In the course of our work studying drinking water access, contamination, and treatment in rural areas, we have observed relatively high rates of bottled water use. The reasons for increasing bottled water use in rural areas of low- and middle-income countries are varied, but available data indicates that some of the primary reasons are related to perceptions that bottled water is convenient and safer than available drinking water sources. Results from some of our research studies suggest, however, that bottled water may not always be safe. To better understand increasing use of and reliance on bottled water in LMICs we studied available market data which shows that more than half of the top-ten bottled water consuming countries globally are LMICs, and that bottled water use in LMICs is growing rapidly. With respect to global environmental health this trend is problematic in a number of respects, and, we argue, this increasing reliance on bottled water will likely hamper efforts to provide safe and affordable drinking water for all – one of the key objectives of the UN Sustainable Development Goals. As part of this work, we wish to better understand the nature and extent of bottled water contamination; however, there is relatively little publicly available data on bottled water quality, in LMICs or in high-income countries. To complement one of the only systematic review studies examining bottled water use and safety in LMICs, we conducted a comprehensive systematic review and meta-analysis of publicly available research studies on bottled water quality and associated health outcomes in China. After reviewing 7,000+ Chinese-language records, we extracted and analyzed data from 200+ eligible articles; we published our findings from this research in early 2022.
Results from our previous research in rural China suggests that increasing the use of electric kettles for boiling (i.e., treating) drinking water in low-income areas of rural China could help expand access to safer drinking water, reduce household air pollution, and improve environmental and health outcomes in rural Chinese households currently boiling drinking water with solid-fuels (or not treating their water, or drinking contaminated bottled water). Our study was designed (and pre-registered on Chinese Clinical Trials Register & ClinicalTrials.gov) to evaluate the impact of a pilot Rural Electric Kettle Promotion Program offered to low-income households in rural Anhui Province, China. Specifically, we used a parallel arm cohort cluster-randomized controlled (RCT) trial design with a 1:1 ratio to randomize 30 villages (i.e., clusters) to treatment or control using stratified randomization by geography and by cluster proportions of reported electric kettle use at baseline (900 households total).
[Notes: We pre-specified and pre-registered our statistical analysis plan, but data cleaning and analysis were significantly delayed due to the COVID19 pandemic; we anticipate publishing primary findings starting in 2023]