Delivering Drinking Water by Truck in Humanitarian Contexts: Results from Mixed-Methods Evaluations in the Democratic Republic of the Congo and Bangladesh

Abundance and characteristics of microplastics in drinking water treatment plants, distribution systems, water from refill kiosks, tap waters and bottled waters

Limited research studies have revealed the presence of microplastics (MPs) of different polymer types, shapes, and sizes in drinking water sources, influents of drinking water treatment plants (DWTPs), effluents of DWTPs, tap water, and bottled water. Reviewing the available information on MP pollution in waters, which is becoming more worrying in correlation with the increasing plastic production in the world every year, is noteworthy for understanding the current situation, identifying the deficiencies in the studies, and taking the necessary measures for public health as soon as possible. Therefore, this paper, in which the abundance, characteristics, and removal efficiencies of MPs in the processes from raw water to tap water and/or bottled water are reviewed is a guide for dealing with MP pollution in drinking water. In this paper, firstly, the sources of MPs in raw waters are briefly reviewed. In addition, the abundance, and characteristics (polymer type, shape, and size) of MPs in influents and effluents of DWTPs in different countries are reviewed and the effects of treatment stages (coagulation, flocculation, sedimentation, sand filtration, disinfection, and membrane filtration) of DWTPs on MP removal efficiency and the factors that are effective in removal are discussed. Moreover, studies on the factors affecting MP release from drinking water distribution systems (DWDSs) to treated water and the abundance and characteristics of MPs in tap water, bottled water and water from refill kiosks are reviewed. Finally, the deficiencies in the studies dealing with MPs in drinking water were identified and recommendations for future studies are presented.

Comparative Life Cycle Assessment of Water Disinfection Processes Applicable in Low-Income Settings

Access to safe, sufficient water for health and sanitation is a human right, and the reliable disinfection of water plays a critical role in addressing this need. The environmental impact and sustainability of water disinfection methods will also play a role in overall public health. This study presents an investigation of the environmental life cycle impacts of four ultraviolet disinfection systems utilizing ambient solar radiation directly and indirectly for water disinfection in comparison to chlorination and water delivery for application in low-income settings. Product inspection and existing literature were used to define a life cycle functional unit of 1 m³ of water for each system, which allowed quantification of material use, infrastructure requirements, and life cycle of the original components of each system and those needed to keep them operational for the studied lifespans (1, 5, 10, and 20 years) and scales (30, 100, 500, and 1000 L per day). For all studied cases, chlorine had the lowest impact in all impact categories, but end-user acceptance of chlorine in some settings is low, driving interest in low-impact alternatives. Disinfection based on low-pressure mercury lamps had the next lowest normalized impact in most categories and may represent a viable alternative, particularly for long-term (10+ years), high production (500+ liters per day) scenarios.

Field Trial of an Automated Batch Chlorinator System at Two Shared Shallow Tubewells among Camps for Forcibly Displaced Myanmar Nationals (FDMN) in Cox's Bazar, Bangladesh

Chlorination of shallow tubewell water is challenging due to various iron concentrations. A mixed-method, small-scale before-and-after field trial assessed the accuracy and consistency of an automated chlorinator, Zimba, in Rohingya camp housing, Cox’s Bazar. From August–September 2018, two shallow tubewells (iron concentration = 6.5 mg/L and 1.5 mg/L) were selected and 20 households were randomly enrolled to participate in household surveys and water testing. The field-team tested pre-and post-treated tubewell and household stored water for iron, free and total chlorine, and E. coli. A sub-set of households (n = 10) also received safe storage containers (5 L jerry cans). Overall mean iron concentrations were 5.8 mg/L in Zimba water, 1.9 mg/L in household storage containers, and 2.8 mg/L in the project-provided safe storage containers. At baseline, 0% samples at source and 60% samples stored in household vessels were contaminated with E. coli (mean log₁₀ = 0.62 MPN/100 mL). After treatment, all water samples collected from source and project-provided safe storage containers were free from E. coli, but 41% of post-treated water stored in the household was contaminated with E. coli. E. coli concentrations were significantly lower in the project-provided safe storage containers (log₁₀ mean difference = 0.92 MPN, 95% CI = 0.59–1.14) compared with baseline and post-treated water stored in household vessels (difference = 0.57 MPN, 95% CI = 0.32–0.83). Zimba is a potential water treatment technology for groundwater extracted through tubewells with different iron concentrations in humanitarian settings.

