Faecal contamination of household drinking water in Rwanda: A national cross-sectional study

Hybrid yoghurt: enhancing consumer acceptance by combining dairy and plant-based derivatives

Hybrid yoghurts combining dairy and plant-based derivatives present a novel approach to enhancing consumer acceptance of plant-based products, which is increasingly significant due to dietary trends and lactose intolerance. This study investigates the production of hybrid yoghurt blending cow's milk (CM) with soy (C:S) and oat (C:O) drinks in various ratios (90%, 70%, and 50% cow's milk), assessing their acceptability and quality. Notably, the C:S (70:30) and C:O (70:30) ratios resulted improved viscosity over time, although still less than CM. The hybrid yoghurts exhibited a favourable pH gradient, enhancing the acidic environment critical for flavour. Sensory analysis revealed that C:O (70:30) offered more favourable attributes on the just-about-right scale, scoring overall 6.86/10. Importantly, microbial analysis confirmed the safety of all hybrid products for consumption, with no harmful microorganisms detected.

Prevalence and associated factors of microbial water quality from drinking water in Ethiopia: A systematic review and meta-analysis protocol

PURPOSE

To determine the pooled prevalence and associated contributing factors of microbial water quality, especially the most recent fecal contamination indicator, fecal coliforms, from drinking water in Ethiopia.

METHOD

The review will be conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and PRISMA-P and registered in PROSPERO CRD42024537804. The studies will be identified from peer-reviewed literature, grey literature, and expert submissions. To identify peer-reviewed literature, "microbial water quality" will be combined with terms to restrict the search for drinking water and measure the prevalence and/or associated factors of microbial water quality. We further restricted the search in Ethiopia. The following databases will be used: PubMed/MEDLINE, Google Scholar, Worldwide Science, and Science Direct. Two independent reviewers will identify studies, extract data, assess the risk of bias, and assess methodological quality. The studies included will be determined in terms of quality based on the criteria listed in the Goanna Bridge Institute quality parameters. Statistical techniques like Higgins I2 will be used to investigate heterogeneity among the included studies. Sensitivity and subgroup analysis will be carried out to evaluate how reliable the results are. A funnel plot will be used to evaluate reporting publication bias, and Begg's and Egger's assessments will be used to check funnel plot balances.

DISCUSSION

This review and meta-analysis will thoroughly discover and integrate the data available on the prevalence and associated factors of fecal coliforms contamination in drinking water. The findings from this systematic review and meta-analysis will be compared and discussed with those from other studies.

CONCLUSION

Our systematic review and meta-analysis will help to develop specific recommendations for identified fecal coliforms contamination and associated factors in drinking water in Ethiopia. Moreover, this study will identify research gaps and guide future research and public health measures.

Drinking water safety evaluation in the selected sub-Saharan African countries: A case study of Madagascar, Uganda and Rwanda

In the sub-Saharan region of Africa, access to safe drinking water remains limited in many countries. This study provides an overview of the quality of surface water and groundwater in rural and peri-urban areas of Madagascar, Uganda, and Rwanda. Selected physico-chemical parameters, inorganic species (including inorganic ions), and organic pollution indicators, such as total organic carbon, non-ionic surfactants, cationic surfactants, anionic surfactants, sum of phenolic compounds and formaldehyde, were analysed. Principal component analysis was applied to assess the variability of the water quality and identify regional dependencies. The inorganic ion composition in the majority of the studied samples meets WHO and EU requirements for drinking water intended for human consumption and poses no human health risk. However, an individual non-cancer-causing health index for nitrates and the values of Water Quality Index show a possible threat of ingesting the studied drinking water. The presence of surfactants (0.1-0.65 mgL-1), phenolic compounds (0.025-1.76 mgL-1) and formaldehyde (0.04-0.32 mgL-1) may also pose a risk to human, animal, and aquatic life. Additionally, in-situ measurements for E. coli and Total Coliforms conducted during the last field campaign in Madagascar (2022) revealed that all studied drinking water sources ranged from intermediate risk to unsafe. This result calls for the urgent need to enhance WASH (water, sanitation, and hygiene) services in the studied areas. The presence of both chemical and microbiological pollutants shows the need for the local authorities to develop and implement a catchment management plan to ensure the protection of water resources from potential pollution, and raise community awareness about the impact of human activity on water resources.

