Water Supply Interruptions Are Associated with More Frequent Stressful Behaviors and Emotions but Mitigated by Predictability: A Multisite Study.

Water supply interruptions contribute to household water insecurity. Unpredictable interruptions may particularly exacerbate water insecurity, as uncertainty limits households' ability to optimize water collection and storage or to modify other coping behaviors. This study used regression models of survey data from 2873 households across 10 sites in 9 middle-income countries to assess whether water supply interruptions and the predictability of interruptions were related to composite indicators of stressful behaviors and emotional distress. More frequent water service interruptions were associated with more frequent emotional distress (ß = 0.49, SE = 0.05, P < 0.001) and stressful behaviors (ß = 0.39, SE = 0.06, P < 0.001). Among households that experienced interruptions, predictability mitigated these respective relationships by approximately 25 and 50%. Where the provision of continuous water supplies is challenged by climate change, population growth, and poor management, water service providers may be able to mitigate some psychosocial consequences of intermittency through scheduled intermittency and communication about water supply interruptions. Service providers unable to supply continuous water should optimize intermittent water delivery to reduce negative impacts on users, and global monitoring regimes should account for intermittency and predictability in post-2030 water service metrics to better reflect household water insecurity experiences.

Intermittent water supply and self-rated health in rural China's karst region.

Introduction: With rapid economic and social development, surging demand for domestic water, and the increasing shortage of water resources, the applications of intermittent water supply systems have become more common in rural China and other developing countries. The accompanying hygiene risks require our more attention. Methods: Based on the Grossman model, this paper conducted an IV-Oprobit model to investigate whether and how intermittent water supply affect rural residents' self-rated health status. Our data came from "China Karst Rural Economic Survey (CKRS)", which covers 8 provinces and 641 villages in rural China's karst region. Results and discussion: We found that: (1) Intermittent water supply has adverse effects on the self-rated health status of rural residents. Compared with the rural residents under continuous water supply, the probability of "fair" health status under intermittent water supply significantly increases by 18.2%, while the probability of "excellent" significantly reduces by 58.8%. (2) Residents' water storage behavior and sanitary water habit are important mechanisms for intermittent water supply to affect residents' self-rated health status; (3) Intermittent water supply has a greater impact on the self-rated health of females and the groups with lower education levels. The results of our study have the following policy implications: relevant departments should make a rational plan about water supply methods and improve related supporting measures; we should strengthen health education for rural residents on water behavior to standardize their water storage and sanitary water behavior; government should enhance the pertinence of policy implementation and favor specific measures to specific populations.

Intermittent Water Supply Impacts on Distribution System Biofilms and Water Quality.

Intermittent water supplies (IWS) are routinely experienced by drinking water distribution systems around the world, either due to ongoing operational practices or due to one off interruptions. During IWS events changing conditions may impact the endemic biofilms leading to hydraulic mobilisation of organic and inorganic materials attached to pipes walls with a resulting degradation in water quality. To study the impact of IWS on the microbiological and physico-chemical characteristics of drinking water, an experimental full-scale chlorinated pipe facility was operated over 60 days under realistic hydraulic conditions to allow for biofilm growth and to investigate flow resumption behaviour post-IWS events of 6, 48 and 144 hours. Turbidity and metal concentrations showed significant responses to flow restarting, indicating biofilm changes, with events greater than 6 hours generating more turbidity responses and hence discolouration risk. The increase in pressure when the system was restarted showed a substantial increase in total cell counts, while the subsequent increases in flow led to elevated turbidity and metals concentrations. SUVA254 monitoring indicated that shorter times of non-water supply increased the risk of aromatic organic compounds and hence risk of disinfection-by-products formation. DNA sequencing indicated that increasing IWS times resulted in increased relative abundance of potential pathogenic microorganisms, such as Mycobacterium, Sphingomonas, and the fungi Penicillium and Cladosporium. Overall findings indicate that shorter IWS result in a higher proportion of aromatic organic compounds, which can potentially react with chlorine and increase risk of disinfection-by-products formation. However, by minimising IWS times, biofilm-associated impacts can be reduced, yet these are complex ecosystems and much remains to be understood about how microbial interactions can be managed to best ensure continued water safe supply.

