An annotated bibliography on boiling drinking water

August 2, 2012 · 0 comments

This annotated bibliography has 11 journal articles and 1 fact sheet that were published from 1985 through August 2012 on boiling drinking water. Links to the full-text are included when possible. Please contact WASHplus if you have other studies and reports to add to this bibliography.


1 – Boiling as Household Water Treatment in Cambodia: A Longitudinal Study of Boiling Practice and Microbiological Effectiveness, Am J Trop Med Hyg. 2012 Jul 23.

Brown J, Sobsey MD.Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.

This paper focuses on the consistency of use and microbiological effectiveness of boiling as it is practiced in rural Cambodia. We followed 60 randomly selected households in Kandal Province over 6 months to collect longitudinal data on water boiling practices and effectiveness in reducing Escherichia coli in household drinking water.

Despite > 90% of households reporting that they used boiling as a means of drinkingwater treatment, an average of only 31% of households had boiled water on hand at follow-up visits, suggesting that actual use may be lower than self-reported use. We collected 369 matched untreated and boiled water samples. Mean reduction of E. coli was 98.5%; 162 samples (44%) of boiled samples were free of E. coli (< 1 colony-forming unit [cfu]/100 mL), and 270 samples (73%) had < 10 cfu/100 mL. Storing boiledwater in a covered container was associated with safer product water than storage in an uncovered container.

2 – Prevalence of Anemia and Its Risk Factors Among Children 6–36 Months Old in Burma, Amer Jnl Trop Med Hyg, Aug 2012.

Ai Zhao, Yumei Zhang*, Ying Peng, Jiayin Li, Titi Yang, Zhaoyan Liu, Yanli Lv and Peiyu Wang*

Address correspondence to Yumei Zhang or Peiyu Wang, School of Public Health, Peking University Health Science Center, Beijing, 100191 China. E-mails: or

Anemia is a common nutritional problem, and it has a remarkably high prevalence rate in Southeast Asia. In this study, children from 6 to 36 months were investigated to determine (1) the prevalence of anemia and (2) risk factors associated with anemia. Convenience sampling was used to select three villages in three different regions in Burma. Hemoglobin and anthropometric indicators were measured for 872 children. Logistic regression analyses were used to determine factors associated with anemia.

The overall prevalence of anemia was 72.6%, with 40.0% having severe anemia. Predictors of anemia are a young age (P < 0.001), mother with anemia (P < 0.001), height-for-age Z score < −2 (P = 0.017), low family income (P < 0.001), mothers without primary education (P = 0.007), drinking unboiled water (P = 0.029), and fever in the last 3 months (P = 0.001). There is a high prevalence of anemia in children, and their nutritional status is quite poor. To control anemia, humanitarians and governments should launch comprehensive interventions.


3 – Coping with poor water supplies: empirical evidence from Kathmandu, NepalJ Water Health. 2011 Mar;9(1):143-58.

Katuwal H, Bohara AK. 1915 Roma Ave NE, University of New Mexico, MSC05 3060, Albuquerque, NM 87131, USA.

The authors examined the demand for clean drinking water using treatment behaviors in Kathmandu, Nepal. Water supply is inadequate, unreliable and low quality. Households engage in several strategies to cope with the unreliable and poor quality of water supplies. Some of the major coping strategies are hauling, storing, and point-of-use treatment. Boiling, filtering, and use of Uro-guard are some of the major treatment methods.

Using Water Survey of Kathmandu, the authors estimated the effect of wealth, education, information, gender, caste/ethnicity and opinion about water quality on drinking water treatment behaviors. The results show that people tend to increase boiling and then filtering instead of only one method if they are wealthier. In addition, people boil and then filter instead of boiling only and filtering only if they think that waterdelivered to the tap is dirty. Exposure to information has the strongest effect in general for the selection of all available treatment modes.

4 – Assessing the microbiological performance and potential cost of boiling drinking water in urban Zambia, Environ Sci Technol. 2011 Jul 15;45(14):6095-101.

Psutka R, Peletz R, Michelo S, Kelly P, Clasen T. London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7H, United Kingdom.

