Locally produced hydrogen sulphide detecting water quality test kits increase household level monitoring in rural Tanzania.

In developing countries, rural water sources have the highest levels of faecal contamination but are the least monitored. Affordable field-based water quality tests are needed. The presence of faecal indicator bacteria can be determined with hydrogen sulphide (H2S) detecting tests, that are inexpensive and simple to make locally. In rural Tanzania, a non-governmental organisation (NGO) designed, produced and evaluated a new H2S water quality test kit. The H2S test results correlated with log10 Escherichia coli densities from conventional water quality tests. The production cost was US$ 1.10 and the test retailed for US$ 1.37. In total, 433 tests were sold through local pharmacies and NGOs. Additionally, 165 WaSH education meetings, reaching 3,408 community members, were conducted with the H2S test demonstrated in over half the meetings. Pre- and post-surveys of 294 meeting participants saw an increased reporting of household level water treatment by 24%. The H2S test was widely accepted, with 94% of those surveyed willing to buy the test in the future. International and national guidelines for drinking water monitoring need to be amended to include locally produced H2S water quality tests. This will enable households to monitor their own water sources and make informed choices about water safety and treatment.

Sub-lethal exposure to chlorfenapyr reduces the probability of developing Plasmodium falciparum parasites in surviving Anopheles mosquitoes.

BACKGROUND: Pyrethroid resistance in the key malaria vectors threatens the success of pyrethroid-treated nets. To overcome pyrethroid resistance, Interceptor® G2 (IG2), a 'first-in-class' dual insecticidal net that combines alpha-cypermethrin with chlorfenapyr, was developed. Chlorfenapyr is a pro-insecticide, requiring bio-activation by oxidative metabolism within the insect's mitochondria, constituting a mode of action preventing cross-resistance to pyrethroids. Recent epidemiological trials conducted in Benin and Tanzania confirm IG2's public health value in areas with pyrethroid-resistant Anopheles mosquitoes. As chlorfenapyr might also interfere with the metabolic mechanism of the Plasmodium parasite, we hypothesised that chlorfenapyr may provide additional transmission-reducing effects even if a mosquito survives a sub-lethal dose. METHODS: We tested the effect of chlorfenapyr netting to reduce Plasmodium falciparum transmission using a modified WHO tunnel test with a dose yielding sub-lethal effects. Pyrethroid-resistant Anopheles gambiae s.s. with L1014F and L1014S knockdown resistance alleles and expression levels of pyrethroid metabolisers CYP6P3, CYP6M2, CYP4G16 and CYP6P1 confirmed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) prior to conducting experiments were exposed to untreated netting and netting treated with 200 mg/m3 chlorfenapyr for 8 h overnight and then fed on gametocytemic blood meals from naturally infected individuals. Prevalence and intensity of oocysts and sporozoites were determined on day 8 and day 16 after feeding. RESULTS: Both prevalence and intensity of P. falciparum infection in the surviving mosquitoes were substantially reduced in the chlorfenapyr-exposed mosquitoes compared to untreated nets. The odds ratios in the prevalence of oocysts and sporozoites were 0.33 (95% confidence interval; 95% CI 0.23-0.46) and 0.43 (95% CI 0.25-0.73), respectively, while only the incidence rate ratio for oocysts was 0.30 (95% CI 0.22-0.41). CONCLUSION: We demonstrated that sub-lethal exposure of pyrethroid-resistant mosquitoes to chlorfenapyr substantially reduces the proportion of infected mosquitoes and the intensity of the P. falciparum infection. This will likely also contribute to the reduction of malaria in communities beyond the direct killing of mosquitoes.

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.

Modelling the influence of short-term climate variability on drinking water quality in tropical developing countries: A case study in Tanzania.

