Clean Water for Developing Countries

Repurposing Sewage and Toilet Systems: Environmental, Public Health, and Person-Centered Healthcare Applications

Global terrestrial water supplies are rapidly depleting due to the consequences of climate change. Water scarcity results in an inevitable compromise of safe hygiene and sanitation practices, leading to the transmission of water-borne infectious diseases, and the preventable deaths of over 800.000 people each year. Moreover, almost 500 million people lack access to toilets and sanitation systems. Ecosystems are estimated to be contaminated by 6.2 million tons of nitrogenous products from human wastewater management practices. It is therefore imperative to transform toilet and sewage systems to promote equitable access to water and sanitation, improve public health, conserve water, and protect ecosystems. Here, the integration of emerging technologies in toilet and sewage networks to repurpose toilet and wastewater systems is reviewed. Potential applications of these systems to develop sustainable solutions to environmental challenges, promote public health, and advance person-centered healthcare are discussed.

Wilderness Medical Society Clinical Practice Guidelines on Water Treatment for Wilderness, International Travel, and Austere Situations: 2024 Update

To provide guidance to medical providers, wilderness users, and travelers, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for treating water in situations where the potability of available water is not assured, including wilderness and international travel, areas impacted by disaster, and other areas without adequate sanitation. The guidelines present the available methods for reducing or eliminating microbiological contamination of water for individuals, groups, or households; evaluation of their effectiveness; and practical considerations. The evidence base includes both laboratory and clinical publications. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians.

Drinking water quality status in Malaysia: a scoping review of occurrence, human health exposure, and potential needs

BACKGROUND

Like other countries, surface water degradation in Malaysia is linked with common global issues. Although different aspects of drinking water suitability have been examined, the overall understanding of drinking water quality in Malaysia is poor.

OBJECTIVE

Hence, the present review aims to provide an understanding of drinking water (tap water, groundwater, gravity feed system) quality and its potential implications on policy, human health, and drinking water management law and identification of potential direction of future drinking water research and management needs in Malaysia.

METHODS

This study utilized a scoping review method. PRISMA Extension for Scoping Reviews was used for search strategy. Relevant studies were screened using the selected keywords and databases.

RESULTS

A total of 26 drinking water quality studies involving tap water, groundwater, and gravity feed systems have been selected for review. These studies found that the majority of Malaysian Drinking Water and WHO Drinking Water standards have been met. High levels of Cu, Cd, Fe and Pb were attributable to galvanized plumbing and pipe material corrosion. Variation of fluoride in tap water depends on dosage planning and operational processes of the public water supply. Pollutants (nitrate and ammonia) in groundwater and gravity feed system water have been linked to agricultural practices in rural areas. Microbiological quality in tap water is associated with growing biofilms inside the pipelines while in groundwater is caused by shallow surface events. However, only eight studies have reported about the human risks of chemical pollutants in tap water.

IMPACT STATEMENT

The review discusses the state of drinking water quality in Malaysia and its impact on public health. It suggests that policymakers can use this information to improve the quality of drinking water and enforce restrictions, while also raising public awareness about the importance of safe drinking water. The study can guide future research and initiatives in Malaysia, ultimately contributing to efforts to ensure access to clean and dependable drinking water.

Efficient Remediation of Cadmium- and Lead-Contaminated Water by Using Fe-Modified Date Palm Waste Biochar-Based Adsorbents

