Quality and access to water for human consumption: a look at the state of Amazonas, Brazil. / Qualidade e acesso à água para consumo humano: um olhar sobre o estado do Amazonas, Brasil.

Surveillance indicators of the quality of water for human consumption in the Amazon were analysed from 2016 to 2020 using 185,528 samples from 11 microregions. Of the samples analysed, 93.20% were from urban areas, 66.65% were from the public water supply system (WSS), 31.02% were from the Collective Alternative Solution-CAS, and 2.33% from the Individual Alternative Solution-IAS. There was an increase in the number of records by the WSS, with a downwards trend and fluctuations in records for the CAS and the IAS. The quality indicators of chemical and physical parameters for urban areas were higher than those for rural areas and traditional communities. Most of the samples presented pH values below the recommended level. In the quantification of microbiological parameters, a higher presence of total coliforms and E. coli was identified in samples from rural areas and in traditional communities. In conclusion, there were inadequacies in the chemical, physical and microbiological parameters as well as problems related to the supply, storage and surveillance of water distributed for human consumption. These findings indicate the need to build an agenda for public management to address water insecurity and its likely effects on food insecurity in the region.

Analisaram-se indicadores de vigilância da qualidade da água para consumo humano no Amazonas, de 2016 a 2020, utilizando 185.528 amostras provenientes de 11 microrregiões. Das amostras analisadas, 93,20% são da área urbana, 66,65% provinham do sistema público (SAA), 31,02% da Solução Alternativa Coletiva (SAC) e 2,33% da Solução de Alternativa Individual (SAI). Observou-se aumento do número de registros pelo SAA, com tendência de queda e oscilações de registros para a SAC e a SAI. Os indicadores de qualidade dos parâmetros químicos e físicos da área urbana foram superiores aos das áreas rurais e de comunidades tradicionais. A maior parte das amostras apresentou valores de pH abaixo do recomendado. Na quantificação dos parâmetros microbiológicos, identificou-se maior presença de coliformes totais e E.coli na área rural e em comunidades tradicionais. Em conclusão, verificaram-se inadequações nos parâmetros químicos, físicos e microbiológicos, assim como problemas relativos ao abastecimento, armazenamento e à vigilância da água distribuída para consumo humano. Tais achados indicam a necessidade de construir uma agenda, pela gestão pública, para o enfrentamento da insegurança hídrica e seus prováveis efeitos sobre a insegurança alimentar existente na região.

Clinical Implications of New Drinking Water Regulation for "Forever Chemicals".

This Viewpoint describes new maximum contaminant levels set by the Environmental Protection Agency for specific perfluoroalkyl and polyfluoroalkyl substances (PFASs) and discusses the role clinicians can play in addressing their patients' PFAS health concerns.

Water, sanitation, and hygiene access among people who inject drugs in Tijuana and San Diego in 2020-2021: a cross-sectional study.

BACKGROUND: Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. METHODS: In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. RESULTS: Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing. CONCLUSION: WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.

A critical review of risk matrices used in water safety planning: improving risk matrix construction.

Risk matrices are used in water safety planning to prioritize improvements to drinking water systems. While water safety plans (WSPs) are promoted globally, no study has evaluated whether risk matrices are comprehensively constructed to accurately assess risk. We used risk matrix criteria adapted from previous risk matrix research to evaluate risk matrices found in twelve templates across global jurisdictions. WSP templates were found using the WSPortal website and definitions of likelihood and impact were extracted from each template to assist in the evaluation of WSP risk matrices. Application of the criteria developed from a detailed mathematical analysis by revealed that 11 of 12 risk matrices evaluated contravene at least one of the risk matrix criteria. Furthermore, definitions of likelihood and impact varied widely across different jurisdictions, due in part to the system specific nature of the WSP methodology. To improve risk matrix construction, we recommend: setting clearer risk level boundary criteria, aligning specific impact category definitions with water system objectives, and selecting specific impact categories as opposed to defining impact in several ways. Finally, we recommend risk matrix construction be reviewed as part of the WSP process to ensure accurate identification of key risks in a water system.

Comparison of potential drinking water source contamination across one hundred U.S. cities.

Drinking water supplies of cities are exposed to potential contamination arising from land use and other anthropogenic activities in local and distal source watersheds. Because water quality sampling surveys are often piecemeal, regionally inconsistent, and incomplete with respect to unregulated contaminants, the United States lacks a detailed comparison of potential source water contamination across all of its large cities. Here we combine national-scale geospatial datasets with hydrologic simulations to compute two metrics representing potential contamination of water supplies from point and nonpoint sources for over a hundred U.S. cities. We reveal enormous diversity in anthropogenic activities across watersheds with corresponding disparities in the potential contamination of drinking water supplies to cities. Approximately 5% of large cities rely on water that is composed primarily of runoff from non-pristine lands (e.g., agriculture, residential, industrial), while four-fifths of all large cities that withdraw surface water are exposed to treated wastewater in their supplies.

