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1.
Environ Sci Technol ; 56(19): 13985-13995, 2022 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-36125807

RESUMO

Over 2 billion people globally lack access to safely managed drinking water. In contrast to the household-level, manually implemented treatment products that have been the dominant strategy for gaining low-cost access to safe drinking water, passive chlorination technologies have the potential to treat water and reduce reliance on individual behavior change. However, few studies exist that evaluate the performance and costs of these technologies over time, especially in small, rural systems. We conducted a nonrandomized evaluation of two passive chlorination technologies for system-level water treatment in six gravity-fed, piped water systems in small communities in the hilly region of western Nepal. We monitored water quality indicators upstream of the treatment, at shared taps, and at households, as well as user acceptability and maintenance costs, over 1 year. At baseline, over 80% of tap samples were contaminated with Escherichia coli. After 1 year of system-level chlorination, only 7% of those same taps had E. coli. However, 29% of household stored water was positive for E. coli. Per cubic meter of treated water, the cost of chlorine was 0.06-0.09 USD, similar to the cost of monitoring technology installations. Safe storage, service delivery models, and reliable supply chains are required, but passive chlorination technologies have the potential to radically improve how rural households gain access to safely managed water.


Assuntos
Água Potável , Purificação da Água , Cloro , Escherichia coli , Halogenação , Humanos , Nepal , Microbiologia da Água , Qualidade da Água , Abastecimento de Água
2.
Proc Natl Acad Sci U S A ; 116(33): 16308-16313, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31358643

RESUMO

"Modern energy for all," an internationally supported initiative to connect populations to electricity services, is expected to help reduce poverty-induced vulnerabilities. It has become a primary strategy for meeting sustainable development goals, especially in sub-Saharan Africa. However, when electricity is supplied by a capacity-constrained grid to a resource-constrained population, the service quality can vary both spatially and temporally. This research explores the quality of electricity services based on a case study of Unguja, Tanzania. Using 1) open-ended interviews, 2) detailed electricity-systems monitoring, and 3) household surveys, we show how voltage quality varies significantly, even within highly localized settings. Fluctuations result in dim lights at best and power outages and broken appliances at worst, denying many Unguja residents the expected benefits of access to modern energy. By combining an extensive understanding of the physical system together with interviews and surveys, this work presents a unique mapping of voltage quality in a system that is financially and physically constrained and highlights the consequences of poor-quality service for poor users.

3.
World Dev ; 135: 105086, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32834382

RESUMO

COVID-19 is a disease with no proven pharmaceutical intervention and no proven vaccine. In such circumstances, prevention is all we have. The role of handwashing in the prevention of communicable diseases has been known for over a century, yet it remains severely neglected as a public health investment, to be periodically re-discovered during pandemic-scale infections. Over 26% of the global population has no access to a handwashing station in the home; for many low-income countries this proportion rises to over 50%. In other instances, the water is unaffordable or the supply has been shut off on account of unpaid bills. But when there is no water in the home or yard, or no mechanism for delivering enough water, good hand-washing is extremely difficult. Well before COVID-19, global cost-benefit analyses of water and sanitation investments, with benefits measured in time-savings as well as health, showed significant net benefits in all sub-regions of the developing world. This Viewpoint paper argues that, in the current crisis and its aftermath, it is imperative for governments and donors to prioritize and generously fund affordable, reliable, and accessible water services in underserved regions of the world. More than ever before, this is a foundational investment for health, dignity and development.

4.
Lancet ; 401(10383): 1139-1141, 2023 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-36963413
5.
Environ Sci Technol ; 51(12): 6945-6956, 2017 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-28528546

RESUMO

Approximately two billion people drink unsafe water. Boiling is the most commonly used household water treatment (HWT) method globally and in China. HWT can make water safer, but sustained adoption is rare and bottled water consumption is growing. To successfully promote HWT, an understanding of associated socioeconomic factors is critical. We collected survey data and water samples from 450 rural households in Guangxi Province, China. Covariates were grouped into blocks to hierarchically construct modified Poisson models and estimate risk ratios (RR) associated with boiling methods, bottled water, and untreated water. Female-headed households were most likely to boil (RR = 1.36, p < 0.01), and among boilers those using electric kettles rather than pots had higher income proxies (e.g., per capita TV ownership RR = 1.42, p < 0.01). Higher-income households with younger, literate, and male heads were more likely to purchase (frequently contaminated) bottled water, or use electric kettles if they boiled. Our findings show that boiling is not an undifferentiated practice, but one with different methods of varying effectiveness, environmental impact, and adoption across socioeconomic strata. Our results can inform programs to promote safer and more efficient boiling using electric kettles, and suggest that if rural China's economy continues to grow then bottled water use will increase.