Heavy metals pollution of water resources is an emerging concern worldwide and seeks immediate attention. Date palm waste was transformed into biochar (BC), which was further modified through Fe-intercalation for the production of magnetic biochar (Fe-BC) in this study. The produced BC and Fe-BC were analyzed for chemical, proximate, surface, and elemental composition. The efficiency of the produced adsorbents to decontaminate the water from Cd²⁺ and Pb²⁺ ions was investigated through kinetics and an isotherm adsorption batch trial. Kinetics adsorption data fit well with the pseudo-second order and power function model, while equilibrium data were described well with the Langmuir and Freundlich isotherms. The maximum adsorption capacity as shown by the Langmuir model was the highest for Fe-BC for both Cd²⁺ (48.44 mg g^-1) and Pb²⁺ (475.14 mg g^-1), compared with that of BC (26.78 mg g^-1 Cd²⁺ and 160.07 mg g^-1 Pb²⁺). Both materials showed higher removal of Pb (36.34% and 99.90% on BC and Fe-BC, respectively) as compared with Cd (5.23% and 12.28% on BC and Fe-BC, respectively) from a binary solution. Overall, Fe-BC was more efficient in adsorbing both of the studied metals from contaminated water. The application of Fe-BC resulted in 89% higher adsorption of Cd²⁺ and 197% higher adsorption of Pb²⁺ from aqueous media as compared to BC. Kinetics and isotherm models as well as SEM-EDS analysis of the post-adsorption adsorbents suggested multiple adsorption mechanisms including chemisorption, pore-diffusion, and electrostatic interactions.

Comprehensive Analysis of the Association between Human Diseases and Water Pollutants

Drinking water is an important natural resource. For many people worldwide, especially in developing countries, access to safe drinking water is still a dream. An increasing number of human activities and industrialization have caused various physical, chemical, and biological pollutants to enter water bodies, affecting human health. Water pollutants contain a vast number of additives, such as perfluorinated chemicals, polybrominated diphenyl ethers, phthalate, nanomaterials, insecticides, microcystins, heavy metals, and pharmacologies. In this work, we aim to explore the potential relationship between water pollutants and human diseases. Here, we explored an integrative approach to identify genes, biological processes, molecular functions, and diseases linked to exposure to these water pollutants. These processes and functions affected by water pollutants are related to many diseases, including colonic neoplasms, breast neoplasms, hepatitis B, bladder cancer, and human cytomegalovirus infection. In addition, further analysis revealed the genes that play a key role in the human diseases induced by water pollutants. Therefore, conducting an integrative toxicogenomic analysis of water pollutants is more appropriate for evaluating the potential effects of water pollutants on human health.

Synergistic cytotoxicity of binary combinations of inorganic and organic disinfection byproducts assessed by real-time cell analysis

Chlorine, chlorine dioxide, and ozone are widely used as disinfectants in drinking water treatments. However, the combined use of different disinfectants can result in the formation of various organic and inorganic disinfection byproducts (DBPs). The toxic interactions, including synergism, addition, and antagonism, among the complex DBPs are still unclear. In this study, we established and verified a real-time cell analysis (RTCA) method for cytotoxicity measurement on Chinese hamster ovary (CHO) cell. Using this convenient and accurate method, we assessed the cytotoxicity of a series of binary combinations consisting of one of the 3 inorganic DBPs (chlorite, chlorate, and bromate) and one of the 32 regulated and emerging organic DBPs. The combination index (CI) of each combination was calculated and evaluated by isobolographic analysis to reflect the toxic interactions. The results confirmed the synergistic effect on cytotoxicity in the binary combinations consisting of chlorite and one of the 5 organic DBPs (2 iodinated DBPs (I-DBPs) and 3 brominated DBPs (Br-DBPs)), chlorate and one of the 4 organic DBPs (3 aromatic DBPs and dibromoacetonitrile), and bromate and one of the 3 organic DBPs (2 I-DBPs and dibromoacetic acid). The possible synergism mechanism of organic DBPs on the inorganic ones may be attributed to the influence of organic DBPs on cell membrane and cell antioxidant system. This study revealed the toxic interactions among organic and inorganic DBPs, and emphasized the latent adverse outcomes in the combined use of different disinfectants.

