Evidence of waste management impacting severe diarrhea prevalence more than WASH: An exhaustive analysis with Brazilian municipal-level data.

Adequate housing protects from diarrhea, which is a substantial health concern in low- and middle-income countries. The purpose of this study was to quantify the relationship between severe diarrhea and housing features at the municipal level to help in public health planning. Regression analyses were performed on annual (2000-2012) datasets on Brazilian municipalities (5570) in six household feature categories (e.g., waste management) and four severe diarrhea outcomes (e.g., diarrhea deaths of under-5 children). Household data were not available elsewhere of this magnitude and granularity, highlighting the scientific value-add of this study. Municipalities were clustered prior to regression analysis because of data heterogeneity. The compositional household feature data were also subjected to principal component analysis to diminish feature variable multicollinearity. The highest explanatory power was found for diarrhea deaths of under-5 children (R2 = 10-22 %), while those in the over-5 population were the least best explained (R2 = 0.3-7 %). Household features predicted diarrhea outcomes more accurately in the "advanced" housing municipality cluster (R2 = 16-22 %) than in the "mid-level" (R2 = 7-20 %) and "basic" (R2 = 6-12 %) ones (over-5 diarrhea deaths excluded). Under-5 children's diarrhea death prevalence was three times higher in the "basic" cluster than in the "advanced" cluster. Importantly, the impact of waste management was overall the largest of all household features, even larger than those of WASH, i.e., water supply, sanitation, and household drinking water treatment. This is surprising in the context of existing literature because WASH is generally regarded as the most important household factor affecting gastrointestinal health. In conclusion, public health interventions could benefit from customizing interventions for diarrhea outcomes, municipality types, and household features. Waste management's identified stronger association with diarrhea compared to WASH may have important implications beyond the water field and Brazil.

Decreased natural organic matter in water distribution decreases nitrite formation in non-disinfected conditions, via enhanced nitrite oxidation.

Nitrite in drinking water is a potentially harmful substance for humans, and controlling nitrite formation in drinking water distribution systems (DWDSs) is highly important. The effect of natural organic matter (NOM) on the formation of nitrite in simulated distribution systems was studied. The objective was to inspect how a reduced NOM concentration affected nitrite development via nitrification, separated from the effects of disinfection. We observed that nitrite formation was noticeably sensitive to the changes in the NOM concentrations. Nitrite declined with reduced NOM (TOC 1.0 mg L-1) but increased with the normal NOM concentration of tap water (TOC 1.6 mg L-1). Ammonium oxidation was not altered by the reduced NOM, however, nitrite oxidation was enhanced significantly according to the pseudo-first order reaction rate model interpretation. The enhanced nitrite oxidation was observed with both ammonium and nitrite as the initial nitrogen source. The theoretical maximum nitrite concentrations were higher with the normal concentration of NOM than with reduced NOM. The results suggest that the role of nitrite oxidation may be quite important in nitrite formation in DWDSs and worth further studies. As a practical result, our study supported enhanced NOM removal in non-disinfected DWDSs.

The Seasonality of Nitrite Concentrations in a Chloraminated Drinking Water Distribution System.

We studied the seasonal variation of nitrite exposure in a drinking water distribution system (DWDS) with monochloramine disinfection in the Helsinki Metropolitan Area. In Finland, tap water is the main source of drinking water, and thus the nitrite in tap water increases nitrite exposure. Our data included both the obligatory monitoring and a sampling campaign data from a sampling campaign. Seasonality was evaluated by comparing a nitrite time series to temperature and by calculating the seasonal indices of the nitrite time series. The main drivers of nitrite seasonality were the temperature and the water age. We observed that with low water ages (median: 6.7 h) the highest nitrite exposure occurred during the summer months, and with higher water ages (median: 31 h) during the winter months. With the highest water age (190 h), nitrite concentrations were the lowest. At a low temperature, the high nitrite concentrations in the winter were caused by the decelerated ammonium oxidation. The dominant reaction at low water ages was ammonium oxidation into nitrite and, at high water ages, it was nitrite oxidation into nitrate. These results help to direct monitoring appropriately to gain exact knowledge of nitrite exposure. Also, possible future process changes and additional disinfection measures can be designed appropriately to minimize extra nitrite exposure.