimilat7 1Don Vicente Rama Memorial National High School Department of Education, Cebu City Division, Region 7, Philippines 2Don Vicente Rama Memorial National High School Department of Education, Cebu City Division, Region 7, Philippines 3Pardo National High School Department of Education, Cebu City Division, Region 7, Philippines 4Ramon Duterte Memorial National High School Department of Education, Cebu City Division, Region 7, Philippines 5Madridejos National High School’s Department of Education, Cebu Province Division, Region 7, Philippines 6SAGE Prep Schoolhouse, Cebu City Philippines 7Abellana National School Department of Education, Cebu City Division, Region 7, Philippines Abstract


Introduction
The need to ensure safe drinking water especially for a vulnerable subpopulation such as school children and the students is anchored on the millennium development goal on environmental sustainability. Water vending is usually associated to private vending of drinking water which World Health Organization (2011) highly recommends that there is a need to constantly monitor the chemical and microbial parameters as part of the requirement for the suitability of water for human consumptions. Furthermore, it will also serve as a basis for the control measure such as water treatment requirements. Water that is supplied to the schools for consumption should meet the guidelines set by the regulatory agencies standards because the quality and adequacy of water supplies vary.
In the Philippines, commercially sold vended water usually is supplied from private and registered water companies in which water is treated prior to delivery and mode of access is through conventionally supplied tankers, others in coin-operated standpipes and/or water kiosks. Hence, good hygiene in handling vended water and its machine is required in order to avoid water-borne diseases caused by disease-causing bacteria and other microorganisms. Ideally, drinking water should not contain pathogenic organism such as E.coli which is considered to be a fecal indicator for water quality test. The presence of this thermotolerant coliform has been conventionally employed to monitor drinking-water quality up to the present time. As reported by Hutin, Luby & Paquet (2003) that vended water has been associated with gastrointestinal diseases such as diarrhea. Such diseases can adversely affect the performance of the students especially on their attendance (Jasper, Le, & Bartram, 2012).
The issue of clean and potable water is a pressing global concern. Issues on water security, water sanitation, and adequacy of water supply are considered a barometer of economic development of a nation in general and local districts in particular. In the local scenario, the Metropolitan Cebu Water District [MCWD] facilitates the equitable distribution of clean water for all domestic purposes. MCWD operates under a strict compliance to standard water sanitation practices, thereby rendering its water safe for human consumption. However, the course to which clean and potable MCWD's water reaches the household is affected by the following factors, namely: (a) stability and well-maintained pipes; (b) presence of septic tanks to which these pipes flow; (c) "pipe-tapping devices", an illegal form of drawing water from the main water lines; and (d) hygiene and sanitation practices in the end-user's household.
Ideally, MCWDs water is clean, purified, underwent standard chlorination, filtration and ozonation processes and are essentially ready for consumption. These protocols increase consumers' trust and confidence that such an affordable water supply is free from pathogenic organisms and has tolerable limits of dissolved metals. Despite MCWD's provided assurance to their consumers as to the safety of the water for drinking, a majority of local people prefer to buy purified water from water refilling stations. Local anecdotal reports from consumers argue on the increased safety once community water provided by MCWD passed through the second filtration process performed by refilling stations.
All over the Philippines, modes of delivery are observed either through the use of water dispensers in households and offices or water vending machines (WVM) in public places. The latter is commonly accessed in public elementary and secondary schools (i.e. where there is an absence of sterile water fountains as in the case of private schools), and these WVMs are operated by private franchisees which do not usually undergo strict sanitary monitoring due to the inherent trust of the schools to these WVMs operators. Drinking water from bottle-less coolers such that of the water vending machines may pose some public health risks to consumers due to either chemical or microbiological contamination (Hussein, Hassan & Bakr, 2009). The lack of sanitary monitoring paved the way for increased complacency on ensuring regular cleaning of WVMs, replacement of old gallons, removal of accumulated residues from biological and non-biological matter.
This alarming condition is a perennial concern especially in public schools where the population is large and children whose ages are vulnerable to gastrointestinal diseases. WHO statistics shows that there are approximately 94,000 deaths occurred in NCR due to diarrhea in 2014 caused by lack of safe water, sanitation and hygiene (WASH) services (WPRO, 2017). As to the report of the Department of Health that in 2018, within a month, 1,051 acute bloody diarrhea cases were reported and this is caused by exposure to various pathogens in food and water.