Identifying predictors of E. coli in rural household water in sub-Saharan Africa using elimination regression

Exposure to fecally contaminated drinking water contributes to the global disease burden, especially in sub-Saharan Africa (SSA). We used cross-sectional data and elimination regression analysis to examine factors influencing E. coli contamination in household drinking water samples from 4,499 rural households in nine countries in SSA (Malawi, Mozambique, and Zambia in Southern Africa; Ghana, Mali, and Niger in Western Africa; and Kenya, Rwanda, and Tanzania in Eastern Africa). The proportion of household water samples containing E. coli was 71%, ranging from 45% (Malawi) to 89% (Tanzania). Pooled and multi-country predictive logistic regression models showed that using an unimproved-type water source, the absence of a community water committee, and domestic animal ownership were significantly associated with household drinking water contamination. Household water treatment and storage practices, sanitation and hygiene practices, and payment for drinking water were not significantly associated with E. coli contamination in any model. The season was a significant predictor of E. coli in the pooled model; samples collected in the rainy season were 2.3 [2.0, 2.7] times as likely to be contaminated with E. coli. Practitioners and policymakers should prioritize implementing piped on-plot water services, establishing effective local water source management structures, and incorporating animal husbandry practices into water, sanitation, and hygiene interventions.

Exploring the drinking water supply in Rwanda with panel data analysis

This study in Rwanda offers a comprehensive analysis of water quality, reliability, and cost-effectiveness, departing from previous research by utilizing panel data analysis for a nuanced understanding of spatiotemporal dynamics. Unlike earlier studies focusing on specific aspects, this research adopts a holistic approach, examining factors crucial for water supply, quality, and cost, thus providing an integrated view of Rwanda's water sector. By analyzing data from various sources, including the Water and Sanitation Corporation (WASAC), the study evaluates the reliability, quality, and cost-effectiveness of drinking water. It identifies cost-effective water treatment plants and studies determinants such as production cost, raw water quality, and supply between 2017 and 2022, introducing novel metrics such as performance scores and a drinking water quality index. Despite an increase in lost water, WASAC notably improves water supply, resulting in a higher water access rate by 2022. The study highlights the influence of factors such as performance scores and raw water quality on water supply and quality. It emphasizes continuous monitoring, targeted interventions, and community engagement for sustainable water service delivery. The findings provide actionable insights for policymakers, stakeholders, and practitioners, aiming to enhance water management strategies and improve water access in Rwanda.

Progress of Using Risk Assessment to Manage Small Drinking-Water Supplies in Rwanda: A Preliminary Study

The World Health Organization promotes risk assessment and risk management through Water Safety Plans (WSPs) as the most effective way to manage drinking-water supplies. Despite proven advantages of this approach in other regions, WSPs are still not widely used across small drinking-water supplies in Sub Saharan Africa. The aim of this research is to identify good practices and related gaps which may assist with formal uptake of WSPs for small drinking-water supplies in Rwanda. Through semi-structured interviews with the key stakeholders involved in small drinking-water supply management across Rwanda, the aim is achieved through the investigation of the following: (i) current drinking-water management challenges; (ii) stakeholder collaboration and data management activities including reporting of information; and (iii) the regulatory and policy environment. The use and awareness of WSPs in Rwanda was confirmed as low. However certain drinking-water management activities which align with the WSP methodology are being carried out. These include catchment management and stakeholder collaboration. Although legislation and policy are in place in Rwanda, communication and training of methods to implement WSPs are required to sustainably embed WSPs into practice. Several elements, including community engagement, systematic review of risks and data management, require greater focus to align with the WSP methodology. Respondents highlighted key drinking-water management challenges, including reactive budgeting and lack of sector prioritization, which could benefit from formal WSP implementation.

