Fecal contamination of shallow tubewells in Bangladesh inversely related to arsenic

Deep tubewell use is associated with increased household microbial contamination in rural Bangladesh: Results from a prospective cohort study among households in rural Bangladesh

Deep tubewells are important sources of arsenic mitigation in rural Bangladesh. Compared to commonly available shallow tubewells, deep tubewells tap into deeper low-arsenic aquifers and greatly reduce exposure to arsenic in drinking-water. However, benefits from these more distant and expensive sources may be compromised by higher levels of microbial contamination at point-of-use (POU). This paper examines differences in microbial contamination levels at source and POU among households using deep tubewells and shallow tubewells, and investigates factors associated with POU microbial contamination among deep tubewell users. We assessed a prospective longitudinal cohort of 500 rural households in Matlab, Bangladesh, across 135 villages. Concentration of Escherichia coli (E. coli) in water samples at source and POU using Compartment Bag Tests (CBTs) was measured across rainy and dry seasons. We employed linear mixed-effect regression models to measure the effect of different factors on log E. coli concentrations among deep tubewell users. CBT results show that log E. coli concentrations are similar at source and at POU during the first dry and rainy season, but are significantly higher at POU among deep tubewell users during the second dry season. Log E. coli at POU among deep tubewell users is positively associated with both presence (exponentiated beta exp(b) = 2.52, 95% Confidence Interval (CI) = 1.70, 3.73) and concentration of E. coli (exp(b) = 1.36, 95% CI = 1.19, 1.54) at source, and walking time to the tubewell source (exp(b) = 1.39, 95% CI = 1.15, 1.69). Drinking-water during the second dry season is associated with reduced log E. coli (exp(b) = 0.33, 95% CI = 0.23, 0.57) compared to the rainy season. These results suggest that while households that use deep tubewells have lower arsenic exposure, they may be at higher risk of consuming microbially contaminated water compared to households that use shallow tubewells.

Spatial and temporal dynamics and potential pathogenicity of fecal coliforms in coastal shallow groundwater wells

Access to water through shallow groundwater wells is a common practice in coastal settlements. This, coupled with a lack of planning for wastewater disposal promotes fecal contamination of groundwater and poses a threat to human health. Here, the spatial and temporal dynamics of groundwater fecal contamination was evaluated during summer and winter (2013 and 2014) in a coastal protected area having a high touristic relevance (Cabo Polonio, Uruguay). Fecal coliforms (FC) abundance in groundwater was significantly higher during summer, related to an influx of ~ 1000 tourists per day. A significant spatial autocorrelation was found in 2014, when the abundance of FC in a well was influenced by its three nearest wells (Moran and Geary tests). The applied statistical models (mixed models) indicated that total phosphorus and organic matter were the variables significantly explaining FC abundance. The risk for human health was estimated using groundwater-extracted DNA and qPCR of genes encoding for E. coli virulence factors (stx1, stx2, and eae). Potential Shiga toxin-producing enteropathogenic and enterohemorrhagic pathotypes were detected, even at FC abundances ≤ 1 CFU (100 mL^-1). Moreover, we found that contaminated groundwater reached the beach, being the presence of FC in sand detected even in winter and showing its highest frequency nearby groundwater wells consistently having high FC abundance (hot spots). Altogether, the results show that fecal contamination of shallow groundwater in Cabo Polonio involves a risk for human health that intensifies during summer (associated to a significant increase of tourists). This contamination also impacts the beach, where FC can remain through the whole year.

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.

Seasonal and gender impacts on fecal exposure trends in an urban slum

Seasonal and gender impacts have not been well considered in fecal exposure assessment, especially in low- and middle-income countries. This study examined the seasonal and gender impacts on fecal exposure trends in children through daily living activities in an urban slum in Bangladesh. We determined Escherichia coli concentrations in seven types of environmental samples (n = 232) and the activity data of children via diary recording, questionnaires, and interview surveys. Daily and monthly exposures were stochastically estimated for drinking, eating, pond bathing, well bathing, and hand-to-mouth contact. Of the five pathways, pond bathing and drinking contributed a large part of the daily and monthly exposure. Significant seasonal differences were observed in daily exposures for bathing, which were higher in the rainy season (2.59 × 10² CFU/day for boys and 6.19 × 10^-1 CFU/day for girls) than in the dry season (1.69 × 10²; 4.30 × 10^-2), because of longer pond bathing time and more contaminated bathing water in the rainy season. In contrast, eating had significantly higher exposure in the dry season (3.71 × 10; 3.22 × 10) than the rainy season (1.50 × 10; 1.24 × 10) due to the higher dish contamination. Significantly higher daily exposure was observed in the bathing for boys than girls, as boys spent longer time for bathing at a heavily contaminated pond.

Faecal contamination of groundwater self-supply in low- and middle income countries: Systematic review and meta-analysis

Self-supply is a ubiquitous response by households to the public water supply inadequacies found worldwide. Self-supply is invested in and managed by an individual household, accessible on-premises and unregulated. Vulnerability to faecal contamination is a concern due to reliance on low-cost technologies and shallow groundwater. This review aims to evaluate the evidence base on the safety of groundwater self-supply in low- and middle income countries in relation to faecal contamination. Differences in microbial water quality between source types, settings, countries and ownership were investigated. A search of peer-reviewed studies in low- and middle income countries was conducted in online databases, including PubMed, Web of Science, ProQuest and Environmental Complete. Studies were included if they had sufficient detail about the water samples to be related to groundwater self-supply, contained extractable data on faecal indicator bacteria (FIB) including thermotolerant coliform or Escherichia coli and were published in English between 1990 and April 2020. A total of 30 studies were included, resulting in 100 datasets and 26,981 water samples across the studies. FIB were present in 36% self-supply samples. The odds of FIB being detected was significantly higher for unimproved sources (OR=8.19, 95% CI [4.04-16.59], p<0.001) and for sources in low income countries (OR=3.85, 95% CI [1.85-7.69], p<0.001). Self-supply was significantly more likely to be contaminated than piped supply (OR=3.45, 95% CI [1.52-7.82], p=0.003). However, water quality was highly heterogeneous (I²=90.9%). Egger's test found no evidence of small study publication bias for self-supply compared to public supply. No evidence of bias due to lack of randomization or season was found, but study design and quality could potentially bias the results. To achieve Sustainable Development Goal 6.1 on safe drinking water for all, more attention is needed from governments to engage with self-supply and formulate balanced policy responses.

What Environmental Factors Influence the Concentration of Fecal Indicator Bacteria in Groundwater? Insights from Explanatory Modeling in Uganda and Bangladesh

Information about microbial water quality is critical for managing water safety and protecting public health. In low-income countries, monitoring all drinking water supplies is impractical because financial resources and capacity are insufficient. Data sets derived from satellite imagery, census, and hydrological models provide an opportunity to examine relationships between a suite of environmental risk factors and microbial water quality over large geographical scales. We investigated the relationships between groundwater fecal contamination and different environmental parameters in Uganda and Bangladesh. In Uganda, groundwater contamination was associated with high population density (p < 0.001; OR = 1.27), high cropland coverage (p < 0.001; OR = 1.47), high average monthly precipitation (p < 0.001; OR = 1.14), and high surface runoff (p < 0.001; OR = 1.37), while low groundwater contamination was more likely in areas further from cities (p < 0.001; OR = 0.66) and with higher forest coverage (p < 0.001; OR = 0.70). In Bangladesh, contamination was associated with higher weekly precipitation (p < 0.001; OR = 1.44) and higher livestock density (p = 0.05; OR = 1.11), while low contamination was associated with low forest coverage (p < 0.001; OR = 1.23) and high cropland coverage (p < 0.001; OR = 0.80). We developed a groundwater contamination index for each country to help decision-makers identify areas where groundwater is most prone to fecal contamination and prioritize monitoring activities. Our approach demonstrates how to harness satellite-derived data to guide water safety management.

