Chinese Studies
2013. Vol.2, No.4, 185-192
Published Online November 2013 in SciRes (http://www.scirp.org/journal/chnstd) http://dx.doi.org/10.4236/chnstd.2013.24030
Open Access 185
Analysis of Rural Drinking Water Status and Improving Strategies
in Pu’er Municipality, Yunnan Province of China
Zhou Xingwu1*, Jane T. Bertrand2, Li Bingcheng3, Guo Linfeng3, Gabriel Cohen2
1Yunan Institute of Parasitic Diseases, Pu’er City, China
2Department of Global Health System and Development, School of Public Health & Tropical Medicine,
Tulane University, New Orleans, USA
3Pu’er Center for Disease Prevention and Control, Pu’er City, China
Received July 17th, 2013; revised October 22nd, 2013; accepted November 6th, 2013
Copyright © 2013 Zhou Xingwu et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Objective: The study aims to assess Pu’er rural drinking water quality and to investigate the reasons why
microbial indexes exceed the national rural drinking water standard. Methods: The study uses existing
data obtained from Pu’er rural drinking water monitoring Network. Simultaneously, a series of semi-con-
structed in-depth interviews were conducted with key informants. Results: The water samples taken from
Pu’er which met the national rural drinking water standard only accounted for 17.5%, while 82.5% of
samples did not meet this standard. The P-value of x2 test of total colony and total coliform number with
chemical and physical treatment was .195 and .000, treated water and tap water was .175 and .340, dry
season and rainy season was .003 and .000. Discussion: The results present that the percentage of water
in Pu’er Municipality which meets the national rural drinking water standard is very low.
Keywords: Rural Safe Drinking Water; Pathogenic Microorganisms; Rural Residents; Vulnerable
Population; Improving Strategies
Introduction
Rural drinking water is a very important livelihood project. It
is involved in a huge vulnerable population. Helping people to
gain access to safe drinking water is one of the most important
health-related infrastructure programs in the world. As of 2007,
around 1.1 billion people were still using unsafe drinking water
in the world (World Health Organization, 2007). Accessing
rural safe drinking water has become a policy priority in Chi-
nese government action plans for comprising more than 70
percent rural residents of China’s total population since 1996.
China’s the 11th Five-Year Plan (2006-2010) focuses on the
construction of water works and technological innovation for
securing water supply and drinking water safety (World Water,
2010). During the 11th Five-Year Plan, the Chinese govern-
ment invested a huge amount of funds to resolve the problem of
the rural safe drinking water and to provide safe drinking water
to most rural residents by 2015. The program has evidently
made tremendous progress. It resolves a lot of rural residents’
drinking water problems, but many of the rural residents still
lack access to clean and safe drinking water.
Pathogenic microorganisms in drinking water, the leading
causes of diarrhea, have drawn a lot of attention in public health
and other related fields. A recent Chinese study (The Subspe-
cialty Groups of Gastroenterology and Infectious Diseases,
2009) found that the diarrheal mortality rate in rural areas of
seven Chinese provinces was .51 per thousand persons. In the
Fourth National Health Service Survey in 2008, only 41.9 per-
cent of rural people had access to water from water treatment
plants (Center for Health Statistics and Information, Ministry of
Health of the People’s Republic of China, 2009). Currently in
rural China, about 300 million rural people are still using un-
safe drinking water. The water construction program is still
ongoing. In poor Pu’er Municipality of Yunnan Province, West
of China, this problem is particularly prominent. This can be
inferred from the data and documents from the recent five years
water surveillance project from Pu’er Municipal Center for
Disease Prevention and Control, in which it is found that
Pathogenic microorganisms of most projects exceed the na-
tional rural drinking water standard.
Pu’er is a large agricultural prefecture level city with 9 coun-
ties and 1 district, and a population of 2,542,898 as of Decem-
ber, 2010. Among this population ethnic groups were
1,551,313，comprising 61.01% of the total population, whereas,
Chinese Han was 991,585, accounting for 38.99%. In addition,
rural population is 1,754,600, making up 69.0%, while urban
population was 788,298, only covering 31% (Pu’ershi Renkou
Pucha Ban’gongshi 普洱市人口普查办公室, 2011). Pu’er
belongs to an underdeveloped area. Based on statistics, the
annual net income of the rural population is RBM 3456 (about
$557.4) (Pu’ershi Tongjijv普洱市统计局, 2010). According to
the survey of construction of water infrastructure of Pu’er
(Pu’ershi Zhenzhi Xieshang Huiyi 普洱市政治协商会议,
2011), 781,800 rural residents are still waiting to access safe
drinking water, accounting for 37.4%. While in the areas where
there is access to drinking water, the construction standard of
the water projects is quite low and the water sources are rela-
*Corresponding author.