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Such precedence is the standpoint of this initial assessment in order to investigate the quality of drinking water distributed through water vending machines located in different public schools in Cebu City.

Review of Related Literature
It is an inherent right for every citizen to have access to safe drinking water (WHO, 2011). Due to the increase in demand for potable water by the growing population, water service providers respond to the need through the placement of Water Vending Machines in populated areas such as in schools. The Philippine government must strengthen the regulation of these water supplies by ensuring them to be compliant to the national standard (i.e., PNSDW) for drinking water and that of the international institutions (i.e., WHO and US-EPA) ( 198 (1973) to monitor the local water standards and assess its compliance with the national standard. Administrative Order 0012 s. 2017 stipulates the guidelines for monitoring water vending machines such that the minimum frequency of sampling should be conducted once a month for a microbiological test and twice a year for physico-chemical analysis. Despite the tasked force and legal mandate, access to safe drinking water still remains an issue which prompted researchers to conduct an independent and third-party assessment of the water quality in their locality.
In the published reports conducted in the Philippines, Tonog and Poblete (2015) looked into the quality of drinking water obtained from various sources such as deep well, pump well and communal faucets in some barangays in Northern Samar and found out that all water samples were positive for fecal coliforms. Meanwhile, Alambatin, Germano, Pagaspas, Peñas, Pun-an, & Galarpe (2017) evaluated the physicochemical parameters of drinking water samples in Cagayan de Oro and found out that water is fit for human consumption, however; findings lack analysis on the presence of heavy metals, pathogens, and organic components. Meanwhile, Austero, Bernardes, Dael, dela Cruz, Honkulada, Jawadil, Stacy, & Uy (2013) evaluated the water samples collected from water vending machines within the radius of the hospital, and found out that all of the samples were positive for total coliform, total bacterial and fecal coliform count which rendered the water unfit for drinking.
In the global scenario, this water quality monitoring has been practiced. Decades ago, Chaidez, Rusin, Naranjo, & Gerba (1999) have already initially assessed the water vending machine in terms of microbiological and physicochemical parameters. They concluded that there is a high bacterial concentration of total coliforms and Escherichia coli detected in the drain samples. No significant correlations were found between the physicochemical and bacteriological parameters. Similarly, Al Moosa, Ali Khan, Alalami, & Hussain (2015) investigated the water dispenser machines installed in schools and universities in UAE in terms of a microbial parameter. They concluded that the water samples were found unsatisfactory as total coliform and E.coli were detected. They attributed it to the low maintenance and improper hygiene and unsanitary conditions of the water dispenser machines. The aforementioned condition of water implies the need for ensuring water quality locally. From the prevailing scenarios both at the local and global scene, similar conclusions have been presented on the water samples collected -that it is not fit for human consumption due to the presence of pathogenic organisms. US-EPA (2018) strongly emphasized that there should be zero tolerance for the presence of fecal coliform in drinking water. Hence, this present study would like to verify if the water vending machines located in schools in Cebu are compliant with that national and global standard. pg. 3

Study Site
This descriptive survey was conducted in eight (8) randomly selected public schools (composed of 4 elementary schools and 4 high schools) located in different regions within the city (refer to Figure 1). The number of schools selected as a sampling site is ten percent of the overall number of public schools in the whole division of Cebu City. In addition, the schools belong to the criteria of very large population size and the presence of WVM in the school premises. The city is divided into two congressional districts, north and south. There were four schools purposively selected for each of the district (comprised of 2 elementary schools and 2 secondary schools). From each school, water sample [total 2.5L] was collected from 10:00-11: 00 AM for the summer month of April 2017 on the same day and these were analyzed for microbial contaminants (i.e. total coliform). Meanwhile, three schools were randomly chosen from the six schools that registered higher than the normal level of E. coli test results (<1.1 CFU/ml) using a fishbowl technique (composed of one elementary and two high schools) for further physicochemical testing of the water from WVM found in the school for the pH, hardness and presence of heavy metals (Hg, Pb and As).