Seasonal contamination of well-water in flood-prone colonias and other unincorporated U.S. communities

Many of the six million residents of unincorporated communities in the United States depend on well-water to meet their needs. One group of unincorporated communities is the colonias, located primarily in several southwestern U.S. states. Texas is home to the largest number of these self-built communities, of mostly low-income families, lacking basic infrastructure. While some states have regulations that mandate minimum infrastructure for these communities, water and sewage systems are still lacking for many of their residents. Unprotected wells and self-built septic/cesspool systems serve as the primary infrastructure for many such colonias. This research was designed to probe how wells and septic/cesspool systems are influenced by heavy rainfall events. Such events are hypothesized to impact water quality with regard to human health. Inorganic and microbiological water quality of the wells in nine colonias located in Nueces County, Texas, were evaluated during dry and wet periods. Nueces County was selected as an example based on its flooding history and the fact that many colonias there depend entirely on well-water and septic/cesspool systems. The results demonstrate that well-water quality in these communities varies seasonally with respect to arsenic (up to 35 μg/L) and bacterial contamination (Escherichia coli), dependent on the amount of rainfall, which leaves this population vulnerable to health risks during both wet and dry periods. Microbial community analyses were also conducted on selected samples. To explore similar seasonal contamination of well-water, an analysis of unincorporated communities, flooding frequency, and arsenic contamination in wells was conducted by county throughout the United States. This nationwide analysis indicates that unincorporated communities elsewhere in the United States are likely experiencing comparable challenges for potable water access because of a confluence of socioeconomic, infrastructural, and policy realities.

Considering Alternate Pathways of Drinking-Water Contamination: Evidence of Risk Substitution from Arsenic Mitigation Programs in Rural Bangladesh

Deep tubewells are a key component of arsenic mitigation programs in rural Bangladesh. Compared to widely prevalent shallow tubewells, deep tubewells reduce ground-water arsenic exposure and provide better microbial water quality at source. However, the benefits of clean drinking-water at these more distant sources may be abated by higher levels of microbial contamination at point-of-use. One such potential pathway is the use of contaminated surface water for washing drinking-water storage containers. The aim of this study is to compare the prevalence of surface water use for washing drinking-water storage containers among deep and shallow tubewell users in a cohort of 499 rural residents in Matlab, Bangladesh. We employ a multi-level logistic regression model to measure the effect of tubewell type and ownership status on the odds of washing storage containers with surface water. Results show that deep tubewell users who do not own their drinking-water tubewell, have 6.53 times the odds [95% CI: 3.56, 12.00] of using surface water for cleaning storage containers compared to shallow tubewell users, who own their drinking-water source. Even deep tubewell users who own a private well within walking distance have 2.53 [95% CI: 1.36, 4.71] times the odds of using surface water compared to their shallow tubewell counterparts. These results highlight the need for interventions to limit risk substitution, particularly the increased use of contaminated surface water when access to drinking water is reduced. Increasing ownership of and proximity to deep tubewells, although crucial, is insufficient to achieve equity in safe drinking-water access across rural Bangladesh.

Child undernutrition in households with microbiologically safer drinking water and 'improved water' in Tanna, Vanuatu

The Sustainable Development Goal drinking water indicators include microbiological safety measures, whereas the Millennium Development Goal indicator 'improved water' may be microbiologically unsafe. In rural Vanuatu, we undertook household surveys, child anthropometry, and tested stored drinking water, to investigate relationships between water and undernutrition. Using Escherichia coli most probable number, we categorized results according to Compartment Bag Test drinking water cutoffs: <1/100 mL (safe), 1-10/100 mL (intermediate risk), >10-100/100 mL (high risk), and >100/100 mL (very high risk). Of 201 households, 191 (95%) had microbiologically unsafe drinking water, regardless of 'improved' status. We investigated cross-sectional associations between households with microbiologically safer drinking water (≤10 E. coli/100 mL) versus 'improved water' and undernutrition among children. Of children under 5, 145 (48.8%, 95% CI: 42.8, 54.8) were stunted and 59 (19.1%, 95% CI: 14.4, 23.8) were underweight. Among households with 'improved water', the adjusted prevalence ratio (95% CI) of stunting was 0.61 (0.46, 0.80) and underweight was 0.46 (0.29, 0.73) compared with 'unimproved water'. However, we found no association between having drinking water with ≤10 E. coli/100 mL at one point in time and undernutrition. Longer-term variations in water quality and unmeasured conditions beyond water may have contributed to these associations.

Assessment of groundwater quality based on principal component analysis and pollution source-based examination: a case study in Ho Chi Minh City, Vietnam

The current study aimed to assess the quality of apportion pollution sources and examine the impacts of anthropogenic activities on groundwater. The study was implemented in two sequential steps of (1) bulk examination of groundwater quality followed by principal component analysis/factor analysis (PCA/FA) to apportion pollution sources and (2) pollution source-based examination to assess the effects of anthropogenic activities. Well-water samples were taken in Ho Chi Minh City, Vietnam, in 2015 (233 samples) and 2019 (20 samples) and analyzed for 8 and 15 water quality parameters, respectively. The results showed that 99% of studied wells had pH value lower than the permissible limit, and 29, 20, 15, and 14% of studied wells had concentrations of Fe, NH₄⁺, COD (chemical oxygen demand), and coliform, respectively, higher than the maximum permissible limit. PCA/FA revealed that three pollution sources, ranked in the order of importance: agricultural, urban, and industrial activities, could mainly contribute to enriching the pollutant concentrations of groundwater. While agricultural activities may contaminate groundwater with organic substances, the urban area may enrich bacterial-pathogen density such as E. coli and coliform, and the industrial area may contribute to contaminating groundwater with some inorganic parameters. Groundwater quality index and ANOVA showed that groundwater of the studied area was poor to very poor in quality and that in the agricultural area was the worst of the three land-use types. In brief, the groundwater quality in the studied area was degraded and agricultural activities were the most important factor causing the degradation followed by urban and industrial activities.

Assessing Drinking Water Quality at the Point of Collection and within Household Storage Containers in the Hilly Rural Areas of Mid and Far-Western Nepal

Accurate assessments of drinking water quality, household hygenic practices, and the mindset of the consumers are critical for developing effective water intervention strategies. This paper presents a microbial quality assessment of 512 samples from household water storage containers and 167 samples from points of collection (POC) in remote rural communities in the hilly area of western Nepal. We found that 81% of the stored drinking water samples (mean log₁₀ of all samples = 1.16 colony-forming units (CFU)/100 mL, standard deviation (SD) = 0.84) and 68% of the POC samples (mean log₁₀ of all samples = 0.57 CFU/100 mL, SD = 0.86) had detectable E. coli. The quality of stored water was significantly correlated with the quality at the POC, with the majority (63%) of paired samples showing a deterioration in quality post-collection. Locally applied household water treatment (HWT) methods did not effectively improve microbial water quality. Among all household sanitary inspection questions, only the presence of livestock near the water storage container was significantly correlated with its microbial contamination. Households' perceptions of their drinking water quality were mostly influenced by the water's visual appearance, and these perceptions in general motivated their use of HWT. Improving water quality within the distribution network and promoting safer water handling practices are proposed to reduce the health risk due to consumption of contaminated water in this setting.

What are the main factors influencing the presence of faecal bacteria pollution in groundwater systems in developing countries?