ZHOU X. W. ET AL.
tively unstable. The local rural residents have cultural norms of
eating and cooking raw food, such as salad, and drinking un-
boiled water, which could be a great potential threat from the
unsafe drinking water. The most dangerous of the issues would
potentially bring diseases such as diarrhea or intestinal diseases
to the vulnerable population. For the vulnerable population’s
health and safe drinking water, the study is trying to obtain the
following objectives:
1) To assess Pu’er rural drinking water quality, especially
focusing on pathogenic microorganisms by analyzing national
monitoring data of rural drinking water.
2) To explore reasons why the microbial index exceeds the
national rural water standard.
3) To recommend intervention strategies to improve the qual-
ity of safe rural drinking water.
Materials and Method
The study involved 2 types of data collection:
Water Samples Data Collection
The study used existing data obtained from Pu’er Municipal-
ity Rural Water Supply Projects of Water Quality Monitoring
Network of the 11th Five-Year National Plan from 2008-2011
collected by Pu’er Municipal Center for Diseases Prevention
and Control. The water samples were collected in dry season
and rainy season from treated water and tap water and tested by
the GB 5749-2006 National Standard for Rural Drinking Water
Quality.
The data was collected by stratified random sampling method.
At the first stage, the surveillance counties were selected by
stratified random sampling according to the proportion of water
quality, water source, and treatment, which can typically repre-
sent the feature of the central or dispersal water supply of the
counties. At the second stage, from the selected counties,
monitoring sites were selected by stratified random sampling
according to water source, treatment methods, and population
covered, but the sites in county capitals were required to be
included (The National Office of Patriotic Public Health Cam-
paign, 2011).
In total, 905 samples from 5 of the 10 counties/districts in
Pu’er Municipality in 2008-2011 were collected from monitor-
ing sites by 4 different categorized forms: the general informa-
tion of central water quality supply of rural monitoring county,
water source and water supply, monitoring site information and
results of the water sample test, and the pollution events reports.
Each entered data included ID number, card number, name of
counties and sites, type of water supply, water source, time of
completion, invested fund, disinfection methods and facility,
population covered, water supply capacity, date of water sam-
pled, and test date of water sample. In total, there were 20 in-
dexes of water samples tested in labs of Center for Disease
Prevention and Control. All of these labs responsible for the
data collection and testing had already passed the quality au-
thentication of ISO9002. However, most of samples (885 of
905) had no residual chlorine index due to lack of chemical
treatment. So the study only used 19 indexes, including 13
physical and chemical indexes, 3 toxic indexes, 3 microorgan-
ism indexes, which excluded 1 disinfectant index—free residual
chlorine.
Semi-Structured Interviews with Key Informants
In order to justify and help to explain results of the national
water monitoring data in Pu’er Municipality, semi-structured
interviews of qualitative method were used to conduct further
investigations to perceive depth, richness, and complexity in-
herent in the problem as well. The key informants included the
relevant water authorities in different levels, the water moni-
toring professionals and beneficiaries of villages.
The semi-structured interviews only focused on key infor-
mants due to lack of funds to support. These informants in-
cluded:
The water authorities from 2 levels, Pu’er Municipal Gov-
ernment and County/district government, who were especially
responsible for the rural water project, were identified for inter-
views to obtain information about project plan, implementation,
monitoring, and evaluation. In order to avoid refusals, espe-
cially with some politicians, it was crucial to clearly explain the
purpose, necessity, and importance of the survey before the
interviews.
Professionals responsible for collecting water samples and
technicians in labs for testing samples working with the coun-
ties and prefecture CDPC were also interviewed to obtain water
treatment, training and sample tests, among other information.
