Occurrence of waterborne pathogens and antibiotic resistance in water supply systems in a small town in Mozambique.

BACKGROUND: . Microbiological quality of drinking water supplied in Moamba, a small town in southern Mozambique, was assessed by collecting and analyzing 91 water sample from 5 sampling sites: raw or inlet water, treated water and 3 household taps along the water distribution system. The presence of Escherichia coli as indicator fecal contamination, three bacterial pathogens, Vibrio cholerae, Salmonella and Campylobacter spp., and Cefotaximee resistant E. coli as antibiotic resistance determinant, was assessed. RESULTS: . The results showed fecal contamination in all types of water samples: E. coli was found in 100% of inlet water samples, in 21% of treated water samples, and in 22% of tap water samples. No Salmonella spp. was detected during the study. The presence of V. cholerae was detected in 42% of all water samples tested: 100% of inlet water samples, in 16% of treated water samples, and in 23% household tap water samples. All V. cholerae confirmed isolates where genotyped by PCR as non-O1/non-O139; however, 9 isolates showed the presence of the genes encoding for cholera toxin. The presence of Campylobacter spp. was detected in 36% of the water samples tested: in 95% of inlet water samples, in 10% of treated water samples and in 23% household tap water samples. Cefotaxime resistant E. coli was detected in 63% of inlet water, 16% of treated water, and in 9% of tap water samples, these isolates were also resistant to multiple other antibiotics: ampicillin, streptomycin, tetracycline chloramphenicol. All 70 V. cholerae non-O1/non-O139 confirmed isolated were resistant to ampicillin, 51% to streptomycin, 13% to gentamycin, and 1 isolate was resistant to tetracycline; 13% showed a multi-drug resistant profile, being resistant to at least three antibiotics. CONCLUSION: . The presence of fecal contamination and pathogens in the water treatment system and household taps in Moamba indicates a health risk for the population. This burden increases by the presence of bacterial pathogens showing multidrug resistance.

Do health risk perceptions motivate water - and health-related behaviour? A systematic literature review.

Health-related risk perceptions are important determinants of health behaviours and components of behaviour change theories. What someone thinks or feels will motivate or hinder their intention or hesitancy to implement a certain behaviour. Thus, a perceived potential risk to our health and well-being can influence our health-promoting and/or health-seeking behaviour. We aimed to review and synthesize available peer-reviewed literature to better understand the links between water and health-related risk perceptions and behaviours. We conducted the first systematic review of peer-reviewed literature on risk perceptions and behaviours in the context of water and health, published between 2000 and 2021. A total of 187 publications met the inclusion criteria. We extracted data relating to study characteristics and categorized our results according to the major themes emerging from the literature, namely drinking water, sanitation, hygiene and wasterelated topics, health risk factors, diseases and mental health implications, and preventative measures. Our review shows that the literature has grown over the past twenty years, reporting information from different countries belonging to different income groups around the globe, conducted in various settings and contexts, among different target populations, from various disciplinary angles, using different methods, theories and approaches. Our review provides evidence of health risk perceptions determining behaviour particularly related to drinking water sources and water safety. Evidence on disease prevention, health seeking, variations and changes in perception and behaviour over space, geography, socioeconomic differences and time, and the relevance of cultural context is provided. Our review shows that risk perception studies are vital for WASH governance in terms of policy, raising awareness, education and behaviour change. In order to make risk perception and behaviour studies even more relevant to effective public health planning and health messaging, future research needs to increasingly focus on early culturally sensitive interventions and changes in perceptions and behaviours over time.

Assessment of the 20L SODIS bucket household water treatment technology under field conditions in rural Malawi.

Two billion people worldwide consume unsafe drinking water. The problem is particularly pronounced in Sub-Saharan Africa, where more than a quarter of the population relies on unimproved surface water sources. Based on the principles of solar water disinfection (SODIS), a new household water treatment technology, the SODIS bucket, was developed to improve the microbial quality of water from these sources based on controlled tests in a laboratory setting. This study set out to evaluate the efficacy of the technology in a field setting, in rural communities in the Chikwawa District in southern Malawi. SODIS experiments were carried out in two different vessels (1-L PET bottles and 20-L polypropylene SODIS buckets), over three months using unprotected water sources normally used by community members. Vessels were exposed to direct sunlight for 8 h per day in a village setting and were sampled at regular intervals to determine total coliforms, E. coli, turbidity, UV transmittance and UV dose. In these experiments, the SODIS bucket reached inactivation targets for E. coli (<1 CFU/100 mL) in two of seven experiments and for total coliforms in one of seven for total coliforms (<50 CFU/100 mL), despite having greater UV doses than were seen in the evaluation carried out under controlled conditions during the bucket's development. PET bottles reached inactivation targets for both E. coli and total coliforms in five of seven experiments. There was no single factor that could be identified as preventing adequate inactivation, but the role of organic matter, inconsistent nature of the water source, and vessel size, when coupled with organic matter, were identified as contributing factors. This study highlights the need for further prototyping to provide a suitable pre-treatment step for unprotected water sources, and the importance of field testing with real-life parameters to ensure new technologies are context appropriate.