Effect of operational strategies on microbial water quality in small scale intermittent water supply systems: The case of Moamba, Mozambique.

Intermittent drinking water supply affects the health of over 300 million people globally. In Mozambique, it is largely practiced in cities and small towns. This results in frequent microbial contamination of the supplied drinking water posing a health risk to consumers. In Moamba, a small town in Southern Mozambique with 2,500 water connections, the impact of changes in operational strategies, namely increased chlorine dosage, increased supply duration and first-flush, on the microbial water quality was studied to determine best practices. To that aim, water quality monitoring was enhanced to provide sufficient data on the microbial contamination from 452 samples under the different strategies. The water at the outlet of the water treatment plant during all strategies was free of E. coli complying to the national standards. However, E. coli could be detected at household level. By increasing the chlorine dosage, the number of samples that showed E. coli absence increased at the two sampling locations in the distribution network: in Cimento from 72% to 83% and in Matadouro from 52% to 86%. Modifying the number and duration of supply cycles showed a different impact on the water quality at both locations in the distribution network. A positive effect was shown in Cimento, where the mean concentrations decreased slightly from 0.54 to 0.23 CFU/100 mL and 16.7 to 7.3 CFU/100 mL for E. coli and total coliforms respectively. The percentage of samples positive for bacteria was, however, similar. In contrast, a negative effect was shown in Matadouro where the percentage of positive samples increased and the mean bacterial concentrations increased slightly: E. coli from 0.9 to 1.5 CFU/100 mL and total coliforms 17.6 to 23.0 CFU/100 mL. Enhanced water quality monitoring improved operational strategies safeguarding the microbial water quality. The E. coli contamination of the drinking water at household level could point at recontamination in the distribution or unsafe hygienic practices at household level. Presence of faecal contamination at household level indicates potential presence of pathogens posing a health risk to consumers. Increasing chlorine dosage ensured good microbiological drinking water quality but changing the number of supply cycles had no such effect.

Microbial water quality improvement associated with transitioning from intermittent to continuous water supply in Nagpur, India.

Nearly half a billion people living in Indian cities receive their drinking water from an intermittent water supply (IWS), which can be associated with degraded water quality and risk of waterborne disease. The municipal water supply in Nagpur, India is transitioning from intermittent to continuous supply in phases. We conducted cross-sectional sampling to compare microbial water quality under IWS and continuous water supply (CWS) in Nagpur. In 2015 and 2017, we collected 146 grab samples and 90 large-volume dead-end ultrafiltration (DEUF) samples (total volume: 6,925 liters). In addition to measuring traditional water quality parameters, we also assayed DEUF samples by droplet digital PCR (ddPCR) for waterborne pathogen gene targets. At household taps served by IWS, we detected targets from enterotoxigenic E. coli, Shigella spp./enteroinvasive E. coli, norovirus GI and GII, adenovirus A-F, Cryptosporidium spp., and Giardia duodenalis. We observed a significant increase in the proportion of grab samples positive for culturable E. coli (p = 0.0007) and DEUF concentrates positive for waterborne pathogen gene targets (p = 0.0098) at household taps served by IWS compared to those served by CWS. IWS continues to be associated with fecal contamination, and, in this study, with increased prevalence of molecular evidence of waterborne pathogens. These findings add mounting evidence that, despite the presence of piped on premise infrastructure, IWS is less likely to meet the requirements for safely-managed drinking water as defined by the Sustainable Development Goals. Importantly, these findings demonstrate the transition from IWS to CWS in Nagpur is yielding meaningful improvements in microbial water quality.

Optimizing Household Water Decisions for Managing Intermittent Water Supply in Mexico City.

One billion people worldwide experience intermittent water supply (IWS), in which piped water is delivered for limited durations. Households with IWS must invest in water storage infrastructure and often rely on multiple sources of water; therefore, these household-level purchasing and infrastructure decisions is a critical component of water access. Informed by interviews with IWS households, we use radial basis function networks, a type of artificial neural network, to determine optimal household water management decisions that maximize reliability of water supply while minimizing costs for a representative household in Mexico City that uses municipal piped water, trucked water, and rainwater. We find that securing reliable water supply for IWS households is greatly assisted by installation of household storage tanks of at least 2500 L. In the case of IWS households with limited storage options, the overall cost for water supply is reduced by scheduling water deliveries on nonconsecutive days. Rainwater harvesting systems were shown to be economically viable for households with limited water supply. This study demonstrates the importance of considering the management of multiple sources and household storage infrastructure when evaluating water investments in cities with IWS.

