Water chemistry poses health risks as reliance on groundwater increases: A systematic review of hydrogeochemistry research from Ethiopia and Kenya.

Reliance on groundwater is increasing in Sub-Saharan Africa as development programmes work towards improving water access and strengthening resilience to climate change. In lower-income areas, groundwater supplies are typically installed without water quality treatment infrastructure or services. This practice is underpinned by an assumption that untreated groundwater is typically suitable for drinking due to the relative microbiological safety of groundwater compared to surface water; however, chemistry risks are largely disregarded. This article systematically reviews groundwater chemistry results from 160 studies to evaluate potential health risk in two case countries: Ethiopia and Kenya. Most studies evaluated drinking water suitability, focusing on priority parameters (fluoride, arsenic, nitrate, or salinity; 18 %), pollution impacts (10 %), or overall suitability (45 %). The remainder characterised general hydrogeochemistry (13 %), flow dynamics (10 %), or water quality suitability for irrigation (3 %). Only six studies (4 %) reported no exceedance of drinking water quality thresholds. Thus, chemical contaminants occur widely in groundwaters that are used for drinking but are not regularly monitored: 78 % of studies reported exceedance of contaminants that have direct health consequences ranging from hypertension to disrupted cognitive development and degenerative disease, and 81 % reported exceedance of aesthetic parameters that have indirect health impacts by influencing perception and use of groundwater versus surface water. Nevertheless, the spatiotemporal coverage of sampling has substantial gaps and data availability bias is driven by a) the tendency for research to concentrate in areas with known water quality problems, and b) analytical capacity limitations. Improved in-country analytical capacity could bolster more efficient assessment and prioritisation of water chemistry risks. Overall, this review demonstrates that universal and equitable access to safe drinking water (Sustainable Development Goal target 6.1) will not be achieved without wider implementation of groundwater treatment, thus a shift is required in how water systems are designed and managed.

Spatio-temporal variability and potential health risks assessment of heavy metals in the surface water of Awash basin, Ethiopia.

Increasing urbanization and industrialization are impacting on water quality globally. In the Awash River basin, Ethiopia, these drivers are impacting on water quality with further impacts created due to changes in water management releasing geogenic contaminants. The resulting water quality has potential to cause significant ecological and human health impacts. The physicochemical and heavy metals saptio-temporal variability and their associated risks to human health and ecology were assessed across twenty sampling stations in the Awash River basin. Over twenty-two physicochemical and ten heavy metals parameters were analyzed using different instruments including inductively coupled plasma mass spectrometer (ICP-MS). Elevated levels of heavy metals (As, V, Mo, Mn, and Fe) were detected in the surface water, surpassing the drinking water quality standards set by the World Health Organization (WHO). Seasonal variation was evident with peak concentration of As, Ni, Hg, and Cr were recorded in the dry season. A water quality index, hazard quotient, hazard index, heavy metal pollution index and heavy metal evaluation index were formulated to assess the potential risks to both human health and the environment. The highest values of heavy metal pollution index (HPI) above the threshold (>100) were observed in stations at Lake Beseka with HPI values ranged from 105 to 177. Similarly, the highest values of the heavy metals evaluation index (HEI) were observed in stations situated at cluster 3. The evaluation of health risk that is not related to cancer through hazard quotient demonstrated that in the case of both dermal and ingestion contact, cluster C3 > C1 > C4 > C2 and C3 > C4 > C2 > C1 were observed in children and adults, respectively. Overall, measures to reduce potential pollution risks must be taken in accordance with the standards in the river basin. Nevertheless, further research on the toxicity of heavy metals that pose risks to human health is also necessary.

When Water Quality Crises Drive Change: A Comparative Analysis of the Policy Processes Behind Major Water Contamination Events.