Climate change is expected to increase the prevalence of water-borne diseases especially in developing countries. Climate-resilient drinking water supplies are critical to protect communities from faecal contamination and thus against increasing disease risks. However, no quantitative assessment exists for the impacts of short-term climate variability on faecal contamination at different drinking water sources in developing countries, while existing understanding remains largely conceptual. This critical gap limits the ability to predict drinking water quality under climate change or to recommend climate-resilient water sources for vulnerable communities. This study aims to provide such quantitative understanding by investigating the relationships between faecal contamination and short-term climate variability across different types of water sources. We collected a novel dataset with over 20 months' monitoring of weather, Escherichia coli (E. coli) and total coliforms, at 233 different water sources in three climatically different regions in Tanzania. We then took a rigorous statistical analysis with Bayesian hierarchical models, to relate both contamination occurrence and amount to climate variability. The model results explained the temporal variability in drinking water faecal contamination using climate predictors, and also revealed the climate sensitivity of faecal contamination for individual water sources. We found that: a) short-term climate variability and baseline contamination levels can explain about half the observed variability in faecal contamination (R2 ≥ 0.44); b) increased contamination was most consistently related to recent heavy rainfall and high temperature across different water sources; c) unimproved water sources such as the unprotected dug wells have substantially higher climate sensitivity. Based on these results, we can expect substantial increases in drinking water contamination risks across tropical Sub-Saharan Africa and South-East Asian developing countries under a warmer climate, which highlight the urgent need of protecting vulnerable communities from the severe climate impacts.

Understanding the Impacts of Short-Term Climate Variability on Drinking Water Source Quality: Observations From Three Distinct Climatic Regions in Tanzania.

Climate change is expected to increase waterborne diseases especially in developing countries. However, we lack understanding of how different types of water sources (both improved and unimproved) are affected by climate change, and thus, where to prioritize future investments and improvements to maximize health outcomes. This is due to limited knowledge of the relationships between source water quality and the observed variability in climate conditions. To address this gap, a 20-month observational study was conducted in Tanzania, aiming to understand how water quality changes at various types of sources due to short-term climate variability. Nine rounds of microbiological water quality sampling were conducted for Escherichia coli and total coliforms, at three study sites within different climatic regions. Each round included approximately 233 samples from water sources and 632 samples from households. To identify relationships between water quality and short-term climate variability, Bayesian hierarchical modeling was adopted, allowing these relationships to vary with source types and sampling regions to account for potentially different physical processes. Across water sources, increases in E. coli/total coliform levels were most closely related to increases in recent heavy rainfall. Our key recommendations to future longitudinal studies are (a) demonstrated value of high sampling frequency and temporal coverage (a minimum of 3 years) especially during wet seasons; (b) utility of the Bayesian hierarchical models to pool data from multiple sites while allowing for variations across space and water sources; and (c) importance of a multidisciplinary team approach with consistent commitment and sharing of knowledge.

High prevalence of ESBL-Producing E. coli in private and shared latrines in an informal urban settlement in Dar es Salaam, Tanzania.

Background: Data about the burden of extended-spectrum beta-lactamase (ESBL)-producing microorganisms in Africa are limited. Our study aimed to estimate the prevalence of human faecal ESBL carriage in the community of an informal urban settlement in Dar es Salaam (Tanzania, East Africa) by using environmental contamination of household latrines with ESBL as a surrogate marker. Methods: Within the context of a large survey in February 2014 assessing 636 randomly selected household latrines for faecal contamination by the detection of growth of E. coli and total faecal coliform bacteria, a randomly selected subset of the samples were screened for ESBL. Results: Seventy latrines were screened for ESBL. An average of 11.4 persons (SD ±6.5) were sharing one latrine. Only three (4.3%) latrines had hand-washing facilities and 50 showed faeces on the floor. ESBL-producing Enterobacteriaceae were confirmed in 17 (24.3%) of the 70 latrine samples: 16 E. coli and 1 Klebsiella pneumoniae. Five ESBL E. coli strains were detected on door handles. The most prevalent ESBL type was CTX-M-1 group (76.5%). Pulsed-field gel electrophoresis typing of a subset of ESBL-producing E. coli isolates revealed both diverse singular types and a cluster of 3 identical isolates. There was no significant difference of the latrine and household characteristics between the group with ESBL (n = 17) and the group with non-ESBL E. coli (n = 53) (p > 0.05). Conclusions: Almost a quarter of private and shared latrines in an informal urban settlement in Tanzania are contaminated with ESBL-producing microorganisms, suggesting a high prevalence of human ESBL faecal carriage in the community. Shared latrines may serve as a reservoir for transmission in urban community settings in Tanzania.