Hydrological Regime and Water Shortage as Drivers of the Seasonal Incidence of Diarrheal Diseases in a Tropical Montane Environment

Impact of wastewater treatment and drought in an Alpine region: a multidisciplinary case study

In the context of global climate change, drought occurrence in streams of alpine origin is a recent phenomenon, whose impact is still poorly investigated. In this study, we adopted a three-disciplinary approach to investigate the response of an Alpine river (NW Italy) to severe drought conditions occurred in the year 2022. We hypothesised that the considerable loss in the water flow could exacerbate wastewater treatment plant (WWTP) discharge effects, lowering dilution capacity of the stream system and then increasing chemical/microbial pollution and altering benthic community characteristics. To assess river response to drought conditions of the considered year, the concentration of the main chemical variables, faecal indicator bacteria, pathogen presence and structural/functional organisation of benthic macroinvertebrates and diatom communities were measured monthly in the reaches located upstream and downstream of a WWTP (January-December 2022). Main environmental variables, such as flow velocity, water depth, and flow regime, were also considered. A multivariate analysis approach was then applied to emphasise correlations between selected variables and flow regime. Comparing upstream and downstream sections over the considered year, a common behaviour of chemical/microbiological parameters was observed, with generally higher concentrations of nutrients and bacterial indicators downstream of the local WWTP. Moreover, a positive correlation between water scarcity and nutrients/bacterial concentrations was revealed. The macroinvertebrate communities responded accordingly, both in terms of density and biological metric shift. Interestingly, differences between the two sections were strictly associated with hydrological conditions, with higher dissimilarities found in low-flow conditions. As the magnitude and duration of drought events are projected to increase in the years to come in different parts of Europe, this work can serve as a first building block and as a hint for future studies aimed at improving our knowledge about the consequences of these events that is pivotal for planning effective management strategies.

Village Settlements in Mountainous Tropical Areas, Hotspots of Fecal Contamination as Evidenced by Escherichia coli and Stanol Concentrations in Stormwater Pulses

Fecal bacteria in surface water may indicate threats to human health. Our hypothesis is that village settlements in tropical rural areas are major hotspots of fecal contamination because of the number of domestic animals usually roaming in the alleys and the lack of fecal matter treatment before entering the river network. By jointly monitoring the dynamics of Escherichia coli and of seven stanol compounds during four flood events (July-August 2016) at the outlet of a ditch draining sewage and surface runoff out of a village of Northern Lao PDR, our objectives were (1) to assess the range of E. coli concentration in the surface runoff washing off from a village settlement and (2) to identify the major contributory sources of fecal contamination using stanol compounds during flood events. E. coli pulses ranged from 4.7 × 104 to 3.2 × 106 most probable number (MPN) 100 mL-1, with particle-attached E. coli ranging from 83 to 100%. Major contributory feces sources were chickens and humans (about 66 and 29%, respectively), with the highest percentage switching from the human pole to the chicken pole during flood events. Concentrations indicate a severe fecal contamination of surface water during flood events and suggest that villages may be considered as major hotspots of fecal contamination pulses into the river network and thus as point sources in hydrological models.

Water and Handwashing in a Drought-Prone Region of Southern Niger: How Environment, Household Infrastructure, and Exposure to Social and Behavior Change Messages Interact

This study aims to inform multisectoral development programs by exploring the extent to which social and behavior change (SBC) messages, environment, and household infrastructure are associated with knowledge and practice of handwashing behaviors. A cross-sectional survey of 2,708 households in the Maradi and Zinder districts of Niger was collected in April 2021. Household data were integrated with two local environmental measures: 1) water level at the nearest waterhole point, and 2) anomalous rainfall for the previous rainy season derived from climate hazards infrared precipitation with station rainfall (CHIRPS) data. Logistic regression models were constructed to explore how environment, household infrastructure, and exposure to SBC messages were associated with two hygiene-related outcomes: 1) observed water and soap available at household handwashing stations, a behavior, and 2) knowledge of critical moments for handwashing, a behavioral determinant. We find that in households near a water point with higher water depth, households were statistically significantly more likely (odds ratio [OR] = 1.25); (confidence interval [CI] = 1.12-1.49) to have water and soap observed at the handwashing station. Women in households near a water point with increased water depth (more water) were more likely to know three or more critical handwashing moments (OR = 1.07; CI = 1.03-1.11). Exposure to messages about the importance of handwashing was significantly associated with knowledge of critical handwashing moments and having water and soap observed at a handwashing station. Multisectoral programming should consider layering efforts so that development projects that increase access to water sources are complemented with SBC approaches focused on hygiene.

Effects of Ambient Temperature, Relative Humidity, and Precipitation on Diarrhea Incidence in Surabaya

BACKGROUND

Diarrhea remains a common infectious disease caused by various risk factors in developing countries. This study investigated the incidence rate and temporal associations between diarrhea and meteorological determinants in five regions of Surabaya, Indonesia.

METHOD

Monthly diarrhea records from local governmental health facilities in Surabaya and monthly means of weather variables, including average temperature, precipitation, and relative humidity from Meteorology, Climatology, and Geophysical Agency were collected from January 2018 to September 2020. The generalized additive model was employed to quantify the time lag association between diarrhea risk and extremely low (5th percentile) and high (95th percentile) monthly weather variations in the north, central, west, south, and east regions of Surabaya (lag of 0-2 months).