Groundwater is the major source of drinking water in most rural areas in developing countries. This resource is threatened by the potential presence of faecal bacteria coming from a variety of sources and pollution paths, the former including septic tanks, landfills, and crop irrigation with untreated, or insufficiently treated, sewage effluent. Accurately assessing the microbiological safety of water resources is essential to reduce diseases caused by waterborne faecal exposure. The objective of this study is to discern which are the most significant sanitary, hydrogeological, geochemical, and physical variables influencing the presence of faecal bacterial pollution in groundwater by means of statistical multivariate analyses. The concentration of Escherichia coli was measured in a number of waterpoints of different types in a rural area located in the coast of Kenya, assessing both a dry and a wet season. The results from the analyses reaffirm that the design of the well and their maintenance, the distance to latrines, and the geological structure of the waterpoints are the most significant variables affecting the presence of E. coli. Most notably, the presence of faecal bacteria in the study area correlates negatively with the concentration of ion Na⁺ (being an indirect indicator of fast recharge in the study site), and also negatively with the length of the water column inside the well.

Effectiveness of a community-based water, sanitation, and hygiene (WASH) intervention in reduction of diarrhoea among under-five children: Evidence from a repeated cross-sectional study (2007-2015) in rural Bangladesh

Diarrhoea, the most common disease directly related to water, sanitation, and hygiene (WASH), still remains one of the most significant health problems among children under-five worldwide. In this reality, BRAC, the largest NGO in the world initiated a comprehensive WASH intervention in 50 upazilas (sub-districts) of Bangladesh in 2007 which was later scaled up to cover 150 upazilas in two subsequent phases. The intervention period of the programme was 2007-2011. The present study encompassed 30 upazilas of the first phase of intervention. The aim of the study was to investigate the effectiveness of this intervention on reduction of diarrhoea among under-five children, and to identify the factors associated with childhood diarrhoea. A repeated cross-sectional study design was followed, and a population-based survey was carried out on four occasions: baseline (2007), midline (2009), endline (2011), and post-endline (2015) among 4,775 households. This analysis considers only households having at least one under-five children. Absence of handwashing practice with soap after defecation and before eating food, unclean latrine condition, and unsafe disposal of child faeces were identified as significant risk factors associated with under-five diarrhoea from Log-binomial regression. The prevalence of under-five diarrhoea within the past 2 weeks of the survey declined from 13.7% at baseline to 3.6% at end-line (p < 0.001) in the WASH intervention area. However, the progress seemingly stalled after 2011, which may have occurred due to the lack of improvement in unsafe disposal of child faeces and unclean latrine condition after the intervention period. Study findings suggest that, to reduce the prevalence of childhood diarrhoea it is important to promote safe disposal of child faeces, maintaining cleanliness of latrines, and washing hand with soap at critical times, beyond merely increasing the sanitation coverage. Findings also underline the necessity of maintaining a small-scale monitoring component involving local community, such as a WatSan committee (a local committee comprising the user communities for supervising WASH related activities) for periodic monitoring at household level for a certain period after the program intervention works to make the behavioural change more sustainable and to keep the reduction rate of under-five diarrhoeal prevalence steady.

Water pollution in Bangladesh and its impact on public health

Bangladesh – one of the most densely populated countries of the world— has plentiful water sources, but these sources are being polluted continuously. Both surface water and groundwater sources are contaminated with different contaminants like toxic trace metals, coliforms as well as other organic and inorganic pollutants. As most of the population uses these water sources, especially groundwater sources which contain an elevated amount of arsenic throughout the country; health risk regarding consuming water is very high. Death due to water-borne diseases is widespread in Bangladesh, particularly among children. Anthropogenic sources such as untreated industrial effluents, improper disposal of domestic waste, agricultural runoffs are the main contributors regarding water pollution. A total water pollution status of this country, as well as the sources of this severe condition, is crucial to evaluate public health risk. For this purpose, we reviewed hundreds of well recognized international and national journals, conference proceedings and other related documents to draw a complete picture of recent water pollution status and its impact on public health; also the sources of water pollution are identified.

Effectiveness of Different Approaches to Arsenic Mitigation over 18 Years in Araihazar, Bangladesh: Implications for National Policy

About 20 million rural Bangladeshis continue to drink well water containing >50 μg/L arsenic (As). This analysis argues for reprioritizing interventions on the basis of a survey of wells serving a population of 380,000 conducted one decade after a previous round of testing overseen by the government. The available data indicate that testing alone reduced the exposed population in the area in the short term by about 130,000 by identifying the subset of low As wells that could be shared at a total cost of <US$1 per person whose exposure was reduced. Testing also had a longer term impact, as 60,000 exposed inhabitants lowered their exposure by installing new wells to tap intermediate (45-90 m) aquifers that are low in As at their own expense of US$30 per person whose exposure was reduced. In contrast, the installation of over 900 deep (>150 m) wells and a single piped-water supply system by the government reduced exposure of little more than 7000 inhabitants at a cost of US$150 per person whose exposure was reduced. The findings make a strong case for long-term funding of free well testing on a massive scale with piped water or groundwater treatment only as a last resort.

Relation of childhood diarrheal morbidity with the type of tube well used and associated factors of Shigella sonnei diarrhea in rural Bangladesh site of the Global Enteric Multicenter Study

Background

Diarrheal disease still remains a major public health threat and is often associated with fatal outcome especially in children with shigellosis mostly in developing countries. This study aimed to determine the presence of any associations between drinking shallow tube well (STW) water and childhood shigellosis. A total of 1394 children aged 0–59 months who presented with moderate-to-severe diarrhea (MSD) in Kumudini Women’s Medical College and Hospital, Bangladesh, from December 2007 to March 2011 were enrolled into the study.

Results

Among the study children, STW users often represented poor families (44% vs. 37%, p = 0.010); less often had household electricity (60% vs. 68%, p = 0.001) and cemented floor material (12% vs. 21%, p < 0.001); washed hand before eating (79% vs. 84%, p = 0.020); and had Shigella sonnei infections (7.8% vs. 13.1, p = 0.002) compared to deep tube well (DTW) water families (in bivariate analysis). After adjusting for covariates, a significant negative association was observed between childhood MSD episodes due to Shigella sonnei infections and the use of STW water (aOR 0.53, 95% CI 0.36, 0.79).

Conclusions

An emergence of less severe Shigella sonnei has replaced relatively more severe Shigella flexneri among the MSD children from DTW-user families. However, more monitoring in terms of disease surveillance for changes in the distribution of Shigella serogroups and serotypes and its upsurges and antimicrobial susceptibility is essential.

Deep tubewell microbial water quality and access in arsenic mitigation programs in rural Bangladesh

The objective of this paper is to determine whether deep tubewells installed through arsenic mitigation efforts in rural Bangladesh provide better drinking water microbial quality compared to shallow tubewells. We conducted a stratified random cross-sectional survey of 484 households to assess microbial contamination of deep tubewell water at source and at point of use (POU) compared to shallow tubewell water using the Compartment Bag Test. In addition, we measured storage time, distance, travel time and ownership status among both sets of users to assess deep tubewell efficacy and under what conditions they offer poorer or better water quality. Differences in tubewell characteristics were compared using non-parametric Mann-Whitney U tests and two-proportion Z-tests. Prevalence ratios of microbial contamination stratified by water quality, storage time and distance to tubewells and ownership were estimated using unadjusted Mantel-Haenszel tests. There was no significant difference in microbial contamination between shallow and deep tubewells at source. The presence of POU water microbial contamination in storage containers in deep tubewell households was 1.11 times the prevalence in shallow tubewell storage containers (95% CI = 0.97-1.27). Deep tubewell users stored water longer and walked significantly farther to obtain water compared to shallow tubewell users. Among deep tubewell households, those residing farther away from the source were 1.24 times as likely to drink contaminated water from storage containers compared to those located nearby (95% CI = 1.04-1.48). Our findings suggest that deep tubewells have comparable water quality to shallow tubewells at source, but increasing distance from the household exacerbates risk of microbial contamination at POU.