Nontyphoidal Salmonella among Children under 5 Years Old in Sub-Saharan Africa and South Asia in the Global Enteric Multicenter Study.

Factors associated with nontyphoidal Salmonella (NTS) infection have not been well characterized to date. We aimed to compare the associated factors among children under age 5 years with NTS infection in sub-Saharan Africa and South Asia. Data from children having moderate-to-severe diarrhea (MSD) and asymptomatic children with NTS isolated from fecal specimens were extracted from the Global Enteric Multicenter Study (GEMS), conducted from December 2007 to March 2011. Compared with NTS-negative children, NTS-associated MSD cases in South Asia were associated with the presence of goat in the house (adjusted odds ratio [aOR]: 2.15; 95% confidence interval [CI]: 1.25-3.70) and handwashing after handling an animal (aOR: 2.26; 95% CI: 1.36-3.74). In sub-Saharan Africa, children with NTS associated MSD had a greater association with stunting (1.21 95% CI: 1.01-1.45), longer duration of diarrhea (aOR: 1.25 95% CI: 1.19-1.31); presence of cow in house (aOR: 1.54 95% CI: 1.09-2.16), handwashing after handling animal (aOR: 2.41 95% CI: 1.74-3.33). Drinking tube well water (aOR: 0.54 95% CI: 0.32-0.91), availability of toilet facility (aOR: 0.58 95% CI: 0.53-0.65), and handwashing before eating (aOR: 0.76 95% CI: 0.57-1.00) and after defecation (aOR: 0.80 95% CI: 0.69, 0.94) were found to be protective. The differentials between children of both regions having fecal NTS are distinct and underscore the need for policymaking for preventive and control strategies targeting stunted children.

An Application of the Integrated Behavioral Model for Water, Sanitation and Hygiene to Assess Perceived Community Acceptability and Feasibility of the Biosand Filter among Maasai Pastoralists in Rural Tanzania.

In addition to diarrheal disease risk, lack of access to safe water may have other indirect effects throughout one's life, such as school and workplace absenteeism, leading to less economic productivity. In contexts with scarce resources and unsafe drinking water, household water treatment and safe storage options such as the Biosand filter (BSF) allows households to directly reduce contamination and increase the quality of their drinking water. This study aimed to develop an understanding of perceived community acceptability and feasibility related to pre- and post-implementation of a BSF pilot project in rural Maasai households in the Ngorongoro Conservation Area (NCA), Tanzania. The study was guided by the Integrated Behavioral Model for Water Sanitation and Hygiene interventions (IBM-WASH) to understand the various factors influencing end-user perceptions of the BSF. In-depth interviews, group discussions and think tanks were conducted among a cross-section of community members, stakeholders, and other actors from May 2016 to September 2017. The data were analyzed using a thematic content analysis approach. A range of perceived contextual, technological, and psychosocial factors were found to potentially affect the acceptability and feasibility of BSF adoption in the NCA, highlighting the complex layers of influences in the setting. Whilst the BSF is seemingly an accepted option to treat water within the NCA, the community identified key barriers that may lower BSF adoption. The application of the IBM-WASH model served as a useful framework for evaluating the introduction of the BSF, identifying insights into contextual, technological, and psychosocial community factors.

Unequal geographic distribution of water and sanitation at the household and school level in Sudan.

The Sudanese Government launched the National SDG-6 Plan and commences its implementation to achieve and sustain universal and equitable access to basic WASH services by 2030. It is critical to understand the geographical heterogeneity of Sudan and patterns in the inequality of access to safe drinking water and sanitation. Through such research, the disease control strategy can be optimized, and resource allocation can be prioritized. We explored spatial heterogeneity and inequality in access to improved water and sanitation across Sudan by mapping the coverage at both the state and district levels. We decomposed the inequality across Sudan into within-state, between-state, within-district, and between-state inequalities using the Theil L and Theil T indices. We calculated the Gini coefficient to assess the inequality of access to improved water and sanitation, based on the deviation of the Lorenz curve from the line of perfect equality. The study population was 105,167 students aged 8-13 at 1,776 primary schools across the country. Geographical heterogeneity was prominent in the Central Darfur, South Darfur, East Darfur, Kassala, West Kordofan, and Blue Nile States, all of which showed severe inequality in access to an improved latrine at the household level in terms of the Theil T or Theil L index. The overall inequality in the coverage of improved sanitation went beyond the warning limit of 0.4 for the Gini coefficient. The inequality in terms of the Theil L and Theil T indices, as well as the Gini coefficient, was always higher for improved sanitation than for improved water at the household level. Within-state inequality accounted for 66% or more of national inequalities in the distribution of improved sanitation and drinking water for both the Theil L and Theil T indices. This is the first study to measure geographical heterogeneity and inequalities in improved water and sanitation coverage across Sudan. The study may help to prioritize resource allocation to areas with the greatest water and sanitation needs.

Assessing tap water awareness: The development of an empirically-based framework.