Source to Tap Risk Assessment for Intermittent Water Supply Systems in Arid Regions: An Integrated FTA-Fuzzy FMEA Methodology.

Water utilities in arid regions deal with multifaceted issues of natural groundwater contamination, high treatment costs, and low water rates. These utilities rely on intermittent supplies resulting in numerous water quality failures at source, treatment, distribution, and in-house plumbing systems. The present research presents an inclusive risk assessment methodology for managing water quality from source to tap. Three-year monitoring data for turbidity, TDS, pH, iron, ammonia, nitrates, residual chlorine, Coliform group, E. coli, and Fecal Streptococci identified the root causes of failures. The cause-effect relationships in the form of a fault tree were solved using multiple failure modes and effect analysis (FMEA) to handle both the Boolean operations. The fuzzy sets addressed the uncertainties associated with data limitations in calculating exceedance probabilities (Pe) and vagueness in expert opinion for subjective evaluation of severity and detectability. The methodology was applied on a smaller system serving 18,000 consumers in Qassim, Saudi Arabia. Potable supplied water underwent reoccurrence of TDS (Pe = 20%), turbidity (Pe = 10%), and Fe (Pe = 2%) failures in distribution that further increased up to 44%, 33%, and 11% at the consumer end. The Pe for residual chlorine failure soared up to 89%. Economic controls reduced the cumulative risk to 50%, while the shift to continuous supply can limit the remaining failures under the acceptable risk. The framework will help utilities manage water quality in intermittent systems from source to tap in Saudi Arabia, the Gulf, and elsewhere.

COVID-19 and the call for 'Safe Hands': Challenges facing the under-resourced municipalities that lack potable water access - A case study of Chitungwiza municipality, Zimbabwe.

Billions of people living in developing countries lack access to safe drinking water, not to mention water for handwashing, one of the most effective ways to contain the fast spreading novel coronavirus (COVID -19). The recent global spread of COVID-19 has fostered diverse initiatives such as the 'Safe Hands' challenge led by the World Health Organization. Individuals are encouraged to regularly wash their hands for 40-60 s under running water with soap. This call for 'Safe Hands' comes at a time when water insecurity and limited access to handwashing facilities in Africa is heightened. In this article, Chitungwiza city in Zimbabwe is used as a case study to assess the implications of the 'Safe Hands' challenge for poor municipalities in developing countries and characterize the challenges they face. To do so, interviews were conducted at water points/boreholes used by residents during Zimbabwe's COVID-19 national lockdown. The calculation of water requirements for proper hand hygiene determined the capacity for water-stressed regions to effectively implement 'Safe Hands'. On average, it was established that one person consumes an extra 4.5 L per day of water when they practice WHO 'Safe Hands' in the context of COVID-19. This increases domestic water demand in Chitungwiza by 9%. Due to water scarcity, people in Chitungwiza were experiencing challenges with practicing 'Safe Hands'. With their 'dry taps' woes, they might not be able to meet the standards of this WHO challenge. Lack of soap also reduced the effectiveness of the 'Safe Hands' challenge. This paper proposes short- and long-term measures that would allow effective implementation of the 'Safe Hands' by means of sustainable potable water supply. These measures include extensive social awareness and temporary change of household water use behavior. Municipalities are recommended to establish public private partnerships (PPPs) to create immediate and long-term water investments. Structural and transformational reforms would enhance, through flexible planning, investments for both water infrastructure and governance. This narrative has the potential to improve the urban water systems resiliency against future pandemics.

Bacterial Contamination of Drinking Water in Guadalajara, Mexico.