RESULT

The average incidence rate for diarrhea was 11.4 per 100,000 during the study period, with a higher incidence during rainy season (November to March) and in East Surabaya. This study showed that the weather condition with the lowest diarrhea risks varied with the region. The diarrhea risks were associated with extremely low and high temperatures, with the highest RR of 5.39 (95% CI 4.61, 6.17) in the east region, with 1 month of lag time following the extreme temperatures. Extremely low relative humidity increased the diarrhea risks in some regions of Surabaya, with the highest risk in the west region at lag 0 (RR = 2.13 (95% CI 1.79, 2.47)). Extremely high precipitation significantly affects the risk of diarrhea in the central region, at 0 months of lag time, with an RR of 3.05 (95% CI 2.09, 4.01).

CONCLUSION

This study identified a high incidence of diarrhea in the rainy season and in the deficient developed regions of Surabaya, providing evidence that weather magnifies the adverse effects of inadequate environmental sanitation. This study suggests the local environmental and health sectors codevelop a weather-based early warning system and improve local sanitation practices as prevention measures in response to increasing risks of infectious diseases.

The Burden of Diarrheal Diseases and Its Associated Factors among Under-Five Children in Welkite Town: A Community Based Cross-Sectional Study

Objective: This study assessed the magnitude of diarrhea and associated risk factors among under-five children in Welkite town.

Methods: We used a community-based cross-sectional study design. Data collection period was February to March 2021 and 426 parents/guardians of under-five children were the study participants. A structured questionnaire and observation checklist were used to collect the data.

Results: The 2 weeks prevalence of diarrhea among under-five years old children was 20.7% (88/426); 95% CI (17.1, 24.6). The child’s mother/caregiver being merchant (AOR: 5.34; 95% CI: 2.1, 13.8) compared to housewife, partial immunization status (AOR: 2.67; 95% CI: 1.2, 5.8), disposing child’s stool into the garbage (AOR: 5.05; 95% CI: 1.1, 23.3) compared to putting in a toilet, not covering water storage materials (AOR: 2.4; 95% CI: 1.2, 4.7) and presence of flies in food preparation area (AOR: 2.24; 95% CI: 1.05, 4.8) were associated with increased odds of having diarrhea.

Conclusion: The prevalence of diarrhea among under-five old children is high and it is associated with the occupation of the mothers/caregivers, the immunization status of children, unhygienic water storage condition and non-hygienic household practice.

Climate change and health in Southeast Asia - defining research priorities and the role of the Wellcome Trust Africa Asia Programmes

This article summarises a recent virtual meeting organised by the Oxford University Clinical Research Unit in Vietnam on the topic of climate change and health, bringing local partners, faculty and external collaborators together from across the Wellcome and Oxford networks. Attendees included invited local and global climate scientists, clinicians, modelers, epidemiologists and community engagement practitioners, with a view to setting priorities, identifying synergies and fostering collaborations to help define the regional climate and health research agenda. In this summary paper, we outline the major themes and topics that were identified and what will be needed to take forward this research for the next decade. We aim to take a broad, collaborative approach to including climate science in our current portfolio where it touches on infectious diseases now, and more broadly in our future research directions. We will focus on strengthening our research portfolio on climate-sensitive diseases, and supplement this with high quality data obtained from internal studies and external collaborations, obtained by multiple methods, ranging from traditional epidemiology to innovative technology and artificial intelligence and community-led research. Through timely agenda setting and involvement of local stakeholders, we aim to help support and shape research into global heating and health in the region.

Climate change and health in Southeast Asia - defining research priorities and the role of the Wellcome Trust Africa Asia Programmes

This article summarises a recent virtual meeting organised by the Oxford University Clinical Research Unit in Vietnam on the topic of climate change and health, bringing local partners, faculty and external collaborators together from across the Wellcome and Oxford networks. Attendees included invited local and global climate scientists, clinicians, modelers, epidemiologists and community engagement practitioners, with a view to setting priorities, identifying synergies and fostering collaborations to help define the regional climate and health research agenda. In this summary paper, we outline the major themes and topics that were identified and what will be needed to take forward this research for the next decade. We aim to take a broad, collaborative approach to including climate science in our current portfolio where it touches on infectious diseases now, and more broadly in our future research directions. We will focus on strengthening our research portfolio on climate-sensitive diseases, and supplement this with high quality data obtained from internal studies and external collaborations, obtained by multiple methods, ranging from traditional epidemiology to innovative technology and artificial intelligence and community-led research. Through timely agenda setting and involvement of local stakeholders, we aim to help support and shape research into global heating and health in the region.

The effects of seasonal variations on household water security and burden of diarrheal diseases among under 5 children in an urban community, Southwest Nigeria

BACKGROUND

Household water security encompasses water-related factors that pose threats to public health at the household level. It presents a reliable access to water in sufficient quantity and quality towards meeting basic human needs. This study assessed the dynamics of seasonal variations in household water security and the association between household water security and diarrheal disease across dry and wet seasons in an urban settlement in Southwest Nigeria.

METHODS

A panel study design was employed to study 180 households selected using a multistage sampling technique. The selected households were studied during dry and rainy seasons. Household water security was assessed through the application of the all or none principle to 9 indicators associated with household water security. The intensity of water insecurity was also assessed using the nine indicators. The higher the number of indicators a household failed, the higher the intensity of household water insecurity. The association between the intensity of household water insecurity and the burden of diarrheal disease across the seasons was assessed using the Mantel-Haenszel test.

