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.

Examining the efficacy of the legal framework governing the management of greywater in South Africa's informal settlements.

The management of greywater and sanitation in South Africa's urban informal settlements is a pressing concern. This review critically examines the legal framework that governs greywater management in South Africa's informal settlements, aiming to shed light on the existing regulations, gaps, and opportunities for sustainable greywater reuse. By scrutinizing the legal framework, the review identifies gaps and challenges in the regulatory environment, including inconsistencies, lack of clarity, and limited enforcement mechanisms. It explores the potential for international best practices to inform possible amendments to the existing legal framework. This was a quantitative research design utilizing a cross sectional survey model. Questionnaires were administered electronically to a sample of 17 municipal leaders from the City of Tshwane, City of Johannesburg and Buffalo City municipalities whose responsibilities were on water management. Descriptive statistics were employed in analysis of the data. Outcomes were reviewed against the alignment or the lack thereof with the SANS 1732:201x standards. This paper underscores the critical need for a coherent and robust legal framework to support responsible greywater management in South Africa's informal settlements. The paper's insights contribute to the ongoing discourse on water governance, shedding light on the pathways toward a more equitable water future.

Financial inclusion and improved water usage among households in Ghana.

BACKGROUND: In Ghana, about 76% of households are at risk of drinking water polluted with faecal matter, hence, poor sanitation and unsafe water are responsible for 80% of all diseases in the country. Given this, some studies have been carried out concerning the factors that determine access and use of improved water among households in Ghana. However, although financial inclusion can make it easy for households to afford and hence, use improved water, it has received very little attention. This study, thus, examines the effect of financial inclusion on the use of improved water among households in Ghana. METHODS: The Ghana Living Standards Survey round 7 (GLSS7) is used as the data source while the binary logit regression is employed as the main empirical estimation technique. RESULTS: The results show that households with financial inclusion (employing an indicator which has not been disaggregated into formal and informal financial inclusion) have a higher likelihood of using improved water sources relative to those without financial inclusion. The results are robust using formal financial inclusion as well as a combined index of financial inclusion. CONCLUSION: Enhancing financial inclusion, especially formal financial inclusion can be utilised as a major policy instrument towards increasing access and use of improved water sources among households in Ghana.

Adherence to Legionella control regulations and guidelines in Norwegian nursing homes: a cross-sectional survey.

BACKGROUND: Infection by Legionella bacteria is a risk to elderly individuals in health care facilities and should be managed by preventing bacterial proliferation in internal water systems. Norwegian legislation calls for a mandatory Legionella-specific risk assessment with the subsequent introduction of an adapted water management programme. The present study investigates adherence to legislation and guidelines on Legionella control and prevention in Norwegian nursing homes. METHODS: A cross-sectional survey was distributed to Norwegian municipalities to investigate the status of Legionella specific risk assessments of internal water distribution systems and the introduction of water management programmes in nursing homes. RESULTS: A total of 55.1% (n = 228) of the participating nursing homes had performed Legionella-specific risk assessments, of which 55.3% (n = 126) stated that they had updated the risk assessment within the last year. 96.5% introduced a water management programme following a risk assessment, whereas 59.6% of the ones without a risk assessment did the same. Nursing homes with risk assessments were more likely to monitor Legionella levels than those without (61.2% vs 38.8%), to remove dead legs (44.7% vs 16.5%), and to select biocidal preventive treatment over hot water flushing (35.5% vs 4.6%). CONCLUSIONS: This study presents novel insight into Legionella control in Norway, suggesting that adherence to mandatory risk assessment in nursing homes is moderate-low. Once performed, the risk assessment seems to be advantageous as an introduction to future Legionella prevention in terms of the scope and contents of the water management programme.

Household-level water, sanitation and hygiene factors and interventions and the prevention of relapse after severe acute malnutrition recovery: A systematic review.

Severe acute malnutrition (SAM) is the most serious form of acute malnutrition and is associated with high mortality risk among children under 5. While the Community-based Management of Acute Malnutrition (CMAM) approach, recommended for treating cases of uncomplicated SAM, has increased treatment coverage and recovery outcomes, high relapse rates have been reported. Several risk factors for SAM relapse, such as insufficient food intake and high infectious disease burden in the community, have been identified. However, the role of household water, sanitation and hygiene (WASH) conditions remains unclear. This systematic review: (1) assesses the effectiveness of WASH interventions on preventing SAM relapse and (2) identifies WASH-related conditions associated with relapse to SAM among children aged 6-59 months discharged as recovered following SAM CMAM treatment. We performed electronic searches of six databases to identify relevant studies published between 1 January 2000 and 6 November 2023 and assessed their quality. After deduplication, 10,294 documents were screened by title and abstract, with 13 retrieved for full-text screening. We included three studies ranging from low- to medium-quality. One intervention study found that providing a WASH kit during SAM outpatient treatment did not reduce the risk of relapse to SAM. Two observational studies found inconsistent associations between household WASH conditions-unimproved sanitation and unsafe drinking water-and SAM relapse. Despite the paucity of evidence, the hypothesised causal pathways between WASH conditions and the risk of relapse remain plausible. Further evidence is needed to identify interventions for an integrated postdischarge approach to prevent relapse.

