A Transdisciplinary Methodology for Introducing Solar Water Disinfection to Rural Communities in Malawi-Formative Research Findings

Risk Factors, Temporal Dependence, and Seasonality of Human Extended-Spectrum β-Lactamases-Producing Escherichia coli and Klebsiella pneumoniae Colonization in Malawi: A Longitudinal Model-Based Approach

BACKGROUND

Sub-Saharan Africa has the highest estimated death rate attributable to antimicrobial resistance, especially from extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E). However, the dynamics of human colonization in the community with ESBL-E are not well described. Inadequate water, sanitation, and hygiene infrastructure and associated behaviors are believed to play an important role in transmission of ESBL-E, and an improved understanding of the temporal dynamics of within-household transmission could help inform the design of future policies.

METHODS

In this 18-month study, using microbiological data and household surveys, we built a multivariable hierarchical harmonic logistic regression model to identify risk factors for colonization with ESBL-producing Escherichia coli and Klebsiella pneumoniae, reflecting household structure and temporal correlation of colonization status.

RESULTS

Being male was associated with a lower risk of colonization with ESBL-producing E. coli (odds ratio [OR], 0.786; credible interval [CrI], .678-.910), whereas the use of a tube well or a borehole was associated with an increased risk (OR, 1.550; CrI, 1.003-2.394). For ESBL-producing K. pneumoniae, recent antibiotic exposure increased risk of colonization (OR, 1.281; CrI, 1.049-1.565), whereas sharing plates decreased that risk (OR, 0.672; CrI, .460-.980). Finally, the temporal correlation range of 8 to 11 weeks provided evidence that within-household transmission occurs within this time frame.

CONCLUSIONS

We describe different risks for colonization with different enteric bacterial species. Our findings suggest interventions to reduce transmission targeted at the household level need to focus on improving water, sanitation, and hygiene infrastructure and associated behaviors, whereas at the community level, they should focus on both environmental hygiene and antibiotic stewardship.

Worldwide Research Trends on Solar-Driven Water Disinfection

“Ensure access to water for all”, states Goal 6 of the UN’s Sustainable Development Goals. This worldwide challenge requires identifying the best water disinfection method for each scenario. Traditional methods have limitations, which include low effectiveness towards certain pathogens and the formation of disinfection byproducts. Solar-driven methods, such as solar water disinfection (SODIS) or solar photocatalysis, are novel, effective, and financially and environmentally sustainable alternatives. We have conducted a critical study of publications in the field of water disinfection using solar energy and, hereby, present the first bibliometric analysis of scientific literature from Elsevier’s Scopus database within the last 20 years. Results show that in this area of growing interest USA, Spain, and China are the most productive countries in terms of publishing, yet Europe hosts the most highly recognized research groups, i.e., Spain, Switzerland, Ireland, and UK. We have also reviewed the journals in which researchers mostly publish and, using a systematic approach to determine the actual research trends and gaps, we have analyzed the capacity of these publications to answer key research questions, pinpointing six clusters of keywords in relation to the main research challenges, open areas, and new applications that lie ahead. Most publications focused on SODIS and photocatalytic nanomaterials, while a limited number focused on ensuring adequate water disinfection levels, testing regulated microbial indicators and emerging pathogens, and real-world applications, which include complex matrices, large scale processes, and exhaustive cost evaluation.

A Qualitative Analysis of Factors Influencing Household Water Treatment Practices Among Consumers of Self-Supplied Water in Rural Ethiopia

Background

The health of a community depends greatly on the availability of sufficient and clean water. Rural households relying on self-supplied drinking water must take full responsibility for the treatment of their drinking water. Globally, not many inquiries appear to have been carried out to satisfactorily inform us regarding how and why improvements in behavior related to water treatment occur in some selected individuals and not in others. Related investigations in Ethiopia are even fewer.

Methods

In the rural Aleta Wondo district of Ethiopia, a total of fifteen focus group discussions were conducted with community members. Similarly, ten key informant interviews were conducted with officers responsible for organizing water and hygiene programs. To gather data for this study, two qualitative data collection methods, viz., key informant interviews and focus group discussions, were used. Open code software 4.03 was used for thematic analysis.

Results

Factors influencing household water treatment practices were categorized into individual-level factors (eg cognitive factors, emotional factors), household-level factors (household means and decision-making balance), community-level factors (the value that is given for water quality and Public resources) and, environment and context-related factors (access to products and reliance on external sources).