RESULTS

No household was water-secure in both dry and rainy seasons; however, the intensity of insecurity was more pronounced during the dry season compared with the rainy season. Ninety households (52.0%), had water insecurity intensity scores above fifty percentiles during the dry season while 21 (12.1%) households had a water insecurity score above the 50th percentile during raining season, p < 0.001. The burden of diarrheal disease was significantly higher among households with a water insecurity intensity score above the 50th percentile, 9 (8.1%) compared to households with a water insecurity intensity score below the 50th percentile 7 (3.0%), p = 0.034. There was no statistically significant association between the intensity of water insecurity and diarrheal disease burden across the dry and rainy seasons, p = 0.218.

CONCLUSION

The high burden of household water insecurity deserves concerted efforts from all concerned stakeholders, a panacea to an important health threat in the developing world.

High intestinal parasite infection detected in children from Región Autónoma Atlántico Norte (R.A.A.N.) of Nicaragua

There is a lack of epidemiological information concerning intestinal parasitic infections, and especially in soil-transmitted helminths, occurring in some departments of Nicaragua. Up to now, this is the first study involving two nearby areas (Puerto Cabezas and Siuna municipalities) of the Región Autónoma Atlántico Norte (R.A.A.N.). One stool sample was analyzed by Kato-Katz, formaldehyde-ethyl acetate concentration method and modified Ziehl-Neelsen technique, and a simple questionnaire concerning demographic, sanitary and behavioral data was distributed among 735 children and evaluated. Overall prevalence of infection reached 97.0%, being the highest prevalences detected in all Nicaragua. The higher protozoan prevalence appears in Siuna (94.5%), a rural interior municipality, with a typical tropical monsoon climate, while the higher helminths rates were reached in Puerto Cabezas (92.8%), the urbanized coastal capital, with a typical tropical rainforest climate. No statistical differences were found with regard to sex. However, the 6-11-year age-group children presented the highest prevalences. Most T. trichiura infections (59.4%) were of light intensity, while 51.7% of Ascaris lumbricoides were of moderate intensity. Multivariable logistic regression analysis indicated that those who drink rainwater and walk barefoot were 2.9 and 2.5 times more likely to have helminth infections, respectively. Results from one geographical setting might not be applied to other nearby with different climatic conditions. The use of anthelmintic drugs only will not be sufficient to bring prevalence to low levels. It is necessary to design geographically more specific intervention, with communication and interaction between different disciplines (e.g. parasitology, biochemistry, molecular biology, epidemiology, public health, etc.) being imperative to reduce STH infection.

Determinants of Pathogen Contamination of the Environment in the Greater Yangon Area, Myanmar

Recent results from water, sanitation, and hygiene interventions highlight the need to better understand environmental influences on enteropathogen transmission. We quantified a range of viral, bacterial, and protozoal pathogens and one indicator, Enterococcus faecalis in soil and water from urban and rural sites in and around Yangon, Myanmar. We found that environmental characteristics associated with contamination differed by pathogens and substrates. In soil, bacterial pathogen gene counts were associated with elevation and drainage ditches (compared to stagnant water) (RR = 0.96, 95% CI 0.93, 0.99 and RR = 1.70, 95% CI 1.18, 2.45, respectively), while viral gene counts were associated with the presence of sanitation facilities within 50 m of the collection point (RR = 3.99, 95% CI 1.12, 14.24). In water, E. faecalis, total pathogen, and bacterial pathogen gene counts were associated with drainage ditches (RR = 1.86, 95% CI 1.27, 2.72, RR = 1.38 95% CI 1.09, 1.74, and RR = 1.38 95% CI 1.07, 1.77, respectively). E. faecalis, total pathogen, bacterial pathogen, and viral gene counts were associated with the presence of uncollected garbage within 50 m of the collection point (RR = 1.57, 95% CI 1.00, 2.47, RR = 1.52, 95% CI 1.16, 2.00, RR = 1.52, 95% CI 1.13, 2.06, and RR = 1.75, 95% CI 1.17, 2.61 respectively). Measuring the environment provides added specificity toward identifying important environmental pathways that require mitigation.

Climate change and health in Southeast Asia - defining research priorities and the role of the Wellcome Trust Africa Asia Programmes

This article summarises a recent virtual meeting organised by the Oxford University Clinical Research Unit in Vietnam on the topic of climate change and health, bringing local partners, faculty and external collaborators together from across the Wellcome and Oxford networks. Attendees included invited local and global climate scientists, clinicians, modelers, epidemiologists and community engagement practitioners, with a view to setting priorities, identifying synergies and fostering collaborations to help define the regional climate and health research agenda. In this summary paper, we outline the major themes and topics that were identified and what will be needed to take forward this research for the next decade. We aim to take a broad, collaborative approach to including climate science in our current portfolio where it touches on infectious diseases now, and more broadly in our future research directions. We will focus on strengthening our research portfolio on climate-sensitive diseases, and supplement this with high quality data obtained from internal studies and external collaborations, obtained by multiple methods, ranging from traditional epidemiology to innovative technology and artificial intelligence and community-led research. Through timely agenda setting and involvement of local stakeholders, we aim to help support and shape research into global heating and health in the region.