Peak grain forecasts for the US High Plains amid withering waters.

Irrigated agriculture contributes 40% of total global food production. In the US High Plains, which produces more than 50 million tons per year of grain, as much as 90% of irrigation originates from groundwater resources, including the Ogallala aquifer. In parts of the High Plains, groundwater resources are being depleted so rapidly that they are considered nonrenewable, compromising food security. When groundwater becomes scarce, groundwater withdrawals peak, causing a subsequent peak in crop production. Previous descriptions of finite natural resource depletion have utilized the Hubbert curve. By coupling the dynamics of groundwater pumping, recharge, and crop production, Hubbert-like curves emerge, responding to the linked variations in groundwater pumping and grain production. On a state level, this approach predicted when groundwater withdrawal and grain production peaked and the lag between them. The lags increased with the adoption of efficient irrigation practices and higher recharge rates. Results indicate that, in Texas, withdrawals peaked in 1966, followed by a peak in grain production 9 y later. After better irrigation technologies were adopted, the lag increased to 15 y from 1997 to 2012. In Kansas, where these technologies were employed concurrently with the rise of irrigated grain production, this lag was predicted to be 24 y starting in 1994. In Nebraska, grain production is projected to continue rising through 2050 because of high recharge rates. While Texas and Nebraska had equal irrigated output in 1975, by 2050, it is projected that Nebraska will have almost 10 times the groundwater-based production of Texas.

Effect of deforestation on access to clean drinking water.

Using satellite data on deforestation and weather in Malawi and linking those datasets with household survey datasets, we estimate the causal effect of deforestation on access to clean drinking water. In the existing literature on forest science and hydrology, the consensus is that deforestation increases water yield. In this study, we directly examine the causal effect of deforestation on households' access to clean drinking water. Results of the two-stage least-squares (2SLS) with cluster and time fixed-effect estimations illustrate strong empirical evidence that deforestation decreases access to clean drinking water. Falsification tests show that the possibility of our instrumental variable picking up an unobserved time trend is very unlikely. We find that a 1.0-percentage-point increase in deforestation decreases access to clean drinking water by 0.93 percentage points. With this estimated impact, deforestation in the last decade in Malawi (14%) has had the same magnitude of effect on access to clean drinking water as that of a 9% decrease in rainfall.

Detecting community response to water quality violations using bottled water sales.

Drinking-water contaminants pose a risk to public health. When confronted with elevated levels of contaminants, individuals can take actions to reduce exposure. Yet, few studies address averting behavior due to impaired water, particularly in high-income countries. This is a problem of national interest, given that 9 million to 45 million people have been affected by water quality violations in each of the past 34 years. No national analysis has focused on the extent to which communities reduce exposure to contaminated drinking water. Here, we present an assessment that sheds light on how communities across the United States respond to violations of the Safe Drinking Water Act, using consumer purchases of bottled water. This study provides insight into how averting behavior differs across violation types and community demographics. We estimate the change in sales due to water quality violations, using a panel dataset of weekly sales and violation records in 2,151 counties from 2006 to 2015. Critical findings show that violations which pose an immediate health risk are associated with a 14% increase in bottled water sales. Generally, greater averting action is taken against contaminants that might pose a greater perceived health risk and that require more immediate public notification. Rural, low-income communities do not take significant averting action for elevated levels of nitrate, yet experience a higher prevalence of nitrate violations. Findings can inform improvements in public notification and targeting of technical assistance from state regulators and public health agencies in order to reduce community exposure to contaminants.

The impact of mosquito proof lids of underground tanks "tanka" on the breeding of Anopheles stephensi in a village in western Rajasthan, India.