Spatial and Seasonal Drinking Water Quality Assessment in a Sub-Saharan Country (Guinea-Bissau)

The United Nations Sustainable Development Goal target 6.1 calls for universal and equitable access to safe and affordable drinking water. Worldwide, about 2.2 billion people live without access to safe water, and millions of people suffer from waterborne pathogens each year, representing the most pressing situation in developing countries. The aim of this study was to investigate the drinking water quality dynamics across an endemic cholera sub-Saharan country (Guinea-Bissau), and understand its implications for public health. Microbiological and physical–chemical quality parameters of 252 major water sources spread all over the country were seasonally surveyed. These comprised hand-dug shallow wells and boreholes, fitted with a bucket or a pump to retrieve water. The results showed that the majority of water sources available to the population were grossly polluted with faecal material (80%), being unsuitable for consumption, with significantly (p < 0.05) higher levels during the wet season. Hand-dug wells revealed the highest contamination levels. The chemical contamination was less relevant, although 83% of the water sources were acidic (pH < 6.5). This study highlights the potential health risk associated with the lack of potable drinking water, reinforcing the evidence for water monitoring, and the need to improve WASH (water, sanitation, and hygiene) infrastructure and water management in West African countries. In addition, the authors suggest easy-to-implement interventions that can have a dramatic impact in the water quality, assisting to reduce the associated waterborne diseases rise.

Nanotraps based on multifunctional materials for trapping and enrichment

Many biomarkers for early diagnosis of cancer and other diseases are difficult to detect because they often exist in body fluids in very low concentrations and are masked by high-abundance proteins such as albumin and immunoglobulins. At the same time, water pollution is one of the most serious environmental problems, but the existing adsorption materials have many shortcomings such as slow kinetics, small adsorption capacity and low adsorption efficiency. Nanotraps, mixed with gases or liquids, can capture and concentrate target substances, such as biomolecules, metal ions and oxoanions. Using nanotraps is a versatile sample pre-processing approach and it can improve the sensitivity of downstream analysis techniques. Herein, the preparations and applications of different types of nanotraps are mainly introduced. What's more, the shortcomings of using nanotraps in practical applications are also discussed. Using nanotraps is a promising sample pre-processing technology, which is of great significance for biomarkers discovery, diseases diagnosis, sewage purification and valuable ions recovery. STATEMENT OF SIGNIFICANCE: This review collates and summarizes the preparations and applications of different types of nanotraps, and discusses the shortcomings of using nanotraps in practical applications. Nanotraps, mixed with gases or liquids, can capture and concentrate target materials, such as biomolecules, metal ions and oxoanions. Using nanotraps is a versatile sample pre-processing approach and it can improve the sensitivity of downstream analysis techniques. During the COVID-19 pandemic, hydrogel nanotraps were successfully utilized for RT-PCR analysis with the FDA Emergency Used Authorization for COVID-19. Using nanotraps is a promising sample pre-processing technology, which is of great significance for biomarkers discovery, diseases diagnosis, sewage purification and valuable ions recovery.

Removal of Copper, Nickel, and Zinc Ions from an Aqueous Solution through Electrochemical and Nanofiltration Membrane Processes

Heavy metal contamination in water is a major health concern, directly related to rapid growth in industrialization, urbanization, and modernization in agriculture. Keeping this in view, the present study has attempted to develop models for the process optimization of nanofiltration (NF) membrane and electrocoagulation (EC) processes for the removal of copper, nickel, and zinc from an aqueous solution, employing the response surface methodology (RSM). The variable factors were feed concentration, temperature, pH, and pressure for the NF membrane process; and time, solution pH, feed concentration, and current for the EC process, respectively. The central composite design (CCD), the most commonly used fractional factorial design, was employed to plan the experiments. RSM models were statistically analyzed using analysis of variance (ANOVA). For the NF membrane, the rejection of Zn, Ni, and Cu was observed as 98.64%, 90.54%, and 99.79% respectively; while the removal of these through the EC process was observed as 99.81%, 99.99%, and 99.98%, respectively. The above findings and a comparison with the conventional precipitation and adsorption processes apparently indicate an advantage in employing the NF and EC processes. Further, between the two, the EC process emerged as more efficient than the NF process for the removal of the studied metals.

