Household Drinking Water Quality Updates

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A case study of income generation activities in Nairobi with the LifeStraw Community filter

22 July 2014 9:22 (America/New_York)

A case study of income generation activities in Nairobi with the LifeStraw Community filter, 2014.

Author: Felix Nyakundi Mangera

The LifeStraw Community filter is a 25 liter capacity filtration device which used hollow fiber membrane technology and does not need cartridges, electricity, chemicals and is easy to maintain and operate. The filter has a lifetime capacity of 80,000 liters. Access to safe drinking water is a challenge in many areas and this filter could be a solution for small scale water supply. We wanted to pilot different business models around Nairobi to see if the filter could be used for income generation. This would make the filter more interesting for microfinance projects and potential customers of the filter who would become micro-entrepreneurs.

July 23, 2014 WSUP/WASHplus Webinar – The power of creative thinking: working within and around challenging institutional frameworks

21 July 2014 12:05 (America/New_York)

The power of creative thinking: working within and around challenging institutional frameworks

Join WSUP and the WASHplus project for this webinar and discussion

  • Date:  Wednesday, July 23, 2014
  • Time: 10:00 AM – 11:00 AM EDT (New York);  15.00 PM – 16:00 PM BST (London)

Register today and reserve your webinar seat:
https://www1.gotomeeting.com/register/846901233

Regardless of the setting, the local institutional framework for water and sanitation services will have a huge impact on the design and effectiveness of a WASH programme. These frameworks are not always functioning well, so the implementing organisation must answer some basic questions: who has the mandate to provide these services and how can we help them? What is the regulatory framework and which services does it cover? What are the bottlenecks to change? In many cases, creative thinking is required to find solutions and provide essential services that comply with regulations. Drawing upon case studies from WSUP and the USAID-funded WASHplus project, this webinar will explore how service provision can be improved in contexts with less-than-perfect institutional frameworks: we invite you to participate and share your experience!

Presenters:

  • Baghi Baghirathan, Programme Director, WSUP, will talk about “Breaking the barriers to water connections in low-income urban communities: experience from Mozambique”
  • Orlando Hernandez, Monitoring & Evaluation Specialist, WASHplus, will talk about “Flexible institutional partnerships to support sustainable WASH services in Madagascar”

An interactive panel discussion will follow the presentations. Questions are welcome!

Panelists:

  • Baghi Baghirathan, Programme Director, WSUP
  • Orlando Hernandez, Monitoring & Evaluation Specialist, WASHplus
  • Andy Narracott, Deputy CEO, WSUP
  • Jonathan Annis, Sanitation and Innovation Adviser, WASHplus

ModeratorGuy Norman, Head of Evaluation, Research and Learning, WSUP

Impact of the Provision of Safe Drinking Water on School Absence Rates in Cambodia: A Quasi-Experimental Study

21 July 2014 10:30 (America/New_York)

Impact of the Provision of Safe Drinking Water on School Absence Rates in Cambodia: A Quasi-Experimental Study. PLoS One, March 2014.

Paul R. Hunter, Helen Risebro, Marie Yen, et al.

Background – Education is one of the most important drivers behind helping people in developing countries lift themselves out of poverty. However, even when schooling is available absenteeism rates can be high. Recently interest has focussed on whether or not WASH interventions can help reduce absenteeism in developing countries. However, none has focused exclusively on the role of drinking water provision. We report a study of the association between absenteeism and provision of treated water in containers into schools.

Methods and Findings – We undertook a quasi-experimental longitudinal study of absenteeism rates in 8 schools, 4 of which received one 20 L container of treated drinking water per day. The water had been treated by filtration and ultraviolet disinfection. Weekly absenteeism rates were compared across all schools using negative binomial model in generalized estimating equations. There was a strong association with provision of free water and reduced absenteeism (Incidence rate ratio = 0.39 (95% Confidence Intervals 0.27–0.56)). However there was also a strong association with season (wet versus dry) and a significant interaction between receiving free water and season. In one of the intervention schools it was discovered that the water supplier was not fulfilling his contract and was not delivering sufficient water each week. In this school we showed a significant association between the number of water containers delivered each week and absenteeism (IRR = 0.98 95%CI 0.96–1.00).