Effects of the substitution of cow’s milk with soymilk on the micronutrients, microbial, and sensory qualities of yoghurt

The consumption of imported dairy products is high especially in developing countries including Nigeria where little or no milk is produced locally which makes the products expensive, out of reach to common consumers and also inconvenient for lactose intolerance and vegans. Soymilk, as plant-based milk was substituted for cow’s milk in parts and in whole for the production of yoghurt and the effect of substitution was evaluated on the minerals, vitamins, microbial, and sensory properties of the products using the established methods. Significant differences (p < 0.05) exits among the yoghurt samples in the micronutrient contents. The soymilk substitution produced yoghurts with trace/macro mineral contents’ range of 0.14–28.50 mg/100 g and vitamin contents (ranged 0.02–0.43 mg/100 g) that were of comparable range of values with the yoghurt made with 100% cow’s milk (0.21–29.60 mg/100 g minerals and 0.05–0.58 mg/100 g vitamins). Generally, no significant difference (p < 0.05) was observed in most of the sensory attributes evaluated (range 8.00–8.01) in the entire samples (except in the 100% soymilk yoghurt). The microbial analysis proved the safety of the entire products for consumption. These showed the positive effect of substituting soymilk for cow’s milk at all the levels used, thus, the lactose intolerance and vegans can find alternative to dairy yoghurt in the 100% soymilk substitution and enjoy the functional health benefits of yoghurt. Also, the total dependence on importation of dairy milk and cost of production of composited milk yoghurt could be reduced to improve the nation’s economy and make the product economically accessible to common man.

Graphical abstract

Effects of adding household water filters to Rwanda's Community-Based Environmental Health Promotion Programme: a cluster-randomized controlled trial in Rwamagana district

Unsafe drinking water remains a major cause of mortality and morbidity. While Rwanda's Community-Based Environmental Health Promotion Programme (CBEHPP) promotes boiling and safe storage, previous research found these efforts to be ineffective in reducing fecal contamination of drinking water. We conducted a cluster randomized control led trial to determine if adding a household water filter with safe storage to the CBEHPP would improve drinking water quality and reduce child diarrhea. We enrolled 1,199 households with a pregnant person or child under 5 across 60 randomly selected villages in Rwamagana district. CBEHPP implementers distributed and promoted water purifiers to a random half of villages. We conducted two unannounced follow-up visits over 13-16 months after the intervention delivery. The intervention reduced the proportions of households with detectable E. coli in drinking water samples (primary outcome) by 20% (PR 0.80, 95% CI 0.74-0.87, p < 0.001) and with moderate and higher fecal contamination (≥10 CFU/100 mL) by 35% (PR 0.65, 95% CI 0.57-0.74, p < 0.001). The proportion of children under 5 experiencing diarrhea in the last week was reduced by 49% (aPR 0.51, 95%CI 0.35-0.73, p < 0.001). Our findings identify an effective intervention for improving water quality and child health that can be added to the CBEHPP.

Prevalence, production, and ecotoxicity of chlorination-derived metformin byproducts in Chinese urban water systems

The widely used antidiabetic drug metformin has become an emerging contaminant of water systems. In a prior study, we demonstrated the marked mammalian toxicity of the disinfection-derived byproducts (DBPs) Y (yellow, C₄H₆ClN₅) and C (colorless, C₄H₆ClN₃), and here assess the distribution, formation, and ecotoxicity of these in Chinese urban water systems. A national tap water assessment showed that metformin and C concentrations were higher in large, dense urban areas and surface water sources than in sparsely populated areas and groundwater sources. Water types' analysis clearly showed that C derived from chlorination of metformin-contaminated water (up to 4308.5 ng/L) circulated from domestic water (0.7-9.7 ng/L) via sewage (2.3 ng/L in effluent) to surface water (0.6-3.5 ng/L). Simulated disinfection and aqueous stability results systematically showed rapid formation and 24 h stability of both byproducts, indicating high exposure odds for water users. Both byproducts showed clear but distinct toxic effects on the growth (72 h IC₅₀, 0.6 mg/L for Y and 4.4 mg/L for C) and photosynthesis of the microalgae Pseudokirchneriella subcapitata at milligram levels. Combinedly, our work reveals that metformin byproducts have been disseminated to urban water cycle and contaminated tap water, increasing potential toxic risk for drinking water. Its outcomes provide a preliminary reference for future studies on the environmental fate and ecotoxicological effects of unintended DBPs formed in the chlorination of metformin-contaminated water.