Environmental determinants of E. coli, link with the diarrheal diseases, and indication of vulnerability criteria in tropical West Africa (Kapore, Burkina Faso)

In 2017, diarrheal diseases were responsible for 606 024 deaths in Sub-Saharan Africa. This situation is due to domestic and recreational use of polluted surface waters, deficits in hygiene, access to healthcare and drinking water, and to weak environmental and health monitoring infrastructures. Escherichia coli (E. coli) is an indicator for the enteric pathogens that cause many diarrheal diseases. The links between E. coli, diarrheal diseases and environmental parameters have not received much attention in West Africa, and few studies have assessed health risks by taking into account hazards and socio-health vulnerabilities. This case study, carried out in Burkina Faso (Bagre Reservoir), aims at filling this knowledge gap by analyzing the environmental variables that play a role in the dynamics of E. coli, cases of diarrhea, and by identifying initial vulnerability criteria. A particular focus is given to satellite-derived parameters to assess whether remote sensing can provide a useful tool to assess the health hazard. Samples of surface water were routinely collected to measure E. coli, enterococci and suspended particulate matter (SPM) at a monitoring point (Kapore) during one year. In addition, satellite data were used to estimate precipitation, water level, Normalized Difference Vegetation Index (NDVI) and SPM. Monthly epidemiological data for cases of diarrhea from three health centers were also collected and compared with microbiological and environmental data. Finally, semi-structured interviews were carried out to document the use of water resources, contact with elements of the hydrographic network, health behavior and condition, and water and health policy and prevention, in order to identify the initial vulnerability criteria. A positive correlation between E. coli and enterococci in surface waters was found indicating that E. coli is an acceptable indicator of fecal contamination in this region. E. coli and diarrheal diseases were strongly correlated with monsoonal precipitation, in situ SPM, and Near Infra-Red (NIR) band between March and November. Partial least squares regression showed that E. coli concentration was strongly associated with precipitation, Sentinel-2 reflectance in the NIR and SPM, and that the cases of diarrhea were strongly associated with precipitation, NIR, E. coli, SPM, and to a lesser extent with NDVI. Moreover, E. coli dynamics were reproduced using satellite data alone, particularly from February to mid-December (R2 = 0.60) as were cases of diarrhea throughout the year (R2 = 0.76). This implies that satellite data could provide an important contribution to water quality monitoring. Finally, the vulnerability of the population was found to increase during the rainy season due to reduced accessibility to healthcare and drinking water sources and increased use of water of poor quality. During this period, surface water is used because it is close to habitations, easy to use and free from monetary or political constraints. This vulnerability is aggravated by marginality and particularly affects the Fulani, whose concessions are often close to surface water (river, lake) and far from health centers.

Decay Rate of Escherichia coli in a Mountainous Tropical Headwater Wetland

Surface water contamination by pathogen bacteria remains a threat to public health in the rural areas of developing countries. Fecal indicator bacteria (FIB) like Escherichia coli (E. coli) are widely used to assess water contamination, but their behavior in tropical ecosystems is poorly documented. Our study focused on headwater wetlands which are likely to play a key role in stream water purification of fecal pollutants. Our main objectives were to: (i) evaluate decay rates (k) of the total, particle-attached and free-living E. coli; (ii) quantify the relative importance of solar radiation exposition and suspended particles deposition on k; and (iii) investigate E. coli survival in the deposited sediment. We installed and monitored 12 mesocosms, 4500 mL each, across the main headwater wetland of the Houay Pano catchment, northern Lao People’s Democratic Republic (Lao PDR), for 8 days. The four treatments with triplicates were: sediment deposition-light (DL); sediment deposition-dark (DD); sediment resuspension-light (RL); and sediment resuspension-dark (RD). Particle-attached bacteria predominated in all mesocosms (97 ± 6%). Decay rates ranged from 1.43 ± 0.15 to 1.17 ± 0.13 day−1 for DL and DD treatments, and from 0.50 ± 0.15 to −0.14 ± 0.37 day−1 for RL and RD treatments. Deposition processes accounted for an average of 92% of E. coli stock reduction, while solar radiation accounted for around 2% over the experiment duration. The sampling of E. coli by temporary resuspension of the deposited sediment showed k values close to zero, suggesting potential survival or even growth of bacteria in the sediment. The present findings may help parameterizing hydrological and water quality models in a tropical context.

Experimental and modelling evidence of splash effects on manure borne Escherichia coli washoff

In tropical montane South-East Asia, recent changes in land use have induced increased runoff, soil erosion and in-stream suspended sediment loads. Land use change is also contributing to increased microbial pathogen dissemination and contamination of stream waters. Escherichia coli (E. coli) is frequently used as an indicator of faecal contamination. Field rain simulations were conducted to examine how E. coli is exported from the surface of upland, agricultural soils during runoff events. The objectives were to characterize the loss dynamics of this indicator from agricultural soils contaminated with livestock waste, and to identify the effect of splash on washoff. Experiments were performed on nine 1 m2 plots, amended or not with pig or poultry manure. Each plot was divided into two 0.5 m2 sub-plots. One of the two sub-plots was protected with a mosquito net for limiting the raindrop impact effects. Runoff, soil detachment by raindrop impact and its entrainment by runoff, and E. coli loads and discharge were measured for each sub-plot. The results show that raindrop impact strongly enhances runoff generation, soil detachment and entrainment and E. coli export. When the impact of raindrops was reduced with a mosquito net, total runoff was reduced by more than 50%, soil erosion was on average reduced by 90% and E. coli export from the amended soil surface was on average 3 to 8 times lower. A coupled physics-based approach was performed using the Cast3M platform for modelling the time evolutions of runoff, solid particles detachment and transfer and bacteria transport that were measured for one of the nine plots. After estimation of the saturated hydraulic conductivity, soil erodibility and attachment rate of bacteria, model outputs were consistent with measured runoff coefficients, suspended sediment and E. coli loads. This work therefore underlines the need to maintain adequate vegetation at the soil surface to avoid the erosion and export of soil borne potential pathogens towards downstream aquatic systems.