A review on adsorptive separation of toxic metals from aquatic system using biochar produced from agro-waste

Water is a basic and significant asset for living beings. Water assets are progressively diminishing due to huge populace development, industrial activities, urbanization and rural exercises. Few heavy metals include zinc, copper, lead, nickel, cadmium and so forth can easily transfer into the water system either direct or indirect activities of electroplating, mining, tannery, painting, fertilizer industries and so forth. The different treatment techniques have been utilized to eliminate the heavy metals from aquatic system, which includes coagulation/flocculation, precipitation, membrane filtration, oxidation, flotation, ion exchange, photo catalysis and adsorption. The adsorption technique is a better option than other techniques because it can eliminate heavy metals even at lower metal ions concentration, simplicity and better regeneration behavior. Agricultural wastes are low-cost biosorbent and typically containing cellulose have the ability to absorb a variety of contaminants. It is important to note that almost all agro wastes are no longer used in their original form but are instead processed in a variety of techniques to improve the adsorption capacity of the substance. The wide range of adsorption capacities for agro waste materials were observed and almost more than 99% removal of toxic pollutants from aquatic systems were achieved using modified agro-waste materials. The present review aims at the water pollution due to heavy metals, as well as various heavy metal removal treatment procedures. The primary objectives of this research is to include an overview of adsorption and various agriculture based adsorbents and its comparison in heavy metal removal.

Making waves: How does the emergence of antimicrobial resistance affect policymaking?

This article considers current trends in antimicrobial resistance (AMR) research and knowledge gaps relevant to policymaking in the water sector. Specifically, biological indicators of AMR (antibiotic-resistant bacteria and their resistance genes) and detection methods that have been used so far are identified and discussed, as well as the problems with and solutions to the collection of AMR data, sewage surveillance lessons from the COVID-19 pandemic, and the financial burden caused by AMR, which could be synergically used to improve advocacy on AMR issues in the water sector. Finally, this article proposes solutions to overcoming existing hurdles and shortening the time it will take to have an impact on policymaking and regulation in the sector.

Geographic information system-based health risk assessment of rural drinking water in Central China: a case study of You County, Hunan

This study assessed potential human health hazards posed by drinking water from centralized water supply systems in rural You County, along with its spatial distribution. While most previous studies have focused on source water or urban drinking water, this study evaluated the health risk posed by 20 common pollutants (arsenic, cadmium, chromium(VI), lead, mercury, selenium, cyanide, fluoride, nitrate nitrogen, trichloromethane, tetrachloromethane, chlorite, aluminum, iron, manganese, copper, zinc, ammonia nitrogen, chlorine dioxide, and volatile phenols) in rural terminal tap water. The assessment adopted the model recommended by the US Environmental Protection Agency (EPA) and was combined with the geographic information system (GIS) analysis to explore the spatial distribution of risk factors. Water samples were collected from 13 townships in You County across four quarters of 2019. The results indicated that the average carcinogenic risk of the rural drinking water was 2.45 × 10^-5, ranging from 1.80 × 10^-5 to 3.89 × 10^-5, which never exceeded the maximum acceptable range recommended by the US EPA (1.0 × 10^-4 ~ 1.0 × 10^-6). The average hazard index (HI), which reflects noncarcinogenic risk levels, was 0.75 and ranged from 0.34 to 1.74. Throughout the year, some townships presented HI > 1, indicating a non-carcinogenic risk. The GIS analysis indicated that noncarcinogenic risks were mainly distributed in the north, followed by the east and west. This is generally consistent with the spatial distribution of chlorite concentrations, which contribute most strongly to noncarcinogenic risk levels. The northern You County should therefore be prioritized for health risk control, followed by the eastern and western regions. Chlorite is the priority pollutant for control.