Reservoirs of faecal indicator bacteria in well-head hand pumps in Bangladesh

The majority of the population of Bangladesh (90%) rely on untreated groundwater for drinking and domestic use. At the point of collection, 40% of these supplies are contaminated with faecal indicator bacteria (FIB). Recent studies have disproved the theory that latrines discharging to shallow aquifers are the major contributor to this contamination. In this study, we tested the hypothesis that hand pumps are a reservoir of FIB. We sampled the handle, spout, piston and seal from 19 wells in Araihazar Upazila, Bangladesh and identified that the spout and seal were reservoirs of FIB. These findings led to our recommendation that well spouts be regularly cleaned, including the removal of precipitated deposits, and that the seals be regularly changed. It is envisaged that one or both of these interventions will reduce the numbers of FIB in drinking water, thereby reducing the burden of diarrhoeal disease in Bangladesh.

Microbial Groundwater Quality Status of Hand-Dug Wells and Boreholes in the Dodowa Area of Ghana

To assess the suitability of water sources for drinking purposes, samples were taken from groundwater sources (boreholes and hand-dug wells) used for drinking water in the Dodowa area of Ghana. The samples were analyzed for the presence of fecal indicator bacteria (Escherichia coli) and viruses (Adenovirus and Rotavirus), using membrane filtration with plating and glass wool filtration with quantitative polymerase chain reaction (PCR), respectively. In addition, sanitary inspection of surroundings of the sources was conducted to identify their vulnerability to pollution. The presence of viruses was also assessed in water samples from the Dodowa River. More than 70% of the hand-dug wells were sited within 10 m of nearby sources of contamination. All sources contained E. coli bacteria, and their numbers in samples of water between dug wells and boreholes showed no significant difference (p = 0.48). Quantitative PCR results for Adenovirus indicated 27% and 55% were positive for the boreholes and hand-dug wells, respectively. Samples from all boreholes tested negative for the presence of Rotavirus while 27% of the dug wells were positive for Rotavirus. PCR tests of 20% of groundwater samples were inhibited. Based on these results we concluded that there is systemic microbial and fecal contamination of groundwater in the area. On-site sanitation facilities, e.g., pit latrines and unlined wastewater drains, are likely the most common sources of fecal contamination of groundwater in the area. Water abstracted from groundwater sources needs to be treated before use for consumption purposes. In addition, efforts should be made to delineate protected areas around groundwater abstraction points to minimize contamination from point sources of pollution.

Seeking evidence of multidisciplinarity in environmental geochemistry and health: an analysis of arsenic in drinking water research

A multidisciplinary approach to research affords the opportunity of objectivity, creation of new knowledge and potentially a more generally acceptable solution to problems that informed the research in the first place. It increasingly features in national programmes supporting basic and applied research, but for over 40 years, has been the arena for many research teams in environmental geochemistry and health. This study explores the nature of multidisciplinary research in the earth and health sciences using a sample selected from co-authored articles reporting research on arsenic (As) in drinking water from 1979 to 2013. A total of 889 relevant articles were sourced using the online version of the science citation index-expanded (SCI-expanded). The articles were classified according to author affiliation and later by author discipline/research interests using the Revised Field of Science and Technology Frascati manual DSTI/EAS/STP/NESTI (2006) 19/FINAL and a decision algorithm. Few articles were published on the topic until 2000. More articles were published across all affiliations in the last 10 years of the review period (2004-2013) than in the first 10 years (1979-1988). Only 84 (~9%) articles fell within the "earth and health" only and "earth, health and other" categories when classification was undertaken by author affiliation alone. This suggests that level of collaboration between earth and health scientists in arsenic in drinking water research may be very low. By refining the classification further using author discipline/research interests, only 28 of the 84 articles appear to be co-authored by earth and health scientists alongside professionals in other fields. More than half of these 28 articles involved descriptive non-experimental, observational study designs, limited in direct causal hypotheses and mechanistic investigation. If collaborative research is to lead to the increased multidisciplinary research, early interaction should be encouraged between students from different disciplines. In order to achieve multidisciplinarity in practise, it is imperative that scientific communities and research agencies do more to encourage interaction and integration between researchers from different disciplines. This must develop from educational institutions seeing opportunities to improve graduate skills in an increasingly diverse research landscape.

Human and livestock waste as a reduced carbon source contributing to the release of arsenic to shallow Bangladesh groundwater

Recent studies have demonstrated that the supply of relatively young organic carbon stimulates the release of arsenic to groundwater in Bangladesh. This study explores the potential role of human and livestock waste as a significant source of this carbon in a densely populated rural area with limited sanitation. Profiles of aquifer sediment samples were analyzed for phytosterols and coprostanol to assess the relative contributions of plant-derived and human/livestock waste-derived organic carbon at two well-characterized sites in Araihazar. Coprostanol concentrations increased with depth from non-detection (<10m at Site B and <23m at Site F) to maxima of 1.3 and 0.5ng/g in aquifer sands recovered from 17m (Site B) and 26m (Site F), respectively. The commonly used sewage contamination index ([5β-coprostanol]/([5α-cholestanol]+[5β-coprostanol])) exceeds 0.7 between 12 and 19m at Site B and between 24 and 26m at Site F, indicating input of human/livestock waste to these depths. Urine/fecal input within the same depth range is supported by groundwater Cl/Br mass ratios >1000 compared to Cl/Br <500 at depths >50m. Installed tube wells in the area's study sites may act as a conduit for DOC and specifically human/livestock waste into the aquifer during flood events. The depth range of maximum input of human/livestock waste indicated by these independent markers coincides with the highest dissolved Fe (10-20mg/L) and As (200-400μg/L) concentrations in groundwater at both sites. The new findings suggest that the oxidation of human/livestock waste coupled to the reductive dissolution of iron-(oxy)-hydroxides and/or arsenate may enhance groundwater contamination with As.

Determinants of the use of alternatives to arsenic-contaminated shallow groundwater: an exploratory study in rural West Bengal, India

Shallow groundwater containing toxic concentrations of arsenic is the primary source of drinking water for millions of households in rural West Bengal, India. Often, this water also contains unpleasant levels of iron and non-negligible fecal contamination. Alternatives to shallow groundwater are increasingly available, including government-built deep tubewells, water purchased from independent providers, municipal piped water, and household filters. We conducted a survey of 501 households in Murshidabad district in 2014 to explore what influenced the use of available alternatives. Socioeconomic status and the perceived likelihood of gastrointestinal (GI) illness (which was associated with dissatisfaction with iron in groundwater) were the primary determinants of the use of alternatives. Arsenic knowledge was limited. The choice amongst alternatives was influenced by economic, social, and aesthetic factors, but not by health risk perceptions. The use of purchased water was rarely exclusive and was strongly associated with socioeconomic status, suggesting that this form of market-based water provision does not ensure universal access. Demand for purchased water appeared to decrease significantly shortly after free piped water became available at public taps. Our results suggest that arsenic mitigation interventions that also address co-occurring water problems (iron, GI illness) could be more effective than a focus on arsenic alone.