Effects of hydrological regime and land use on in-stream Escherichia coli concentration in the Mekong basin, Lao PDR

In the basin of Mekong, over 70 million people rely on unimproved surface water for their domestic requirements. Surface water is often contaminated with fecal matter and yet little information exists on the underlying mechanisms of fecal contamination in tropical conditions at large watershed scales. Our objectives were to (1) investigate the seasonality of fecal contamination using Escherichia coli as fecal indicator bacteria (FIB), and (2) establish links between the fecal contamination in stream water and its controlling factors (hydrology and land use). We present the results of (1) a sampling campaign at the outlet of 19 catchments across Lao PDR, in both the dry and the rainy seasons of 2016, and (2) a 10-day interval monitoring conducted in 2017 and 2018 at three point locations of three rivers (Nam Ou, Nam Suang, and Mekong) in northern Lao PDR. Our results show the presence of fecal contamination at most of the sampled sites, with a seasonality characterized by higher and extreme E. coli concentrations occurring during the rainy season. The highest E. coli concentrations, strongly correlated with total suspended sediment concentrations, were measured in catchments dominated by unstocked forest areas, especially in mountainous northern Lao PDR and in Vientiane province.

Understanding the Impact of Rainfall on Diarrhea: Testing the Concentration-Dilution Hypothesis Using a Systematic Review and Meta-Analysis

BACKGROUND

Projected increases in extreme weather may change relationships between rain-related climate exposures and diarrheal disease. Whether rainfall increases or decreases diarrhea rates is unclear based on prior literature. The concentration-dilution hypothesis suggests that these conflicting results are explained by the background level of rain: Rainfall following dry periods can flush pathogens into surface water, increasing diarrhea incidence, whereas rainfall following wet periods can dilute pathogen concentrations in surface water, thereby decreasing diarrhea incidence.

OBJECTIVES

In this analysis, we explored the extent to which the concentration-dilution hypothesis is supported by published literature.

METHODS

To this end, we conducted a systematic search for articles assessing the relationship between rain, extreme rain, flood, drought, and season (rainy vs. dry) and diarrheal illness.

RESULTS

A total of 111 articles met our inclusion criteria. Overall, the literature largely supports the concentration-dilution hypothesis. In particular, extreme rain was associated with increased diarrhea when it followed a dry period [incidence rate ratio ( IRR ) = 1.26 ; 95% confidence interval (CI): 1.05, 1.51], with a tendency toward an inverse association for extreme rain following wet periods, albeit nonsignificant, with one of four relevant studies showing a significant inverse association (IRR = 0.911 ; 95% CI: 0.771, 1.08). Incidences of bacterial and parasitic diarrhea were more common during rainy seasons, providing pathogen-specific support for a concentration mechanism, but rotavirus diarrhea showed the opposite association. Information on timing of cases within the rainy season (e.g., early vs. late) was lacking, limiting further analysis. We did not find a linear association between nonextreme rain exposures and diarrheal disease, but several studies found a nonlinear association with low and high rain both being associated with diarrhea.

DISCUSSION

Our meta-analysis suggests that the effect of rainfall depends on the antecedent conditions. Future studies should use standard, clearly defined exposure variables to strengthen understanding of the relationship between rainfall and diarrheal illness. https://doi.org/10.1289/EHP6181.

Understory Limits Surface Runoff and Soil Loss in Teak Tree Plantations of Northern Lao PDR

Many mountainous regions of the humid tropics experience serious soil erosion following rapid changes in land use. In northern Lao People’s Democratic Republic (PDR), the replacement of traditional crops by tree plantations, such as teak trees, has led to a dramatic increase in floods and soil loss and to the degradation of basic soil ecosystem services such as water filtration by soil, fertility maintenance, etc. In this study, we hypothesized that conserving understory under teak trees would protect soil, limit surface runoff, and help reduce soil erosion. Using 1 m2 microplots installed in four teak tree plantations in northern Lao PDR over the rainy season of 2017, this study aimed to: (1) assess the effects on surface runoff and soil loss of four understory management practices, namely teak with no understory (TNU; control treatment), teak with low density of understory (TLU), teak with high density of understory (THU), and teak with broom grass, Thysanolaena latifolia (TBG); (2) suggest soil erosion mitigation management practices; and (3) identify a field visual indicator allowing a rapid appraisal of soil erosion intensity. We monitored surface runoff and soil loss, and measured teak tree and understory characteristics (height and percentage of cover) and soil surface features. We estimated the relationships among these variables through statistics and regression analyses. THU and TBG had the smallest runoff coefficient (23% for both) and soil loss (465 and 381 g·m−2, respectively). The runoff coefficient and soil loss in TLU were 35% and 1115 g·m−2, respectively. TNU had the highest runoff coefficient and soil loss (60%, 5455 g·m−2) associated to the highest crusting rate (82%). Hence, the soil loss in TBG was 14-times less than in TNU and teak tree plantation owners could divide soil loss by 14 by keeping understory, such as broom grass, within teak tree plantations. Indeed, a high runoff coefficient and soil loss in TNU was explained by the kinetic energy of rain drops falling from the broad leaves of the tall teak trees down to bare soil, devoid of plant residues, thus leading to severe soil surface crusting and soil detachment. The areal percentage of pedestal features was a reliable indicator of soil erosion intensity. Overall, promoting understory, such as broom grass, in teak tree plantations would: (1) limit surface runoff and improve soil infiltrability, thus increase soil water stock available for both root absorption and groundwater recharge; and (2) mitigate soil loss while favoring soil fertility conservation.