Monitoring Drinking Water Quality in Nationally Representative Household Surveys in Low- and Middle-Income Countries: Cross-Sectional Analysis of 27 Multiple Indicator Cluster Surveys 2014-2020

BACKGROUND

The 2030 Sustainable Development Goals (SDGs) set an ambitious new benchmark for safely managed drinking water services (SMDWs), but many countries lack national data on the availability and quality of drinking water.

OBJECTIVES

We quantified the availability and microbiological quality of drinking water, monitored SMDWs, and examined risk factors for Escherichia coli (E. coli) contamination in 27 low-and middle-income countries (LMICs).

METHODS

A new water quality module for household surveys was implemented in 27 Multiple Indicator Cluster Surveys. Teams used portable equipment to measure E. coli at the point of collection (PoC, n=61,170) and at the point of use (PoU, n=64,900) and asked respondents about the availability and accessibility of drinking water. Households were classified as having SMDW services if they used an improved water source that was free of E. coli contamination at PoC, accessible on premises, and available when needed. Compliance with individual SMDW criteria was also assessed. Modified Poisson regression was used to explore household and community risk factors for E. coli contamination.

RESULTS

E. coli was commonly detected at the PoC (range 16-90%) and was more likely at the PoU (range 19-99%). On average, 84% of households used an improved drinking water source, and 31% met all of the SMDW criteria. E. coli contamination was the primary reason SMDW criteria were not met (15 of 27 countries). The prevalence of E. coli in PoC samples was lower among households using improved water sources [risk ratio (RR)=0.74; 95% confidence interval (CI): 0.64, 0.85] but not for households with water accessible on premises (RR=0.99; 95% CI: 0.94, 1.05) or available when needed (RR=0.95; 95% CI: 0.88, 1.02). E. coli contamination of PoU samples was less common for households in the richest vs. poorest wealth quintile (RR=0.70; 95% CI: 0.55, 0.88) and in communities with high (>75%) improved sanitation coverage (RR=0.94; 95% CI: 0.90, 0.97). Livestock ownership (RR=1.08; 95% CI: 1.04, 1.13), rural vs. urban residence (RR=1.10; 95% CI: 1.04, 1.16), and wet vs. dry season sampling (RR=1.07; 95% CI: 1.01, 1.15) were positively associated with contamination at the PoU.

DISCUSSION

Cross-sectional water quality data can be collected in household surveys and can be used to assess inequalities in service levels, to track the SDG indicator of SMDWs, and to examine risk factors for contamination. There is an urgent need for better risk management to reduce widespread exposure to fecal contamination through drinking water services in LMICs. https://doi.org/10.1289/EHP8459.

Attributes of drinking water, sanitation, and hygiene associated with microbiological water quality of stored drinking water in rural schools in Mozambique and Uganda

Contaminated drinking water causes morbidity and mortality worldwide, especially in low- and middle-income countries. Drinking water quality has been studied extensively in household settings, but little research is available on drinking water quality in schools. School settings are of particular importance, because children are more susceptible than adults to a variety of diseases from contaminated drinking water. Many school water, sanitation and hygiene (WaSH) interventions have been studied for their efficacy to reduce diarrheal disease incidence, but few have evaluated drinking water quality, which reflects an important exposure pathway between WaSH services and health outcomes. Using school surveys developed from internationally established WaSH indicators and field microbiological water quality tests, we studied 374 rural schools in Mozambique and Uganda to understand the association between specific WaSH services and drinking water microbiological contamination, specifically testing most probable number (MPN) of Escherichia coli, an indicator of fecal contamination, per 100 mL. In Mozambique and Uganda, 71% and 83% respectively of rural schools had low risk drinking water quality (<1 E. coli/100 mL); thirteen percent and seven percent had very high-risk water quality (≥100 E. coli/100 mL). When accounting for all WaSH services studied, schools that used an improved-type water source had 0.22 times less E. coli in stored drinking water in Mozambique (95% CI: 0.07, 0.65) and 0.12 times less E. coli in Uganda (95% CI: 0.02, 0.80). In Mozambique, use of a water source within 30 minutes for travel and collection and the presence of water and soap/ash for handwashing were also significantly associated with less E. coli in drinking water. The findings of this study provide public health practitioners with implementable WaSH services to improve school drinking water quality, which has implications for the health, learning environment, and cognitive development of school children in rural Mozambique and Uganda.