Boiling is the most common method of disinfecting water in the home and the benchmark against which other point-of-use water treatment is measured. In a six-week study in peri-urban Zambia, we assessed the microbiological effectiveness and potential cost of boiling among 49 households without a water connection who reported “always” or “almost always” boiling their water before drinking it. Source and householddrinking water samples were compared weekly for thermotolerant coliforms (TTC), an indicator of fecal contamination. Demographics, costs, and other information were collected through surveys and structured observations. Drinking water samples taken at the household (geometric mean 7.2 TTC/100 mL, 95% CI, 5.4-9.7) were actually worse in microbiological quality than source water (geometric mean 4.0 TTC/100 mL, 95% CI, 3.1-5.1) (p < 0.001), although both are relatively low levels of contamination.

Only 60% of drinking water samples were reported to have actually been boiled at the time of collection from the home, suggesting over-reporting and inconsistent compliance. However, these samples were of no higher microbiological quality. Evidence suggests that water quality deteriorated after boiling due to lack of residual protection and unsafe storage and handling. The potential cost of fuel or electricity for boiling was estimated at 5% and 7% of income, respectively. In this setting where microbiological water quality was relatively good at the source, safe-storage practices that minimize recontamination may be more effective in managing the risk of disease from drinking water at a fraction of the cost of boiling.

5 – Microbiologic effectiveness of boiling and safe water storage in South Sulawesi, Indonesia, J Water Health. 2011 Sep;9(3):577-85.

Sodha SV, Menon M, Trivedi K, Ati A, Figueroa ME, Ainslie R, Wannemuehler K, Quick R. Centers for Disease Control and Prevention, Division of Foodborne, Waterborne, and Environmental Diseases, 1600 Clifton Road, MS E-05 Atlanta, GA 30333, USA.

In Indonesia, where diarrhea remains a major cause of mortality among children <5 years, the government promotes boiling of drinking water. We assessed the impact of boiling on water quality in South Sulawesi. We surveyed randomly selected households with at least one child <5 years old in two rural districts and tested source and stored water samples for Escherichia coli contamination. Among 242 households, 96% of source and 51% of stored water samples yielded E. coli. Unboiled water samples, obtained from 15% of households, were more likely to yield E. coli than boiled samples [prevalence ratios (PR) = 2.0, 95% confidence interval (CI) 1.7-2.5].

Water stored in wide-mouthed (PR = 1.4, 95% CI = 1.1-1.8) or uncovered (PR = 1.8, 95% CI = 1.3-2.4) containers, or observed to be touched by the respondent’s hands (PR = 1.6, 95% CI = 1.3-2.1) was more likely to yield E. coli. A multivariable model showed that households that did not boil water were more likely to have contaminated stored water than households that did boil water (PR = 1.9, 95% CI = 1.5-2.3).

Although this study demonstrated the effectiveness of boiling in reducing contamination, overall impact on water quality was suboptimal. Future studies are needed to identify factors behind the success of boiling water in Indonesia to inform efforts to scale up other effective water treatment practices.


6 – Microbiological effectiveness of disinfecting water by boiling in rural Guatemala, Am J Trop Med Hyg. 2010 Mar;82(3):473-7.

Rosa G, Miller L, Clasen T. Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.

Boiling is the most common means of treating water in the home and the benchmark against which alternative point-of-use water treatment options must be compared. In a 5-week study in rural Guatemala among 45 households who claimed they always or almost always boiled theirdrinking water, boiling was associated with a 86.2% reduction in geometric mean thermotolerant coliforms (TTC) (N = 206, P < 0.0001).

Despite consistent levels of fecal contamination in source water, 71.2% of stored water samples from self-reported boilers met the World Health Organization guidelines for safe drinking water (0 TTC/100 mL), and 10.7% fell within the commonly accepted low-risk category of (1-10 TTC/100 mL). As actually practiced in the study community, boiling significantly improved the microbiological quality of drinking water, though boiled and stored drinking water is not always free of fecal contaminations.


7 – Boiling: Household Water Treatment Options in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 538KB). CDC/Safewater; USAID.

Boiling is arguably the oldest and most commonly practiced household water treatment method, and it has been widely promoted for decades. Organizations recommend boiling both for water treatment in developing countries and to provide safe drinking water in emergency situations throughout the world.


8 – Microbiological effectiveness and cost of boiling to disinfect drinking water in rural Vietnam, Environ Sci Technol. 2008 Jun 15;42(12):4255-60.

Clasen TF, Thao do H, Boisson S, Shipin O. London School of Hygiene and Tropical Medicine, Keppel St., London, WCIE 7H, U.K.