Some key rural community leaders and villagers near the
Pu’er Municipality were identified for interviews to acquire
certain information regarding operation, maintenance, and
problems. At the same time, the location of the water projects
was observed, including source of water, facilities, physical
structure and methods used for the treatment of water.
Lastly, some of the relevant documents about the project,
such as national and local policy, strategy, and water project
management were also collected for review.
Analysis Methods
The study was trying to search for cause and effect relation-
ships related to the levels of pathogenic microorganisms. The
features of the entire water projects over the 11th Five-Year
Plan were comprehensively analyzed to look at Pu’er rural
water quality, especially focusing on pathogenic microorganism
levels and their trend in different seasons over time, and then to
explain some reasons through database analysis.
SPSS software was used to analyze the collected data. First,
based on the GB 5749-2006 National Standard for Drinking
Water Quality, water samples were analyzed to obtain the per-
centage of water samples which met the national rural drinking
water standard through 13 physical and chemical indexes, 3
toxic indexes, and 3 microorganism indexes. Second, x2 test
was used to test the association of water samples which met and
did not meet the national rural drinking water standard with the
total colony and coliform number among the dry season and
rainy season, treated water and tap water, water sample types,
and physical and chemical treatment. From the significance of
the P value, some potential variables associated with the effect
of the water microbial index could be fairly identified. Finally,
One Way ANOVA was used to find mean total amount of the
microbial levels among 6 sources of water: reservoir, river,
ditch and pond, spring, well, and stream. The results of One
Way ANOVA could find the association of sources of water
with the microorganism levels and help to interpret the quality
among 6 sources of water. It was hoped the study could find
Open Access 186

ZHOU X. W. ET AL.
some clues or evidence of the causality and provide information
on the distribution of risk factors. Once interesting and strong
associations were observed, they could provide the evidence for
designing intervention strategies.
Beyond the data itself, the qualitative method semi-structured
interviews might find some information about project design
drawback, management and policy problems, treatment facili-
ties, environmental pollution, or the protection of water sources.
The responses of the semi-structured interviews were compre-
hensively evaluated to formulate a descriptive statement about
the issue. It was expected to identify some meaningful rela-
tionship of interests or evidence related to the problem from the
critical stakeholders’ perspective views of projects, policies,
and management.
Results
Pu’er Water Source and Tre atment
The rural drinking water sources were mainly composed of
streams (78.2%), spring (17.2%), and reservoir (2.7%). The
other water sources, river (.9%), ditch and pond (.4%), and well
(.6%), only accounted for a very small proportion. The water
treatment methods most commonly used in Pu’er Municipality
were chemical and physical methods. Within chemical method,
only 1.8% used chemical method and most of them (98.2%) did
not. In regards to physical treatment, the sediment and filtration
were the main types of water purification used, covering 55%.
The untreated water is still comprised of 43.2%, and the com-
plete treated water was only 1.8%. The low application of
chemical treatment was due to lack of treatment facilities be-
cause most of them have no such facilities, covering 92.9%,
and 5.7% had facilities but did not use them.
Pu’er Water Quality
The drinking water quality was strictly examined by assess-
ing four classes of attributes: physical, chemical, toxic and
microbial indexes. There was a national standard of water qual-
ity set for each of these four classes of attributes. According to
GB 5749-2006 National Standard for Drinking Water Quality,
developed by the Ministry of Health, a water sample met the
standard only if all indexes conformed to the standard of re-
quirement, limitation, or maximums. Following the standard,
the water samples of Pu’er which met the standard only covered
17.5%, and the others which did not meet the standard were
82.5%. The results presented the percentage of water samples
which met the standard was very low. The following were at-
tributes of each category:
Physical, chemical, and toxic indexes: It was notable that the
3 toxic indexes, fluoride, arsenic and nitrate, all met the stan-
dard. All chemical indexes, chloride, sulphate, total dissolved
solid, and hardness also met the standard. On the other hand,
the proportion that met the standard of physical index of color,
turbidity, unpleasant taste and smell, visible substance were
99.3%, 89.5%, 98.8%, and 84.2%, respectively. There were still
a considerable amount of water of these indexes which did not
meet the standard, covering .7%, 10.5%, 1.2%, and 15.8%,
respectively.