Environmental sanitation and hygiene of elderly workers in Nakhon Si Thammarat Province, Thailand

Introduction

Thailand will become a completely aged society in 2021 and a super-aged society in 2030, resulting in a high proportion of older people. Living environments, especially at home, play an essential health determinant for the elders.

Methods

This cross-sectional analytical study evaluated 319 households in Nakhon Si Thammarat Province according to the standard of housing sanitation for elders and assessed biological contamination in food, water, and indoor air in the homes.

Results

The housing assessment results revealed some issues that are necessary to be improved, i.e., the wet and dry areas in bathrooms were not separated (89.4%), there was no anti-slip sheet in the bathrooms (97.2%), and handrails were not suitably installed (96.2%). The proportion of coliform bacteria contamination in the samples of cooked rice, side dish, dish, spoon, elderly hand, and drinking water was 93.3, 83.9, 82.5, 88.1, 78.0 and 97.5%, respectively. The average total bacteria count in bedrooms and kitchens was 111 CFU/m³ and 149 CFU/m³, respectively. The average total fungi count was 83 CFU/m³ in bedrooms and 93 CFU/m³ in kitchens. Most indoor air quality parameters complied with the standards.

Conclusions

Significant health risks for the elderly workers while living at home were injuries due to slipping fall in the house, especially in the bathroom, as well as foodborne and waterborne diseases. The health risks should be communicated to the elders. Prevention of the risks should be performed by the cooperation of relevant government agencies and the older adults in the study area.

Seasonality in faecal contamination of drinking water sources in the Jirapa and Kassena-Nankana Municipalities of Ghana

This paper examines seasonal variations in faecal contamination of drinking water sources in the Jirapa and Kassena-Nankana Municipalities of Ghana. Data collection involved a survey of 568 households, testing of faecal coliform concentrations in drinking water source samples (141 in the rainy season, 128 in the dry season), in-depth interviews with key water stakeholders, and field observation to identify sources of faecal contamination. From the water quality testing, faecal coliforms were detected in all source types, including 'treated' pipe-borne water. Contamination was significantly higher in the rainy season than in the dry season (P < 0.05) with 51.8% of water samples in the rainy season and 27.3% in the dry season failing to meet the World Health Organisation and Ghana Standard Authority guideline on faecal coliform concentrations in drinking water sources. The proportion of population at risk of faecal contamination in the rainy season was 41.5% compared to 33.1% in the dry season. We argue that in Ghana and Sub-Saharan Africa at large, water surveillance agencies risk underestimating population exposed to faecal contamination through drinking water sources if monitoring is only done in the dry season. To avoid this, we recommend seasonal monitoring of faecal concentration in drinking water sources. However, in periods of limited resources, monitoring is most appropriate in the rainy season when the risk of contamination is high.

Effect of Inter-Observer Variation on the Association between Contamination Hazards and the Microbiological Quality of Water Sources: A Longitudinal Study

Sanitary risk inspection protocols are often used to identify contamination hazards at water sources; however, different observers sometimes struggle to record hazards consistently. This study aimed to assess the effect of inter-observer variation in hazard observations on the strength of relationships between observed hazards and the bacterial contamination of water sources, particularly relationships with animal-related hazards. In a longitudinal study, five surveyors independently recorded hazards at 93 water sources used by 234 households in Siaya County, Kenya, in both wet and dry seasons. One surveyor collected samples from sources for subsequent Escherichia coli and intestinal enterococci testing. The relationship between each surveyor’s hazard observations and high bacterial contamination was examined using logistic regression. After controlling for water source type and preceding rainfall; percentage scores for animal-related hazards were significantly related to high contamination with enterococci and E. coli for one surveyor (odds ratio 1.02; 95% confidence intervals 1.00–1.03 for both parameters), but not for the remaining four surveyors. The relationship between observed contamination hazards and the microbiological contamination of water sources is sensitive to variation in hazard recording between surveyors. Sanitary risk protocols should be designed to enable robust and consistent observation of hazards.