Assuntos
Água Potável , Purificação da Água , China , Ingestão de Líquidos , Feminino , Humanos , Masculino , População Rural , Temperatura de Transição , Abastecimento de Água
6.
J Water Health ; 15(5): 799-812, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29040082

RESUMO

Shallow groundwater containing toxic concentrations of arsenic is the primary source of drinking water for millions of households in rural West Bengal, India. Often, this water also contains unpleasant levels of iron and non-negligible fecal contamination. Alternatives to shallow groundwater are increasingly available, including government-built deep tubewells, water purchased from independent providers, municipal piped water, and household filters. We conducted a survey of 501 households in Murshidabad district in 2014 to explore what influenced the use of available alternatives. Socioeconomic status and the perceived likelihood of gastrointestinal (GI) illness (which was associated with dissatisfaction with iron in groundwater) were the primary determinants of the use of alternatives. Arsenic knowledge was limited. The choice amongst alternatives was influenced by economic, social, and aesthetic factors, but not by health risk perceptions. The use of purchased water was rarely exclusive and was strongly associated with socioeconomic status, suggesting that this form of market-based water provision does not ensure universal access. Demand for purchased water appeared to decrease significantly shortly after free piped water became available at public taps. Our results suggest that arsenic mitigation interventions that also address co-occurring water problems (iron, GI illness) could be more effective than a focus on arsenic alone.


Assuntos
Arsênio/análise , Água Potável/análise , Água Subterrânea/análise , Poluentes Químicos da Água/análise , Abastecimento de Água , Adulto , Idoso , Monitoramento Ambiental , Características da Família , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Masculino , Pessoa de Meia-Idade , População Rural , Abastecimento de Água/estatística & dados numéricos , Adulto Jovem
7.
PLoS Med ; 12(10): e1001892, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26505897

RESUMO

BACKGROUND: Intermittent delivery of piped water can lead to waterborne illness through contamination in the pipelines or during household storage, use of unsafe water sources during intermittencies, and limited water availability for hygiene. We assessed the association between continuous versus intermittent water supply and waterborne diseases, child mortality, and weight for age in Hubli-Dharwad, India. METHODS AND FINDINGS: We conducted a matched cohort study with multivariate matching to identify intermittent and continuous supply areas with comparable characteristics in Hubli-Dharwad. We followed 3,922 households in 16 neighborhoods with children <5 y old, with four longitudinal visits over 15 mo (Nov 2010-Feb 2012) to record caregiver-reported health outcomes (diarrhea, highly credible gastrointestinal illness, bloody diarrhea, typhoid fever, cholera, hepatitis, and deaths of children <2 y old) and, at the final visit, to measure weight for age for children <5 y old. We also collected caregiver-reported data on negative control outcomes (cough/cold and scrapes/bruises) to assess potential bias from residual confounding or differential measurement error. Continuous supply had no significant overall association with diarrhea (prevalence ratio [PR] = 0.93, 95% confidence interval [CI]: 0.83-1.04, p = 0.19), bloody diarrhea (PR = 0.78, 95% CI: 0.60-1.01, p = 0.06), or weight-for-age z-scores (Δz = 0.01, 95% CI: -0.07-0.09, p = 0.79) in children <5 y old. In prespecified subgroup analyses by socioeconomic status, children <5 y old in lower-income continuous supply households had 37% lower prevalence of bloody diarrhea (PR = 0.63, 95% CI: 0.46-0.87, p-value for interaction = 0.03) than lower-income intermittent supply households; in higher-income households, there was no significant association between continuous versus intermittent supply and child diarrheal illnesses. Continuous supply areas also had 42% fewer households with ≥1 reported case of typhoid fever (cumulative incidence ratio [CIR] = 0.58, 95% CI: 0.41-0.78, p = 0.001) than intermittent supply areas. There was no significant association with hepatitis, cholera, or mortality of children <2 y old; however, our results were indicative of lower mortality of children <2 y old (CIR = 0.51, 95% CI: 0.22-1.07, p = 0.10) in continuous supply areas. The major limitations of our study were the potential for unmeasured confounding given the observational design and measurement bias from differential reporting of health symptoms given the nonblinded treatment. However, there was no significant difference in the prevalence of the negative control outcomes between study groups that would suggest undetected confounding or measurement bias. CONCLUSIONS: Continuous water supply had no significant overall association with diarrheal disease or ponderal growth in children <5 y old in Hubli-Dharwad; this might be due to point-of-use water contamination from continuing household storage and exposure to diarrheagenic pathogens through nonwaterborne routes. Continuous supply was associated with lower prevalence of dysentery in children in low-income households and lower typhoid fever incidence, suggesting that intermittently operated piped water systems are a significant transmission mechanism for Salmonella typhi and dysentery-causing pathogens in this urban population, despite centralized water treatment. Continuous supply was associated with reduced transmission, especially in the poorer higher-risk segments of the population.


