Multi-criteria decision analysis framework for engaging stakeholders in river pollution risk management.

Water pollution presents a substantial environmental challenge with extensive implications for water resources, ecosystem sustainability, and human health. Using a South African catchment, this study aimed to provide watershed managers with a framework for selecting best management practices (BMPs) to reduce pollution and the related risk to river users, while also including the perspectives of key catchment stakeholders. The framework encompassed the identification of and consultation with key stakeholders within the catchment. A Multi-Criteria Decision Analysis (MCDA) methodology using the Simple Multi-Attribute Rating Technique for Enhanced Stakeholder Take-up (SMARTEST) was used to identify and prioritise suitable BMPs in a case study. Decision alternatives and assessment criteria as well as their weights were derived based on stakeholder responses to a two-stage survey. Stakeholders included those utilising the river for domestic and recreational purposes, municipal representatives, scientists, NGOs, and engineers. The assessment of decision alternatives considered environmental, economic, and social criteria. The aggregated scores for decision alternatives highlighted the significance of involving stakeholders throughout the decision process. This study recommends the pairing of structural and non-structural BMPs. The findings provide valuable insights for catchment managers, policymakers, and environmental stakeholders seeking inclusive and effective pollution mitigation strategies in a catchment.

Quantitative assessment of human health risks from chemical pollution in the uMsunduzi River, South Africa.

A quantitative chemical risk assessment was performed using published data as well as data from the official monitoring programme for the uMsunduzi River in KwaZulu-Natal, South Africa. The chemicals assessed were organochlorinated pesticides (OCPs), pharmaceuticals and personal care products (PPCPs), heavy metals, and nitrates and phosphates. The water from uMsunduzi River is used locally without treatment. Consequently, the exposure routes investigated were via ingestion during domestic drinking and incidental ingestion during recreational activities, which were swimming and non-competitive canoeing, for both adults and children. For the individual chemicals, non-carcinogenic risks using the hazard quotient (HQ) and carcinogenic risks using the cancer risk (CR) were quantified. It was found that the exposed population is likely to experience non-carcinogenic effects from pesticides and phosphates, but not from PPCPs, heavy metals and nitrates. This study also found that the carcinogenic risks for OCPs were higher than the tolerable limit of 10-5, while for lead the risk was below the tolerable limit. Some of the activities that potentially contribute to chemicals onto the uMsunduzi River are subsistence farming, small plantations, illegal dumping, industries, and broken sewers. The findings of this study may act as the technical foundation for the introduction of pollution reduction measures within the catchment, including public education.

Water quality modelling and quantitative microbial risk assessment for uMsunduzi River in South Africa.

South African rivers generally receive waste from inadequate wastewater infrastructure, mines, and farming activities, among others. The uMsunduzi River in KwaZulu-Natal, South Africa, is among these recipients with recorded poor to very poor water quality. To identify parts of the uMsunduzi River that are polluted by Cryptosporidium and Escherichia coli (E. coli), this study mapped out pollutants emanating from point and non-point sources using the Soil and Water Assessment Tool (SWAT). Streamflow calibration in the upper and lower reaches of the catchment showed good performance with R2 of 0.64 and 0.58, respectively. SWAT water quality output data were combined with a Quantitative Microbial Risk Assessment (QMRA) to understand the microbial health implications for people using river water for drinking, recreational swimming, and non-competitive canoeing. QMRA results for Cryptosporidium and pathogenic E. coli showed that the probability of infection for most users exceeds the acceptable level for drinking and recreation as outlined in the South African water quality guidelines, and by the World Health Organization (WHO). The results of this study can be used as a baseline to assess the economic and health implications of different management plans, resulting in better-informed, cost-effective, and impactful decision-making.

An assessment of the health risks associated with shared sanitation: a case study of the community ablution blocks in Durban, South Africa.

Shared sanitation facilities have been hailed as an innovative approach to solve the challenge with sanitation access. However, these facilities may act as hotspots for disease transmission due to unhygienic conditions. In this study we used quantitative (based on Escherichia coli contamination) techniques to assess the health risks associated with the use of community ablution blocks (CABs). The most contaminated surfaces were the cistern handle (5.7 Log10 cfu/cm2) and internal pull latch (5.8 Log10 cfu/cm2). Based on the E. coli contamination, at least two people out of 100 CAB users might be potentially infected when they touch "hot" surfaces. These risks were modelled assuming transfer of potentially pathogenic E. coli from these surfaces to the mouth. The incorporation of risk-reduction measures, such as wiping of these surfaces or washing of hands, could potentially result in significant reduction of infection risks. The most significant risk-reduction intervention was determined to be wiping of the contact surfaces, especially twice prior to contact. A combination of risk-reduction interventions could further reduce the risks. This study shows that contamination of contact surfaces within shared CABs could lead to increased risks of infections, requiring measures aimed at reducing the associated risks. The risk assessment framework used in this study could therefore be applied in similar settings to estimate associated health risks with the use of such facilities.