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.

Low voltage iron electrocoagulation as a tertiary treatment of municipal wastewater: removal of enteric pathogen indicators and antibiotic-resistant bacteria.

In this paper we analyse the feasibility of low voltage iron electrocoagulation as a means of municipal secondary effluent treatment with a focus on removal of microbial indicators, Antibiotic Resistant Bacteria (ARB) and nutrients. A laboratory scale batch unit equipped with iron electrodes was used on synthetic and real secondary effluent from a municipal wastewater treatment plant. Synthetic secondary effluent was separately assayed with spiked Escherichia coli WR1 and with bacteriophage ΦX174, while real effluent samples were screened before and after treatment for E. coli, Extended Spectrum Betalactamase-producing E. coli, Enterococci, Vancomycin Resistant Enterococci, Clostridium perfringens spores and somatic coliphages. Charge dosage (CD) and charge dosage rate (CDR) were used as the main process control parameters. Experiments with synthetic secondary effluent showed >4log10 and >5log10 removal for phage ΦX174 and for E. coli WR1, respectively. In real effluents, bacterial indicator removal exceeded 3.5log10, ARB were removed below detection limit (≥2.5log10), virus removal reached 2.3log10 and C. perfringens spore removal exceeded 2.5log10. Experiments in both real and synthetic wastewater showed that bacterial removal increased with increasing CD and decreasing CDR. Virus removal increased with increasing CD but was irresponsive to CDR. C. perfringens spore removal increased with increasing CD yet reached a removal plateau, being also irresponsive to CDR. Phosphate removal exceeded 99%, while total nitrogen and chemical oxygen demand removal were below 15% and 58%, respectively. Operational cost estimates were made for power and iron plate consumption, and were found to be in the range of 0.01 to 0.24€/m3 for the different assayed configurations. In conclusion, low voltage Fe-EC is a promising technology for pathogen reduction of secondary municipal effluents, with log10 removals comparable to those achieved by conventional disinfection methods such as chlorination, UV or ozonation.

Status of Water Safety Plan Development and Implementation in Uganda.

Uganda was among the first countries in Africa that pioneered Water Safety Plan (WSP) development and implementation, with the first WSP dating back to 2002. The objective of this study was to assess WSP status in Uganda, focusing on the experience of the National Water and Sewerage Corporation (NWSC), in order to understand the factors that influenced it and strategies for scaling-up. This study consisted of a review of documentation for 20 WSPs, 42 interviews, a focus group discussion and four field visits. Results show that the development of the 20 WSPs over the last 15 years was largely incomplete and diverse. Most of the WSPs focused on system assessment and improvement, but failed to include WSP monitoring, verification and management. The monitoring of control measures was implemented in nine of the 20 systems, while verification took place in the form of internal (5/20) and external (2/20) auditing. The main barriers identified to WSP implementation were inadequate training, team composition and deployment, mistaken perception and inability to evaluate WSP effectiveness. Conversely, the main enabling factors were management commitment, public health responsibility, good customer relations, financial availability and reliable laboratories. These findings suggest a need for more institutionalization of WSPs with improved coordination across stakeholder groups.

Capacity building and training approaches for water safety plans: A comprehensive literature review.

The World Health Organization has recommended Water Safety Plans (WSPs), a holistic risk assessment and risk management approach, for drinking-water suppliers across low-, middle- and high-income countries, since publishing its 2004 Guidelines for Drinking-Water Quality. While rapid WSP adoption has occurred, capacity is still catching up to implementation needs. Many countries and regions lack case examples, legal requirements, and training resources for WSPs, corresponding to widespread capacity shortfall in the water supply sector. We undertook a comprehensive review of the literature on capacity building and training for WSPs, with the goal of providing recommendations for multiple stakeholder groups at the scales of individual utilities, national governments, and intermediate units of governance. We propose a WSP training taxonomy and discuss it in relation to the stages of learning (introduction, practice, and reinforcement); describe the importance of customizing training to the target group, local language and circumstances; highlight the relevance of auditing for evaluating change over time; and call for robust methods to monitor WSP capacity development.

Application of UVOX Redox® for swimming pool water treatment: Microbial inactivation, disinfection byproduct formation and micropollutant removal.