Sources of and Solutions to Toxic Metal and Metalloid Contamination in Small Rural Drinking Water Systems: A Rapid Review

Exposure to toxic metals and metalloids (TMs) such as arsenic and lead at levels of concern is associated with lifelong adverse health consequences. As exposure to TMs from paint, leaded gasoline, canned foods, and other consumer products has decreased in recent decades, the relative contribution of drinking water to environmental TM exposure and associated disease burdens has increased. We conducted a rapid review from June to September 2019 to synthesize information on the sources of TM contamination in small rural drinking water systems and solutions to TM contamination from these sources, with an emphasis on actionable evidence applicable to small rural drinking water systems worldwide. We reviewed publications from five databases (ProQuest, PubMed, Web of Science, Embase, and Global Health Library) as well as grey literature from expert groups including WHO, IWA, and others; findings from 61 eligible review publications were synthesized. Identified sources of TMs in included studies were natural occurrence (geogenic), catchment pollution, and corrosion of water distribution system materials. The review found general support for preventive over corrective actions. This review informs a useful planning and management framework for preventing and mitigating TM exposure from drinking water based on water supply characteristics, identified contamination sources, and other context-specific variables.

Nanotrap Grafted Anion Exchangeable Hybrid Materials for Efficient Removal of Toxic Oxoanions from Water

Water pollution has attracted worldwide significant attention ever since the finding of its harmful effects on the whole ecosystem, including human health. Although several materials are known for selective removal of specific contaminants, designing a single material that can adsorb a variety of water contaminants is still a very challenging task due to a lack of proper design strategies. Herein, we have rationally designed a new class of anion exchangeable hybrid material where the nanosized cationic metal-organic polyhedra (MOP) are embedded inside a porous covalent organic framework (COF) with specific binding sites for toxic oxoanions. The resulting hybrid material exhibits very fast and selective sequestration of high as well as trace amount of a wide range of toxic oxoanions (HAsO₄ ^2-, SeO₄ ^2-, CrO₄ ^2-, ReO₄ ^-, and MnO₄ ^-) from the mixture of excessive (∼1000-fold) other interfering anions to well below the permissible drinking water limit. Moreover, the hybrid cationic nanotrap material can reduce the As(V) level from a highly contaminated groundwater sample to below the WHO permitted level.

Barriers and Enabling Factors Associated with the Implementation of Household Solar Water Disinfection: A Qualitative Study in Northwest Ethiopia

Household water treatment including solar disinfection (SODIS) is recognized worldwide as an important intervention for prevention and control of diarrheal and other waterborne diseases. However, in Ethiopia's countryside, SODIS is not being practiced. Therefore, the objective of this qualitative study conducted in villages of Dabat district in northwest Ethiopia was to explore barriers to and enabling factors for consistent and wider implementation of SODIS. This phenomenological study design included four focus group discussions with 25 parents of children younger than 5 years and interviews with four key informants to elicit their experiences and opinions. ATLAS.ti 8.0 software (GmbH, Berlin, Germany) was used for data organization, and the content was analyzed thematically. Enabling factors were categorized into four themes, such as supportive values for SODIS (positive attitude, advantage of SODIS, and cultural acceptance of SODIS), consistent use of SODIS (community's interest, health education, availability of bright sunlight, and simplicity of the method), participation of family and community in daily implementation of the SODIS process (controlling theft of bottles and recognizing the importance of SODIS technology), and willingness to pay for new polyethylene terephthalate (PET) bottles. On the other hand, barriers were grouped into three themes such as sociocultural (poor knowledge, hesitation to leave SODIS bottles unguarded outdoor, less attention, and unplanned social events), environmental (cloud, shadow over SODIS bottles, turbidity and leeches in source water, and geographical settings), and behavioral (mishandling of SODIS bottles and drinking water). The analysis of the data revealed that all the participants had positive attitude toward the implementation of SODIS, and it was culturally accepted. They identified the barriers to and enabling factors for the implementation of SODIS. Promoting enabling factors and mitigating barriers are substantially important for consistent implementation of SODIS as a long-term interventional measure widely in rural Ethiopia for the achievement of the goal of safe drinking water for all.