Conclusion

Household water treatment practice has a range of multilevel influences. Beyond the model of providing ongoing safe water education by health extension workers, potential initiatives could be improved by community mobilization activities that include community leaders, women’s groups, etc., in promoting water treatment at community engagements. Also, the results of the present study indicate that it could be beneficial to provide health extension staff with additional training to improve their ability to encourage community members across, a wide range of user types or levels of readiness, to treat their water.

Innovative Research Approaches to Cope with Water Security in Africa

To achieve a water-secure world, water management should be approached from a multidimensional and integrative perspective, addressing the water-related issues of health, household supply, economics, the environment, and resilience to water-related and climate change hazards. Although water security has significantly improved since 2000 in Africa, there are still vast inequalities in access to water suitable in terms of quantity and quality, especially in rural areas. To achieve water-related sustainable development of African economies, a broad scope of innovative technological and management solutions is required, involving governments, research institutions, private sector parties, and civil society. This special series, composed of 8 papers, illustrates a selection of the most relevant results achieved by the 7 research projects selected and financed by the European Union under 2 dedicated Horizon 2020 calls in 2015: Water-5b-2015 "A coordination platform" and Water-5c-2015 "Development of water supply and sanitation technology, systems and tools, and/or methodologies." The innovations presented in this special series include both technological advancements and w'ater management approaches, given that the development of water-related technologies in developing countries needs to be integrated into water management strategies and economic instruments. This special series aims to help policy makers take informed decisions on how to implement innovative approaches to increase water security in African countries. Integr Environ Assess Manag 2020;16:853-855. © 2020 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Enhancing solar disinfection (SODIS) with the photo-Fenton or the Fe2+/peroxymonosulfate-activation process in large-scale plastic bottles leads to toxicologically safe drinking water

Solar disinfection (SODIS) in 2-L bottles is a well-established drinking water treatment technique, suitable for rural, peri‑urban, or isolated communities in tropical or sub-tropical climates. In this work, we assess the enlargement of the treatment volume by using cheap, large scale plastic vessels. The bactericidal performance of SODIS and two solar-Fe²⁺ based enhancements, namely photo-Fenton (light/H₂O₂/Fe²⁺) and peroxymonosulfate activation (light/PMS/Fe²⁺) were assessed in 19-L polycarbonate (PC) and 25-L polyethylene terephthalate (PET) bottles, in ultrapure and real water matrices (tap water, lake Geneva water). Although SODIS always reached total (5-logU) inactivation, under solar light, enhancement by or both Fe²⁺/H₂O₂ or Fe²⁺/PMS was always beneficial and led to an increase in bacterial elimination kinetics, as high as 2-fold in PC and PET bottles with tap water for light/H₂O₂/Fe²⁺, and 8-fold in PET bottles with Lake Geneva water. The toxicological safety of the enhancements and their effects on the plastic container materials was assessed using the E-screen assay and the Ames test, after 1-day or 1-week exposure to SODIS, photo-Fenton and persulfate activation. Although the production of estrogenic compounds was observed, we report that no treatment method, duration of exposure or material resulted in estrogenicity risk for humans, and similarly, no mutagenicity risk was measured. In summary, we suggest that SODIS enhancement by either HO^•- or SO₄^•--based advanced oxidation process is a suitable enhancement of bacterial inactivation in large scale plastic bottles, without any associated toxicity risks.

Perspectives and Practices on Water, Sanitation, and Hygiene from a Fishing Community along Lake Malombe, Southern Malawi

People living in fishing communities have a high burden of preventable water, sanitation, and hygiene (WASH) related diseases but have often been neglected in research and policy. We explored practices and perspectives on WASH among fishing villages around Lake Malombe, Malawi. We employed a mixed methods design, and data were initially collected through participant observations (five weeks), followed by a second phase of qualitative interviews (n = 16), focus group discussions (n = 7), and quantitative surveys (n = 242). We observed that safe water sources were scarce; latrines were basic; and handwashing facilities were limited. Seventy-one percent (n = 174) of households collected water from unsafe sources (open wells and the lake). Eighty-six percent (n = 207) of households had basic short-term latrines. Twenty-four percent (n = 59) of households had handwashing facilities with soap. Qualitative data supported these observations and identified additional factors which compounded poor WASH practices including, a high transient population associated with the fishing trade, poor infrastructure design and construction which lacked consideration of the environmental factors, context and social and cultural norms. As such, fishing communities are underserved and marginalised with constrained access to WASH services, which must be addressed through behaviour-centered and context appropriate solutions.