Molecular prevalence of intestinal parasites infections in children with diarrhea in Franceville, Southeast of Gabon

Background

Pediatric diarrhea caused by a range of pathogens, including intestinal parasites, is one of main causes of death among children under 5 years of age. The distribution of these parasitic infections overlaps in many environmental, socioeconomic and epidemiological settings. Their distribution and prevalence varies from region to region. In the current study, we assess the prevalence of intestinal parasites among pediatric patients with syndromic diarrheal disease living in Franceville, Gabon.

Methods

A cross-sectional study conducted in the Amissa Bongo Regional Hospital and Chinese-Gabonese Friendship Hospital in Franceville, between November 2016 and August 2017, enrolled a total of 100 diarrheic children between 0 and 180 months of age. Parasite detection in stool samples was performed using molecular diagnostic by PCR. Difference in means were tested by Student’s t test and ANOVA while principal component analysis was used to determine the correlation between parasite distributions and age groups.

Results

The overall prevalence of intestinal parasite infection was 61% (61/100). Hymenolepis sp and Cryptosporidium hominis/parvum were the most common parasites (31 and 19%, respectively), followed by Encephalitozoon intestinalis (15%), Trichuris trichiura (4%), Dientamoeba fragilis (4%), and Enterocytozoon bieneusi (2%). The polyparasitism rate was 19.7%, with 83.3% double and 16.7% triple infections. Protozoan infections (66.7%) were more prevalent than helminths infections (33.3%). Seasonal association of the circulation of intestinal parasite was statistically significant (p = 0.03). Correlations between different parasites was also observed.

Conclusion

The prevalence of intestinal parasitic infections is highest in diarrheic pediatric children. The prevalence of parasitic infections indicates that protozoa and helminths are the most common parasites in the Franceville environment. This study reinforces the importance of routine examination of diarrheic stool samples for the diagnostic of intestinal parasites. Further analyses are required to better understand the local epidemiology and risk factors associated with the transmission of intestinal parasites in Franceville, Gabon.

Keyswords

diarrhea, children, intestinal parasitic infections, molecular diagnostic, Franceville, Gabon.

The effects of climate variability and seasonal influence on diarrhoeal disease in the tropical city-state of Singapore - A time-series analysis

BACKGROUND

Diarrhoeal disease is common and imposes substantial health and economic burdens across the globe, especially in the African and Southeast Asian regions. Besides causing high mortality and morbidity, diarrhoeal disease has also been associated with growth and cognitive shortfalls in children in low-resource settings. Extreme weather events brought about by climate change may increase diarrhoeal disease and impact vulnerable populations in countries regardless of levels of development. We examined the seasonal and climatic influences of acute diarrhoeal disease reports in Singapore, a city-state located in Southeast Asia.

METHODS

We used a time-series analysis, adjusting for time-varying potential confounders in a negative binomial regression model and fitting fractional polynomials to investigate the relationship between climatic factors (temperature, relative humidity and rainfall) and reported diarrhoeal disease.

RESULTS

We included 1,798,198 reports of diarrhoeal disease from 2005 to 2018. We observed annual trimodal peaks in the number of reports. Every 10% increase in relative humidity in the present week was positively associated with an increase in reports one week later [Incidence Rate Ratio (IRR): 1.030, 95% CI 1.004-1.057] and negatively associated with a decrease in reports six weeks later (IRR: 0.979, 95% CI 0.961-0.997). We observed effect modification of relative humidity on the risk of diarrhoeal disease in the first calendar quarter (January to March). There was weak evidence of a delayed effect of ambient air temperature on reports of diarrhoeal disease one week later (IRR: 1.013, 95% CI 0.998-1.027). No threshold effects of climatic factors were observed. Each week of school holidays was associated with a 14.4% reduction in diarrhoeal disease reports (IRR: 0.856, 95% CI: 0.840 to 0.871). Public holidays were associated with a reduction in reports in the same week and an increase a week later.

CONCLUSIONS

Diarrhoeal disease is highly seasonal and is associated with climate variability. Food safety and primary healthcare resource mitigation could be timed in anticipation of seasonal and climate driven increases in disease reports.

Assessing the effect of climate factors on childhood diarrhoea burden in Kathmandu, Nepal

INTRODUCTION

This study was undertaken to assess the effect of climate variability on diarrhoeal disease burden among children under 5 years of age living in Kathmandu, Nepal. The researchers sought to predict future risk of childhood diarrhoea under different climate change scenarios to advance the evidence base available to public health decision-makers, and the Nepalese infection control division, in planning for climate impacts.

METHODS

A time series study was conducted using the monthly case count of diarrhoeal disease (2003-2013) among children under 5 years of age living in Kathmandu, Nepal. A quasi Poisson generalised linear equation with distributed lag linear model was fitted to estimate the lagged effect of monthly maximum temperature and rainfall on childhood diarrhoea. The environmental framework of comparative risk assessment was used to assess the environmental burden of diarrhoea within this population.

RESULTS

A total of 219,774 cases of diarrhoeal disease were recorded during the study period with a median value of 1286 cases per month. The results of a regression model revealed that the monthly count of diarrhoea cases increased by 8.1% (RR: 1.081; 95% CI: 1.02-1.14) per 1 °C increase in maximum temperature above the monthly average recorded within that month. Similarly, rainfall was found to have significant effect on the monthly diarrhoea count, with a 0.9% (RR; 1.009; 95% CI: 1.004-1.015) increase in cases for every 10 mm increase in rainfall above the monthly cumulative value recorded within that month. It was estimated that 7.5% (95% CI: 2.2%-12.5%) of the current burden of diarrhoea among children under 5 years of age could be attributed to climatic factors (maximum temperature), and projected that 1357 (UI: 410-2274) additional cases of childhood diarrhoea could be climate attributable by the year 2050 under low-risk scenario (0.9 °C increase in maximum temperature).