A longitudinal study of the association between domestic contact with livestock and contamination of household point-of-use stored drinking water in rural Siaya County (Kenya)

Background

Emerging evidence suggests close domestic proximity of livestock and humans may lead to microbiological contamination of hands, objects, food and water supplies within domestic environments, adversely impacting public health. However, evidence quantifying the relationship between livestock, domestic animals, humans and microbiological contamination of household stored water remains limited.

Aim

This longitudinal study aimed to examine the relationship between domestic contact with livestock and domestic animals on microbiological contamination of household Point-of-Use (POU) stored drinking water in rural Kenya and assess the influence of choice of faecal indicator on such associations.

Methodology

A survey was performed in 234 households in Siaya county, Kenya, to observe presence of livestock (cattle, goats, poultry) and domestic animals (cats, dogs) in household compounds, alongside other risk factors for contamination of POU stored drinking water such as sanitation, storage conditions and hygiene practices. Samples from water sources (e.g. piped, spring/wells, boreholes, surface and rainwater) and from POU storage containers were tested for E. coli and intestinal enterococci. Livestock-related risk factors for water contamination were examined through multinomial regression, controlling for confounders.

Results

Rainwater was the main POU water source and was found to be highly susceptible to contamination. Multivariate analysis showed greater risk of gross (>100 CFU/100 mL) water contamination (with E. coli) for households where goats were observed, and/or where poultry roosted in proximity to stored household water (relative risk RR = 2.71; p = 0.001 and RR = 2.02; p = 0.012 respectively). Presence of a poultry coop was also associated with elevated intestinal enterococci densities (RR = 4.46; p = 0.001). Associations between contamination and livestock risk factors were thus similar for both bacteria groups, but E. coli counts declined more rapidly following collection from surface waters than enterococci counts (p = 0.024).

Conclusion

The presence of livestock (particularly goats) and poultry within household compounds increases POU water contamination risk, suggesting the need for improved interventions to address cross-contamination within rural domestic settings. Within Siaya county, more effective community education is needed to raise awareness of POU water quality protection, particularly of rainwater.

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Poultry and goats are risk factors for household stored water contamination.

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Poultry are risk factors for both enterococci and E. coli contamination.

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Attenuation of enterococci in household stored water is lower than for E. coli.

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Residual free chlorine is mostly too low to prevent stored water recontamination.

Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution

BACKGROUND

Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention.

OBJECTIVE

This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda).

METHODS

We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to < 80   years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682).

CONCLUSIONS

This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407.

Seasonal assessment of drinking water sources in Rwanda using GIS, contamination degree (Cd), and metal index (MI)

The quality of drinking water source remains as a major concern in areas of developing and underdeveloped countries worldwide. The treatment and supply of drinking water in Rwanda are carried out by Water and Sanitation Corporation, a state-owned public company. However, it is not able to supply water to all households. Consequently, the non-serviced households depend on natural water sources, like springs, to meet their water requirements. Nevertheless, the water quality in these springs is scarcely known. Therefore, this study assessed and compared metal elements in drinking water sources in the dry and rainy seasons in 2017 using the contamination degree, metal index, and geographic information systems to reveal the spatial distribution of water quality within the considered water sources of springs in Rwanda. The samples were collected monthly from nine water sources of springs and the measured elements are aluminium, calcium, copper, iron, manganese, and zinc. The metal index indicated that during the dry season and rainy season, the sites of Kibungo (1.10 and 1.26) and Kinigi (1.01 and 1.54) have assessed a metal index which is higher than 1. Thus, the water quality of those sites was getting the threshold of warning. The analysis indicated that pollutants are easily transported into water bodies during the rainy season in urban and rural areas to a greater extent than during the dry season .

Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda

BACKGROUND

Unsafe drinking water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household water filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale.

METHODS AND FINDINGS

In a large-scale program in Western Province, Rwanda, water filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking water (piped, borehole, protected spring/well, or rainwater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have water in their filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes.