Despite certain shortcomings, boiling is still the most common means of treating water in the home and the benchmark against which alternative household-based disinfection and filtration methods must be measured. We assessed the microbiological effectiveness and cost of boiling among a vulnerable population relying on unimproved water sources and commonly practicing boiling as a means of disinfecting water. In a 12 week study among 50 households from a rural community in Vietnam, boiling was associated with a 97% reduction in geometric mean thermotolerant coliforms (TTCs) (p < 0.001).

Despite high levels of faecal contamination in source water, 37% of stored water samples from self-reported boilers met the WHO standard for safe drinking water (0 TTC/100 mL), and 38.3% fell within the low risk category (1–10 TTC/100 mL). Nevertheless, 60.5% of stored drinking water samples were positive for TTC, with 22.2% falling into the medium risk category (11–100 TTC/100 mL). The estimated cost of wood used to boil water was US$ 0.272 per month for wood collectors and US$ 1.68 per month for wood purchasers, representing approximately 0.48% to 1.04%, respectively, of the average monthly income of participating households.


9 - Fecal contamination of drinking water within peri-urban households, Lima, Peru, Am J Trop Med Hyg. 2007 Oct;77(4):699-704.

Oswald WE, Lescano AG, Bern C, Calderon MM, Cabrera L, Gilman RH. Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Lima, Peru.

We assessed fecal contamination of drinking water in households in 2 peri-urban communities of Lima, Peru. We measured Escherichia coli counts in municipal source water and, within households, water from principal storage containers, stored boiled drinking water, and water in a serving cup. Source water was microbiologically clean, but 26 (28%) of 93 samples of water stored for cooking had fecal contamination. Twenty-seven (30%) of 91 stored boiled drinking water samples grew E. coli. Boiled water was more frequently contaminated when served in a drinking cup than when stored (P < 0.01).

Post-source contamination increased successively through the steps of usage from source water to the point of consumption. Boiling failed to ensure safe drinking water at the point of consumption because of easily contaminated containers and poor domestic hygiene. Hygiene education, better point-of-use treatment and storage options, and in-house water connections are urgently needed.

1985 – 2000

10 – To boil or not: drinking water for children in a periurban barrio, Soc Sci Med. 2000 Oct;51(8):1211-20.

Mclennan JD. Canadian Centre for Studies of Children at Risk, McMaster University, Hamilton, Ontario.

Boiling water, or other water purification methods, are common recommendations of health promoters in developing countries to improve the quality of drinking water in an attempt to decrease the incidence of childhood diarrhea. Health education programs frequently employ an approach based on knowledge deficits to promote this practice. However, there has been little published about water purification practices or associated variables such as knowledge deficits. We interviewed 266 randomly selected child caregivers about water purification in a poor periurban district of Santo Domingo, Dominican Republic. Though most reported that they provided purified drinking water for their children when they were babies, only half of the children five years of age and under were regularly drinking purified water at the time of the study.

Only one knowledge variable remained significantly related to purifying drinking water in the final multivariate model. Other factors that remained in the final model were level of maternal education, endorsing being too tired to boil water and a global measure of social support. Several other hypothesized variables were not related to purifying water. Knowledge deficits may play only a limited role in determining this prevention practice. Further work is required to better identify key factors to improve this practice and hence guide health promotion efforts.

11 - Boiling drinking water: a critical look, Waterlines, July 1986.

DeWolfe Miller

One short-term solution to water-related disease control in areas with unsafe water supplies is the implementation of programmes to boil all drinking water. Dr DeWolfe Miller provides evidence that this approach may have drawbacks and limitations

12 – Boiling of drinking-water: can a fuel-scarce community afford it? Bull World Health Organ. 1985;63(1):157-63.

Gilman RH, Skillicorn P.

In the prevention of diarrhoea, health professionals often advocate boiling as a method of choice to provide safe household drinking-water to villagers in the less developed countries. We have examined the financial feasibility of this recommendation in a village study in Bangladesh. Family income was categorized and the pattern of household fuel consumption was determined. Families in the lowest income quartile would have to spend approximately 22% of their yearly income on fuel, and those in the highest income bracket approximately 10%.

Boiling of drinking-water would result in an 11% increase in the household budget (as a percentage of income) for a typical family in the lowest income quartile, compared with a 3% increase for a family in the highest income quartile. We conclude that recommendations concerning boiling ofdrinking-water in developing countries should not be made until their economic feasibility has been demonstrated.

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