The occurrence of major water contamination events across the world have been met with varying levels of policy responses. Arsenic-a priority water contaminant globally, occurring naturally in groundwater, causing adverse health effects-is widespread in Bangladesh. However, the policy response has been slow, and marked by ineffectiveness and a lack of accountability. We explore the delayed policy response to the arsenic crisis in Bangladesh through comparison with water contamination crises in other contexts, using the Multiple Streams Framework to compare policy processes. These included Escherichia coli O157:H7 and Campylobacter in Walkerton, Canada; lead and Legionella in Flint, Michigan, USA; and chromium-6 contamination in Hinkley, California, USA. We find that, while water contamination issues are solvable, a range of complex conditions have to be met in order to reach a successful solution. These include aspects of the temporal nature of the event and the outcomes, the social and political context, the extent of the public or media attention regarding the crisis, the politics of visibility, and accountability and blame. In particular, contaminants with chronic health outcomes, and longer periods of subclinical disease, lead to smaller policy windows with less effective policy changes. Emerging evidence on health threats from drinking water contamination raise the risk of new crises and the need for new approaches to deliver policy change.

Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh.

The emergence of virulent extended spectrum ß-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common ß-lactam resistance gene was blaCTX-M-1 (91%), followed by blaTEM (76.1%), blaSHV (68.7%), blaOXA-1 (29.9%), blaGES (14.9%), blaCTX-M-9 (11.9%), and blaCTX-M-2 (4.5%). The carbapenemase genes blaKPC (55.2%), blaIMP (28.4%), blaVIM (14.9%), blaNDM-1 (13.4%), and blaOXA-48 (10.4%) and virulence-associated genes such as fimH (71.6%), ugeF (58.2%), wabG (56.7%), ureA (47.8%) and kfuBC (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections.

Wastewater surveillance of SARS-CoV-2 in Bangladesh: Opportunities and challenges.

The ongoing pandemic of the coronavirus disease 2019 (COVID-19) is a public health crisis of global concern. The progression of the COVID-19 pandemic has been monitored in the first place by testing symptomatic individuals for SARS-CoV-2 virus in the respiratory samples. Concurrently, wastewater carries feces, urine, and sputum that potentially contains SARS-CoV-2 intact virus or partially damaged viral genetic materials excreted by infected individuals. This brings significant opportunities for understanding the infection dynamics by environmental surveillance. It has advantages for the country, especially in densely populated areas where individual clinical testing is difficult. However, there are several challenges including: 1) establishing a sampling plan and schedule that is representative of the various catchment populations 2) development and validation of standardized protocols for the laboratory analysis 3) understanding hydraulic flows and virus transport in complex wastewater drainage systems and 4) collaborative efforts from government agencies, NGOs, public health units and academia.

Fear, Efficacy, and Environmental Health Risk Reporting: Complex Responses to Water Quality Test Results in Low-Income Communities.

Reducing disease from unsafe drinking-water is a key environmental health objective in rural Sub-Saharan Africa, where water management is largely community-based. The effectiveness of environmental health risk reporting to motivate sustained behaviour change is contested but as efforts to increase rural drinking-water monitoring proceed, it is timely to ask how water quality information feedback can improve water safety management. Using cross-sectional (1457 households) and longitudinal (167 participants) surveys, semi-structured interviews (73 participants), and water quality monitoring (79 sites), we assess water safety perceptions and evaluate an information intervention through which Escherichia coli monitoring results were shared with water managers over a 1.5-year period in rural Kitui County, Kenya. We integrate the extended parallel process model and the precaution adoption process model to frame risk information processing and stages of behaviour change. We highlight that responses to risk communications are determined by the specificity, framing, and repetition of messaging and the self-efficacy of information recipients. Poverty threatscapes and gender norms hinder behaviour change, particularly at the household-level; however, test results can motivate supply-level managers to implement hazard control measures-with effectiveness and sustainability dependent on infrastructure, training, and ongoing resourcing. Our results have implications for rural development efforts and environmental risk reporting in low-income settings.

Infrastructure alone cannot ensure resilience to weather events in drinking water supplies.

Climate resilient water supplies are those that provide access to drinking water that is sustained through seasons and through extreme events, and where good water quality is also sustained. While surface and groundwater quality are widely understood to vary with rainfall, there is a gap in the evidence on the impact of weather and extremes in rainfall and temperature on drinking water quality, and the role of changes in water system management. A three-country (Bangladesh, Nepal and Tanzania) observational field study tracked 2353 households clustered around 685 water sources across seven different geographies over 14 months. Water quality (E. coli) data was modelled using GEE to account for clustering effects and repeated measures at households. All types of infrastructure were vulnerable to changes in weather, with differences varying between geographies; protected boreholes provided the greatest protection at the point of collection (PoC). Water quality at the point of use (PoU) was vulnerable to changes in weather, through changes in PoC water quality as well as changes in management behaviours, such as safe storage, treatment and cleaning. This is the first study to demonstrate the impact of rainfall and temperature extremes on water quality at the PoC, and the role that weather has on PoU water quality via management behaviours. Climate resilience for water supplies needs to consider the infrastructure as well as the management decisions that are taking place at a community and household level.