Assuntos
Mortalidade da Criança , Água Potável/microbiologia , Microbiologia da Água , Abastecimento de Água/normas , Doenças Transmitidas pela Água/mortalidade , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Prevalência , Saúde da População Urbana , Qualidade da Água , Doenças Transmitidas pela Água/epidemiologia
8.
Am J Public Health ; 104(4): 603-11, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24524500

RESUMO

With this article, we develop the Drinking Water Disparities Framework to explain environmental injustice in the context of drinking water in the United States. The framework builds on the social epidemiology and environmental justice literatures, and is populated with 5 years of field data (2005-2010) from California's San Joaquin Valley. We trace the mechanisms through which natural, built, and sociopolitical factors work through state, county, community, and household actors to constrain access to safe water and to financial resources for communities. These constraints and regulatory failures produce social disparities in exposure to drinking water contaminants. Water system and household coping capacities lead, at best, to partial protection against exposure. This composite burden explains the origins and persistence of social disparities in exposure to drinking water contaminants.


Assuntos
Água Potável/normas , Exposição Ambiental/estatística & dados numéricos , Disparidades nos Níveis de Saúde , California , Humanos , Modelos Organizacionais , Política Pública , Abastecimento de Água/normas
9.
Environ Res Lett ; 19(2): 024017, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38283952

RESUMO

Climate change intensifies longstanding tensions over groundwater sustainability and equity of access among users. Though private land ownership is a primary mechanism for accessing groundwater in many regions, few studies have systematically examined the extent to which farmland markets transform groundwater access patterns over time. This study begins to fill this gap by examining farmland transactions overlying groundwater from 2003-17 in California. We construct a novel dataset that downscales well construction behavior to the parcel level, and we use it to characterize changes in groundwater access patterns by buyer type on newly transacted parcels in the San Joaquin Valley groundwater basin during the 2011-17 drought. Our results demonstrate large-scale transitions in farmland ownership, with 21.1% of overlying agricultural acreage statewide sold at least once during the study period and with the highest rates of turnover occurring in critically overdrafted basins. By 2017, annual individual farmland acquisitions had halved, while acquisitions by limited liability companies increased to one-third of all overlying acres purchased. Together, these trends signal increasing corporate farmland acquisitions; new corporate farmland owners are associated with the construction, on comparable parcels, of agricultural wells 77-81 feet deeper than those drilled by new individual landowners. We discuss the implications of our findings for near-term governance of groundwater, and their relevance for understanding structural inequities in exposure to future groundwater level declines.