BACKGROUND: Western Rajasthan in India has a typical desert climate. Until the introduction of the canal water irrigation system, malaria was an unstable and seasonal occurrence. Due to the scarcity of water, the community practised having one large underground tank (locally known as the tanka) in their house to collect rainwater for long-term household use. Anopheles stephensi, one of the major malaria vectors, breeds in improperly covered "tankas" if not properly covered and harbours a vector population throughout the year. METHODS: Two villages, Ajasar (intervention) and Tota (control), with similar ecological features, were selected for the study. A pre-intervention survey was carried out in both villages to assess the presence and quality of lids of tankas, and mosquito breeding and adult mosquito density. Awareness of the community about malaria and mosquitoes was also assessed during the pre-intervention period. In the intervention village, damaged or improper lids were replaced with improved mosquito proof polyvinyl chloride plastic (PVC) lids and lasted longer than the conventional lids. The fitness of the lids was assessed one year after the pre-intervention survey. The entomological assessment was carried out in both intervention and non-intervention villages. The level of community awareness about malaria, mosquitoes, their breeding places, and the role of tankas in malaria transmission was assessed both during pre- and post-intervention. RESULTS: During the pre-intervention survey, Anopheles breeding was found in 22.1% (58/262) of tankas in the intervention village and 27.1% (19/70) in tankas in the control village. Mosquito breeding was observed in the tankas with iron lids in the intervention village (48.3%) and the control village (42.1%). In the intervention village, out of 262 tankas in the village, 200 lids were replaced, resulting in the complete absence of mosquito breeding. In the pre-intervention survey conducted in May 2018, Anopheles stephensi consisted of 46% of adult mosquitoes in the intervention village and 55% in the control village. Its density was significantly reduced to 0.55 per man-hour (94.95%) and 0.22 per man-hour (97.8%) in the post-intervention survey in June 2018 and a follow-up survey in May 2019, respectively, in the intervention village. DISCUSSION: The density of Anopheles stephensi adults was reduced significantly (97.8%) in the intervention village due to complete prevention of breeding in the underground tankas in the intervention village as compared to the control with no density reduction. The awareness level of the community was also improved due to their involvement in the study. CONCLUSION: Provision of proper metal lids or replacement of damaged lids on underground water storage tanks as an environmental management approach prevented the breeding of  the malaria vector, Anopheles stephensi, in a desert village in western Rajasthan.

Inequalities in access to safe drinking water in Peruvian households according to city size: an analysis from 2008 to 2018.

BACKGROUND: Peru is one of the countries with the lowest percentage of population with access to safe drinking water in the Latin American region. This study aimed to describe and estimate, according to city size, socioeconomic inequalities in access to safe drinking water in Peruvian households from 2008 to 2018. METHODS: Secondary analysis of cross-sectional data using data from the 2008-2018 ENAHO survey. Access to safe drinking water, determined based on the presence of chlorinated water supplied by the public network, as well as socioeconomic variables were analyzed. A trend analysis from 2008 to 2018, and comparisons between 2008 versus 2018 were performed to understand and describe changes in access to safe drinking water, according to city size. Concentration curves and Erreygers concentration index (ECI) were estimated to measure inequalities in access to safe drinking water. RESULTS: In 2008, 47% of Peruvian households had access to safe drinking water, increasing to 52% by 2018 (p for trend < 0.001). For small cities, access to safe drinking water did not show changes between 2018 and 2008 (difference in proportions - 0.2 percentage points, p = 0.741); however, there was an increase in access to safe drinking water in medium (difference in proportions 3.3 percentage points, p < 0.001) and large cities (difference in proportions 12.8 percentage points, p < 0.001). The poorest households showed a decreasing trend in access to safe drinking water, while the wealthiest households showed an increasing trend. In small cities, socioeconomic inequalities showed an increase between 2008 and 2018 (ECI 0.045 and 0.140, p < 0.001), while in larger cities, socioeconomic inequality reduced in the same period (ECI: 0.087 and 0.018, p = 0.036). CONCLUSIONS: We report a widening gap in the access to safe drinking water between the wealthiest and the poorest households over the study period. Progress in access to safe drinking water has not been equally distributed throughout the Peruvian population. Promoting and supporting effective implementation of policies and strategies to safe drinking water, including equity-oriented infrastructure development and resource allocation for most vulnerable settings, including emerging small cities, is a priority.

Microbial contamination in drinking water at public outdoor recreation facilities in New Zealand.

AIM: The aim of our study was to assess the presence and risk of waterborne pathogens in the drinking water of outdoor facilities in New Zealand and track potential sources of microbial contamination in water sources. METHODS AND RESULTS: A serial cross-sectional study with a risk-based sample collection strategy was conducted at 15 public campgrounds over two summer seasons (2011-2012 and 2012-2013). Drinking water supplied to these campgrounds was not compliant with national standards, based on Escherichia coli as an indicator organism, in more than half of the sampling occasions. Campylobacter contamination of drinking water at the campgrounds was likely to be of wild bird origin. Faecal samples from rails (pukeko and weka) were 35 times more likely to return a Campylobacter-positive result compared to passerines. Water treatment using ultraviolet (UV) irradiation or a combination of filtration and UV irradiation or chemicals was more likely to result in water that was compliant with the national standards than water from a tap without any treatment. The use of filters alone was not associated with the likelihood of compliance. CONCLUSIONS: Providing microbiologically safe drinking water at outdoor recreational facilities is imperative to avoid gastroenteritis outbreaks. This requires an in-depth understanding of potential sources of contamination in drinking water sources and the installation of adequate water treatment facilities. SIGNIFICANCE AND IMPACT OF THE STUDY: Our study provides evidence that drinking water without treatment or filter-only treatment in public campgrounds is unlikely to comply with national standards for human consumption and extra water treatment measures such as UV irradiation or chemical treatment are needed.