The Likelihood of Coliform Bacteria in NJ Domestic Wells Based on Precipitation and Other Factors

The influence of precipitation on coliform bacteria detection rates in domestic wells was investigated using data collected through the New Jersey Private Well Testing Act. Measured precipitation data from the National Weather Service (NWS) monitoring stations was compared to estimated data from the Multisensor Precipitation Estimate (MPE) in order to determine which source of data to include in the analyses. A strong concordance existed between these two precipitations datasets; therefore, MPE data was utilized as it is geographically more specific to individual wells. Statewide, 10 days of cumulative precipitation prior to testing was found to be an optimal period influencing the likelihood of coliform detections in wells. A logistic regression model was developed to predict the likelihood of coliform occurrence in wells from 10 days of cumulative precipitation data and other predictive variables including geology, season, coliform bacteria analysis method, pH, and nitrate concentration. Total coliform (TC) and fecal coliform or Escherichia coli (FC/EC) were detected more frequently when the preceding 10 days of cumulative precipitation exceeded 34.5 and 54 mm, respectively. Furthermore, the likelihood of coliform detection was highest in wells located in the bedrock region, during summer and autumn, analyzed with the enzyme substrate method, with pH between 5 and 6.99, and (for FC/EC but not TC) nitrate greater than 10 mg/L. Thus, the likelihood of coliform presence in domestic wells can be predicted from readily available environmental factors including timing and magnitude of precipitation, offering outreach opportunities and potential changes to coliform testing recommendations.

Animal Feces Contribute to Domestic Fecal Contamination: Evidence from E. coli Measured in Water, Hands, Food, Flies, and Soil in Bangladesh

Fecal-oral pathogens are transmitted through complex, environmentally mediated pathways. Sanitation interventions that isolate human feces from the environment may reduce transmission but have shown limited impact on environmental contamination. We conducted a study in rural Bangladesh to (1) quantify domestic fecal contamination in settings with high on-site sanitation coverage; (2) determine how domestic animals affect fecal contamination; and (3) assess how each environmental pathway affects others. We collected water, hand rinse, food, soil, and fly samples from 608 households. We analyzed samples with IDEXX Quantitray for the most probable number (MPN) of E. coli. We detected E. coli in source water (25%), stored water (77%), child hands (43%), food (58%), flies (50%), ponds (97%), and soil (95%). Soil had >120 000 mean MPN E. coli per gram. In compounds with vs without animals, E. coli was higher by 0.54 log10 in soil, 0.40 log10 in stored water and 0.61 log10 in food (p < 0.05). E. coli in stored water and food increased with increasing E. coli in soil, ponds, source water and hands. We provide empirical evidence of fecal transmission in the domestic environment despite on-site sanitation. Animal feces contribute to fecal contamination, and fecal indicator bacteria do not strictly indicate human fecal contamination when animals are present.

Enteric Viruses and Fecal Bacteria Indicators to Assess Groundwater Quality and Suitability for Irrigation

According to Italian Ministerial Decree No. 185 of 12 June 2003, water is considered suitable for irrigation if levels of fecal bacteria (i.e., Escherichia coli and Salmonella) are within certain parameters. The detection of other microorganisms is not required. The aim of this study is to determine the bacteriological quality of groundwater used for irrigation and the occurrence of enteric viruses (Norovirus, Enterovirus, Rotavirus, Hepatovirus A), and to compare the presence of viruses with the fecal bacteria indicators. A total of 182 wells was analyzed. Widespread fecal contamination of Apulian aquifers was detected (141 wells; 77.5%) by the presence of fecal bacteria (i.e., E. coli, Salmonella, total coliforms, and enterococci). Considering bacteria included in Ministerial Decree No. 185, the water from 35 (19.2%) wells was unsuitable for irrigation purposes. Among 147 wells with water considered suitable, Norovirus, Rotavirus, and Enterovirus were detected in 23 (15.6%) wells. No Hepatovirus A was isolated. Consequently, 58 wells (31.9%) posed a potential infectious risk for irrigation use. This study revealed the inadequacy of fecal bacteria indicators to predict the occurrence of viruses in groundwater and it is the first in Italy to describe the presence of human rotaviruses in well water used for irrigation.

Can Sanitary Inspection Surveys Predict Risk of Microbiological Contamination of Groundwater Sources? Evidence from Shallow Tubewells in Rural Bangladesh

Accurately assessing the microbiological safety of water sources is essential to reduce waterborne fecal exposures and track progress toward global targets of safe water access. Sanitary inspections are a recommended tool to assess water safety. We collected 1,684 water samples from 902 shallow tubewells in rural Bangladesh and conducted sanitary surveys to assess whether sanitary risk scores could predict water quality, as measured by Escherichia coli. We detected E. coli in 41% of tubewells, mostly at low concentrations. Based on sanitary scores, 31% of wells were low risk, 45% medium risk, and 25% high or very high risk. Older wells had higher risk scores. Escherichia coli levels were higher in wells where the platform was cracked or broken (Δlog₁₀ = 0.09, 0.00-0.18) or undercut by erosion (Δlog₁₀ = 0.13, 0.01-0.24). However, the positive predictive value of these risk factors for E. coli presence was low (< 50%). Latrine presence within 10 m was not associated with water quality during the wet season but was associated with less frequent E. coli detection during the dry season (relative risk = 0.72, 0.59-0.88). Sanitary scores were not associated with E. coli presence or concentration. These findings indicate that observed characteristics of a tubewell, as measured by sanitary inspections in their current form, do not sufficiently characterize microbiological water quality, as measured by E. coli. Assessments of local groundwater and geological conditions and improved water quality indicators may reveal more clear relationships. Our findings also suggest that the dominant contamination route for shallow groundwater sources is short-circuiting at the wellhead rather than subsurface transport.

Influence of Climate Extremes and Land Use on Fecal Contamination of Shallow Tubewells in Bangladesh

Climate extremes in conjunction with some land use practices are expected to have large impacts on water quality. However, the impacts of land use and climate change on fecal contamination of groundwater has not been well characterized. This work quantifies the influences of extreme weather events and land use practices on Escherichia coli presence and concentration in groundwater from 125 shallow wells, a dominant drinking water resource in rural Bangladesh, monitored over a 17 month period. The results showed that E. coli presence was significantly associated with the number of heavy rain days, developed land and areas with more surface water. These variables also had significant impacts on E. coli concentration, with risk ratios of 1.38 (95% CI = 1.16, 1.65), 1.07 (95% CI: 1.05, 1.09), and 1.02 (95% CI = 1.01, 1.03), respectively. Significant synergistic effects on E. coli presence and concentration were observed when land use and weather variables were combined. The findings suggest that climate extremes and land use practices, particularly urbanization, might promote fecal contamination of shallow well water, thus increasing the risk of diarrheal diseases.

Dissolved Organic Matter Quality in a Shallow Aquifer of Bangladesh: Implications for Arsenic Mobility

In some high arsenic (As) groundwater systems, correlations are observed between dissolved organic matter (DOM) and As concentrations, but in other systems, such relationships are absent. The role of labile DOM as the main driver of microbial reductive dissolution is not sufficient to explain the variation in DOM-As relationships. Other processes that may also influence As mobility include complexation of As by dissolved humic substances, and competitive sorption and electron shuttling reactions mediated by humics. To evaluate such humic DOM influences, we characterized the optical properties of filtered surface water (n = 10) and groundwater (n = 24) samples spanning an age gradient in Araihazar, Bangladesh. Further, we analyzed large volume fulvic acid (FA) isolates (n = 6) for optical properties, C and N content, and (13)C NMR spectroscopic distribution. Old groundwater (>30 years old) contained primarily sediment-derived DOM and had significantly higher (p < 0.001) dissolved As concentration than groundwater that was younger than 5 years old. Younger groundwater had DOM spectroscopic signatures similar to surface water DOM and characteristic of a sewage pollution influence. Associations between dissolved As, iron (Fe), and FA concentration and fluorescence properties of isolated FA in this field study suggest that aromatic, terrestrially derived FAs promote As-Fe-FA complexation reactions that may enhance As mobility.