10.
Environ Health Perspect ; 131(1): 16001, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36715546

RESUMO

BACKGROUND: Centralized chlorination of urban piped water supplies has historically contributed to major reductions in waterborne illness. In locations without effective centralized water treatment, point-of-use (POU) chlorination for households is widely promoted to improve drinking water quality and health. Realizing these health benefits requires correct, consistent, and sustained product use, but real-world evaluations have often observed low levels of use. To our knowledge, no prior reviews exist on adoption of chlorine POU products. OBJECTIVES: Our objectives were to identify which indicators of adoption are most often used in chlorine POU studies, summarize levels of adoption observed, understand how adoption changes over time, and determine how adoption is affected by frequency of contact between participants and study staff. METHODS: We conducted a systematic review of household POU chlorination interventions or programs from 1990 through 2021 that reported a quantitative measure of adoption, were conducted in low- and middle-income countries, included data collection at households, and reported the intervention start date. RESULTS: We identified 36 studies of household drinking water chlorination products that met prespecified eligibility criteria and extracted data from 46 chlorine intervention groups with a variety of chlorine POU products and locations. There was no consensus definition of adoption of household water treatment; the most common indicator was the proportion of household stored water samples with free chlorine residual >0.1 or 0.2mg/L. Among studies that reported either free or total chlorine-confirmed adoption of chlorine POU products, use was highly variable (across all chlorine intervention groups at the last time point measured in each study; range: 1.5%-100%; sample size-weighted median=47%; unweighted median=58%). The median follow-up duration among intervention groups was 3 months. On average, adoption declined over time and was positively associated with frequency of contact between respondents and study staff. DISCUSSION: Although prior research has shown that POU chlorine products improve health when correctly and consistently used, a reliance on individual adoption for effective treatment is unlikely to lead to the widespread public health benefits historically associated with pressurized, centralized treatment of piped water supplies. https://doi.org/10.1289/EHP10839.


Assuntos
Água Potável , Purificação da Água , Humanos , Halogenação , Cloro , Qualidade da Água , Abastecimento de Água
11.
PLoS One ; 18(4): e0283892, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37023105

RESUMO

Despite dramatic reductions in global risk exposures to unsafe water sources, lack of access to clean water remains a persistent problem in many rural and last-mile communities. A great deal is known about demand for household water treatment systems; however, similar evidence for fully treated water products is limited. This study evaluates an NGO-based potable water delivery service in rural Bihar, India, meant to stand-in for more robust municipal treated water supply systems that have yet to reach the area. We use a random price auction and discrete choice experiment to examine willingness to pay (WTP) and stated product preferences, respectively, for this service among 162 households in the region. We seek to determine the impact of short-term price subsidies on demand for water delivery and the extent to which participation in the delivery program leads to changes in stated preferences for service characteristics. We find that mean WTP for the first week of service is roughly 51% of market price and represents only 1.7% of median household income, providing evidence of untapped demand for fully treated water. We also find mixed evidence on the effect of small price subsidies for various parts of the delivery service, and that one week of initial participation leads to significant changes in stated preferences for the taste of the treated water as well as the convenience of the delivery service. While more evidence is needed on the effect of subsidies, our findings suggest that marketing on taste and convenience could help increase uptake of clean water delivery services in rural and last-mile communities that have yet to receive piped water. However, we caution that these services should be seen as a stopgap, not a substitute for piped municipal water systems.


Assuntos
Água Potável , Purificação da Água , Humanos , Renda , População Rural , Índia
12.
Environ Health ; 11: 84, 2012 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-23151087

RESUMO

BACKGROUND: Few studies of environmental justice examine inequities in drinking water contamination. Those studies that have done so usually analyze either disparities in exposure/harm or inequitable implementation of environmental policies. The US EPA's 2001 Revised Arsenic Rule, which tightened the drinking water standard for arsenic from 50 µg/L to 10 µg/L, offers an opportunity to analyze both aspects of environmental justice. METHODS: We hypothesized that Community Water Systems (CWSs) serving a higher proportion of minority residents or residents of lower socioeconomic status (SES) have higher drinking water arsenic levels and higher odds of non-compliance with the revised standard. Using water quality sampling data for arsenic and maximum contaminant level (MCL) violation data for 464 CWSs actively operating from 2005-2007 in California's San Joaquin Valley we ran bivariate tests and linear regression models. RESULTS: Higher home ownership rate was associated with lower arsenic levels (ß-coefficient= -0.27 µg As/L, 95% (CI), -0.5, -0.05). This relationship was stronger in smaller systems (ß-coefficient = -0.43, CI, -0.84, -0.03). CWSs with higher rates of homeownership had lower odds of receiving an MCL violation (OR, 0.33; 95% CI, 0.16, 0.67); those serving higher percentages of minorities had higher odds (OR, 2.6; 95% CI, 1.2, 5.4) of an MCL violation. CONCLUSIONS: We found that higher arsenic levels and higher odds of receiving an MCL violation were most common in CWSs serving predominantly socio-economically disadvantaged communities. Our findings suggest that communities with greater proportions of low SES residents not only face disproportionate arsenic exposures, but unequal MCL compliance challenges.