Impact of sludge bulking on receiving environment using quantitative microbial risk assessment (QMRA)-based management for full-scale wastewater treatment plants.

During sludge bulking in wastewater treatment plants (WWTPs), high amounts of potentially pathogenic bacteria would release into the environment, causing various human-health risks. This is the first study attempting to assess the microbial infections associated with the reuse of WWTP effluents under various bulking conditions. Three common waterborne pathogens, viz., E. coli O157:H7, Salmonella, and Mycobacterium, were quantified from full-scale WWTPs using DNA extraction and qPCR at different sludge volume indices (SVIs). The detected pathogens were incorporated into a quantitative microbial risk assessment (QMRA) model to determine the applicability of WWTP discharge for recreational (bathing) activities and agricultural practices. The QMRA exposures were children, women, and men during swimming, and farmers and vegetable consumers during irrigation. Bacterial abundance in the treated wastewater increased in response to SVIs, and the QMRA values at all bulking events exceeded the tolerable risk of one case of infection per 10,000 people per year. Hence, various disinfection scenarios (chlorination, ultraviolet, and ozonation) were hypothetically tested to control the risks associated with pathogenic bacteria, allowing for safe disposal and reuse of the treated effluent. The ultraviolet application provided the highest ability to inactivate the pathogenic bacteria, except for the case of children exposed to Salmonella infection during swimming. The reduction of Mycobacterium infection risks with either chlorination or ozonation showed inefficient results. This study would be helpful for the management of human health risks associated with effluent wastewater containing pathogens, i.e., particularly concerning the case of sludge bulking.

Effects of socio-demographic characteristics and household water management on Aedes aegypti production in suburban and rural villages in Laos and Thailand.

BACKGROUND: Dengue fever is a mosquito-borne disease accounting for 50-100 million annual cases globally. Laos and Thailand are countries in south-east Asia where the disease is endemic in both urban and rural areas. Household water storage containers, which are favourable breeding sites for dengue mosquitoes, are common in these areas, due to intermittent or limited access to water supply. This study assessed the effect of household water management and socio-demographic risk factors on Aedes aegypti infestation of water storage containers. METHODS: A cross-sectional survey of 239 households in Laos (124 suburban and 115 rural), and 248 households in Thailand (127 suburban and 121 rural) was conducted. Entomological surveys alongside semi-structured interviews and observations were conducted to obtain information on Ae. aegypti infestation, socio-demographic factors and water management. Zero-inflated negative binomial regression models were used to assess risk factors associated with Ae. aegypti pupal infestation. RESULTS: Household water management rather than socio-demographic factors were more likely to be associated with the infestation of water containers with Ae. aegypti pupae. Factors that was significantly associated with Ae. aegypti infestation were tanks, less frequent cleaning of containers, containers without lids, and containers located outdoors or in toilets/bathrooms. CONCLUSIONS: Associations between Ae. aegypti pupae infestation, household water management, and socio-demographic factors were found, with risk factors for Ae. aegypti infestation being specific to each study setting. Most of the containers did not have lids, larvicides, such as temephos was seldom used, and containers were not cleaned regularly; factors are facilitating dengue vector proliferation. It is recommended that, in Lao villages, health messages should promote proper use and maintenance of tightly fitted lids, and temephos in tanks, which were the most infested containers. Recommendations for Thailand are that small water containers should be cleaned weekly. Furthermore, in addition to health messages on dengue control provided to communities, attention should be paid to larval control for indoor containers in rural villages. Temephos or other immature control measures such as the use of pyriproxyfen, antilarval bacteria, or larvivorous fish should be used where temephos resistance is prevalent. Dengue control is not possible without additional adult mosquito control and community participation.

Antibiotic Resistant Superbugs: Assessment of the Interrelationship of Occurrence in Clinical Settings and Environmental Niches.