Sampling
Water samples were collected from the water vending machines installed in randomly selected schools (names withheld for privacy and anonymity and ethical considerations). Specifically, grab sampling technique was employed in this study in which a sample was collected from those chosen schools simultaneously during the Month of April 2017 and is assumed to represent the composition of the water only at that time and place. In each school, the researchers collected 1.5 liters (L) water sample for chemical analysis and 1L water sample for the microbiological test. To avoid affecting the quality of data, the first and second running of water were disregarded. The third time was then used as the sample and was then taken into sterile containers without superficial disinfection of the outlet nozzles. Specimens were then submitted to the laboratory of MCWD in a cool box within 6 hours. Analyses of the physical property (i.e. pH and hardness) of the water samples were done at the Chemistry laboratory of a university. Heavy metal concentrations were analyzed at the Metro Cebu Water District.

Physicochemical and Microbiological Analysis
The drinking water samples were taken directly from the nozzle of the water dispenser machine. The samples were stored in a pre-sterilized 500 ml bottle. Right after the collection, drinking water samples were immediately submitted to the microbiological laboratory for the analysis. The colilert reagent was used to identify the presence of total coliform and E.coli.

Data Analysis
Data from diagnostic laboratories were collated, tabulated and analyzed using descriptive statistics (i.e. mean+S.D.) for parameters with 1 sample/trial. All data were presented and were correspondingly compared versus permis-  Table 3) and microbiological component (see Table 1).

Results and Discussion
Water quality is assessed in terms of the following parameters: biological, chemical and physical properties and these parameters are presented in separate tables below. Briefly, chemical properties include dissolved heavy metals alone while physical properties include pH and water hardness in terms of concentration of CaCl. For microbiological attributes, the presence of fecal coliform and total coliform counts were determined.

Biological Property of Water from WVM
The biological component of drinking water was assessed using Multiple Tube Fermentation Technique (MTFT) in two parameters, namely: appearance (in terms of colonies) and total coliform as well as fecal coliform ( Table  1). The result shows that all eight samples did not show any remarkable appearance of colonies in the growth media, indicating the insignificant bacterial growth in the water samples. Meanwhile, total coliform registered 2.6 CFU/mL while specific E.coli testing posted <1.1 to 2.6 CFU/ml. Total coliform test for all samples (2.6 CFU/ml) were all higher than the Philippines standard value for clean water (i.e. <1.1/100 ml) and international standard set by WHO and US EPA which is 0.00. E. coli test, on the other hand, resulted to normal levels (<1.1 CFU/ml) in 2 (School B and H) of the 8 schools sampled if based on PNSDW standard but still violates the strict international standard. Although such colony counts were within the standard values for E.coli testing, its total coliform counts were beyond standard values (see Table 1) and this finding is in consonance to Prasai, Lekhak, Joshi, & Baral (2007) that registered 82.6% and 92.4% of drinking water samples found to cross the WHO guideline value for drinking water. Furthermore, the same finding also agrees with the studies of Tonog  Appearance refers to the presence or absence of visible colonies of bacteria when grown in growth media during testing. Total coliform refers to the Gram-negative non-spore forming and motile or non-motile bacteria which pg. 5  These bacteria originate from the intestine of warm-blooded animals (like humans and most mammals). Evaluation of total coliform is an important measure of whether the water came in contact with human feces (fecal-oral route) along the way to the pipes (processing to filtration) and eventually to human (Chaidez et al., 1999). Hence, in this study, the majority of the water samples is not fit for human consumption due to the presence of fecal coliform as it did not qualify for the permissible standard value set by the PNSDW, US EPA, and WHO. This finding also implies that it may cause an adverse effect on the gastrointestinal health of the consumers. It is not an assurance that although the water appears clears it is free from contamination (LeChevallier, 2003).