Escherichia coli Attenuation by Fe Electrocoagulation in Synthetic Bengal Groundwater: Effect of pH and Natural Organic Matter

Technologies addressing both arsenic and microbial contamination of Bengal groundwater are needed. Fe electrocoagulation (Fe-EC), a simple process relying on the dissolution of an Fe(0) anode to produce Fe(III) precipitates, has been shown to efficiently remove arsenic from groundwater at low cost. We investigated Escherichia coli (E. coli) attenuation by Fe-EC in synthetic Bengal groundwater as a function of Fe dosage rate, total Fe dosed, pH, and presence of natural organic matter (NOM). A 2.5 mM Fe dosage simultaneously achieved over 4-log E. coli attenuation and arsenic removal from 450 to below 10 μg/L. E. coli reduction was significantly enhanced at pH 6.6 compared to pH 7.5, which we linked to the decreased rate of Fe(II) oxidation at lower pH. 3 mg/L-C of NOM (Suwanee River fulvic acid) did not significantly affect E. coli attenuation. Live-dead staining and comparisons of Fe-EC with chemical coagulation controls showed that the primary mechanism of E. coli attenuation is physical removal with Fe(III) precipitates, with inactivation likely contributing as well at lower pH. Transmission electron microscopy showed that EC precipitates adhere to and bridge individual E. coli cells, resulting in large bacteria-Fe aggregates that can be removed by gravitational settling. Our results point to the promising ability of Fe-EC to treat arsenic and bacterial contamination simultaneously at low cost.

Seasonal variation of fecal contamination in drinking water sources in developing countries: a systematic review

Accounting for fecal contamination of drinking water sources is an important step in improving monitoring of global access to safe drinking water. Fecal contamination varies with time while its monitoring is often infrequent. We sought to understand seasonal trends in fecal contamination to guide best practices to capture seasonal variation and ascertain the extent to which the results of a single sample may overestimate compliance with health guidelines. The findings from 22 studies from developing countries written in English and identified through a systematic review were analyzed. Fecal contamination in improved drinking water sources was shown to follow a statistically significant seasonal trend of greater contamination during the wet season (p<0.001). This trend was consistent across fecal indicator bacteria, five source types, twelve Köppen-Geiger climate zones, and across both rural and urban areas. Guidance on seasonally representative water quality monitoring by the World Health Organization and national water quality agencies could lead to improved assessments of access to safe drinking water.

Effects of source- versus household contamination of tubewell water on child diarrhea in rural Bangladesh: a randomized controlled trial

BACKGROUND

Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh.

METHODS

We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants' source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions.

FINDINGS

Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias.

CONCLUSIONS

Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01350063.

Risk of diarrhoea from shallow groundwater contaminated with enteropathogens in the Kathmandu Valley, Nepal

Shallow groundwater is the main water source among many alternatives in the Kathmandu Valley, Nepal, which has a rapidly growing population and intermittent piped water supply. Although human pathogens are detected in groundwater, its health effects are unclear. We estimated risk of diarrhoea from shallow groundwater use using quantitative microbial risk assessment. Escherichia coli, Giardia cyst and Cryptosporidium oocyst levels were analysed in dug and tube wells samples. E. coli concentrations were converted to those of enteropathogenic E. coli (EPEC). Risks from EPEC in dug wells and from Cryptosporidium and Giardia in both dug and tube wells were higher than the acceptable limit (<10⁻⁴ infections/person-year) for both drinking and bathing exposures. Risk from protozoan enteropathogens increased the total risk 10,000 times, indicating that ignoring protozoans could lead to serious risk underestimation. Bathing exposure considerably increased risk, indicating that it is an important pathway. Point-of-use (POU) water treatment decreased the risk six-fold and decreased risk overestimation. Because removal efficiency of POU water treatment has the largest impact on total risk, increasing the coverage and efficiency of POU water treatment could be a practical risk management strategy in the Kathmandu Valley and similar settings.

Arsenic removal from drinking water by a household sand filter in Vietnam--effect of filter usage practices on arsenic removal efficiency and microbiological water quality

Household sand filters are applied to treat arsenic- and iron-containing anoxic groundwater that is used as drinking water in rural areas of North Vietnam. These filters immobilize poisonous arsenic (As) via co-oxidation with Fe(II) and sorption to or co-precipitation with the formed Fe(III) (oxyhydr)oxides. However, information is lacking regarding the effect of the frequency and duration of filter use as well as of filter sand replacement on the residual As concentrations in the filtered water and on the presence of potentially pathogenic bacteria in the filtered and stored water. We therefore scrutinized a household sand filter with respect to As removal efficiency and the presence of fecal indicator bacteria in treated water as a function of filter operation before and after sand replacement. Quantification of As in the filtered water showed that periods of intense daily use followed by periods of non-use and even sand replacement did not significantly (p<0.05) affect As removal efficiency. The As concentration was reduced during filtration from 115.1 ± 3.4 μg L(-1) in the groundwater to 5.3 ± 0.7 μg L(-1) in the filtered water (95% removal). The first flush of water from the filter contained As concentrations below the drinking water limit and suggests that this water can be used without risk for human health. Colony forming units (CFUs) of coliform bacteria increased during filtration and storage from 5 ± 4 per 100mL in the groundwater to 5.1 ± 1.5 × 10(3) and 15 ± 1.4 × 10(3) per 100mL in the filtered water and in the water from the storage tank, respectively. After filter sand replacement, CFUs of Escherichia coli of <100 per 100mL were quantified. None of the samples contained CFUs of Enterococcus spp. No critical enrichment of fecal indicator bacteria belonging to E. coli or Enterococcus spp. was observed in the treated drinking water by qPCR targeting the 23S rRNA gene. The results demonstrate the efficient and reliable performance of household sand filters regarding As removal, but indicate a potential risk for human health arising from the enrichment of coliform bacteria during filtration and from E. coli cells that are introduced by sand replacement.

Metagenomes of microbial communities in arsenic- and pathogen-contaminated well and surface water from bangladesh

The contamination of drinking water from both arsenic and microbial pathogens occurs in Bangladesh. A general metagenomic survey of well water and surface water provided information on the types of pathogens present and may help elucidate arsenic metabolic pathways and potential assay targets for monitoring surface-to-ground water pathogen transport.

Association of climate variability and childhood diarrhoeal disease in rural Bangladesh, 2000-2006

This study examined the effects of meteorological factors, particularly, extreme weather events, on the prevalence of childhood diarrhoeal disease in Matlab, Bangladesh. Logistic regression models were used to examine impacts of temperature, rainfall and the extreme weather factors (the number of hot days and days with heavy rainfall) on childhood diarrhoea from 2000 to 2006 at the bari (cluster of dwellings) level. The results showed that the increases in the number of hot days and days with heavy rainfall were associated with an increase in daily diarrhoea cases by 0·8-3·8% and 1-6·2%, respectively. The results from multivariable stepwise models showed that the extreme weather factors were still positively associated with childhood diarrhoea, while the associations for average temperature and rainfall could be negative after other variables were controlled. The findings showed that not only the intensity, but also the frequency of extreme weather events had significant effects on childhood diarrhoea.