Conclusion – There appears to be a strong association between providing free safe drinking water and reduced absenteeism, though only in the dry season. The mechanism for this association is not clear but may in part be due to improved hydration leading to improved school experience for the children.

Evaluation of A Point-Of Use Water Purification System (Llaveoz) in a Rural Setting of Chiapas, Mexico

21 July 2014 10:26 (America/New_York)

Evaluation of A Point-Of Use Water Purification System (Llaveoz) in a Rural Setting of Chiapas, Mexico. J Microbiol Exp 2014, 1(3): 00015

*Corresponding author: Javier Gutierrez-Jimenez, University of Science and Arts of Chiapas, Libramiento norte poniente#1150, Col. Lajas Maciel, Tuxtla Gutierrez, Chiapas, Mexico, Tel: +52-9616170440/ 4303; E-mail: javier.gutierrez@unicach.mx

Access to potable water is a priority for highly-marginalized rural communities of Chiapas, Mexico where consumption of poorly sanitized water has fostered severe diarrheal diseases among children. Interventions aimed to reduce contaminants present in water are necessary to reduce morbidity and mortality rates. In this work we evaluated the efficiency of a point of use water purification system, Llaveoz, to eradicate total coliform (TC) bacteria and diarrheagenic E. coli (DEC) strains in 62 paired water samples obtained from households during the dry and rainy season. TC was determined by the membrane filtration method whereas DEC strains were evaluated by a multiplex PCR approach. After Llaveoz treatment, water samples collected during the dry season (N=20) had an 80.3% reduction of TC counts (p<0.05). Similarly, TC were significantly reduced (72.3%, (p<0.05)) in water samples treated during the rainy season (N=42). A total of 28 E. coli strains were isolated of which 14.3% (N=4) were identified as DEC strains (ETEC (N=2), EAEC (N=1) or EIEC (N=1)) in untreated water samples. Llaveoz-treated water did not contain DEC strains. Thus, the Llaveoz system represents an alternative method to obtain more pure water in regions where potable water sources are not available.

The Llaveoz™ water disinfection system (patent US2011/0215037 A1) consists in a plastic faucet which is placed at the base of a water container used at home for water storage; the faucet contains an ultraviolet light bulb UVC type which uses electricity (110V or 12V). Its light goes on when the faucet is opened in order to pour clean water. To eliminate suspended solids, parasites and bacteria, the faucet is connected to a microfiltration cartridge which contains polypropylene membranes with 0.1µm pore diameter. In vitro studies demonstrate that Llaveoz is able to eliminate ∼99, 100% and ∼99% of parasites, bacteria and virus, respectively. Llaveoz purification system is fabricated and distributed to rural and peri-urban communities by EOZ group, a non-profit organization funded by Flor Cassassuce with a self-funding mechanism.

Heterogeneous Effects of Information on Household Behaviors to Improve Water Quality

21 July 2014 10:21 (America/New_York)

Heterogeneous Effects of Information on Household Behaviors to Improve Water Quality, 2014.

Joe Brown, Georgia Institute of Technology – School of Civil and Environmental Engineering
Amar Hamoudi, Duke University – Sanford School of Public Policy
Marc Jeuland, Duke University
Gina Turrini, Duke University

Providing information about health risks only sometimes induces protective action. This raises questions about whether and how risk information is understood and acted upon, and how responses vary across contexts. We stratified a randomized experiment across two periurban areas in Cambodia, which differed in terms of socioeconomic status and infrastructure.

In one area, showing households specific evidence of water contamination altered their beliefs about health risk and increased their demand for a treatment product; in the other area, it had no effect on these outcomes. These findings highlight the importance of identifying specific drivers of responses to health risk information.

Health insurance and health environment: India’s subsidized health insurance in a context of limited water and sanitation services

21 July 2014 10:17 (America/New_York)

Health insurance and health environment: India’s subsidized health insurance in a context of limited water and sanitation services, 2014.

Florence McBain, Zentrum für EntwicklungsforschungCenter for Development ResearchUniversity of Bonn.