In many regions where drinking water supply is intermittent and unreliable, households adapt by storing water in cisterns or rooftop tanks. Both intermittent supply and stored water can be vulnerable to contamination by microorganisms with deleterious health effects. The Metropolitan Zone of Guadalajara is a rapidly growing urban center with over five million residents where household storage is nearly ubiquitous. This pilot study was conducted in July 2018 to examine the microbiological quality of drinking water in Guadalajara. Samples were tested for free available chlorine residual, total coliform bacteria, and Escherichia coli. A survey on access to water and public perspectives was also conducted. Water exiting rooftop tanks exceeded regulatory limits for total coliform levels in half of the homes studied. Piped water arriving at two homes had total coliform levels that far exceeded regulatory limits. No E. coli were detected in any of the samples. Only 35% of homes had a chlorine residual between the recommended 0.2 and 1.5 mg/L. Many homes reported unpleasant odors and colors. Only 7% of residents drank the piped water. Future studies are needed, especially during April and May when many homes reported a higher disruption to water service.

Informed community mobilization for dengue prevention in households with and without a regular water supply: Secondary analysis from the Camino Verde trial in Nicaragua.

BACKGROUND: Studies in different countries have identified irregular water supply as a risk factor for dengue virus transmission. In 2013, Camino Verde, a cluster-randomised controlled trial in Managua, Nicaragua, and Mexico's Guerrero State, demonstrated impact of evidence-based community mobilisation on recent dengue infection and entomological indexes of infestation by Aedes aegypti mosquitoes. This secondary analysis of data from the trial impact survey asks: (1) what is the importance of regular water supply in neighbourhoods with and without the trial intervention and (2) can community interventions like Camino Verde reasonably exclude households with adequate water supply? METHODS: Entomological data collected in the dry season of 2013 in intervention and control communities allow contrasts between households with regular and irregular water supplies. Indicators of entomological risk included the House Index and pupa positive household index. Generalised linear mixed models with cluster as a random effect compared households with and without regular water, and households in intervention and control communities. RESULTS: For the House Index, regular water supply was associated with a protection in both intervention households (OR 0.7, 95%CI 0.6-0.9) and control households (OR 0.6, 95%CI 0.5-0.8). For the pupa positive household index, we found a similar protection from regular water supply in intervention households (OR 0.6, 95%CI 0.4-0.8) and control households (OR 0.7, 95%CI 0.5-0.9). The Camino Verde intervention had a similar impact on House Index in households with regular water supply (OR 0.7, 95%CI 0.5-1.0) and irregular water supply (OR 0.6, 95%CI 0.4-0.8); for the pupa positive household index, the effect of the intervention was very similar in households with regular (OR0.5, 95%CI 0.3-0.8) and irregular (OR 0.5, 95%CI 0.3-0.9) water supply. CONCLUSION: While Aedes aegypti control efforts based on informed community mobilisation had a strong impact on households without a regular water supply, this intervention also impacted entomological indices in households with a regular water supply. These households should not be excluded from community mobilisation efforts to reduce the Aedes aegypti vector. TRIAL REGISTRATION: ISRCTN27581154 .

Comparing microbial water quality in an intermittent and continuous piped water supply.

Supplying piped water intermittently is a common practice throughout the world that increases the risk of microbial contamination through multiple mechanisms. Converting an intermittent supply to a continuous supply has the potential to improve the quality of water delivered to consumers. To understand the effects of this upgrade on water quality, we tested samples from reservoirs, consumer taps, and drinking water provided by households (e.g. from storage containers) from an intermittent and continuous supply in Hubli-Dharwad, India, over one year. Water samples were tested for total coliform, Escherichia coli, turbidity, free chlorine, and combined chlorine. While water quality was similar at service reservoirs supplying the continuous and intermittent sections of the network, indicator bacteria were detected more frequently and at higher concentrations in samples from taps supplied intermittently compared to those supplied continuously (p < 0.01). Detection of E. coli was rare in continuous supply, with 0.7% of tap samples positive compared to 31.7% of intermittent water supply tap samples positive for E. coli. In samples from both continuously and intermittently supplied taps, higher concentrations of total coliform were measured after rainfall events. While source water quality declined slightly during the rainy season, only tap water from intermittent supply had significantly more indicator bacteria throughout the rainy season compared to the dry season. Drinking water samples provided by households in both continuous and intermittent supplies had higher concentrations of indicator bacteria than samples collected directly from taps. Most households with continuous supply continued to store water for drinking, resulting in re-contamination, which may reduce the benefits to water quality of converting to continuous supply.