Modeling Improved Performance of Reduced-Height Biosand Water Filter Designs

Point-of-use biosand water filters are widely distributed in undeveloped or developing regions due to their water treatment success and low-cost design, but two gaps remain in the basic technology: (1) the filter body is oversized relative to its contaminant removal performance, and (2) the heavy design largely excludes difficult to reach locations in need of clean water solutions. Here, we model design modifications to the v.10 Centre for Affordable Water and Sanitation Technology biosand filter using a reduced filter height, increased biolayer area, and conserved reservoir volume. We compare the hydraulic characteristics (dynamic velocity and head pressure) and percent contaminant removal of bacteria Escherichia coli and virus MS2 of the modified designs to the traditional control design using a finite element approximation of Darcy’s law with discrete time steps and a slow-sand filtration model. We demonstrate that a reduced-height design has a greater impact on contaminant removal compared to the traditional design (largely due to the increased residence time from the decreased flow rate inside the filter). For example, our 70% reduced-height filter design removed 99.5% and 73.93% of E. coli and MS2, respectively, where the traditional filter design removed 62.81% and 27.6%, respectively. Reduced-height designs should be pursued as a viable solution to improve filter performance while allowing for alternative construction techniques with greater end-user accessibility compared to the traditional design.

Comparing THMs level in old and new water distribution systems; seasonal variation and probabilistic risk assessment

Trihalomethanes (THMs) in drinking water are associated with many chemical parameters in water. However, the available evidence on the relationship between physical parameters of the water distribution system (WDS) and THMs is still scarce; therefore, this study aimed to compare the THMs concentration in the old and new WDS in Yazd, Iran. Moreover, we investigated the seasonal trend and health risk assessment of exposure to THMs through ingestion, dermal, and inhalation pathways. Mann-Whitney test was applied to compare THMs between old and new WDS as well as fall season and winter season. The order of THM concentrations was: chloroform > BDCM > DBCM > bromoform. The maximum levels of THMs in the fall and winter were 31 and 39 ppb, respectively, which were less than the WHO recommended limits for drinking water, i.e., <200 ppb. There was a significant difference between the concentration of BDCM in autumn and winter (P-value = 0.01). There was a marginally significant difference between THM concentration in the autumn and winter (P-value 0.09). The total concentration of THMs and chloroform in the old WDS were significantly higher than the new WDS. The mean values of lifetime cancer risks (LTCR) for oral, dermal, and inhalation exposure pathways to THMs were in the acceptable and low-risk levels. The inhalation exposure pathway had the highest LTCR from among the three mentioned exposure pathways. The hazard index was found to be < 1 through oral and dermal pathways. Moreover, the sensitivity analysis revealed that the ingestion rate for oral exposure, the exposure time for dermal and exposure duration for the inhalation exposure pathway had the highest impact on chronic daily intake (CDI). Our finding confirmed that THM concentration in tap water was associated with the lifespan of WDS and this finding could be useful for urban planners and decision-makers.

Removal of heavy metals from water sources in the developing world using low-cost materials: A review

Heavy metal contamination is a growing concern in the developing world. Inadequate water and wastewater treatment, coupled with increased industrial activity, have led to increased heavy metal contamination in rivers, lakes, and other water sources in developing countries. However, common methods for removing heavy metals from water sources, including membrane filtration, activated carbon adsorption, and electrocoagulation, are not feasible for developing countries. As a result, a significant amount of research has been conducted on low-cost adsorbents to evaluate their ability to remove heavy metals. In this review article, we summarize the current state of research on the removal of heavy metals with an emphasis on low-cost adsorbents that are feasible in the context of the developing world. This review evaluates the use of adsorbents from four major categories: agricultural waste; naturally-occurring soil and mineral deposits; aquatic and terrestrial biomass; and other locally-available waste materials. Along with a summary of the use of these adsorbents in the removal of heavy metals, this article provides a summary of the influence of various water-quality parameters on heavy metals and these adsorbents. The proposed adsorption mechanisms for heavy metal removal are also discussed.