Assessment of the microbiological quality of groundwater in three regions of the Valencian Community (Spain)

Urban groundwater development was traditionally constrained by concerns about its quality. This study was conducted in the regions of La Ribera Alta and Ribera Baja and La Plana de Requena-Utiel of the Valencian Community (Valencia, Spain) where population density, demand for drinking water and agricultural activities are high. Groundwater bodies (GWBs) are regarded as management areas within each territory, and were used to establish protection policies. This study analyzed eleven GWBs. We used two databases with microbiological measurements from 154 wells over a 7-year period (2004–2011), risk factors and groundwater information. Wells were grouped according to frequency of microbiological contamination using E. coli measurements, category <1, or wells with low-frequency microbiological contamination and high-frequency wells or category 1–100, according to World Health Organization (WHO) quality criteria of drinking water. Of all wells, 18.12% showed high-frequency microbiological contamination with a majority distribution in the Ribera Alta region (26.98%, p < 0.001). No significant differences were found between the two risk categories for flow, static level, well depth and distance from population centres. This paper reveals that the vulnerability classes established by the Geological and Mining Institute of Spain (IGME) do not match the microbiological results, and that only eight wells with high-frequency contamination coincide with the high vulnerability areas.

Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator "use of an improved source," which does not account for water quality measurements. Our objectives were to determine whether water from "improved" sources is less likely to contain fecal contamination than "unimproved" sources and to assess the extent to which contamination varies by source type and setting.

METHODS AND FINDINGS

Studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of Escherichia coli or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for "improved" sources than "unimproved" sources (odds ratio [OR] = 0.15 [0.10-0.21], I2 = 80.3% [72.9-85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52-3.71]; p<0.001) and rural areas (OR = 2.37 [1.47-3.81] p<0.001) were more likely to be contaminated. Studies rarely reported stored water quality or sanitary risks and few achieved robust random selection. Safety may be overestimated due to infrequent water sampling and deterioration in quality prior to consumption.

CONCLUSION

Access to an "improved source" provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe drinking-water and do not fully reflect disparities in access. An enhanced monitoring strategy would combine indicators of sanitary protection with measures of water quality.

Importance of Reversible Attachment in Predicting E. Coli Transport in Saturated Aquifers From Column Experiments

Drinking water wells indiscriminatingly placed adjacent to fecal contaminated surface water represents a significant but difficult to quantify health risk. Here we seek to understand mechanisms that limit the contamination extent by scaling up bacterial transport results from the laboratory to the field in a well constrained setting. Three pulses of E. coli originating during the early monsoon from a freshly excavated pond receiving latrine effluent in Bangladesh were monitored in 6 wells and modeled with a two-dimensional (2-D) flow and transport model conditioned with measured hydraulic heads. The modeling was performed assuming three different modes of interaction of E. coli with aquifer sands: 1) irreversible attachment only (best-fit ki=7.6 day-1); 2) reversible attachment only (ka=10.5 and kd=0.2 day-1); and 3) a combination of reversible and irreversible modes of attachment (ka=60, kd=7.6, ki=5.2 day-1). Only the third approach adequately reproduced the observed temporal and spatial distribution of E. coli, including a 4-log10 lateral removal distance of ∼9 m. In saturated column experiments, carried out using aquifer sand from the field site, a combination of reversible and irreversible attachment was also required to reproduce the observed breakthrough curves and E. coli retention profiles within the laboratory columns. Applying the laboratory-measured kinetic parameters to the 2-D calibrated flow model of the field site underestimates the observed 4-log10 lateral removal distance by less than a factor of two. This is promising for predicting field scale transport from laboratory experiments.

Transport of E. coli in Aquifer Sediments of Bangladesh: Implications for Widespread Microbial Contamination of Groundwater

Fecal bacteria are frequently found at much greater distances than would be predicted by laboratory studies, indicating that improved models that incorporate more complexity are might be needed to explain the widespread contamination of many shallow aquifers. In this study, laboratory measurements of breakthrough and retained bacteria in columns of intact and repacked sediment cores from Bangladesh were fit using a two-population model with separate reversible and irreversible attachment sites that also incorporated bacterial decay rates. Separate microcosms indicated an average first order decay rate of 0.03 log₁₀ / day for free bacteria in both the liquid phase and bacteria attached to the solid phase. Although two-thirds of the column results could be well fit with a dual deposition site, single population model, fitting of one third of the results required a two-population model with a high irreversible attachment rate (between 5 and 60 hr^-1) for one population of bacteria and a much lower rate (from 5 hr^-1 to essentially zero) for the second. Inferred attachment rates for the reversible sites varied inversely with grain size (varying from 1 - 20 hr^-1 for grain sizes between 0.1 and 0.3 mm) while reversible detachment rates were found to be nearly constant (approximately 0.5 hr^-1). Field simulations based on the fitted two-population model parameters predict only a two-fold reduction in fecal source concentration over a distance of 10 m, determined primarily by the decay rate of the bacteria. The existence of a secondary population of bacteria with a low attachment rate might help explain the observed widespread contamination of tubewell water with E. coli at the field site where the cores were collected, as well as other similar sites.

Protective benefits of deep tube wells against childhood diarrhea in Matlab, Bangladesh

OBJECTIVES

We investigated whether deep tube wells installed to provide arsenic-free groundwater in rural Bangladesh have the added benefit of reducing childhood diarrheal disease incidence.

METHODS

We recorded cases of diarrhea in children younger than 5 years in 142 villages of Matlab, Bangladesh, during monthly community health surveys in 2005 and 2006. We surveyed the location and depth of 12,018 tube wells and integrated these data with diarrhea data and other data in a geographic information system. We fit a longitudinal logistic regression model to measure the relationship between childhood diarrhea and deep tube well use. We controlled for maternal education, family wealth, year, and distance to a deep tube well.

RESULTS

Household clusters assumed to be using deep tube wells were 48.7% (95% confidence interval = 27.8%, 63.5%) less likely to have a case of childhood diarrhea than were other household clusters.

CONCLUSIONS

Increased access to deep tube wells may provide dual benefits to vulnerable populations in Matlab, Bangladesh, by reducing the risk of childhood diarrheal disease and decreasing exposure to naturally occurring arsenic in groundwater.

Unsealed tubewells lead to increased fecal contamination of drinking water

Bangladesh is underlain by shallow aquifers in which millions of drinking water wells are emplaced without annular seals. Fecal contamination has been widely detected in private tubewells. To evaluate the impact of well construction on microbial water quality 35 private tubewells (11 with intact cement platforms, 19 without) and 17 monitoring wells (11 with the annulus sealed with cement, six unsealed) were monitored for culturable Escherichia coli over 18 months. Additionally, two 'snapshot' sampling events were performed on a subset of wells during late-dry and early-wet seasons, wherein the fecal indicator bacteria (FIB) E. coli, Bacteroidales and the pathogenicity genes eltA (enterotoxigenic E. coli; ETEC), ipaH (Shigella) and 40/41 hexon (adenovirus) were detected using quantitative polymerase chain reaction (qPCR). No difference in E. coli detection frequency was found between tubewells with and without platforms. Unsealed private wells, however, contained culturable E. coli more frequently and higher concentrations of FIB than sealed monitoring wells (p < 0.05), suggestive of rapid downward flow along unsealed annuli. As a group the pathogens ETEC, Shigella and adenovirus were detected more frequently (10/22) during the wet season than the dry season (2/20). This suggests proper sealing of private tubewell annuli may lead to substantial improvements in microbial drinking water quality.