The increasing threat to global health posed by antibiotic resistance remains of serious concern. Human health remains at higher risk due to several reported therapeutic failures to many life threatening drug resistant microbial infections. The resultant effects have been prolonged hospital stay, higher cost of alternative therapy, increased mortality, etc. This opinionated review considers the two main concerns in integrated human health risk assessment (i.e., residual antibiotics and antibiotic resistant genes) in various compartments of human environment, as well as clinical dynamics associated with the development and transfer of antibiotic resistance (AR). Contributions of quorum sensing, biofilms, enzyme production, and small colony variants in bacteria, among other factors in soil, water, animal farm and clinical settings were also considered. Every potential factor in environmental and clinical settings that brings about AR needs to be identified for the summative effects in overall resistance. There is a need to embrace coordinated multi-locational approaches and interrelationships to track the emergence of resistance in different niches in soil and water versus the hospital environment. The further integration with advocacy, legislation, enforcement, technological innovations and further research input and recourse to WHO guidelines on antibiotic policy would be advantageous towards addressing the emergence of antibiotic resistant superbugs.

Exploring the potential reservoirs of non specific TEM beta lactamase (bla(TEM)) gene in the Indo-Gangetic region: A risk assessment approach to predict health hazards.

The emergence of antimicrobial resistant bacteria is an important public health and environmental contamination issue. Antimicrobials of ß-lactam group accounts for approximately two thirds, by weight, of all antimicrobials administered to humans due to high clinical efficacy and low toxicity. This study explores ß-lactam resistance determinant gene (blaTEM) as emerging contaminant in Indo-Gangetic region using qPCR in molecular beacon format. Quantitative Microbial Risk Assessment (QMRA) approach was adopted to predict risk to human health associated with consumption/exposure of surface water, potable water and street foods contaminated with bacteria having blaTEM gene. It was observed that surface water and sediments of the river Ganga and Gomti showed high numbers of blaTEM gene copies and varied significantly (p<0.05) among the sampling locations. The potable water collected from drinking water facility and clinical settings exhibit significant number of blaTEM gene copies (13±0.44-10200±316 gene copies/100mL). It was observed that E.crassipes among aquatic flora encountered in both the rivers had high load of blaTEM gene copies. The information on prevalence of environmental reservoirs of blaTEM gene containing bacteria in Indo-Gangetic region and risk associated will be useful for formulating strategies to protect public from menace of clinical risks linked with antimicrobial resistant bacteria.

A probabilistic assessment of the contribution of wastewater-irrigated lettuce to Escherichia coli O157:H7 infection risk and disease burden in Kumasi, Ghana.

Wastewater use for vegetable production is widespread across the cities of many developing countries. Studies on the microbial health risks associated with the practice have largely depended on faecal indicator organisms with potential underestimation or overestimation of the microbial health risks and disease burdens. This study assessed the Escherichia coli O157:H7 infection risk and diarrhoeal disease burden measured in disability-adjusted life years (DALYs) associated with the consumption of wastewater-irrigated lettuce in Kumasi, Ghana using data on E. coli O157:H7 in ready-to-harvest, wastewater-irrigated lettuce. Two exposure scenarios - best case and worst case - associated with a single consumption of wastewater-irrigated lettuce were assessed. The assessment revealed wastewater-irrigated lettuce is contributing to the transmission of E. coli O157:H7 in Kumasi, Ghana. The mean E. coli O157:H7 infection risk and DALYs in the wet and dry seasons, irrespective of the exposure scenario, were above the World Health Organization tolerable daily infection risk of 2.7 × 10⁻7 per person per day and 10⁻6 DALYs per person per year. It is recommended that legislation with clear monitoring indicators and penalties is implemented to ensure that farmers and food sellers fully implement risk mitigating measures.

Comparative assessment of the bacterial communities associated with Aedes aegypti larvae and water from domestic water storage containers.

BACKGROUND: Domestic water storage containers constitute major Aedes aegypti breeding sites. We present for the first time a comparative analysis of the bacterial communities associated with Ae. aegypti larvae and water from domestic water containers. METHODS: The 16S rRNA-temporal temperature gradient gel electrophoresis (TTGE) was used to identify and compare bacterial communities in fourth-instar Ae. aegypti larvae and water from larvae positive and negative domestic containers in a rural village in northeastern Thailand. Water samples were cultured for enteric bacteria in addition to TTGE. Sequences obtained from TTGE and bacterial cultures were clustered into operational taxonomic units (OTUs) for analyses. RESULTS: Significantly lower OTU abundance was found in fourth-instar Ae. aegypti larvae compared to mosquito positive water samples. There was no significant difference in OTU abundance between larvae and mosquito negative water samples or between mosquito positive and negative water samples. Larval samples had significantly different OTU diversity compared to mosquito positive and negative water samples, with no significant difference between mosquito positive and negative water samples. The TTGE identified 24 bacterial taxa, belonging to the phyla Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes and TM7 (candidate phylum). Seven of these taxa were identified in larval samples, 16 in mosquito positive and 13 in mosquito negative water samples. Only two taxa, belonging to the phyla Firmicutes and Actinobacteria, were common to both larvae and water samples. Bacilli was the most abundant bacterial class identified from Ae. aegypti larvae, Gammaproteobacteria from mosquito positive water samples, and Flavobacteria from mosquito negative water samples. Enteric bacteria belonging to the class Gammaproteobacteria were sparsely represented in TTGE, but were isolated from both mosquito positive and negative water samples by selective culture. CONCLUSIONS: Few bacteria from water samples were identified in fourth-instar Ae. aegypti larvae, suggesting that established larval bacteria, most likely acquired at earlier stages of development, control the larval microbiota. Further studies at all larval stages are needed to fully understand the dynamics involved. Isolation of enteric bacteria from water samples supports earlier outcomes of E. coli contamination in Ae. aegypti infested domestic containers, suggesting the need to further explore the role of enteric bacteria in Ae. aegypti infestation.