Alternative disinfection technologies may overcome some of the limitations of conventional treatment applied in swimming pools: chlorine-resistant pathogens (e.g. Cryptosporidium oocysts and Giardia cysts) and the formation of chlorinated disinfection byproducts. In this paper, results of full scale validation of an alternative disinfection technology UVOX Redox® (hereinafter referred to as UVOX) that combines ozonation and UV irradiation are presented. The performance was assessed in terms of microbial inactivation, disinfection byproduct formation and micropollutant removal. UVOX was able to achieve 1.4-2.7 log inactivation of Bacillus subtilis spores at water flows between 20 and 76 m³/h. Lower formation of trichloromethane and dichloroacetic acid was observed with UVOX followed by chlorination when compared to chlorination alone. However, due to the use of ozone and the presence of bromide in the pool water, the formation of trihalomethanes and haloacetic acids shifted to more brominated byproducts. Chlorine alone was able to remove the target micropollutants: acetaminophen, atenolol, caffeine, carbamazepine, estrone, estradiol, and venlafaxine (>97% removal) after 24 h, with the exception of ibuprofen (60% removal). The application of UVOX in chlorinated water enhanced the removal of ibuprofen. The application of UVOX could lower the usage of chlorine to the level that provides an adequate residual disinfection effect.

Potential transmission pathways of clinically relevant fungi in indoor swimming pool facilities.

Possible transmission pathways of fungi in indoor swimming pool facilities were assessed through fungal counting in different areas of the facilities and typing of the collected fungal isolates. Air, water and surface samples were collected from seven different indoor swimming pool facilities. Fungal species were identified based on their internal transcribed spacer (ITS) sequences. Maximum fungal concentrations of 6.2 CFU/cm2, 1.39 CFU/100 mL, and 202 CFU/m³ were found on surfaces, in water and air, respectively. In total, 458 isolates were obtained, belonging to 111 fungal species, of which 50 species were clinically relevant. Phialophora oxyspora (13.3%) and Trichosporon dohaense (5.0%) were the most frequently isolated species and were merely detected on floors, as were the dermatophytes, Trichophyton interdigitale and T. rubrum. Penicillium spp. and Aspergillus spp. were the dominant fungi in water and air. No typical patterns of fungal concentrations along the preferential pathways of pool visitors were observed, however, sites where pool visitors converge while moving from one room (e.g. dressing room) to another (e.g. shower room) and walking barefoot displayed the highest fungal concentrations thus posing the highest risk of contamination. The dispersal of fungi on floors is most likely facilitated by the pool visitors and cleaning tools. Clinically relevant fungi, including the ones rarely identified in nature, were widely detected on floors, in water and in air, as well as on cleaning tools and flexibeams. Preventive measures such as cleaning should minimize the prevalence of clinically relevant fungi in swimming pool facilities since these potentially pose health risks to those vulnerable for infections.

Clinically relevant fungi in water and on surfaces in an indoor swimming pool facility.

The density of fungal contamination and the fungal diversity in an indoor swimming pool facility were assessed. A total of 16 surface samples and 6 water samples were analysed by using a combination of different (semi-) selective culture media. Isolated fungal colonies were identified to the genus or species level by sequencing of the internal transcribed spacer (ITS). The highest fungal counts in water and on surfaces were in the recreational pool (17CFU/100mL) and on a flexibeam (5.8CFU/cm2), respectively as compared with low counts (<0.1CFU/cm2) on the diving platform, bench tops and walls. The 357 obtained isolates belonged to 79 species and species complexes, 42 of which known as clinically relevant. Phialophora oxyspora (13.7%) and Phoma spp. (12.3%) were the most frequently identified groups. We demonstrated that despite chlorine treatment and regular cleaning of surfaces both water and surfaces were commonly infested with fungi, including many clinically relevant species.

Inequalities in microbial contamination of drinking water supplies in urban areas: the case of Lilongwe, Malawi.

Over past decades strategies for improving access to drinking water in cities of the Global South have mainly focused on increasing coverage, while water quality has often been overlooked. This paper focuses on drinking water quality in the centralized water supply network of Lilongwe, the capital of Malawi. It shows how microbial contamination of drinking water is unequally distributed to consumers in low-income (unplanned areas) and higher-income neighbourhoods (planned areas). Microbial contamination and residual disinfectant concentration were measured in 170 water samples collected from in-house taps in high-income areas and from kiosks and water storage facilities in low-income areas between November 2014 and January 2015. Faecal contamination (Escherichia coli) was detected in 10% of the 40 samples collected from planned areas, in 59% of the 64 samples collected from kiosks in the unplanned areas and in 75% of the 32 samples of water stored at household level. Differences in water quality in planned and unplanned areas were found to be statistically significant at p < 0.05. Finally, the paper shows how the inequalities in microbial contamination of drinking water are produced by decisions both on the development of the water supply infrastructure and on how this is operated and maintained.