Recently, many emerging countries have established subsidized health insurance schemes to provide financial protection and support access to health care to poor households. The challenge to ensure the long term sustainability of such schemes is huge. In this paper, the impact of the health environment on the long term sustainability of a health insurance is explored, focusing on water and sanitation. India offers an interesting case to explore this question.

Indeed, since 2008 India launched a fully subsidized health insurance Rashtriya Swasthya Bima Yojana (RSBY) in a context where 56% of its population does not have access to safe sanitation and 8% do not have access to safe water (JMP, 2012). A framework is proposed linking water supply and sanitation; health status of the insured population; health insurance and the productivity of households. Next, based on a literature review, the outcomes of investments in water and sanitation and health insurance are reviewed and the potential synergies and trade-offs of combing these investments are explored. In a last section, the case of India is analysed in detail, with international comparisons and further research lines are proposed.

 

Looking beyond Technology: An Integrated Approach to Water, Sanitation and Hygiene in Low Income Countries

17 July 2014 10:22 (America/New_York)

Looking beyond Technology: An Integrated Approach to Water, Sanitation and Hygiene in Low Income Countries. Env Sci Tech, July 2014.

Elizabeth Tilley, Linda Strande, Christoph Lüthi, Hans-Joachim Mosler, Kai M. Udert, Heiko Gebauer, and Janet G. Hering

Despite investment stimulated by the Millennium Development Goals (MDGs), sanitation-related diseases, such as diarrhea, cholera and typhus, remain a leading cause of death of children under five in low-income countries. Prevention of diarrhea requires a combination of access to safe drinking water, good hygiene and adequate sanitation. The sanitation problem has proven to be particularly intractable, demonstrating the shortcomings of past efforts that have focused on increasing access to toilets.

An alternative view positions the toilet within a service chain that extends to the final point of disposal or end-use of excreta-derived products. An integrated perspective that addresses improved planning, takes advantage of economic opportunities, incorporates specialized technology, and follows-up with behavior change could help to ensure not only access but also sustainable use, operation and maintenance of water, sanitation and hygiene interventions.

 

Association between Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study (GEMS) and Types of Handwashing Materials Used by Caretakers in Mirzapur, Bangladesh

17 July 2014 10:16 (America/New_York)

Association between Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study (GEMS) and Types of Handwashing Materials Used by Caretakers in Mirzapur, Bangladesh. Am J Trop Med Hyg. 2014 Jul 2;91(1):181-9.

Authors: Baker KK, et al.

Abstract: Handwashing practices among caretakers of case and control children < 5 years of age enrolled in the Global Enteric Multicenter Study in Mirzapur, Bangladesh were characterized and analyzed for association with moderate-to-severe diarrhea. Soap or detergent ownership was common, yet 48% of case and 47.7% of control caretakers also kept ashes for handwashing, including 36.8% of the wealthiest households. Soap, detergent, and ash were used for multiple hygiene purposes and were kept together at handwashing areas. Caretakers preferred soap for handwashing, but frequently relied on ash, or a detergent/ash mixture, as a low-cost alternative. Moderate-to-severe diarrhea was equally likely for children of caretakers who kept soap versus those who kept ash (matched OR = 0.91; 0.62-1.32). Contact with ash and water reduced concentrations of bacterial enteropathogens, without mechanical scrubbing. Thus, washing hands with ash is a prevalent behavior in Mirzapur and may help diminish transmission of diarrheal pathogens to children.

Estimates of the WASH-related Global Burden of Disease

7 July 2014 14:31 (America/New_York)

Below are abstracts and links to the full-text of articles in the August 2014 issue of  Tropical Medicine and International Health Focus on the Global Burden of Disease from Water While the methods of Global Burden of Disease (GBD) study continue to evolve, recent changes raise questions about the basis of new estimates of the risk associated with water, sanitation and hygiene and warrant consideration of alternative approaches.