The utility of Escherichia coli as a contamination indicator for rural drinking water: Evidence from whole genome sequencing.

Across the water sector, Escherichia coli is the preferred microbial water quality indicator and current guidance upholds that it indicates recent faecal contamination. This has been challenged, however, by research demonstrating growth of E. coli in the environment. In this study, we used whole genome sequencing to investigate the links between E. coli and recent faecal contamination in drinking water. We sequenced 103 E. coli isolates sampled from 9 water supplies in rural Kitui County, Kenya, including points of collection (n = 14) and use (n = 30). Biomarkers for definitive source tracking remain elusive, so we analysed the phylogenetic grouping, multi-locus sequence types (MLSTs), allelic diversity, and virulence and antimicrobial resistance (AMR) genes of the isolates for insight into their likely source. Phylogroup B1, which is generally better adapted to water environments, is dominant in our samples (n = 69) and allelic diversity differences (z = 2.12, p = 0.03) suggest that naturalised populations may be particularly relevant at collection points with lower E. coli concentrations (<50 / 100mL). The strains that are more likely to have originated from human and/or recent faecal contamination (n = 50), were found at poorly protected collection points (4 sites) or at points of use (12 sites). We discuss the difficulty of interpreting health risk from E. coli grab samples, especially at household level, and our findings support the use of E. coli risk categories and encourage monitoring that accounts for sanitary conditions and temporal variability.

Potential predictability of the Ethiopian summer rains: Understanding local variations and their implications for water management decisions.

Understanding the influence of large-scale oceanic and atmospheric variability on rainfall over Ethiopia has huge potential to improve seasonal forecasting and inform crucial water management decisions at local levels, where data is available at appropriate scales for decision makers. In this study, drivers of Ethiopia's main rainy season, July-September (JAS), are investigated using correlation analysis with sea surface temperature (SST). The analysis showed local spatial variations in the drivers of JAS rainfall. Moreover, the analysis revealed strong correlation between March to May (MAM) SST and JAS rainfall in particular regions. In addition to the influence of SSTs, we highlighted one of the mechanisms explaining the regional pattern of SST influence on Ethiopian rainfall, the East African Low-Level Jet. Moreover, examining the occurrence of large-scale phenomena provided additional information, with very strong ENSO and positive IOD events associated with drier conditions in most part of Ethiopia. A sub-national analysis, focused at a scale relevant for water managers, on the Awash basin, highlighted two distinct climate zones with different relationships to SSTs. June was not included as part of the rainy season as in some areas June is a hot, dry month between rainy seasons and in others it can be used to update sub-seasonal forecasts with lead time of one month for JAS rainfall. This highlights the importance of understanding locally relevant climate systems and ensuing sub-seasonal to seasonal forecasts are done at the appropriate scale for water management in the complex topography and climatology of Ethiopia.

Mapping the social impacts of small dams: The case of Thailand's Ing River basin.

The social impacts of large dams have been studied extensively. However, small dams' social impacts have been largely neglected by the academic community. Our paper addresses this gap. We examine the social impacts of multiple small dams in one upstream and one downstream village in Thailand's Ing River basin. Our research is based on semi-structured interviews with beneficiaries, government and NGOs. We argue that small dams' social impacts are multi-faceted and unequal. The dams were perceived to reduce fish abundance and provide flood mitigation benefits. Furthermore, the dams enabled increased access to irrigation water for upstream farmers, who re-appropriated water via the dams at the expense of those downstream. The small dams thus engendered water allocation conflicts. Many scholars, practitioners and environmentalists argue that small dams are a benign alternative to large dams. However, the results of our research mandate caution regarding this claim.

Tryptophan-like fluorescence as a measure of microbial contamination risk in groundwater.