Occurrence of pharmaceuticals and UV filters in swimming pools and spas.

The occurrence of 32 pharmaceuticals and 14 UV filters in swimming pools and spas was studied. Fifty-one water samples were collected from 17 pools located in sport centres and hotels in Catalonia, Spain. The samples were analysed by liquid chromatography-tandem mass spectrometry. The pharmaceuticals atenolol, carbamazepine, hydrochlorothiazide, metronidazole, ofloxacin, sulfamethoxazole, acetaminophen, ibuprofen, ketoprofen and phenazone were measured in water samples at concentrations higher than their limit of quantification (LOQ). The highest concentration of any individual pharmaceutical was measured for the diuretic hydrochlorothiazide (904 ng/L). The most frequently detected pharmaceutical was carbamazepine, as it was observed in more than half of all the water samples measured (53 %, 27/51). The UV filters at concentrations higher than LOQ in water samples were BP1, BP2, BP3, BP8, THB, 4DHB, 4MBC, OD-PABA, 1HBT, MeBT and DMeBT. The highest concentration of UV filter observed was 4MBC (69.3 ng/L) while the most frequent UV filters in the samples were 1HBT (59 %, 30/51). The results also showed that pharmaceuticals and UV filters were most frequently found in spas. Finally, from a water treatment technology perspective, the lowest occurrence of pharmaceuticals was in the pools applying sand filters followed by disinfection by sodium hypochlorite, while the lowest occurrence of UV filters was in the pools applying coagulation, sand filtration, UV and salt electrolysis.

Full-scale validation of an air scour control system for energy savings in membrane bioreactors.

Membrane aeration represents between 35 and 50% of the operational cost of membrane bioreactors (MBR). New automatic control systems and/or module configurations have been developed for aeration optimization. In this paper, we briefly describe an innovative MBR air scour control system based on permeability evolution and present the results of a full-scale validation that lasted over a 1-year period. An average reduction in the air scour flow rate of 13% was achieved, limiting the maximum reduction to 20%. This averaged reduction corresponded to a decrease in energy consumption for membrane aeration of 14% (0.025 kWh m(-3)) with maximum saving rates of 22% (0.04 kWh m(-3)). Permeability and fouling rate evolution were not affected by the air scour control system, as very similar behavior was observed for these variables for both filtration lines throughout the entire experimental evaluation period of 1 year.

Automatic control systems for submerged membrane bioreactors: a state-of-the-art review.

Membrane bioreactor (MBR) technology has become relatively widespread as an advanced treatment for both industrial and municipal wastewater, especially in areas prone to water scarcity. Although operational cost is a key issue in MBRs, currently only a few crucial papers and inventions aimed to optimise and enhance MBR efficiency have been published. The present review summarises the available solutions in the area of automatic control systems and widely explores the advances in automation and control for MBRs. In this review of state of the art, different control systems are evaluated comparatively, distinguishing between control systems used for the filtration process and those used for the biological process of MBRs and describing the challenge faced by integrated control systems. The existing knowledge is classified according to the manipulated variables, the operational mode (open-loop or closed-loop) and the controlled variables used.

Knowledge-based control module for start-up of flat sheet MBRs.

In start-up periods low MLSS concentration may lead to fouling phenomena and uncommon frequency of chemical cleanings using membrane bioreactors. A knowledge-based control module for the optimisation of start-up procedures in membrane bioreactors is presented and validated in this paper. The main objective of the control module is to accelerate the growth of MLSS and the achievement of the design flux while minimising the fouling phenomenon during start-up periods. The module was validated in a pilot-scale membrane bioreactor with the University of Cape Town configuration and submerged flat sheet microfiltration membranes. The knowledge of the control system was represented as a decision tree before being implemented. A fully satisfactory start-up, both for the filtration and the biological phase, was obtained in 20 days, saving time and preserving the membrane integrity.

Biological nutrient removal in an MBR treating municipal wastewater with special focus on biological phosphorus removal.

The performance of an MBR pilot plant for biological nutrient removal was evaluated during 210days of operation. The set point values for the internal recycles were determined in advance with the use of an optimisation spreadsheet based on the ASM2d model to optimise the simultaneous removal of C, N and P. The biological nutrient removal (BNR) efficiencies were high from the start of operation with COD and N removal efficiencies of 92+/-6% and 89+/-7, respectively. During the course of the experiment P removal efficiencies increased and finally a P-removal efficiency of 92% was achieved. The activity of poly-phosphate accumulating organisms (PAOs) and denitrifying poly-phosphate accumulating organisms (DPAOs) increased and the specific phosphate accumulation rates after 150days of operation amounted to 13.6mgPg(-1)VSSh(-1) and 5.6mgPg(-1)VSSh(-1), for PAOs and DPAOs, respectively.