A case analysis of a mass treatment approach to control GI and water-related conditions in Sudan

Background

The efficiency of mass chlorination in controlling diarrheal diseases during acute emergencies has been extensively reported in literature. However, long-term crises received unparallel attention. Researchers have previously carried out a trial that investigated the impact of using chemical means to treat water reservoirs of Um-Baddah Nevachah, a refugee camp located in the western outskirts of Khartoum, Sudan.

A double-blind community experimental trial was carried out by randomly adding either chlorine or a placebo to the major water tanks in the area. Data were collected using a mixed-methods study design. The primary input was the quantitative data derived from total coliforms lab tests and records of the local primary healthcare center, while the embedded (nested) portion generated most of the qualitative data from direct face-to-face interviews.

As a case analysis, this study aims to critically appraise the original trial. In the Background the authors discussed the context of the trial, approach used, and outcomes. Discussion section included three issues related to the trial: scientific importance, challenges and strategies.

Discussion

Importance: There are two factors that contribute to the importance of this study: First, the integrated and systematic approach followed to resolve associated challenges. The study swiftly moved from investigating potential water contamination, to test whether it is related to an endogenous focus that auto-taints drinking water, and finally it explored the impact of tanks chlorination on public health. Second, the longstanding humanitarian context which remains largely underreported in literature. Challenges: funding limitations were among the first obstacles faced. During the fieldwork preparation phase, a lot of work was required to resolve logistical and security challenges. Keeping volunteers motivated was the biggest concern during the last phase of data collection. Strategies: The “Matrix Solutions Strategy” was developed and used to optimize scarce resources to simultaneously target multiple problems through a single intervention.

Conclusion

Key lessons learned from the whole experience were: persistence is paramount for the success of studies in precarious situations; lateral thinking generates alternative solutions that are novel, feasibility and practical in resources-limited settings; and finally respecting local culture and regulations is essential for building trust with both authorities and vulnerable societies.

Lessons learned from conducting six multi-country mixed-methods effectiveness research studies on water, sanitation, and hygiene (WASH) interventions in humanitarian response

BACKGROUND

Provision of safe water, sanitation, and hygiene (WASH) to affected populations in humanitarian emergencies is necessary for dignity and communicable disease control. Additional evidence on WASH interventions is needed in humanitarian settings. Between 2008 and 2019, we completed six multi-country, mixed-methods effectiveness studies in humanitarian response on six different WASH interventions. In each evaluation, we conducted: key informant interviews; water point observations and water quality testing; household surveys with recipients, including survey and water quality testing; focus group discussions; and/or, secondary data analysis. The research questions were: "What is the effectiveness of [intervention] in reducing the risk of diarrhea/cholera transmission; and, what programmatic factors lead to higher effectiveness?"

DISCUSSION

In all six multi-country, mixed-methods evaluations, policy-relevant outcomes were obtained. We found, in our individual research results, that: interventions could reduce the risk of disease in humanitarian contexts; this reduction of risk did not always occur, as there were large ranges in effectiveness; and, implementation factors were crucial to intervention effectiveness. When collaboratively reviewing our research process across evaluations, we found strategies for successfully conducting this research included: 1) working with partners to identify and evaluate programs; 2) rapidly obtaining approvals to deploy; and, 3) conducting research methodologies consistently. Personal connections, in-person communication, trust, and experience working together were key factors for success in identifying partners for evaluation. Successes in evaluation deployment occurred with flexibility, patience, commitment of adequate time, and understanding of processes; although we note access and security concerns in insecure contexts precluded deployment. Consistent and robust protocols, flexibility, and a consistent researcher on the ground in each context allowed for methodological consistency and high-quality results.

CONCLUSIONS

In conclusion, we have found multi-country, mixed-methods results to be one crucial piece of the WASH evidence base in humanitarian contexts. This is particularly because evaluations of reductions in risk from real-world programming are policy-relevant, and are directly used to improve programming. In future, we need to flexibly work with donors, agencies, institutions, responders, local governments, local responders, and beneficiaries to design safe and ethical research protocols to answer questions related to WASH interventions effectiveness in humanitarian response, and, improve WASH programming.