Assuntos
Arsênio/análise , Justiça Social , Poluentes Químicos da Água/análise , Abastecimento de Água/análise , Arsênio/normas , California , Monitoramento Ambiental , Humanos , Concentração Máxima Permitida , Classe Social , Poluentes Químicos da Água/normas
13.
Environ Sci Technol ; 45(16): 6743-51, 2011 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-21728279

RESUMO

Carbon capture and sequestration (CCS), while controversial, is seen as promising because it will allow the United States to continue using its vast fossil fuel resources in a carbon-constrained world. The public is an important stakeholder in the national debate about whether or not the U.S. should include CCS as a significant part of its climate change strategy. Understanding how to effectively engage with the public about CCS has become important in recent years, as interest in the technology has intensified. We argue that engagement efforts should be focused on places where CCS will first be deployed, i.e., places with many "energy veteran" (EV) citizens. We also argue that, in addition to information on CCS, messages with emotional appeal may be necessary in order to engage the public. In this paper we take a citizen-guided social marketing approach toward understanding how to (positively or negatively) influence EV citizens' attitudes toward CCS. We develop open-ended interview protocols, and a "CCS campaign activity", for Wyoming residents from Gillette and Rock Springs. We conclude that our participants believed expert-informed CCS messages, embedded within an emotionally self-referent (ESR) framework that was relevant to Wyoming, to be more persuasive than the expert messages alone. The appeal to core values of Wyomingites played a significant role in the citizen-guided CCS messages.


Assuntos
Atitude , Sequestro de Carbono , Marketing Social , Emoções , Prova Pericial , Humanos , Comunicação Persuasiva , Wyoming
14.
Lancet Glob Health ; 9(3): e361-e365, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33444550

RESUMO

The public health community has tried for decades to show, through evidence-based research, that safe water, sanitation, and hygiene (WASH) and clean cooking fuels that reduce household air pollution are essential to safeguard health and save lives in low-income and middle-income countries. In the past 40 decades, there have been many innovations in the development of low-cost and efficacious technologies for WASH and household air pollution, but many of these technologies have been associated with disappointing health outcomes, often because low-income households have either not adopted, or inconsistently adopted, these technologies. In this Viewpoint, we argue that public health researchers (ourselves included) have had an oversimplified understanding of poverty; our work has not focused on insights into the lived experience of poverty, with its uncertainties, stresses from constant scarcity, and attendant fears. Such insights are central to understanding why technologies for safe water or clean cooking are unused by so many households that could benefit from them. We argue that, rather than improved versions of household-scale delivery models, transformative investments in safe water and clean cooking for all require utility-scale service models. Until then, research should focus on interim safe water and clean cooking options that are directed towards the utility-scale service model.


Assuntos
Culinária/métodos , Países em Desenvolvimento , Água Potável , Higiene/normas , Saneamento/métodos , Poluição do Ar em Ambientes Fechados/prevenção & controle , Humanos
15.
PLoS One ; 16(1): e0245237, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33471810

RESUMO

Water affordability is central to water access but remains a challenge to measure. California enshrined the human right to safe and affordable water in 2012 but the question remains: how should water affordability be measured across the state? This paper contributes to this question in three steps. First, we identify key dimensions of water affordability measures (including scale, volume of water needed to meet 'basic' needs, and affordability criteria) and a cross-cutting theme (social equity). Second, using these dimensions, we develop three affordability ratios measured at the water system scale for households with median, poverty level, and deep poverty (i.e., half the poverty level) incomes and estimate the corresponding percentage of households at these income levels. Using multiple measures conveys a fuller picture of affordability given the known limitations of specific affordability measures. Third, we analyze our results disaggregated by a key characteristic of water system vulnerability-water system size. We find that water is relatively affordable for median income households. However, we identify high unaffordability for households in poverty in a large fraction of water systems. We identify several scenarios with different policy implications for the human right to water, such as very small systems with high water bills and low-income households within large water systems. We also characterize how data gaps complicate theoretical ideals and present barriers in human right to water monitoring efforts. This paper presents a systematic approach to measuring affordability and represents the first statewide assessment of water affordability within California's community water systems.