  • ​Inadequate water, sanitation and hygiene are estimated to have caused 842,000 deaths from diarrhoea in 2012, i.e., 1.5% of deaths worldwide. These include 361,000 deaths of children under five years.
  • ​A systematic review of the global prevalence of handwashing with soap and its effect on diarrhoeal diseases estimates that only 19% of the world’s population washes hands with soap after contact with excreta and that handwashing reduces the risk of diarrhoeal disease by 23%–40%.
  • ​Based on over 300 studies from a systematic review, an estimated 1.1 billion people are exposed to a drinking water source of moderate to high risk.
  • ​A meta-regression shows that risks of diarrhoea from inadequate drinking water and sanitation could be reduced considerably through targeted interventions. Risk differences depend on type of intervention.

1 – Authors:  Clasen, Thomas, Pruss-Ustun, Annette, Mathers, Colin D., et al. TI  - Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods Abstract - http://onlinelibrary.wiley.com/doi/10.1111/tmi.12330/abstract AB  - The 2010 global burden of disease (GBD) study represents the latest effort to estimate the global burden of disease and injuries and the associated risk factors. Like previous GBD studies, this latest iteration reflects a continuing evolution in methods, scope and evidence base. Since the first GBD Study in 1990, the burden of diarrhoeal disease and the burden attributable to inadequate water and sanitation have fallen dramatically. While this is consistent with trends in communicable disease and child mortality, the change in attributable risk is also due to new interpretations of the epidemiological evidence from studies of interventions to improve water quality. To provide context for a series of companion papers proposing alternative assumptions and methods concerning the disease burden and risks from inadequate water, sanitation and hygiene, we summarise evolving methods over previous GBD studies. We also describe an alternative approach using population intervention modelling. We conclude by emphasising the important role of GBD studies and the need to ensure that policy on interventions such as water and sanitation be grounded on methods that are transparent, peer-reviewed and widely accepted. 2 – Authors: Prüss-Ustün, Annette, Bartram, Jamie, Clasen, Thomas,  et al. TI  - Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries

Full text - http://onlinelibrary.wiley.com/doi/10.1111/tmi.12329/pdf

Objective - To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. Methods - For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Results - In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group. Conclusions - This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene. 3 – Authors: Freeman, Matthew C., Stocks, Meredith E., Cumming, Oliver,  et al. TI  - Systematic review: Hygiene and health: systematic review of handwashing practices worldwide and update of health effects

Full text: http://onlinelibrary.wiley.com/doi/10.1111/tmi.12339/pdf Objective - To estimate the global prevalence of handwashing with soap and derive a pooled estimate of the effect of hygiene on diarrhoeal diseases, based on a systematic search of the literature.

Methods – Studies with data on observed rates of handwashing with soap published between 1990 and August 2013 were identified from a systematic search of PubMed, Embase and ISI Web of Knowledge. A separate search was conducted for studies on the effect of hygiene on diarrhoeal disease that included randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined. The search used Cochrane Library, Global Health, BIOSIS, PubMed, and Embase databases supplemented with reference lists from previously published systematic reviews to identify studies published between 1970 and August 2013. Results were combined using multilevel modelling for handwashing prevalence and meta-regression for risk estimates. Results - From the 42 studies reporting handwashing prevalence we estimate that approximately 19% of the world population washes hands with soap after contact with excreta (i.e. use of a sanitation facility or contact with children’s excreta). Meta-regression of risk estimates suggests that handwashing reduces the risk of diarrhoeal disease by 40% (risk ratio 0.60, 95% CI 0.53–0.68); however, when we included an adjustment for unblinded studies, the effect estimate was reduced to 23% (risk ratio 0.77, 95% CI 0.32–1.86). Conclusions- Our results show that handwashing after contact with excreta is poorly practiced globally, despite the likely positive health benefits. 4 – Authors: Bain, Robert, Cronk, Ryan, Hossain, Rifat,  et al. TI  - Global assessment of exposure to faecal contamination through drinking water based on a systematic review Full text: http://onlinelibrary.wiley.com/doi/10.1111/tmi.12334/pdf Objectives - To estimate exposure to faecal contamination through drinking water as indicated by levels of Escherichia coli (E. coli) or thermotolerant coliform (TTC) in water sources. Methods - We estimated coverage of different types of drinking water source based on household surveys and censuses using multilevel modelling. Coverage data were combined with water quality studies that assessed E. coli or TTC including those identified by a systematic review (n = 345). Predictive models for the presence and level of contamination of drinking water sources were developed using random effects logistic regression and selected covariates. We assessed sensitivity of estimated exposure to study quality, indicator bacteria and separately considered nationally randomised surveys. Results - We estimate that 1.8 billion people globally use a source of drinking water which suffers from faecal contamination, of these 1.1 billion drink water that is of at least ‘moderate’ risk (>10 E. coli or TTC per 100 ml). Data from nationally randomised studies suggest that 10% of improved sources may be ‘high’ risk, containing at least 100 E. coli or TTC per 100 ml. Drinking water is found to be more often contaminated in rural areas (41%, CI: 31%–51%) than in urban areas (12%, CI: 8–18%), and contamination is most prevalent in Africa (53%, CI: 42%–63%) and South-East Asia (35%, CI: 24%–45%). Estimates were not sensitive to the exclusion of low quality studies or restriction to studies reporting E. coli. Conclusions - Microbial contamination is widespread and affects all water source types, including piped supplies. Global burden of disease estimates may have substantially understated the disease burden associated with inadequate water services. 5 – Authors: Wolf, Jennyfer, Prüss-Ustün, Annette, Cumming, Oliver, et al. TI  - Systematic review: Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression

Full text: http://onlinelibrary.wiley.com/doi/10.1111/tmi.12331/pdf Objective - To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings. Methods - The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa–Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates. Results - Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12 515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions. Conclusions - The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented.

Synthetic organic water contaminants in developing communities: an overlooked challenge addressed by adsorption with locally generated char

1 July 2014 10:19 (America/New_York)

Synthetic organic water contaminants in developing communities: an overlooked challenge addressed by adsorption with locally generated char. Journal of Water, Sanitation and Hygiene for Development, In Press

  • Order info or contact Joshua Kearns at the email below to request a reprint.

Joshua P. Kearns, Detlef R. U. Knappe and R. Scott Summers

Department of Civil, Environmental, & Architectural Engineering, University of Colorado-Boulder, 1111 Engineering Dr, ECOT 441, UCB 428, Boulder, CO 80309, USA E-mail: joshua.kearns@colorado.edu
Department of Civil, Construction, & Environmental Engineering, North Carolina State University, 2501 Stinson Dr, Campus Box 7908, Raleigh, NC 27695, USA

Chemical contamination of drinking water sources is a worldwide problem. However, few locally managed, sustainable, and low-cost on-site treatment technologies are available in rural, remote, and emergency/disaster relief/humanitarian crisis situations. Char filter-adsorbers have been used to treat drinking water for thousands of years and are still widely used today. Our studies show that some chars produced by traditional means from a range of feedstocks develop favorable sorption properties for uptake of 2,4-dichlorophenoxyacetic acid (2,4-D), a prevalent herbicide and water contaminant. However, more energy efficient, environmentally sustainable and scalable production of consistent highly sorptive chars can be accomplished with biomass gasification. Our laboratory studies demonstrate that locally produced char adsorbents derived from surplus agricultural and forestry biomass are effective for adsorbing 2,4-D. A year-long study of field-scale application of chars in Thailand is also presented. Based on these studies we present design recommendations for integrating char adsorbers into low-cost, multi-barrier treatment trains for on-site water provision.

Marketing Household Water Treatment: Willingness to Pay Results from an Experiment in Rural Kenya

26 June 2014 13:05 (America/New_York)

Marketing Household Water Treatment: Willingness to Pay Results from an Experiment in Rural Kenya. Water 2014, 6, 1873-1886; doi:10.3390/w6071873.