National trends in drinking water quality violations.

Ensuring safe water supply for communities across the United States is a growing challenge in the face of aging infrastructure, impaired source water, and strained community finances. In the aftermath of the Flint lead crisis, there is an urgent need to assess the current state of US drinking water. However, no nationwide assessment has yet been conducted on trends in drinking water quality violations across several decades. Efforts to reduce violations are of national concern given that, in 2015, nearly 21 million people relied on community water systems that violated health-based quality standards. In this paper, we evaluate spatial and temporal patterns in health-related violations of the Safe Drinking Water Act using a panel dataset of 17,900 community water systems over the period 1982-2015. We also identify vulnerability factors of communities and water systems through probit regression. Increasing time trends and violation hot spots are detected in several states, particularly in the Southwest region. Repeat violations are prevalent in locations of violation hot spots, indicating that water systems in these regions struggle with recurring issues. In terms of vulnerability factors, we find that violation incidence in rural areas is substantially higher than in urbanized areas. Meanwhile, private ownership and purchased water source are associated with compliance. These findings indicate the types of underperforming systems that might benefit from assistance in achieving consistent compliance. We discuss why certain violations might be clustered in some regions and strategies for improving national drinking water quality.

Assessment of Drinking Water Sources for Water Quality, Human Health Risks, and Pollution Sources: A Case Study of the District Bajaur, Pakistan.

The focus of the present study was to assess the quality of different drinking water sources, impacts of poor water quality on human health, and to apportion pollution source(s) of the district Bajaur, Pakistan. Drinking water samples (n = 331) were randomly collected from springs, hand pumps, open wells, and tube wells and analyzed for physicochemical parameters including toxic elements, and bacteriological contamination (i.e., Escherichia coli). Furthermore, a questionnaire survey was conducted to record the cases of waterborne diseases in the study area. The results showed that total suspended solids and bacteriological contamination exceeded the permissible limits of the WHO in all four of the water sources. Among the potentially toxic elements, Cd, Pb, and Mn were above the permissible limits of the WHO in some samples. The hazard index for spring water was found to exceed the toxicity level (i.e., HI > 1) set by US EPA for both adults and children, while the sources from hand pumps, open wells, and tube wells were within the safe limit. The order for the overall safety level for water quality in the study area was tube wells > open wells > hand pumps > springs. The pollution source apportionment statistics revealed that both geogenic and anthropogenic activities are the sources of drinking water contamination. The results of the questionnaire survey indicated that reports of waterborne diseases were highest in respondents who took their drinking water from springs, whereas reports of diseases were moderate in respondents taking their water from open wells and hand pumps and lowest in respondents taking their water from tube wells. Based on the findings of the study, the tube well source of water is recommended for drinking water purposes.

Hydrogeochemistry Assessment of Shallow Groundwater and Human Health Threats in the Northwestern Ordos Basin, China.

Groundwater is the main sources of water supply for drinking purposes in the Ordos Basin in the northwestern part of China. In order to sustain and protect the quality of groundwater resources, shallow groundwater samples were collected and analyzed to identify the hydrogeochemical characteristics, and to evaluate health risk to human. Cluster analysis showed that the 134 groundwater samples were divided into three classes (i.e., class 1, class 2, class 3). The groundwater types are mostly characterized by SO4-Cl type and SO4 type, mixed HCO3 type. The primary natural mechanisms controlling the chemical compositions are water-rock interaction and evaporation-precipitation. The extremely high concentrations of sulfate could be caused by contamination from pyrite or from infiltration of sulfate from inorganic fertilizers or from wastewater discharges. Results of the assessment of the health risks for ingestion of Cl-, NO3-, F-, Cr, and As in drinking water indicated that the total health risks are beyond the US EPA acceptable level of 10-6 per year for consumption of groundwater sourced from all three cluster classes. The highest risks were for ingestion of arsenic and chromium in groundwater. The highest total risks to adults and children were 1.51 × 10-5 and 2.45 × 10-2 (class 1), 4.12 × 10-4 and 8.98 × 10-3 (class 2), 3.06 × 10-3 and 5.49 × 10-2 (class 3), respectively. The study showed that there is a high risk of health problems among the residents of the Ordos Basin in China that are ingesting contaminated drinking water, with the health risks to children higher than the risks to adults.