PCR-based detection of pathogens in improved water sources: a scoping review protocol of the evidence in low-income and middle-income countries.

INTRODUCTION: Occurrence of diverse human enteric bacterial, viral and protozoal pathogens in improved drinking water because of pathogenic microbial contamination is of increasing public health concern, particularly in low-income and middle-income countries (LMICs). Detecting microbial pathogens in water supplies comprehensively and accurately is beneficial to ensure the safety of water in LMICs where water contamination is a major concern. Application of PCR-based methods in detecting the microbial quality of water provides more accurate, sensitive and rapid outcomes over conventional methods of microbial identification and quantification. Therefore, exploring water quality outcomes generated through PCR-based methods is important to better understand the status and monitor progress towards internationally set goals for LMICs. This scoping review aims to map the existing evidence on the magnitude and characteristics of diarrhoeagenic pathogens as detected by PCR-based methods in improved water sources within the context of LMICs. METHODS AND ANALYSIS: This study will be undertaken in line with the Joanna Briggs Institute (JBI) methodology for scoping reviews. We will consider the available publications covering PCR-based microbial water quality assessment of improved drinking water sources in LMICs. Searches will be undertaken in PubMed/Medline, Scopus, Web of Science, JBI, Cochrane Library and Google Scholar. A grey literature search will be conducted in Google and ProQuest. ETHICS AND DISSEMINATION: The College of Natural and Computational Science Institution Review Board of Addis Ababa University gave formal ethical approval to this study protocol. The findings of this study will be disseminated to the concerned body through peer-reviewed publications, presentations and summaries.

The importance of water quality in classifying basic water services: The case of Ethiopia, SDG6.1, and safe drinking water.

INTRODUCTION: Sustainable Development Goal (SDG) 6 aims to coordinate international efforts toward "clean water and sanitation." However, water contaminated with pathogenic bacteria or thermotolerant coliforms (TTC) will not achieve the SDG target of clean water in the lives of people around the world. The aim of this study is to assess the water quality parameters of basic water services in Amhara and Afar regions of Ethiopia as well as the role and importance of local managerial committees in ensuring basic water functionality. METHODS: This mixed methods research, conducted in January-June 2019, sampled 22 districts from food-insecure areas in the Amhara and Afar regions of Ethiopia. From the 22 districts, which represent nearly one third of all districts in each region, 111 water services classified as "basic" were randomly selected. For each selected water service, research included: water quality sample testing, visual observation of water services, interviews and focus group discussions with the associated water managerial committee members. Descriptive statistics frequency, percent, mean, median, standard deviations, normal tables, cross-tables and graphs are used to present the data. RESULTS: Although the international water standard for thermotolerant coliform (TTC) levels is 0 CFU/100ml, in our sample of 111 water services, the maximum TTC counts were 71 CFU/100 ml and the mean was 4 CFU/100 ml. Thermotolerant coliform counts were above the permissible standard values for nearly 40% (n = 111) of the basic water services. TTC was detected in 44 (39.64%) (n = 111) basic water services. Of these, 38 (34.23%) were operationally functional while 6 (5.41%) were not functional. Approximately one third of the basic water services sampled, deemed "functional" by international standards, do not provide potable water due to thermotolerant coliform (TTC) levels. CONCLUSION: Our findings from the Amhara and Afar regions of Ethiopia demonstrate that water quality parameters are not currently considered in classifying basic water services. This suggests that international efforts to address SDG 6 should incorporate water quality as a key parameter to better track international progress toward "clean water and sanitation" efforts. We discuss two potential pathways for stronger inclusion of water quality parameters in international definitions: (1) to mandate water quality within "functional" and "non-functional" definitions or (2) to add a ladder rung titled "safe basic water services" to the international drinking water ladder. Our findings from Ethiopia suggest that additional research should be undertaken in development contexts to assess whether or not "functional" basic water services provide safe drinking water to users.