Microbial indexes: The most serious problem of Pu’er rural
water was that most of the microbial index extremely exceeded
limitations set for rural drinking water standard. The proportion
of colony, coliform and thermo-tolerant coliform number which
did not meet the standard accounted for 15.7%, 78.7%, and
78.7%, respectively. It must be pointed out that given the con-
dition, environmental, and hygiene of the rural area, the total
colony number actually extended to 500 CFU/100ml by the
standard. Table 1 shows the results of water status of the Pu’er
Municipality.
Cause and Effect Relationships with Microorganism
Levels
The association of total colony and total coliform number
among chemical and physical treatment, treated water and tap
water, dry season and rainy season was shown in Table 2.
Chemical treatment had no association with total colony num-
ber, as shown by a P-value of .195, but was associated with the
total coliform number. Physical treatment had an important
effect on total colony and coliform number. Physical treatment
of P-value (.00) showed that there was a highly significant
association. The physical water treatment methods were very
effective against microorganisms. It can greatly reduce the
levels of microorganisms. P-value of treated water and tap wa-
ter is .431 and .340, respectively, which implied no significance.
The reasons may be due to the fact that most of the water
lacked treatment or was not fully treated, or there were no
treatment facilities. Secondly, the secondary water supply sys-
tem from the treatment facilities to households could still ex-
perience some problems from lack of tanker covers and peri-
odic cleaning of the water tanks and pipelines.
The dry and the rainy season had a great effect on the quality
of the water. Both P-value of total colony and total coliform
number between the dry season and rainy season was .000. The
percentage of water samples which met the standard for total
colony number was 51.8% in dry season and 23.2% in rainy
season. The percentage of water samples which met the stan-
dard for total coliform number was 17.5% in dry season and
3.9% in the rainy season. Both water samples which met the
standard in dry season were obviously higher than that in rainy
season.
Figure 1 shows that the trend of mean total colony and coli-
form number in dry season is obviously lower than that in the
rainy season from 2008-2011. This trend explained that the
water quality in dry season is usually better than rainy season.
There was an abnormality of an increasing tendency of both
total colony and coliform number in 2009-2010. One possible
explanation was that the year was extremely dry in the mete-
orological record history, when most of the southern places in
the west of China experienced extreme drought.
The Effect of Water Sources on Microbial Indexes
The different types of water sources also influenced the mi-
crobial indexes. One Way ANOVA analysis showed that the
mean of total colony number among water sources existed the
difference (F = 15.076, P = .00) (F-value did not show on table).
There were essential differences between the two main sources
of water. From the statistic of LSD, it was found that P-value of
total number of colony between spring and stream were sig-
nificantly different with a P-value of .003. The mean of total
colony amounts in spring water was 201.1, but in stream was
763.1. The quality of spring water was obviously better than
that of stream, whereas, the others type of water showed no
difference. Table 3 explains the results of the P-value among
the different sources of water.
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ZHOU X. W. ET AL.
Open Access 188
Table 1.
Basic characteristics of rural water in Pu’er Municipality, Yunnan Province of China.
Index Items
Frequency
(N = 905) % National Rural St d
Basic information
Water source Reservoir 24 2.7
River 8 .9
Ditch and Pond 4 .4
Spring 156 17.2
Well 5 .6
Stream 708 78.2
Sample type Treated water 450 49.7
Tap water 455 50.3
Chemical treatment No 889 98.2
Chlorine dioxide 2 .2
Liquid chlorine 8 .9
Chlorinated lime 6 .7
Physical treatment Sediment & filtration 498 55
Complete treatment 16 1.8
No treatment 391 43.2
Facilities of disinfection Not use 52 5.7
Use 12 1.3
No facilities 841 92.9
Sampling season Dry season 565 62.4
Rainy season 340 37.6
Physical and chemical indexes (13 items)
Color Meet the Std 899 99.3 ≤20
Does not meet Std 6 .7
Turbidity Meet the Std 810 89.5 <5
Does not meet Std 95 10.5
Unpleasant taste and smell No 894 98.8 No
Yes 11 1.2
Visible substance No 762 84.2 No
Yes 143 15.8
PH Meet the Std 852 94.1 ≥6.5 and ≤9.5
Does not meet Std 53 5.9
Fe Meet the Std 877 96.9 ≤.5 mg/L
Does not meet Std 28 3.1
Mn Meet the Std 904 99.9 ≤.3 mg/L
Does not meet Std 1 .1
Chloride Meet the Std 905 100 ≤300 mg/L
Does not meet Std 0 0
Sulphate Meet the Std 905 100 ≤300 mg/L
Does not meet Std 0 0
Total dissolved solid Meet the Std 905 100 ≤1500 mg/L
Does not meet Std 0 0
Hardness Meet the Std 905 100 ≤550 mg/L
Does not meet Std 0 0
BOD Meet the Std 891 98.5 ≤5 mg/L
Does not meet Std 14 1.5

ZHOU X. W. ET AL.