Microbial water quality is frequently assessed with a risk indicator approach that relies on Escherichia coli. Relying exclusively on E. coli is limiting, particularly in low-resource settings, and we argue that risk assessments could be improved by a complementary parameter, tryptophan-like fluorescence (TLF). Over two campaigns (June 2016 and March 2017) we sampled 37 water points in rural Kwale County, Kenya for TLF, E. coli and thermotolerant coliforms (total n = 1082). Using three World Health Organization defined classes (very high, high, and low/intermediate), risk indicated by TLF was not significantly different from risk indicated by E. coli (p = 0.85). However, the TLF and E. coli risk classifications did show disagreement, with TLF indicating higher risk for 14% of samples and lower risk for 13% of samples. Comparisons of duplicate/replicate results demonstrated that precision is higher for TLF (average relative percent difference of duplicates = 14%) compared to culture-based methods (average RPD of duplicates ≥ 26%). Additionally, TLF sampling is more practical because it requires less time and resources. Precision and practicality make TLF well-suited to high-frequency sampling in low resource contexts. Interpretation and interference challenges are minimised when TLF is measured in groundwaters, which typically have low dissolved organic carbon, relatively consistent temperature, negligible turbidity and pH between 5 and 8. TLF cannot be used as a proxy for E. coli on an individual sample basis, but it can add value to groundwater risk assessments by improving prioritization of sampling and by increasing understanding of spatiotemporal variability.

Enhancing the sample diversity of snowball samples: Recommendations from a research project on anti-dam movements in Southeast Asia.

Snowball sampling is a commonly employed sampling method in qualitative research; however, the diversity of samples generated via this method has repeatedly been questioned. Scholars have posited several anecdotally based recommendations for enhancing the diversity of snowball samples. In this study, we performed the first quantitative, medium-N analysis of snowball sampling to identify pathways to sample diversity, analysing 211 reach-outs conducted via snowball sampling, resulting in 81 interviews; these interviews were administered between April and August 2015 for a research project on anti-dam movements in Southeast Asia. Based upon this analysis, we were able to refine and enhance the previous recommendations (e.g., showcasing novel evidence on the value of multiple seeds or face-to-face interviews). This paper may thus be of particular interest to scholars employing or intending to employ snowball sampling.

Restoring water quality in the polluted Turag-Tongi-Balu river system, Dhaka: Modelling nutrient and total coliform intervention strategies.

River water quality in rapidly urbanising Asian cities threatens to damage the resource base on which human health, economic growth and poverty reduction all depend. Dhaka reflects the challenges and opportunities for balancing these dynamic and complex trade-offs which goals can be achieved through effective policy interventions. There is a serious problem of water pollution in central Dhaka, in the Turag-Tongi-Balu River system in Bangladesh with the river system being one of the most polluted in the world at the moment. A baseline survey of water chemistry and total coliforms has been undertaken and shows dissolved oxygen close to zero in the dry season, high organic loading together with extreme levels of Ammonium-N and total coliform in the water. Models have been applied to assess hydrochemical processes in the river and evaluate alternative strategies for policy and the management of the pollution issues. In particular models of flow, Nitrate-N, Ammonium-N and indicator bacteria (total coliforms) are applied to simulate water quality in the river system. Various scenarios are explored to clean up the river system, including flow augmentation and improved effluent treatment. The model results indicate that improved effluent treatment is likely to have a more significant impact on reducing Ammonium-N and total coliforms than flow augmentation, but a combined strategy would greatly reduce the pollution problems in the Turag-Tongi-Balu River System.

Assessing demand for improved sustainable sanitation in low-income informal settlements of urban areas: a critical review.

Sanitation improvement is crucial in saving lives that are lost due to water contamination. Progress towards achieving full sanitation coverage is still slow in low-income informal settlements in most developing countries. Furthermore, resources are being wasted on installing facilities that are later misused or never used because they do not meet the local demand. Understanding demand for improved sanitation in the local context is critical if facilities are to be continually used. Various approaches that attempt to change peoples' behaviours or create demand have been reviewed to identify what they are designed to address. A multi-disciplinary research team using mixed methods is re-emphasised as a comprehensive approach for assessing demand for improved sanitation in low-income informal settlements, where the sanitation situation is more challenging than in other areas. Further research involving a multi-disciplinary research team and use of mixed methods to assess sanitation demand in informal settlements is needed.