Annalise G. Blum 1, Clair Null 2 and Vivian Hoffmann 3,*
1 Department of Environmental Sciences & Engineering, University of North Carolina at Chapel Hill, 148 Rosenau Hall, Chapel Hill, NC 27516, USA; E-Mail: annalise@live.unc.edu
2 Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; E-Mail: clair.null@emory.edu
3 International Food Policy Research Institute, 2033 K Street NW, Washington, DC 20006, USA
* Author to whom correspondence should be addressed; E-Mail: v.hoffmann@cgiar.org

Despite increasing availability of household water treatment products, demand in developing countries remains low. Willingness to pay for water treatment products and factors that affect demand are not well understood. In this study, we estimate willingness to pay for WaterGuard, a dilute chlorine solution for point-of-use water treatment, using actual purchase decisions at randomly assigned prices. Secondly, we identify household characteristics that are correlated with the purchase decision. Among a sample of 854 respondents from 107 villages in rural Kenya, we find that mean willingness to pay is approximately 80% of the market price. Although only 35% of sample households purchased WaterGuard at the market price, 67% of those offered a 50% discount purchased the product.

A marketing message emphasizing child health did not have a significant effect on purchase behavior, overall or among the subset of households with children under five. These findings suggest that rural Kenyans are willing to pay for WaterGuard at low prices but are very sensitive to increasing price. Households with young children that could benefit the most from use of WaterGuard do not appear to be more likely to purchase the product, and a marketing message designed to target this population was ineffective.

MS2 Bacteriophage Reduction and Microbial Communities in Biosand Filters

25 June 2014 13:13 (America/New_York)

MS2 Bacteriophage Reduction and Microbial Communities in Biosand Filters. Environ Sci Technol. 2014 Jun.

Wang H, et al.

This study evaluated the role of physical and biological filter characteristics on the reduction of MS2 bacteriophage in biosand filters (BSFs). Three full-scale concrete Version 10 BSFs, each with a 55 cm sand media depth and a 12 L charge volume, reached 4 log10 reduction of MS2 within 43 days of operation. A consistently high reduction of MS2 between 4 log10 and 7 log10 was demonstrated for up to 294 days. Further examining one of the filters revealed that an average of 2.8 log10 reduction of MS2 was achieved within the first 5 cm of the filter, and cumulative virus reduction reached an average of 5.6 log10 after 240 days. Core sand samples from this filter were taken for protein, carbohydrate, and genomic extraction. Higher reduction of MS2 in the top 5 cm of the sand media (0.56 log10 reduction per cm vs 0.06 log10 reduction per cm for the rest of the filter depth) coincided with greater diversity of microbial communities and increased concentrations of carbohydrates.

In the upper layers, “Candidatus Nitrosopumilus maritimus” and “Ca. Nitrospira defluvii” were found as dominant populations, while significant amounts of Thiobacillus-related OTUs were detected in the lower layers. Proteolytic bacterial populations such as the classes Sphingobacteria and Clostridia were observed over the entire filter depth. Thus, this study provides the first insight into microbial community structures that may play a role in MS2 reduction in BSF ecosystems. Overall, besides media ripening and physical reduction mechanisms such as filter depth and long residence time (45 min vs 24 ± 8.5 h), the establishment of chemolithotrophs and proteolytic bacteria could greatly enhance the reduction of MS2.

The toilet tripod: Understanding successful sanitation in rural India.

25 June 2014 13:04 (America/New_York)

The toilet tripod: Understanding successful sanitation in rural India. Health Place. 2014 Jun 19.

O’Reilly K, Louiss׳ E.

Building toilets and getting people to use them is critical for public health. We deployed a political ecology approach specifically to identify the multi-scalar political, economic, and environmental factors influencing toilet adoption in rural India. The research used ethnographic and technical methods in rural villages of West Bengal and Himachal Pradesh over the period September 2012 to May 2013. The elements of successful sanitation adoption depended on three factors (i.e., toilet tripod):

  • (1) multi-scalar political will on the part of both government and NGOs over the long term;
  • (2) proximate social pressure, i.e., person-to-person contact between rural inhabitants and toilets;
  • (3) political ecology, i.e., assured access to water, compatible soil type, and changing land use.

This research contributes to studies of sustainable development and global public health by developing a theory and framework for successful sanitation.

Ceramic water filters impregnated with silver nanoparticles as a point-of-use water-treatment intervention for HIV-positive individuals

25 June 2014 12:58 (America/New_York)

Ceramic water filters impregnated with silver nanoparticles as a point-of-use water-treatment intervention for HIV-positive individuals in Limpopo Province, South Africa: a pilot study of technological performance and human health benefits. J Water Health. 2014 Jun.