Continued
NH Meet the Std 879 97.1 ≤.5 mg/L
Does not meet Std 26 2.9
Toxic Index (3 Items)
Fluoride Meet the Std 905 100 ≤1.2 mg/L
Does not meet Std 0 0
As Meet the Std 905 100 ≤.05 mg/L
Does not meet Std 0 0
Nitrate Meet the Std 905 100 ≤20 mg/L
Does not meet Std 0 0
Microbial index (3 items)
Total colony # Meet the Std 763 84.3 ≤500 CFU/100ml
Does not meet Std 142 15.7
Total coliform # Meet the Std 193 21.3 No
Does not meet Std 712 78.7
Total thermo-tolerant colifrom # Meet the Std 148 16.4 No
Does not meet Std 674 74.5
Missing 83 9.1
All indexes Meet the St d 158 17.5
Does not meet Std 747 82.5
Table 2.
Comparison of total colony and total coliform number among chemical and physical treatment, treated water and tap water, dry season and rainy
season.
Total colony # Total coliform #
Item Classification
Meet Std
N(%) Does not meet Std N(%) Total P-value Meet Std N(%) Does not meet Std N(%) Total P-value
Yes 14(1.5) 2(.2) 16(1.8) .195 13(1.4) 3(.4) 16(1.8) .000
No 665(73.5) 224(24.8) 889(98.2) 180(19.9)709(78.3) 889(98.2)
Chemical
treatment
Total 679(75.0) 226(25.0) 905(100.0) 193(21.3)712(78.7) 905(100.0)
Yes 419(46.3) 95(10.5) 514(56.8) .000 156(17.2)358(39.6) 514(56.8) .000
No 260(28.7) 385(42.5) 391(43.2) 37(4.1) 354(39.1) 391(43.2)
Physical treat-
ment
Total 679(75.0) 226(96.9) 905(100.0) 193(21.3)712(78.7) 905(100.0)
Treated water 336(37.1) 114(12.6) 450(49.7) .431 99(10.9) 351(38.8) 450(59.7) .340
Tap water 343(41.8) 112(8.5) 455(50.3) 94(10.4) 361(39.9) 455(50.3)
Water
sample type
Total 679(75.0) 226(25.0) 905(100.0) 193(21.3)712(78.7) 905(100.0)
Dry season 469(51.8) 96(10.7) 565(62.4) .000 158(17.5)407(45.0) 565(62.4) .000
Rainy season 210(23.2) 130(14.4) 340(37.6) 35(3.9) 305(33.7) 340(37.6) Test date
Total 679(75.0) 226(25.0) 905(100.0) 193(21.3)712(78.7) 905(100.0)
Table 3.
The P-value of sources of water and total colony number.
P-value
N Mean Std Deviation
Reservoir River Ditch & pond Spring Well Stream
Reservoir 24 232.20 401.85 .790 .863 .947 .927 .230
River 8 466.60 1065.80 .740 .731 .785 .695
Ditch & pond 4 34.25 20.60 .877 .943 .495
Spring 156 201.10 376.36 .946 .003*
Well 5 136.00 144.97 .512
Stream 708 763.10 2390.73
Total 905 642.80 2135.45
*P-value of total number of colony between spring and stream was significantly different.
Open Access 189

ZHOU X. W. ET AL.
Open Access 190
.00
200.00
400.00
600.00
800.00
1000.00
1200.00
1400.00
1600.00
2008 20092010 2011
CFU/100mL
To talcolony#in dryseason
To talcolony#in rainyse ason
To talcolifor m#indryseaso n
To talcolifor m#inrainy
se ason
Years
Figure 1.