CONCLUSION

It is estimated that there exists a significant association (p < 0.05) between childhood diarrhoea and an increase in maximum temperature and rainfall in Kathmandu, Nepal. The findings of this study may inform the conceptualization and design of early warning systems for the prediction and control of childhood diarrhoea, based upon the observed pattern of climate change in Kathmandu.

Climatic Factors in Relation to Diarrhoea Hospital Admissions in Rural Limpopo, South Africa

Diarrheal disease is one of the leading causes of morbidity and mortality globally, particularly in children under 5 years of age. Factors related to diarrheal disease incidence include infection, malnutrition, and exposure to contaminated water and food. Climate factors also contribute to diarrheal disease. We aimed to explore the relationship between temperature, precipitation and diarrhoea case counts of hospital admissions among vulnerable communities living in a rural setting in South Africa. We applied ‘contour analysis’ to visually examine simultaneous observations in frequencies of anomalously high and low diarrhoea case counts occurring in a season, and assigning colours to differences that were statistically significant based on chi-squared test results. Children under 5 years of age were especially vulnerable to diarrhoea during very dry, hot conditions as well as when conditions were wetter than usual. We saw an anomalously higher number of diarrhoea cases during ‘warmer than usual’ conditions in the dry winter season, with average winter temperatures in Limpopo being from about 5 to 10 °C. As for ‘wetter than usual’ conditions, we saw an anomalously higher number of diarrhoea cases during ‘drier than usual’ conditions for the winter and spring. The lagged association seen in cumulative rainfall could not be distinguished in the same way for temperature-related variables (indicating rainfall had a larger impact on higher cases of diarrhoea), nor for the older age group of 5 years and older. Dry conditions were associated with diarrhoea in children under 5 years of age; such conditions may lead to increased water storage, raising the risks of water contamination. Reduced use of water for personal hygiene and cleaning of outdoor pit latrines also affect sanitation quality. Rural communities require adequate and uninterrupted water provision, and healthcare providers should raise awareness about potential diarrhoeal risks, especially during the dry season as well as during wintertime when conditions are warmer than usual.

Climate Change Impacts on Waterborne Diseases: Moving Toward Designing Interventions

PURPOSE

Climate change threatens progress achieved in global reductions of infectious disease rates over recent decades. This review summarizes literature on potential impacts of climate change on waterborne diseases, organized around a framework of questions that can be addressed depending on available data.

RECENT FINDINGS

A growing body of evidence suggests that climate change may alter the incidence of waterborne diseases, and diarrheal diseases in particular. Much of the existing work examines historical relationships between weather and diarrhea incidence, with a limited number of studies projecting future disease rates. Some studies take social and ecological factors into account in considerations of historical relationships, but few have done so in projecting future conditions. The field is at a point of transition, toward incorporating social and ecological factors into understanding the relationships between climatic factors and diarrheal diseases and using this information for future projections. The integration of these components helps identify vulnerable populations and prioritize adaptation strategies.

Health monitoring during water scarcity in Mayotte, France, 2017

Background

During the 2016–2017 austral summer, unprecedented water scarcity was observed in the south of Mayotte, French island in the Indian Ocean. Therefore, authorities introduced restrictive measures to save the water of this part of the island. The rationing system affected over 65,000 people, for four months. In order to detect a possible deterioration of the health situation, a strengthened epidemiological surveillance system was set up.

Methods

Surveillance focused on intestinal and skin diseases, which are often associated with a lack of hygiene or poor-quality drinking and bathing water. Three pathologies were monitored: acute diarrhoea, acute gastroenteritis and skin diseases and also, proportion of antidiarrhoeal and rehydration solutions sales in pharmacies. Cases of leptospirosis were also under surveillance. The analyses consisted of comparing the collected data according to the areas that were either affected or not affected by the water restrictions. Comparisons with historical data were also made.

Results

Although none of the surveillance systems were able to demonstrate any impact on skin diseases, they revealed a very sharp increase in the proportion of consultations for acute diarrhoea and gastro-enteritis in the southern area. This was corroborated by a high increase in the sales of antidiarrhoeals and oral rehydration solutions via the sentinel pharmacists in the south of the island compared with those of the north. Comparison with historical data highlighted the occurrence of an unusual situation.

Conclusion

These water restrictions caused a real deterioration in the health status of the inhabitants who were deprived of water.

Modeling the Impact of Land Use Change on Basin-scale Transfer of Fecal Indicator Bacteria: SWAT Model Performance

Land use change from annual crops to commercial tree plantations can modify flow and transport processes at the watershed scale, including the fate and transport of fecal indicator bacteria (FIB), such as . The Soil and Water Assessment Tool (SWAT) is a useful means for integrating watershed characteristics and simulating water and contaminants. The objective of this study was to provide a comprehensive assessment of the impact of land use change on microbial transfer from soils to streams using the SWAT model. This study was conducted for the Houay Pano watershed located in northern Lao People's Democratic Republic. Under the observed weather conditions, the SWAT model predicted a decrease from 2011 to 2012 and an increase from 2012 to 2013 in surface runoff, suspended solids, and transferred from the soil surface to streams. The amount of precipitation was important in simulating surface runoff, and it subsequently affected the fate and transport of suspended solids and bacteria. In simulations of identical weather conditions and different land uses, fate and transport was more sensitive to the initial number of than to its drivers (i.e., surface runoff and suspended solids), and leaf area index was a significant factor influencing the determination of the initial number of on the soil surface. On the basis of these findings, this study identifies several limitations of the SWAT fertilizer and bacteria modules and suggests measures to improve our understanding of the impacts of land use change on FIB in tropical watersheds.