Abebe LS, et al.

Waterborne pathogens present a significant threat to people living with the human immunodeficiency virus (PLWH). This study presents a randomized, controlled trial that evaluates whether a household-level ceramic water filter (CWF) intervention can improve drinking water quality and decrease days of diarrhea in PLWH in rural South Africa. Seventy-four participants were randomized in an intervention group with CWFs and a control group without filters. Participants in the CWF arm received CWFs impregnated with silver nanoparticles and associated safe-storage containers. Water and stool samples were collected at baseline and 12 months. Diarrhea incidence was self-reported weekly for 12 months.

The average diarrhea rate in the control group was 0.064 days/week compared to 0.015 days/week in the intervention group (p < 0.001, Mann-Whitney). Median reduction of total coliform bacteria was 100% at enrollment and final collection. CWFs are an acceptable technology that can significantly improve the quality of household water and decrease days of diarrhea for PLWH in rural South Africa.

Safety of packaged water distribution limited by household recontamination in rural Cambodia

25 June 2014 12:52 (America/New_York)

Safety of packaged water distribution limited by household recontamination in rural Cambodia. J Water Health. 2014 Jun.

Holman EJ, Brown J.

Packaged water treatment schemes represent a growing model for providing safer water in low-income settings, yet post-distribution recontamination of treated water may limit this approach. This study evaluates drinking water quality and household water handling practices in a floating village in Tonlé Sap Lake, Cambodia, through a pilot cross-sectional study of 108 households, approximately half of which used packaged water as the main household drinking water source.

We hypothesized that households purchasing drinking water from local packaged water treatment plants would have microbiologically improved drinking water at the point of consumption. We found no meaningful difference in microbiological drinking water quality between households using packaged, treated water and those collecting water from other sources, including untreated surface water, however.

Households’ water storage and handling practices and home hygiene may have contributed to recontamination of drinking water. Further measures to protect water quality at the point-of-use may be required even if water is treated and packaged in narrow-mouthed containers.

Business model innovation in the water sector in developing countries

25 June 2014 12:49 (America/New_York)

Business model innovation in the water sector in developing countries. Sci Total Environ. 2014 Aug

Gebauer H, et al.

Various technologies have been deployed in household devices or micro-water treatment plants for mitigating fluoride and arsenic, and thereby provide safe and affordable drinking water in low-income countries. While the technologies have improved considerably, organizations still face challenges in making them financially sustainable. Financial sustainability questions the business models behind these water technologies.

This article makes three contributions to business models in the context of fluoride and arsenic mitigation. Firstly, we describe four business models: A) low-value devices given away to people living in extreme poverty, B) high-value devices sold to low-income customers, C) communities as beneficiaries of micro-water treatment plants and D) entrepreneurs as franchisees for selling water services and highlight the emergence of hybrid business models.

Secondly, we show current business model innovations such as cost transparency & cost reductions, secured & extended water payments, business diversification and distribution channels.

Thirdly, we describe skills and competencies as part of capacity building for creating even more business model innovations. Together, these three contributions will create more awareness of the role of business models in scaling-up water treatment technologies.

Global assessment of exposure to faecal contamination through drinking water based on a systematic review

5 June 2014 15:51 (America/New_York)

Global assessment of exposure to faecal contamination through drinking water based on a systematic review. Trop Med Intl Health, May 2014.

Robert Bain, et al.

OBJECTIVES – To estimate exposure to faecal contamination through drinking water as indicated by levels of Escherichia coli (E. coli) or thermotolerant coliform (TTC) in water sources.

METHODS: We estimated coverage of different types of drinking water source based on household surveys and censuses using multilevel modelling. Coverage data were combined with water quality studies that assessed E. coli or TTC including those identified by a systematic review (n = 345). Predictive models for the presence and level of contamination of drinking water sources were developed using random effects logistic regression and selected covariates. We assessed sensitivity of estimated exposure to study quality, indicator bacteria and separately considered nationally randomised surveys.