The mean total colony and coliform number in dry and rainy season from 2008-2011.
The Spring Water and Mi crobial Index Table 4.
The qualification of spring water with total colony number and coli-
form number.
Pu’er prefecture is a typical mountainous area, where ground
and surface water can easily form runoff of spring and stream.
Generally, compared with the other sources of water, spring
water was considered to be of a high quality. However, from
the result analysis, among the total 156 spring water samples,
the samples of total colony number which met the standard
were 89.1% and 10.9% did not. At the same time, the water
samples of total coliform number which met the standard were
50% and 50% did not. Table 4 shows the results.
Microbial Index Frequency Percent
Meet Std 139 89.1
Total colony #
Does not meet Std 17 10.9
Meet Std 78 50.0
Does not meet Std 78 50.0
Total coliform #
Total 156 100.0
Semi-Structured Interview water source again. This could be potentially a threat to health
of the human being and domestic animal. Currently, there were
still many people who did not have access to drinking water.
The priority of the current government was to make efforts to
increase access to drinking water, rather than fix current prob-
lems because of the limited funds.
Key informants of water authorities: There was only one in-
terview conducted with one official in Prefecture government.
She used a very official tone: “Everything of rural drinking
water is good. There are no problems about rural water pro-
jects”. “We completed rural projects every year according to
the rural drinking water project of the 11th Five-year Plan.
When permission to review some data and document about the
project was requested, she asked me to look for the data from
the Statistic Bureau of Pu’er Municipality. She refused my
request to review the project’s plan, management, and policies
in detail. Much information from the prefecture government
could not be collected.
Community Informants: There were 3 villages observed and
6 villagers were interviewed. The 2 community villagers who
were using the spring water, held the point of views that their
water was of very good quality. They thought the spring water
was better than any other kind of water. There was no pollution
to the water because pipes were directly connected to the mouth
of the spring. But they recognized that the water was slightly
affected in the rainy season since the water became a little bit
turbid at that time. They hoped that the government now invests
funds to help the village to construct their roads. When asked
about their drinking habits, they said: “Most of the people drink
boiled water, but some young men still drink the unboiled wa-
ter.”
Interviews were conducted with officials of Simao District
Government (a county level), which were a group of people
working in the same office. They knew that colony and coli-
form levels of rural water exceeded the national rural drinking
water standard. They acknowledged that extensive deforesta-
tion contributed to reduction of water sources. In recent years,
many places concentrated on developing commercial plants,
such as planting tea, coffee, and rubber trees. Therefore, many
of the forests with very good function of conserving the water
were replaced by planting the pine trees and other commercial
plants. In some areas, people were facing water shortages.
Therefore, protection of the forest was very crucial to regenera-
tion of the water. Second, there were many villages clustered
around the water source. The domestic sewerage was dis-
charged into the water source. It seriously affected the water
quality of the low level of stream. Third, there were many ag-
riculture fields near some of the water projects. The use of fer-
tilizer and insecticides often polluted water sources. However,
the polluted water was untreated and then converged into the
The other 2 villagers who were using the stream water wor-
ried about their drinking water very much because their drink-
ing water was drawn from stream of the mountains by the pipes.
I could see some of the water tank covered with the asbestos
tiles. When looked into tap water under the sunlight, there was
still some visual substance suspended in the water. They did not
use disinfectant or treatment facilities. While one village near
the Pu’er Municipaliy was much more developed, although
they used stream water, they bought an advanced purification
unit to treat the water for their community. They happily told
me: “Our water is good like bottle water. You can drink right
from it.”
CDPC professionals and technicians: There was one interview

ZHOU X. W. ET AL.
with a professional in Ning’er County CDPC and some infor-
mal interviews in Pu’er Prefecture CDPC including several
ones from the Lab. Both the county CDPC and prefecture
CDPC professionals were very concerned about the water qual-
ity. The county CDPC knew the circumstances about their wa-
ter quality because they tested every water sample in their cen-
ter. They said they used to test high concentration microbes in
the samples. From the interview, the professional in Ning’er
County CDPC said: “Most of the drinking water projects did
not set protection zones to protect water source in the Counties”.