Assuntos
Direitos Humanos , Abastecimento de Água/economia , California , Custos e Análise de Custo , Humanos , Renda , Pobreza
16.
Environ Manage ; 45(1): 177-91, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19967363

RESUMO

This article asks three connected questions: First, does the public view private and public utilities differently, and if so, does this affect attitudes to conservation? Second, do public and private utilities differ in their approaches to conservation? Finally, do differences in the approaches of the utilities, if any, relate to differences in public attitudes? We survey public attitudes in California toward (hypothetical but plausible) voluntary and mandated water conservation, as well as to price increases, during a recent period of shortage. We do this by interviewing households in three pairs of adjacent public and private utilities. We also survey managers of public and private urban water utilities to see if they differ in their approaches to conservation and to their customers. On the user side we do not find pronounced differences, though a minority of customers in all private companies would be more willing to conserve or pay higher prices under a public operator. No respondent in public utility said the reverse. Negative attitudes toward private operators were most pronounced in the pair marked by a controversial recent privatization and a price hike. Nonetheless, we find that California's history of recurrent droughts and the visible role of the state in water supply and drought management undermine the distinction between public and private. Private utilities themselves work to underplay the distinction by stressing the collective ownership of the water source and the collective value of conservation. Overall, California's public utilities appear more proactive and target-oriented in asking their customers to conserve than their private counterparts and the state continues to be important in legitimating and guiding conservation behavior, whether the utility is in public hands or private.


Assuntos
Conservação dos Recursos Naturais/métodos , Opinião Pública , Abastecimento de Água , Atitude , California , Participação da Comunidade , Conservação dos Recursos Naturais/legislação & jurisprudência , Conservação dos Recursos Naturais/tendências , Coleta de Dados , Secas , Entrevistas como Assunto , Parcerias Público-Privadas , Abastecimento de Água/economia , Abastecimento de Água/legislação & jurisprudência
17.
Artigo em Inglês | MEDLINE | ID: mdl-32098057

RESUMO

Swachh Bharat Abhiyan, India's flagship sanitation intervention, set out to end open defecation by October 2019. While the program improved toilet coverage nationally, large regional disparities in construction and use remain. Our study used ethnographic methods to explore perspectives on open defecation and latrine use, and the socio-economic and political reasons for these perspectives, in rural Bihar. We draw on insights from social epidemiology and political ecology to explore the structural determinants of latrine ownership and use. Though researchers have often pointed to rural residents' preference for open defecation, we found that people were aware of its many risks. We also found that (i) while sanitation research and "behavior change" campaigns often conflate the reluctance to adopt latrines with a preference for open defecation, this is an erroneous conflation; (ii) a subsidy can help (some) households to construct latrines but the amount of the subsidy and the manner of its disbursement are key to its usefulness; and (iii) widespread resentment towards what many rural residents view as a development bias against rural areas reinforces distrust towards the government overall and its Swachh Bharat Abhiyan-funded latrines in particular. These social-structural explanations for the slow uptake of sanitation in rural Bihar (and potentially elsewhere) deserve more attention in sanitation research and promotion efforts.


Assuntos
Defecação , Banheiros , Adolescente , Adulto , Idoso , Ira , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , População Rural , Saneamento , Responsabilidade Social , Adulto Jovem
18.
Environ Health Perspect ; 128(12): 127002, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33275452