RESULTS: We estimate that 1.8 billion people globally use a source of drinking water which suffers from faecal contamination, of these 1.1 billion drink water that is of at least ‘moderate’ risk (>10 E. coli or TTC per 100 ml). Data from nationally randomised studies suggest that 10% of improved sources may be ‘high’ risk, containing at least 100 E. coli or TTC per 100 ml. Drinking water is found to be more often contaminated in rural areas (41%, CI: 31%-51%) than in urban areas (12%, CI: 8-18%), and contamination is most prevalent in Africa (53%, CI: 42%-63%) and South-East Asia (35%, CI: 24%-45%). Estimates were not sensitive to the exclusion of low quality studies or restriction to studies reporting E. coli.

CONCLUSIONS: Microbial contamination is widespread and affects all water source types, including piped supplies. Global burden of disease estimates may have substantially understated the disease burden associated with inadequate water services.

Assessing the impact of drinking water and sanitation on diarrhoeal disease

5 June 2014 15:43 (America/New_York)

Assessing the impact of drinking water and sanitation on diarrhoeal disease in low-and middle-income settings: systematic review and meta-regression. Trop Med Intl Health, May 2014.

Jennyfer Wolf, et al.

Objective - To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings.

Methods - The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa–Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates.

Results - Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12 515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions.

Conclusions - The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented.

Assessing point-of-use ultraviolet disinfection for safe water in urban developing communities

5 June 2014 15:37 (America/New_York)

Assessing point-of-use ultraviolet disinfection for safe water in urban developing communities. Journal of Water and Health In Press, 2014.

Christina K. Barstow, Aaron D. Dotson and Karl G. Linden

Residents of urban developing communities often have a tap in their home providing treated and sometimes filtered water but its microbial quality cannot be guaranteed. Point-of-use (POU) disinfection systems can provide safe drinking water to the millions who lack access to clean water in urban communities. While many POU systems exist, there are several concerns that can lead to low user acceptability, including low flow rate, taste and odor issues, high cost, recontamination, and ineffectiveness at treating common pathogens.

An ultraviolet (UV) POU system was constructed utilizing developing community-appropriate materials and simple construction techniques based around an inexpensive low-wattage, low pressure UV bulb. The system was tested at the bench scale to characterize its hydrodynamic properties and microbial disinfection efficacy. Hydraulically the system most closely resembled a plug flow reactor with minor short-circuiting. The system was challenge tested and validated for a UV fluence of 50 mJ/cm2 and greater, over varying flow rates and UV transmittances, corresponding to a greater than 4 log reduction of most pathogenic bacteria, viruses, and protozoa of public health concern.

This study presents the designed system and testing results to demonstrate the potential architecture of a low-cost open-source UV system for further prototyping and field-testing.

Water Filter Provision and Home-Based Filter Reinforcement Reduce Diarrhea in Kenyan HIV-Infected Adults

21 May 2014 9:56 (America/New_York)

Am J Trop Med Hyg. 2014 May 19.

Water Filter Provision and Home-Based Filter Reinforcement Reduce Diarrhea in Kenyan HIV-Infected Adults and Their Household Members.

Authors: Pavlinac PB, Naulikha JM, et al.

Among human immunodeficiency virus (HIV) -infected adults and children in Africa, diarrheal disease remains a major cause of morbidity and mortality. We evaluated the effectiveness of provision and home-based reinforcement of a point-of-use water filtration device to reduce diarrhea among 361 HIV-infected adults in western Kenya by comparing prevalence of self-reported diarrhea before and after these interventions. After provision of the filter, 8.7% of participants reported diarrhea compared with 17.2% in the 3 months before filter provision (odds ratio [OR] = 0.39, 95% confidence interval [95% CI] = 0.23-0.66, P < 0.001).

The association was similar among 231 participants who were already taking daily cotrimoxazole prophylaxis before being given a filter (OR = 0.47, 95% CI = 0.25-0.88, P = 0.019). Educational reinforcement was also associated with a modest reduction in self-reported diarrhea (OR = 0.50, 95% CI = 0.20-0.99, P = 0.047). Provision and reinforcement of water filters may confer significant benefit in reducing diarrhea among HIV-infected persons, even when cotrimoxazole prophylaxis is already being used.​

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