Fecal Indicator Bacteria Data to Characterize Drinking Water Quality in Low-Resource Settings: Summary of Current Practices and Recommendations for Improving Validity

Fecal indicator bacteria (FIB) values are widely used to assess microbial contamination in drinking water and to advance the modeling of infectious disease risks. The membrane filtration (MF) testing technique for FIB is widely adapted for use in low- and middle-income countries (LMICs). We conducted a systematic literature review on the use of MF-based FIB data in LMICs and summarized statistical methods from 172 articles. We then applied the commonly used statistical methods from the review on publicly available datasets to illustrate how data analysis methods affect FIB results and interpretation. Our findings indicate that standard methods for processing samples are not widely reported, the selection of statistical tests is rarely justified, and, depending on the application, statistical methods can change risk perception and present misleading results. These results raise concerns about the validity of FIB data collection, analysis, and presentation in LMICs. To improve evidence quality, we propose a FIB data reporting checklist to use as a reminder for researchers and practitioners.

A Structural Equation Model to Decipher Relationships among Water, Sanitation, and Health in Colonias-Type Unincorporated Communities

The colonias along the United States-Mexico border are generally self-built neighborhoods of low-income families that lack basic infrastructure. While some government assistance has provided roads and electricity, water and wastewater services are still lacking in many colonias. This research is the first to collect a comprehensive dataset on water, sanitation, health, and living conditions in these unincorporated neighborhoods through collection of water samples and surveys; 114 households in 23 colonias across three geographically diverse Texas counties are studied. Water quality is assessed via traditional microbial indicators, chlorine, and arsenic. This complex dataset requires an advanced statistical tool to disentangle relationships among diverse factors. Structural equation modeling is utilized to identify relationships among surveyed and measured variables. The model reveals that colonias residents with well/hauled water accurately predict their water quality, while those with treated+piped water tend to think that their water is worse than it actually is. Dwelling quality and connection to sanitary sewers influence perceived health risks and household health, respectively. Furthermore, these communities have an overwhelming need and desire for point-of-use water treatment. This model can inform decision making and may be adapted to probe other questions and social dynamics for water and sanitation in unincorporated communities elsewhere.

Effectiveness of water chlorination programs along the emergency-transition-post-emergency continuum: Evaluations of bucket, in-line, and piped water chlorination programs in Cox's Bazar

Supplying safe drinking water in humanitarian emergencies is critical, and source water chlorination is a commonly implemented intervention to provide safe water. We evaluated three different source water chlorination programs (bucket, in-line, and piped water chlorination) in the ongoing humanitarian response in Cox's Bazar refugee camps in Bangladesh. We used a mixed-methods research protocol including key informant interviews, water point observations, focus group discussions, household surveys, and water quality testing. The three evaluated programs were implemented at different response stages and required different levels of staffing, infrastructure, and community mobilization work. In the bucket chlorination program, highly contaminated open well water was chlorinated, in in-line and piped water chlorination programs, groundwater was treated. Overall, 71% of bucket, 36% of in-line, and 60% of piped water chlorination households had stored water that met free chlorine residual (FCR) criteria, respectively. Additionally, 71% of bucket, 86% of in-line, and 91% of piped water chlorination households had stored water that met Escherichia coli (E. coli) criteria (<10 E. coli CFU/100 mL). Regression results indicate presence of FCR, serving water by pouring, and higher source water pH were associated with meeting E. coli criteria. Our results highlight: no individual program fully met international standards as implemented, although each partially met standards; the importance of understanding beneficiary preferences and behavior change campaigns; and, the benefits and drawbacks of each source water chlorination program must be considered before implementation. Overall, we found appropriate source water chlorination program choice is a continuum, depending on humanitarian phase and context. Therefore, we recommend continuing context- and phase-appropriate source water chlorination programs, emphasizing consistent and acceptable chlorine dosage, implementing programmatic improvements, and incorporating user preferences to reduce microbial contamination and consequently the risk of waterborne diseases.