Chemical Property of Water from WVM
Majority of the reported and recorded water-related health problems is due to the microbial contamination and also brought about by chemical contamination of drinking water (WHO, 2011)  <60 mg/l = soft; 60-120 mg/l = moderately hard; 120-180 mg/l = hard; >180 mg/l, very hard The typical contribution of calcium in the diet is 5-20% of the drinking water and the rest of it are obtained from food sources for the recommended 80% dietary intake. Mineral-rich drinking water can be a good source of these recommended nutrients and may supplement the needed calcium requirement by the body, in addition to main food sources of Calcium such as milk, cheese, and other dairy products (WHO, 2011). The pH of water from different WVMs ranges from 5.50 (slightly acidic) to 7.00 (neutral). Normally, pH range for drinking water is between 6.50 to 8.50 (Tan et al., 2016), thus except for one sample (School B), the two other schools have WVMs providing a water with acceptable pH level. This may suggest a slightly higher concentration of hydrogen ion in the water medium due to rapid loss of electrolytes like sodium, calcium, and magnesium. Water samples from WVMs came from water refilling stations that employ purification process hence the water is slightly acidic as it becomes an active absorber of carbon dioxide as it comes in contact with air (Flanagan & McCauley, 2010). The acidity can be linked to poor maintenance of either the container, nozzle tube or the entire machine in general.
In general, water with a pH < 6.5 could be classified as acidic, soft, and corrosive. The acidity of the water may indicate a significant amount of metal ions such as Fe, Mn, Co, Pb, and Zn. Hence, acidic water contains a high amount of toxic metals which may be associated with health risks and pose a detrimental effect on the human body. Thus, neutralizing solutions are used (i.e. containing sodium carbonate or commonly known as soda ash) which may eventually increase pH level. On the other hand, the hardness of water is indicated by a pH level of >8.5 which is considered alkaline which does not pose a health risk. However, hard water may cause aesthetic problems such as alkali taste, the formation of scale deposits on the surface that comes in contact with the water, slippery and difficult to lather for soaps and sometimes forms insoluble precipitates on clothing. While the ideal pH level pg. 7 of drinking water should be between 6.50 -8.50 (US-EPA, 2018), the human body has the ability to maintain pH equilibrium regularly regardless of the water intake. For instance, our stomach maintains a naturally low pH level of 2 which is needed and aids in the digestion of food.

Conclusion
Based on the results of the study, chemical and physical test were within the acceptable levels as heavy metals (which are known to be toxic in large amounts) were at the negligible to a normal level, pH was relatively acceptable, and hardness level is acceptable. However, the water samples obtained from the WVM were relatively unclear of coliform bacteria such as E.coli and total coliform count as evidenced by a relatively higher CFU/mL compared to the acceptable values in drinking water. Hence, the study concluded that the water sample is unfit for human consumption. As the results may suggest, these water vending machines need routine cleaning and maintenance to avoid accumulation of coliforms and contamination of E.coli.

Recommendations
In order to ensure the quality of drinking water accessed by the public through vending machines installed in schools, it should be regularly cleaned, monitored and tested by the company owner to comply with the guidelines and also by the designated government agency for public safety and welfare. Furthermore, hygienic conditions in handling, delivery, and storage of water should be given utmost priority. A school administrator also must create and implement guidelines and protocols in regulating the bottles of water supplied, machines installed in schools, as well as the usage and maintenance of the overall facility to ensure utmost compliance to the standard for safe drinking water. Local Government Units must conduct regular monitoring as mandated in the Administrative Order 0012 s. 2007 that all the water vending machines installed in public places be analyzed for microbiological constituent monthly and physicochemical analysis twice a week not just in schools but also in eateries and convenient stores where most of the water vending machines are placed.