Why do water and sanitation systems for the poor still fail? Policy analysis in economically advanced developing countries.

The results of an independent evaluation of 60 case studies of water and sanitation infrastructure projects in India, Mexico, and South Africa, most of them implemented since 2000, demonstrate an ongoing problem of failing infrastructure even in economically advanced developing countries. This paper presents a meta-analysis of those project case study results and analyses whether the design of existing policies or other factors contribute to failures. It concludes that the observed failures are due to well-known reasons and recommends how the implementation of the Dublin-Rio Principles can be improved. (They were introduced twenty years ago to avoid such failures by means of more sustainable planning.).

Quantification of the health risk associated with wastewater reuse in Accra, Ghana: a contribution toward local guidelines.

Quantitative Microbial Risk Assessment (QMRA) models with 10,000 Monte Carlo simulations were applied to ascertain the risks of rotavirus and Ascaris infections for farmers using different irrigation water qualities and consumers of lettuce irrigated with the different water qualities after allowing post-harvest handling. A tolerable risk (TR) of infection of 7.7 x 10(-4) and 1 x 10(-2) per person per year were used for rotavirus and Ascaris respectively. The risk of Ascaris infection was within a magnitude of 10(-2) for farmers accidentally ingesting drain or stream irrigation water; approximately 10(0) for farmers accidentally ingesting farm soil and 10(0) for farmers ingesting any of the irrigation waters and contaminated soil. There was a very low risk (10(-5)) of Ascaris infection for farmers using pipe-water. For consumers, the annual risks of Ascaris and rotavirus infections were 10(0) and 10(-3) for drain and stream irrigated lettuce respectively with slight increases for rotavirus infections along the post-harvest handling chain. Pipe irrigated lettuce recorded a rotavirus infection of 10(-4) with no changes due to post harvest handling. The assessment identified on-farm soil contamination as the most significant health hazard.

Microbial risk assessment of local handling and use of human faeces.

Dry urine-diverting toilets may be used in order to collect excreta for the utilisation of nutrients. A quantitative microbial risk assessment was conducted in order to evaluate the risks of transmission of infectious disease related to the local use of faeces as a fertiliser. The human exposures evaluated included accidental ingestion of small amounts of faeces, or a mixture of faeces and soil, while emptying the storage container and applying the material in the garden, during recreational stays to the garden, and during gardening. A range of pathogens representing various groups of microorganisms was considered. Results showed that 12-months' storage before use was sufficient for the inactivation of most pathogens to acceptable levels. When working or spending time in the garden the annual risk of infection by Ascaris was still slightly above 10(-4) in these scenarios, although the incidence rate for Ascaris is very low in the population in question. Measures to further reduce the hygienic risks include longer storage, or treatment, of the faeces. The results can easily be extended to other regions with different incidence rates.

Microbial risk assessment of source-separated urine used in agriculture.

A screening-level quantitative microbial risk assessment (QMRA) was undertaken for a urine separating sewerage system. Exposures evaluated included the handling of stored and unstored urine as well as consumption of crops fertilised with urine. Faecal cross-contamination was the source of risk and Campylobacter jejuni, Cryptosporidium parvum and rotavirus were the organisms chosen to represent different groups of enteric pathogens. Accidental ingestion of unstored urine implied a high risk (Pinf = 0.56) for infection from rotavirus whereas the risks for infection from bacteria and protozoa were approximately 1:10 000. After six months storage at 20 degrees C the risk for viral infections by accidental ingestion of 1 ml of urine was < 10(-3), the suggested acceptable risk benchmark. Ingestion of crops contaminated with urine resulted in risks of < 10(-5) after a 3-week (<10(-7) after 4 weeks) withholding period between fertilising and harvesting.