Biochar-based water treatment systems as a potential low-cost and sustainable technology for clean water provision

Approximately 600 million people lack access to safe drinking water, hence achieving Sustainable Development Goal 6 (Ensure availability and sustainable management of water and sanitation for all by 2030) calls for rapid translation of recent research into practical and frugal solutions within the remaining 13 years. Biochars, with excellent capacity to remove several contaminants from aqueous solutions, constitute an untapped technology for drinking water treatment. Biochar water treatment has several potential merits compared to existing low-cost methods (i.e., sand filtration, boiling, solar disinfection, chlorination): (1) biochar is a low-cost and renewable adsorbent made using readily available biomaterials and skills, making it appropriate for low-income communities; (2) existing methods predominantly remove pathogens, but biochars remove chemical, biological and physical contaminants; (3) biochars maintain organoleptic properties of water, while existing methods generate carcinogenic by-products (e.g., chlorination) and/or increase concentrations of chemical contaminants (e.g., boiling). Biochars have co-benefits including provision of clean energy for household heating and cooking, and soil application of spent biochar improves soil quality and crop yields. Integrating biochar into the water and sanitation system transforms linear material flows into looped material cycles, consistent with terra preta sanitation. Lack of design information on biochar water treatment, and environmental and public health risks constrain the biochar technology. Seven hypotheses for future research are highlighted under three themes: (1) design and optimization of biochar water treatment; (2) ecotoxicology and human health risks associated with contaminant transfer along the biochar-soil-food-human pathway, and (3) life cycle analyses of carbon and energy footprints of biochar water treatment systems.

Waterborne transmission of protozoan parasites: Review of worldwide outbreaks - An update 2011-2016

This review provides a comprehensive update of worldwide waterborne parasitic protozoan outbreaks that occurred with reports published since previous reviews largely between January 2011 and December 2016. At least 381 outbreaks attributed to waterborne transmission of parasitic protozoa were documented during this time period. The nearly half (49%) of reports occurred in New Zealand, 41% of the outbreaks in North America and 9% in Europe. The most common etiological agent was Cryptosporidium spp., reported in 63% (239) of the outbreaks, while Giardia spp. was mentioned in 37% (142). No outbreaks attributed to other parasitic protozoa were reported. The distribution of reported outbreaks does not correspond to more broadly available epidemiological data or general knowledge of water and environmental conditions in the reporting countries. Noticeably, developing countries that are probably most affected by such waterborne disease outbreaks still lack reliable surveillance systems, and an international standardization of surveillance and reporting systems has yet to be established.

Employing CBPR to investigate function, utility, and longevity of household filters to improve potable water quality for indigenous peoples at Lake Atitlán, Guatemala: a pilot study with San Pedro de La Laguna

Cyanobacterial blooms at Lake Atitlán in Guatemala threaten and compromise the livelihood and health of local residents. Indigenous Tz'utujil, Kaqchikel, and K'iche' rely directly on lake water for drinking, bathing, cleaning, cooking, and fishing. Nonpoint source runoff and untreated wastewater pumped directly into the lake contribute to high fecal pathogen loads into source waters. Concurrent nutrient loading results in cyanobacterial blooms further compromising water quality. A lakeside municipality facing high rates of childhood gastrointestinal illness volunteered to engage in community-based participatory research (CBPR) to evaluate efficacy, utility, and longevity of filters in households. The filters consistently reduced the risk of coliforms and E. coli in household water drawn from the lake based on World Health Organization guidelines. Household surveys were simultaneously administered through a student leadership group regarding water usage, water quality, and community health. Filters demonstrated ability to reduce high loads of fecal indicators from source waters and ability to remove a cyanobacterial toxin (microcystin) at 10 μg/L in deionized water. Further studies are imperative to determine longevity of use in households and CBPR provides a powerful avenue to test efficacy of a possible intervention while engaging stakeholders and empowering community members with sustainable solutions.