However, according to The Law on Prevention and Control of
Water Pollution (Quan’guo Renming Daibiao Dahui Changwu
Weiyuanhui 全国人民代表大会常务委会, 2008), the gov-
ernment above the county level had the right to define the area
for protecting water source to conserve the water quality. Sec-
ond, “most of the water tanks had no cover, no purification and
disinfection procedures and facilities”, which could be a poten-
tial risk of microbial pollution. Third, “there are no special
persons responsible for the maintenance and running the water
facilities in the villages”.
Discussion
The rural drinking water status of Pu’er Municipality is in a
very severe situation. From the analysis of these water samples,
the percentage water samples which meet the standard is very
low, only 17.5% and water samples which do not meet the
standard predominates 82.5%. The 3 microbial indexes, the
total colony, coliform and thermo-tolerant coliform number, are
significantly above the national rural water standard, which
seriously affect the overall quality of the rural drinking water.
The high rate of the microbial index reveals the poor sanitation
of the rural community. The water may be contaminated by
human waste, which causes water-borne diseases such as diar-
rhea, typhoid, and hepatitis (Root et al., 1982). Rural commu-
nity water pollution may easily cause diarrhea and intestinal
diseases from drinking and cooking with such kinds of water.
These are the main threats to the health of the Pu’er rural resi-
dents.
The water treated by chemical and physical method is obvi-
ously better than the untreated water by comparing the micro-
bial level. The results of the analysis of the water in the regions
have demonstrated it is very necessary for regular treatment of
water to serve the population no matter what source of water
since all of them exist heath risks. On the other hand, these
methods are still quite effective when used, especially the
physical treatment. Once these facilities were established, there
will be long term benefits to the vulnerable population.
The dry season and rainy season have a great effect on the
microbial indexes. The water samples which meet the standard
in dry season are better than in rainy season. These might be
attributed to the fact that these water projects have no cover or
protected barriers. In addition, in the rainy season, the water
source especially the stream may increase density of the mi-
crobe and concentration of pollutants, such as human and ani-
mal feces and toxic metal and other indexes due to the ground
surface runoff.
The quality of spring water is better than any other main type
of water. Spring water is generally regarded as a source of safe
drinking water that many villagers think they can directly drink.
Nevertheless, the spring water still has great hazards to the
health because the total colony number in many of the spring
water samples and the total coliform number in half of the
spring water samples exceed the rural drinking water standard.
The villagers misunderstand the real situation and still take it as
a safe one. They should receive correct information so that they
can change their behaviors in regards to drinking unboiled wa-
ter.
Recommended Intervention Strategies
Designing some appropriate intervention strategies to mini-
mize the microbial amounts is important to address problems at
the policy level, which can improve the water status and help
capacity building for future drinking water projects. These fol-
lowing strategies are strongly recommended to improving water
quality in Pu’er Municipality
The health education is a long and lasting program to change
the rural community drinking and cooking behavior. It is im-
portant to continue the emphasis on health and hygiene educa-
tion, rather than physical sanitation investments only. Existing
survey results suggest that traditional approaches and measures
in dissemination of health and hygiene education may not be
sufficient (Meng, Tao, & Liu, 2004). The health departments
and government must consistently conduct health education to
the rural residents so that they are aware of the potential risks of
drinking unboiled water. The proper information must be dis-
seminated to the target population through the media, such as
TV, newspaper, internet, poster, VCD, and community loud-
speaker to improve rural residents’ compliance to drink boiled
water and try to avoid washing vegetables with unboiled water
and other unsanitary cooking methods.
Community participation in water protection is critical to
water quality improvement and project sustainability. Drinking
water is an important livelihood that local residents rely on.
They pay close attention to their project. Experience from pre-
vious studies indicates that communities usually have very high
motivation in participation and involvement in planning, con-
structing, facilities maintenance, and management (Chris, 2000).
Additionally, they have a strong responsibility to participate in
protecting the water source forest and maintain the environment
hygiene. Once the residents form the positive feeling of em-
powerment, the projects can easily succeed and move into sus-
tainable development and the government can greatly reduce
the successive investment of maintenance and management.