Despite the often emphasized importance of water awareness, and notwithstanding the fact that calls for increasing public awareness are becoming commonplace, most studies do not define the concept, let alone operationalise it into measurable units. This is, however, essential to measure and evaluate efforts related to water awareness such as public campaigns, customer communication and behavioural interventions. To address this gap, we conceptualise, operationalise and assess tap water awareness, hereby differentiating between cognitive awareness (head), affectional awareness (heart), and behavioural awareness (hands). In parallel, we also differentiate between tap water quality, quantity and system. By building on a variety of contemporary conceptual insights in literature and a series of expert interviews, an assessment framework is developed. A cohesive set of nine awareness components are identified and operationalised into a set of tangible questions which are put to the test in a large-scale online survey (n = 1003) in the Netherlands, applying both a traditional and modern segmentation approach based on four types of perspectives ('quality & health concerned', 'aware & committed', 'egalitarian & solidary', and 'down to earth & confident'). Based on the analysis of the results of the first empirical application of our tap water awareness assessment framework, we conclude that-with a score 53.5 points out of 100-tap water awareness in the Netherlands shows ample room for improvement. Interestingly, most significant variations in awareness are generally not related to sociodemographic factors but rather apply to the four customer perspectives on drinking water that are based on people's subjective views and preferences.

Cholera risk in cities in Uganda: understanding cases and contacts centered strategy (3CS) for rapid cholera outbreak control.

INTRODUCTION: in the recent past, cities in sub-Saharan Africa have reported serious cholera outbreaks that last for several months. Uganda is one of the African countries where cities are prone to cholera outbreaks. Studies on cholera in Bangladesh show increased risk of cholera for the immediate household members (contacts) yet the control interventions mainly target cases with little or no focus on contacts. This study aimed to describe the rapid control of cholera outbreaks in Kampala and Mbale cities, Uganda, using, "Cases and Contacts Centered Strategy (3CS)" that consisted of identification and treatment of cases, promotion of safe water, sanitation, hygiene (WaSH) and selective chemoprophylaxis for the contacts. METHODS: a cross-sectional study was conducted in 2015-2016 in the Kampala and Mbale cities during cholera outbreaks. Cholera cases were treated and 816 contacts from 188 households were listed and given cholera preventive packages. Data were collected, cleaned, analysed and stored in spreadsheet. Comparison of categories was done using Chi-Square test. RESULTS: a total of 58 and 41 confirmed cholera cases out of 318 and 153 suspected cases were recorded in Kampala and Mbale cities respectively. The outbreaks lasted for 41 days in both cities. Case fatality rates were high; 12.1% (5/41) for Mbale city and 1.7% (1/58) for Kampala city. Fifty-five percent (210/379) of stool samples were tested by culture to confirm V. choleraeO1. No contacts listed and given cholera preventive package developed cholera. Both sexes and all age groups were affected. In Kampala city, the males were more affected than the females in the age groups less than 14 years, p-value of 0.0097. CONCLUSION: this study showed that by implementing 3CS, it was possible to rapidly control cholera outbreaks in Kampala and Mbale cities and no cholera cases were reported amongst the listed household contacts. The findings on 3CS and specifically, selective antibiotic chemoprophylaxis for cholera prevention, could be used in similar manner to oral cholera vaccines to complement the core cholera control interventions (disease surveillance, treatment of cases and WaSH). However, studies are needed to guide such rollout and to understand the age-sex differences in Kampala city.

Study of some risk factors for fungal contamination of dental unit waterlines in Alexandria, Egypt.

INTRODUCTION: Monitoring the microbial quality of water in dental unit waterlines is an important part of infection control measures carried out in dental clinics. Fungal contamination of such waterlines has not been extensively studied, compared with bacterial contamination. This study aimed at assessing the magnitude and risk factors for fungal contamination of dental unit waterlines. METHODOLOGY: This cross-sectional study included 82 dental units, randomly collected from 3 private clinics and 8 governmental hospitals in Alexandria, Egypt. A total of 204 water samples from dental unit waterlines output were membrane-filtered and cultured for fungal enumeration and species identification. The biofilm forming-ability was assessed for the most prevalent fungal species. The acceptability of samples was determined according to the Swedish drinking water guidelines. RESULTS: The acceptability of samples was 89.7%. The most common mould was Aspergillus flavus, while Candida spp. was the most common yeast (10 isolates), with unusual predominance of Candida dubliniensis (9 isolates). All isolates of Aspergillus flavus and Candida dubliniensis were biofilm-formers. The risk factors for fungal contamination of dental unit waterlines included: dental specialty (p = 0.042), time of sample collection (p < 0.001), older age of dental unit (p < 0.001) and use of 5-15% of sodium hypochlorite. CONCLUSIONS: The presence of biofilm-forming fungi in dental unit waterlines is a potential hazard, even when samples have acceptable levels of fungal counts. Risk factors for contamination are numerous and should be addressed.