RESUMO

BACKGROUND: Inadequate access to safe drinking water remains a global health problem, particularly in rural areas. Boiling is the most commonly used form of point-of-use household water treatment (HWT) globally, although the use of bottled water in low- and middle-income countries (LMICs) is increasing rapidly. OBJECTIVES: We assessed the regional and seasonal prevalence of HWT practices (including bottled water use) in low-income rural areas in two Chinese provinces, evaluated the microbiological safety of drinking water and associated health outcomes, and estimated the air pollution burden associated with the use of solid fuels for boiling. METHODS: We conducted cross-sectional surveys and collected drinking water samples from 1,033 rural households in Guangxi and Henan provinces. Temperature sensors affixed to pots and electric kettles were used to corroborate self-reported boiling frequencies and durations, which were used to model household air pollution (HAP) in terms of estimated particulate matter ≤2.5µm in aerodynamic diameter (PM2.5) concentrations. RESULTS: Based on summer data collection in both provinces, after controlling for covariates, boiling with electric kettles was associated with the largest log reduction in thermotolerant coliforms (TTCs) (-0.66 log10 TTC most probable number/100mL), followed by boiling with pots (-0.58), and bottled water use (-0.39); all were statistically significant (p<0.001). Boiling with electric kettles was associated with a reduced risk of TTC contamination [risk ratio (RR)=0.25, p<0.001] and reported diarrhea (RR=0.80, p=0.672). TTCs were detected in 51% (n=136) of bottled water samples. For households boiling with biomass, modeled PM2.5 concentrations averaged 79 µg/m3 (standard deviation=21). DISCUSSION: Our findings suggest that where boiling is already common and electricity access is widespread, the promotion of electricity-based boiling may represent a pragmatic stop-gap means of expanding safe water access until centralized, or decentralized, treated drinking water is available; displacing biomass use for water boiling could also reduce HAP concentrations and exposures. Our results also highlight the risks of increasing bottled water use in rural areas, and its potential to displace other sources of safe drinking water, which could in turn hamper efforts in China and other LMICs toward universal and affordable safe water access. https://doi.org/10.1289/EHP7124.


Assuntos
Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Água Potável/química , Exposição Ambiental/estatística & dados numéricos , Poluição Química da Água/estatística & dados numéricos , China , Humanos , População Rural
19.
Am J Trop Med Hyg ; 100(5): 1101-1104, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30834880

RESUMO

Although access to piped drinking water continues to increase globally, information on the prevalence and clonal composition of coliforms found in piped water systems in low-resource settings remains limited. From June to July 2016, we examined Escherichia coli isolates in domestic water from the distribution system in Alibag, a small town in India. We analyzed the isolates for drug resistance and genotyped them by multilocus sequence typing. Of 147 water samples, 51 contained coliforms, and 19 (37%) of the 51 were biochemically confirmed to contain E. coli. These samples contained 104 E. coli isolates-all resistant to ampicillin. Resistance to ceftazidime was observed in 52 (50%) isolates, cefotaxime in 59 (57%), sulfamethoxazole-trimethoprim in 46 (44%), ciprofloxacin in 30 (29%), and gentamicin in two (2%). Thirty-eight (36%) belonged to sequence types recognized as extraintestinal pathogenic E. coli (ExPEC); 19 (50%) of these 38 ExPEC belonged to known uropathogenic E. coli lineages. This exploratory field research shows the extent to which "improved" drinking water is a potential source of E. coli strains capable of causing extraintestinal infections.


Assuntos
Antibacterianos/farmacologia , Água Potável/microbiologia , Farmacorresistência Bacteriana Múltipla , Escherichia coli Extraintestinal Patogênica/efeitos dos fármacos , Escherichia coli Extraintestinal Patogênica/isolamento & purificação , Técnicas de Tipagem Bacteriana , Escherichia coli Extraintestinal Patogênica/genética , Genótipo , Índia , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Virulência , Fatores de Virulência
20.
Annu Rev Environ Resour ; 44(1): 287-318, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32587484

RESUMO

Sanitation research focuses primarily on containing human waste and preventing disease; thus, it has traditionally been dominated by the fields of environmental engineering and public health. Over the past 20 years, however, the field has grown broader in scope and deeper in complexity, spanning diverse disciplinary perspectives. In this article, we review the current literature in the range of disciplines engaged with sanitation research in low- and middle-income countries (LMICs). We find that perspectives on what sanitation is, and what sanitation policy should prioritize, vary widely. We show how these diverse perspectives augment the conventional sanitation service chain, a framework describing the flow of waste from capture to disposal. We review how these perspectives can inform progress toward equitable sanitation for all [i.e., Sustainable Development Goal (SDG) 6]. Our key message is that both material and nonmaterial flows-and both technological and social functions-make up a sanitation "system." The components of the sanitation service chain are embedded within the flows of finance, decision making, and labor that make material flows of waste possible. The functions of capture, storage, transport, treatment, reuse, and disposal are interlinked with those of ensuring equity and affordability. We find that a multilayered understanding of sanitation, with contributions from multiple disciplines, is necessary to facilitate inclusive and robust research toward the goal of sanitation for all.

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