The drinking water project must emphasize the protection of
the water source and restoring the ecological system around
water sources. Based on the geographic location, source of
water and national law, local governments need to define the
protection zones of water sources and formulate protecting
measures and regulations. The project needs to consider build-
ing walls, barriers, and covers to protect the water from the
pollution. Secondly, the water authority’s permits are required
for discharge to water source from both sanitary and industrial
wastes. In the water source zone, the pollution control includes
these contents: prohibit the discharge of pollutants, restrict the
use of noxious fertilizer and insecticide, ban deforestation, and
exclude the placement of hazardous substances near village and
houses (Quanguo Aiguo Weisheng Yundong Weiyuanhui 全国
爱国卫生运动委员会, 2008). The government can help the
community establish regulations to protect environmental hy-
giene and forest near water sources. In the areas of ecological
system damage, a reforestation campaign needs to be conducted
to restore the original ecological system.
Open Access 191

ZHOU X. W. ET AL.
Open Access 192
Water authorities and other relevant water project depart-
ments must closely cooperate fully to communicate in design-
ing, implementing, monitoring and evaluating the project. In
rural areas, there is a lack of design engineers and reference
materials for rural water plant design. This has led to techni-
cally irrational design of some water plants (Meng, Tao, & Liu,
2004). The choice of appropriate disinfection and purification
measures and treatment facilities based on the water quality
analysis and water source must be included into the standard for
water projects. It is greatly encouraged to expand construction
of rural drinking water infrastructure, while maintaining or
even improving quality is important as well (Liu et al., 2009).
Since many water samples do not meet the rural drinking water
standard, some surveys can be conducted to explore the possi-
ble reasons from water project design and the corresponding
measures must be put forward to improve the water project.
In the rural area, the financial restraint impedes the water
project development. The government is always the subject of
investment to provide the basic service of safe drinking water.
These still included the physical and chemical treatment facili-
ties as well as the earmarked fund and personnel responsible for
the maintenance and provide chemical disinfectants. Non-gov-
ernment funds source, such as private, enterprise and other
association and organization can participate in the water con-
struction project as well and the participation can be diversified.
No matter who invests, they are accountable for state laws and
regulations. The most significant factor is to have clear property
ownership and supervision so that the owner can be designated
the relevant accountabilities and completely fulfill responsibili-
ties. Meanwhile, the supervisors can effectively undertake the
management. Finally, to small centralized water supply projects
or remote villages, ownership can through beneficiaries of vil-
lages. Thereafter, the health departments must take the physical
examination for the water maintenance personnel and relevant
departments train them how to dose appropriate disinfectant,
operate, and maintain the facilities.
The strength of the studies is that it identifies some risk fac-
tors which are associated with microbial index. Furthermore,
the study uses the national water project monitoring data which
was collected and tested by the authenticated Labs and is con-
sidered of a high accuracy of data quality. Therefore, the result
can be high validity and worth taking into account of the policy
intervention strategy.
The limitation of the study is that the semi-structured inter-
viewers’ responses in such a small scale, although reflecting
some aspects of the existing problem, can not represent the
general problems. In addition, the responses might be subjected
to each individual’s consideration of importance and lead to
refusal or difficulty to distinguish whether response is real or
created because some of them could have response bias con-
nected with their benefits. Lastly, the study design itself could
have some potential risk of the ecological study fallacy because
the inconsistencies of whole samples vs. individual-level with-
out balanced attention to the causes of them (Wikipedia Con-
tributors, 2012).
The study implicates that it is meaningful to conduct a fur-
ther study to explore the direct linkage in the analysis between
individual’s exposure to pathogenic microorganisms and their
own health outcome.
Acknowledgements
The project was sponsored by the Ford foundation Grant
ID-15090351. I wish to express my gratitude to my advisor
Prof. Jane T. Bertrand who helped me in structuring my thesis
and gave me a lot of comments and suggestions. I would like to
thank my practicum preceptor Assoc. Prof. Li Bingcheng, Pu’er
Municipal CDPC, who helped me to conduct the semi-struc-
tured interviews to collect qualitative data. Special thanks also
due to Mr. Guo Linfeng, Pu’er CDPC, who helped me in un-
derstanding the water sample data. I am also grateful to Mr.
Gabriel Cohen’, MPH candidate, Tulane University, for his
help in figuring out unclear ideas, terminologies and revising
the written English for this thesis.
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