Waste-water impacts on groundwater: Cl/Br ratios and implications for arsenic pollution of groundwater in the Bengal Basin and Red River Basin, Vietnam

Across West Bengal and Bangladesh, concentrations of Cl in much groundwater exceed the natural, upper limit of 10 mg/L. The Cl/Br mass ratios in groundwaters range up to 2500 and scatter along mixing lines between waste-water and dilute groundwater, with many falling near the mean end-member value for waste-water of 1561 at 126 mg/L Cl. Values of Cl/Br exceed the seawater ratio of 288 in uncommon NO(3)-bearing groundwaters, and in those containing measurable amounts of salt-corrected SO(4) (SO(4) corrected for marine salt). The data show that shallow groundwater tapped by tube-wells in the Bengal Basin has been widely contaminated by waste-water derived from pit latrines, septic tanks, and other methods of sanitary disposal, although reducing conditions in the aquifers have removed most evidence of NO(3) additions from these sources, and much evidence of their additions of SO(4). In groundwaters from wells in palaeo-channel settings, end-member modelling shows that >25% of wells yield water that comprises ≥10% of waste-water. In palaeo-interfluvial settings, only wells at the margins of the palaeo-interfluvial sequence contain detectable waste water. Settings are identifiable by well-colour survey, owner information, water composition, and drilling. Values of Cl/Br and faecal coliform counts are both inversely related to concentrations of pollutant As in groundwater, suggesting that waste-water contributions to groundwater in the near-field of septic-tanks and pit-latrines (within 30 m) suppress the mechanism of As-pollution and lessen the prevalence and severity of As pollution. In the far-field of such sources, organic matter in waste-water may increase groundwater pollution by As.

Comparison of fecal indicators with pathogenic bacteria and rotavirus in groundwater

Groundwater is routinely analyzed for fecal indicators but direct comparisons of fecal indicators to the presence of bacterial and viral pathogens are rare. This study was conducted in rural Bangladesh where the human population density is high, sanitation is poor, and groundwater pumped from shallow tubewells is often contaminated with fecal bacteria. Five indicator microorganisms (E. coli, total coliform, F+RNA coliphage, Bacteroides and human-associated Bacteroides) and various environmental parameters were compared to the direct detection of waterborne pathogens by quantitative PCR in groundwater pumped from 50 tubewells. Rotavirus was detected in groundwater filtrate from the largest proportion of tubewells (40%), followed by Shigella (10%), Vibrio (10%), and pathogenic E. coli (8%). Spearman rank correlations and sensitivity-specificity calculations indicate that some, but not all, combinations of indicators and environmental parameters can predict the presence of pathogens. Culture-dependent fecal indicator bacteria measured on a single date did not predict total bacterial pathogens, but annually averaged monthly measurements of culturable E. coli did improve prediction for total bacterial pathogens. A qPCR-based E. coli assay was the best indicator for the bacterial pathogens. F+RNA coliphage were neither correlated nor sufficiently sensitive towards rotavirus, but were predictive of bacterial pathogens. Since groundwater cannot be excluded as a significant source of diarrheal disease in Bangladesh and neighboring countries with similar characteristics, the need to develop more effective methods for screening tubewells with respect to microbial contamination is necessary.

Implications of fecal bacteria input from latrine-polluted ponds for wells in sandy aquifers

Ponds receiving latrine effluents may serve as sources of fecal contamination to shallow aquifers tapped by millions of tube-wells in Bangladesh. To test this hypothesis, transects of monitoring wells radiating away from four ponds were installed in a shallow sandy aquifer underlying a densely populated village and monitored for 14 months. Two of the ponds extended to medium sand. Another pond was sited within silty sand and the last in silt. The fecal indicator bacterium E. coli was rarely detected along the transects during the dry season and was only detected near the ponds extending to medium sand up to 7 m away during the monsoon. A log-linear decline in E. coli and Bacteroidales concentrations with distance along the transects in the early monsoon indicates that ponds excavated in medium sand were the likely source of contamination. Spatial removal rates ranged from 0.5 to 1.3 log(10)/m. After the ponds were artificially filled with groundwater to simulate the impact of a rain storm, E. coli levels increased near a pond recently excavated in medium sand, but no others. These observations show that adjacent sediment grain-size and how recently a pond was excavated influence the how much fecal contamination ponds receiving latrine effluents contribute to neighboring groundwater.

Increase in diarrheal disease associated with arsenic mitigation in Bangladesh

BACKGROUND

Millions of households throughout Bangladesh have been exposed to high levels of arsenic (As) causing various deadly diseases by drinking groundwater from shallow tubewells for the past 30 years. Well testing has been the most effective form of mitigation because it has induced massive switching from tubewells that are high (>50 µg/L) in As to neighboring wells that are low in As. A recent study has shown, however, that shallow low-As wells are more likely to be contaminated with the fecal indicator E. coli than shallow high-As wells, suggesting that well switching might lead to an increase in diarrheal disease.

METHODS

Approximately 60,000 episodes of childhood diarrhea were collected monthly by community health workers between 2000 and 2006 in 142 villages of Matlab, Bangladesh. In this cross-sectional study, associations between childhood diarrhea and As levels in tubewell water were evaluated using logistic regression models.

RESULTS

Adjusting for wealth, population density, and flood control by multivariate logistic regression, the model indicates an 11% (95% confidence intervals (CIs) of 4-19%) increase in the likelihood of diarrhea in children drinking from shallow wells with 10-50 µg/L As compared to shallow wells with >50 µg/L As. The same model indicates a 26% (95%CI: 9-42%) increase in diarrhea for children drinking from shallow wells with ≤10 µg/L As compared to shallow wells with >50 µg/L As.

CONCLUSION

Children drinking water from shallow low As wells had a higher prevalence of diarrhea than children drinking water from high As wells. This suggests that the health benefits of reducing As exposure may to some extent be countered by an increase in childhood diarrhea.

Hand-pumps as reservoirs for microbial contamination of well water

The retention and release of total coliforms and Escherichia coli was investigated in hand-pumps removed from tubewells tapping a faecally contaminated aquifer in Matlab, Bangladesh, and from a new hand-pump deliberately spiked with E. coli. All hand-pumps were connected to reservoirs of sterile water and flushed. Faecal coliforms were observed in the discharge from all three of the previously used hand-pumps, at concentrations comparable to levels measured in discharge when they were attached to the tubewells. During daily flushing of one of the previously used hand-pumps, the concentration of total coliforms in the discharge remained relatively constant (approximately 10³ MPN/100 mL). Concentrations of E. coli in the pump discharge declined over time, but E. coli was still detectable up to 29 days after the start of flushing. In the deliberately spiked hand-pump, E. coli was observed in the discharge over 125 days (t₅₀ = 8 days) and found to attach preferentially to elastomeric materials within the hand-pump. Attempts to disinfect both the village and new hand-pumps using shock chlorination were shown to be unsuccessful. These results demonstrate that hand-pumps can act as persistent reservoirs for microbial indicator bacteria. This could potentially influence drinking water quality and bias testing of water quality.

Effect of deep tube well use on childhood diarrhoea in Bangladesh

OBJECTIVE

To determine whether the installation of deep tube wells to reduce exposure to groundwater arsenic in rural Bangladesh had an effect on the incidence of childhood diarrhoeal disease.

METHODS

Episodes of diarrhoeal disease in children aged under 5 years that occurred on one specified day each month between 2005 and 2006 were reported to community health workers for six rural villages. A geographical information system containing details of household water use and sanitation in the villages was built using data obtained by a global positioning system survey. The information system also included health, spatial and demographic data. A field survey was carried out to determine whether households obtained drinking water from deep tube wells installed in 2005. The effect of deep tube well use on the incidence of childhood diarrhoea was assessed using a random effects negative binomial regression model.

FINDINGS

The risk of childhood diarrhoea was 46% lower in the 179 households that used a deep tube well than in the 364 that used a shallow tube well (P=0.032). Neither socioeconomic status, latrine density, population density nor study year had a significant influence on disease risk. The incidence of childhood diarrhoea declined dramatically between 2005 and 2006, irrespective of water source.

CONCLUSION

The introduction of deep tube wells to reduce arsenic in drinking water in rural Bangladesh had the additional benefit of lowering the incidence of diarrhoea among young children.