CONCLUSIONS

Our findings indicate that the intervention improved household drinking water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI.

TRIAL REGISTRATION

Clinical Trials.gov NCT02239250.

Perceived versus actual water quality: Community studies in rural Oaxaca, Mexico

Compromised water quality risks public health, which becomes particularly acute in economically marginalized communities. Although the majority of the clean-water-deprived population resides in Sub-Saharan Africa and Asia, a significant portion (32 million) lives in Meso- and Latin-America. Oaxaca is one of the marginalized southern states of Mexico, which has experienced high morbidity from infectious diseases and also has suffered from a high rate of infant mortality. However, there has been a paucity of reports on the status of water quality of culturally diverse rural Oaxaca. This study follows community-based participatory research methods to address the data gap by reporting on water quality (chemical and microbiological) and by exploring social realities and water use practices within and among communities. Surveys and water quality analyses were conducted on 73 households in three rural communities, which were selected based on the choice of water sources (i.e., river water, groundwater, and spring water). Statistically significant variations among communities were observed including the sanitation infrastructure (p-value 0.001), public perception on water quality (p-value 0.007), and actual microbiological quality of water (p-value 0.001). Results indicate a high prevalence of diarrheal diseases, a desire to improve water quality and reduce the cost of water, and a need for education on water quality and health in all the surveyed communities. The complexities among the three studied communities highlight the need for undertaking appropriate policies and water treatment solutions.

Consistency of Use and Effectiveness of Household Water Treatment among Indian Households Claiming to Treat Their Water

Household water treatment (HWT) can improve drinking water quality and prevent disease if used correctly and consistently by populations at risk. Current international monitoring estimates by the Joint Monitoring Programme for water and sanitation suggest that at least 1.1 billion people practice HWT. These estimates, however, are based on surveys that may overstate the level of consistent use and do not address microbial effectiveness. We sought to assess how HWT is practiced among households identified as HWT users according to these monitoring standards. After a baseline survey (urban: 189 households, rural: 210 households) to identify HWT users, 83 urban and 90 rural households were followed up for 6 weeks. Consistency of reported HWT practices was high in both urban (100%) and rural (93.3%) settings, as was availability of treated water (based on self-report) in all three sampling points (urban: 98.8%, rural: 76.0%). Nevertheless, only 13.7% of urban and 25.8% of rural households identified at baseline as users of adequate HWT had water free of thermotolerant coliforms at all three water sampling points. Our findings raise questions about the value of the data gathered through the international monitoring of HWT as predictors of water quality in the home, as well as questioning the ability of HWT, as actually practiced by vulnerable populations, to reduce exposure to waterborne diseases.

Water Quality, Sanitation, and Hygiene Conditions in Schools and Households in Dolakha and Ramechhap Districts, Nepal: Results from A Cross-Sectional Survey

This study assessed drinking water quality, sanitation, and hygiene (WASH) conditions among 708 schoolchildren and 562 households in Dolakha and Ramechhap districts of Nepal. Cross-sectional surveys were carried out in March and June 2015. A Delagua water quality testing kit was employed on 634 water samples obtained from 16 purposively selected schools, 40 community water sources, and 562 households to examine water quality. A flame atomic absorption spectrophotometer was used to test lead and arsenic content of the same samples. Additionally, a questionnaire survey was conducted to obtain WASH predictors. A total of 75% of school drinking water source samples and 76.9% point-of-use samples (water bottles) at schools, 39.5% water source samples in the community, and 27.4% point-of-use samples at household levels were contaminated with thermo-tolerant coliforms. The values of water samples for pH (6.8–7.6), free and total residual chlorine (0.1–0.5 mg/L), mean lead concentration (0.01 mg/L), and mean arsenic concentration (0.05 mg/L) were within national drinking water quality standards. The presence of domestic animals roaming inside schoolchildren’s homes was significantly associated with drinking water contamination (adjusted odds ratio: 1.64; 95% confidence interval: 1.08–2.50; p = 0.02). Our findings call for an improvement of WASH conditions at the unit of school, households, and communities.