Water and Sediment Microbial Quality of Mountain and Agricultural Streams

Increased public health risk caused by pathogen contamination in streams is a serious issue, and mitigating the risk requires improvement in existing microbial monitoring of streams. To improve understanding of microbial contamination in streams, we monitored in stream water columns and streambed sediment. Two distinct streams and their subwatersheds were studied: (i) a mountain stream (Merced River, California), which represents pristine and wild conditions, and (ii) an agricultural stream (Squaw Creek, Iowa), which represents an agricultural setting (i.e., crop, manure application, cattle access). Stream water column and sediment samples were collected in multiple locations in the Merced River and Squaw Creek watersheds. Compared with the mountain stream, water column concentrations in the agricultural stream were considerably higher. In both mountain and agricultural streams, concentrations in bed sediment were higher than the water column, and principal component analysis indicates that land use affected water column levels significantly ( < 0.05). The cluster analysis showed grouping of subwatersheds for each basin, indicating unique land use features of each watershed. In general, water column levels in the mountain stream were lower than the USEPA's existing water quality criteria for bacteria. However, the levels in the agricultural stream exceeded the USEPA's microbial water quality criteria by several fold, which substantiated that increased agricultural activities, use of animal waste as fertilizers, and combined effect of rainfall and temperature may act as potential determining factors behind the elevated levels in agriculture streams.

Microbial Water Quality: Monitoring and Modeling

Microbial water quality lies in the nexus of human, animal, and environmental health. Multidisciplinary efforts are under way to understand how microbial water quality can be monitored, predicted, and managed. This special collection of papers in the was inspired by the idea of creating a special section containing the panoramic view of advances and challenges in the arena of microbial water quality research. It addresses various facets of health-related microorganism release, transport, and survival in the environment. The papers analyze the spatiotemporal variability of microbial water quality, selection of predictors of the spatiotemporal variations, the role of bottom sediments and biofilms, correlations between concentrations of indicator and pathogenic organisms and the role for risk assessment techniques, use of molecular markers, subsurface microbial transport as related to microbial water quality, antibiotic resistance, real-time monitoring and nowcasting, watershed scale modeling, and monitoring design. Both authors and editors represent international experience in the field. The findings underscore the challenges of observing and understanding microbial water quality; they also suggest promising research directions for improving the knowledge base needed to protect and improve our water sources.

Molecular Analysis of the Enteric Protozoa Associated with Acute Diarrhea in Hospitalized Children

Pediatric diarrhea is a common cause of death among children under 5 years of age. In the current study, we investigated the frequency of intestinal parasites among 580 pediatric patients with chronic diarrhea. Parasitic protozoa (all species combined) were detected by molecular tools in 22.9% of the children and the most common parasite was Cryptosporidium spp. (15.1%). Blastocystis hominis was detected in 4.7%, Dientamoeba fragilis in 4%, Giardia duodenalis in 1.7%, and Entamoeba histolytica in 0.17%. Protozoan infections were observed among all regional groups, but prevalence was highest among Qatari subjects and during the winter season. Typing of Cryptosporidium spp. revealed a predominance of Cryptosporidium parvum in 92% of cases with mostly the IIdA20G1 subtype. Subtypes IIdA19G2, IIdA18G2, IIdA18G1, IIdA17G1, IIdA16G1, and IIdA14G1 were also detected. For Cryptosporidium hominis, IbA10G2 and IbA9G3 subtypes were identified. This study provides supplementary information for implementing prevention and control strategies to reduce the burden of these pediatric protozoan infections. Further analyses are required to better understand the local epidemiology and transmission of Cryptosporidium spp. in Qatar.

Hydrological modeling of Fecal Indicator Bacteria in a tropical mountain catchment

The occurrence of pathogen bacteria in surface waters is a threat to public health worldwide. In particular, inadequate sanitation resulting in high contamination of surface water with pathogens of fecal origin is a serious issue in developing countries such as Lao P.D.R. Despite the health implications of the consumption of contaminated surface water, the environmental fate and transport of pathogens of fecal origin and their indicators (Fecal Indicator Bacteria or FIB) are still poorly known in tropical areas. In this study, we used measurements of flow rates, suspended sediments and of the FIB Escherichia coli (E. coli) in a 60-ha catchment in Northern Laos to explore the ability of the Soil and Water Assessment Tool (SWAT) to simulate watershed-scale FIB fate and transport. We assessed the influences of 3 in-stream processes, namely bacteria deposition and resuspension, bacterial regrowth, and hyporheic exchange (i.e. transient storage) on predicted FIB numbers. We showed that the SWAT model in its original version does not correctly simulate small E. coli numbers during the dry season. We showed that model's performance could be improved when considering the release of E. coli together with sediment resuspension. We demonstrated that the hyporheic exchange of bacteria across the Sediment-Water Interface (SWI) should be considered when simulating FIB concentration not only during wet weather, but also during the dry season, or baseflow period. In contrast, the implementation of the regrowth process did not improve the model during the dry season without inducing an overestimation during the wet season. This work thus underlines the importance of taking into account in-stream processes, such as deposition and resuspension, regrowth and hyporheic exchange, when using SWAT to simulate FIB dynamics in surface waters.