Challenges to achieving sustainable sanitation in informal settlements of Kigali, Rwanda.

Like most cities in developing countries, Kigali is experiencing rapid urbanisation leading to an increase in the urban population and rapid growth in the size and number of informal settlements. More than 60% of the city's population resides in these settlements, where they experience inadequate and poor quality urban services including sanitation. This article discusses the issues and constraints related to the provision of sustainable sanitation in the informal settlements in Kigali. Two informal settlements (Gatsata and Kimisagara) were selected for the study, which used a mixed method approach for data collection. The research found that residents experienced multiple problems because of poor sanitation and that the main barrier to improved sanitation was cost. Findings from this study can be used by the city authorities in the planning of effective sanitation intervention strategies for communities in informal settlements.

Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?

The Millennium Development Goals (MDGs) set out to halve the proportion of the population without access to basic sanitation between 1990 and 2015. The slow pace of progress has lead to a search for innovative responses, including social motivation approaches. One example of this type of approach is 'Community-led Total Sanitation' (CLTS). CLTS represents a major shift for sanitation projects and programmes in recognising the value of stopping open-defecation across the whole community, even when the individual toilets built are not necessarily wholly hygienic. However, recent publications on CLTS document a number of examples of practices which fail to meet basic ethical criteria and infringe human rights. There is a general theme in the CLTS literature encouraging the use of 'shame' or 'social stigma' as a tool for promoting behaviours. There are reported cases where monetary benefits to which individuals are otherwise entitled or the means to practice a livelihood are withheld to create pressures to conform. At the very extreme end of the scale, the investigation and punishment of violence has reportedly been denied if the crime occurred while defecating in the open, violating rights to a remedy and related access to justice. While social mobilisation in general, and CLTS in particular, have drastically and positively changed the way we think about sanitation, they neither need nor benefit from an association with any infringements of human rights.

Fate and transport of viruses during sewage treatment in a mound system.

Studies undertaken to assess the performance of filter materials to remove phosphorus in decentralised sewage systems have not reported on the broader performance of these systems. This study aimed to identify virus fate and transport mechanisms at the laboratory scale for comparison with field experiments on a mound system amended with blast furnace slag. Inactivation was a significant removal mechanism for MS2 bacteriophage, but not for PRD1 bacteriophage. Column studies identified rapid transport of PRD1. Laboratory studies predicted lower removal of PRD1 in a full scale system than was experienced in the field study, highlighting the importance of considering pH and flow rate in pathogen removal estimates. The results highlight the necessity for studying a range of organisms when assessing the potential for pathogen transport.

Transport of MS2 phage, Escherichia coli, Clostridium perfringens, Cryptosporidium parvum, and Giardia intestinalis in a gravel and a sandy soil.

To define protection zones around groundwater abstraction wells and safe setback distances for artificial recharge systems in watertreatment, quantitative information is needed about the removal of microorganisms during soil passage. Column experiments were conducted using natural soil and water from an infiltration site with fine sandy soil and a river bank infiltration site with gravel soil. The removal of phages, bacteria, bacterial spores, and protozoan (oo)-cysts was determined at two velocities and compared with field data from the same sites. The microbial elimination rate (MER) in both soils was generally >2 log, but MER in the gravel soil was higher than that in the fine sandy soil. This was attributed to enhanced attachment, related to higher metal-hydroxides content. From the high sticking efficiencies (>1) and the low influence of flow rate on MER it was deduced that straining played a significant role in the removal of Escherichia coli and Cryptosporidium parvum oocysts in the gravel soil. Lower removal of oocysts than the 4-5 times smaller E. coli and spores in the fine sand indicates that the contribution of straining is variable and needs further attention in transport models. Thus, simple extrapolation of grain size and particle size to the extent of microbial transport underground is inappropriate. Finally, the low MER of indigenous E. coli and Clostridium perfringens observed in the soil columns as well as under field conditions and the second breakthrough peak found for Cryptosporidium and spores in the fine sandy soil upon a change in the feedwater pH indicate a significant role of detachment and retardation to microbial transport and the difficulty of extrapolation of quantitative column test results to field conditions.