Household drinking water safety among the population of Gaza Strip, Palestine: knowledge, attitudes, practices, and satisfaction

Quantitative microbial risk assessment for Escherichia Coli O157: H7 via drinking water in the Gaza Strip, Palestine

Introduction

Microbial contamination of drinking water, particularly by pathogens such as Escherichia coli O157: H7, is a significant public health concern worldwide, especially in regions with limited access to clean water like the Gaza Strip. However, few studies have quantified the disease burden associated with E. coli O157: H7 contamination in such challenging water management contexts.

Objective

This study aimed to conduct a comprehensive Quantitative Microbial Risk Assessment to estimate the annual infection risk and disease burden attributed to E. coli O157: H7 in Gaza's drinking water.

Methods

Applying the typical four steps of the Quantitative Microbial Risk Assessment technique-hazard identification, exposure assessment, dose-response analysis, and risk characterization-the study assessed the microbial risk associated with E. coli O157: H7 contamination in Gaza's drinking water supply. A total of 1317 water samples from various sources across Gaza were collected and analyzed for the presence of E. coli O157: H7. Using Microsoft ExcelTM and @RISKTM software, a Quantitative Microbial Risk Assessment model was constructed to quantify the risk of infection associated with E. coli O157: H7 contamination. Monte Carlo simulation techniques were employed to assess uncertainty surrounding input variables and generate probabilistic estimates of infection risk and disease burden.

Results

Analysis of the water samples revealed the presence of E. coli O157: H7 in 6.9% of samples, with mean, standard deviation, and maximum values of 1.97, 9.74, and 112 MPN/100 ml, respectively. The risk model estimated a median infection risk of 3.21 × 10-01 per person per year and a median disease burden of 3.21 × 10-01 Disability-Adjusted Life Years per person per year, significantly exceeding acceptable thresholds set by the WHO.

Conclusion

These findings emphasize the urgent need for proactive strategies to mitigate public health risks associated with waterborne pathogens in Gaza.

Bottled water quality ranking via the multiple-criteria decision-making process: a case study of two-stage fuzzy AHP and TOPSIS

Access to healthy drinking water is vital to human health and development. Bottled water consumption has been on the rise in recent years. As several chemical and bacteriological parameters affect bottled water quality, it is difficult to choose the highest-quality bottled water. Numerous studies have proposed the use of multiple-criteria decision-making (MCDM) methods to overcome this problem. Herein, the two-stage fuzzy analytic hierarchy process (FAHP) and technique for order preference by similarity to ideal solution (TOPSIS) method were adopted to rank different brands of bottled water. The FAHP approach allows working at the intervals of judgment rather than absolute values. TOPSIS is a technique for ordering performance based on its similarity to the ideal solution. An expert panel selected and classified the criteria and sub-criteria. A pairwise comparison questionnaire was then developed, and the weights of the criteria and sub-criteria were assigned by water quality experts. The data on the quality of different brands of water were collected from the Iranian bottled water database. The final data analysis and weight determination of each parameter were performed in Excel and R software Programs. Finally, the CCi (value of closeness coefficient) and rank of 71 bottled water brands were calculated, and the best brand was introduced. Among the selected criteria, carcinogenic chemical compounds with the weight of 0.368 were the most important compound in ranking bottled water brands, followed by bacteriologic, pathogenic chemical compounds, chemical compounds important in terms of toxicity, nutritious chemical compounds with a low toxicity level, chemical compounds related to esthetic effects, and chemical compounds without health effects, respectively.

Preparedness and Readiness Strategies for Addressing the COVID-19 Pandemic in Fragile and Conflict Settings: Experiences of the Gaza Strip

The COVID-19 pandemic is a global public health threat of serious concern, especially in conflict settings that face fragility and lack adequate resources and capacities. Gaza suffers from a blockade imposed by the Israeli occupation, environmental deterioration, confiscation of lands, demolition of houses and hospitals, restrictions on movement, lack of control over natural resources, and financial constraints. Gaza's population is consequently living in a poor humanitarian situation with high unemployment rates, poverty, over-crowdedness, and a weak health system. This makes Gaza incredibly fragile and affects its ability to respond to the COVID-19 pandemic effectively. The pandemic is expected to deepen Gaza's systems' fragility, which is already overstretched beyond their limits. This will hinder its capacity to deal with the pandemic, and other pre-existing pressing humanitarian needs. Therefore, in this review, we comprehensively explored Gaza's policy failures and successes related to the COVID-19 preparedness and response by state and non-state actors and recommend potential solutions and alternatives. We have addressed critical issues including the health system, water, sanitation, hygiene, socio-economic, education, food security, and others. In Gaza, effectiveness in combating the COVID-19 pandemic can only come from committed political will, transparency from all regulators, strategic dialogue, comprehensive planning, and active international support.

Implementation challenges of an integrated One Health surveillance system in humanitarian settings: A qualitative study in Palestine

Objectives

Several factors have changed interactions between people, animals, plants, and the environment - renewing the relevance of the One Health surveillance system in the fight against zoonotic diseases such as COVID-19. Therefore, this study aimed to explore barriers to implementing an integrated One Health surveillance system in Palestine.

Methods

This qualitative study was conducted from April 2020 until August 2020. Data were collected using semi-structured interview guides. Seven key stakeholders were interviewed during data collection. A thematic analysis was performed.

Results

Four overarching themes emerged explaining barriers to integrated implementation of the One Health surveillance system. They are lack of policy coherence, limited financial resources, poor governance and leadership, and lack of One Health training programmes.

Conclusion

Improved understanding of the transmission and effective control (including One Health approach) of zoonotic disease and better governance and leadership are critical in the diseases that threaten public health, such as the COVID-19.

Impact of the coronavirus disease 2019 pandemic on the Palestinian family: A cross-sectional study

INTRODUCTION

The current study aims to understand and assess the consequences of the coronavirus disease 2019 pandemic on Palestinian families.

METHODS

This online community-based cross-sectional descriptive study was conducted between 19 April 2020 and 5 June 2020, using a validated questionnaire. The questionnaire comprised of three sections: sociodemographic characteristics, living conditions, and impact of the coronavirus disease 2019 pandemic. A convenience sampling method was used to select participants.

RESULTS

A total of 570 adults aged ⩾18 years participated in the study. Of them, 258 (45.3%), 120 (21%), and 192 (33.7%) were residing in the Gaza Strip, West Bank, and East Jerusalem, respectively. A large portion of participants (73.2%) reported that the containment measures of the coronavirus disease 2019 pandemic had caused an excessive burden on their families; 549 (96.3%) revealed that water supplies were not always available at home. However, paying attention to personal hygiene and home cleaning was more than usual before the announcement of the coronavirus disease 2019 pandemic. The mean times of going out of their homes have dropped significantly following the onset of the pandemic, p value = 0.001 (95% confidence interval). In addition, 192 (33.7%) participants reported that they changed to working remotely from home with 66 (11.6%) having lost their employment.

CONCLUSION

The coronavirus disease 2019 pandemic was associated with an additional burden on the Palestinian families. Moreover, we suggest discussing the obtained results with local and national stakeholders to ensure that they know to improve their actions.

COVID-19 Pandemic and Water, Sanitation, and Hygiene: Impacts, Challenges, and Mitigation Strategies

BACKGROUND

In order to protect public health during the outbreaks of infectious diseases including the pandemic COVID-19, provision of Water, Sanitation, and Hygiene (WASH) services is important. The challenges of inaccessible WASH services along with the pandemic COVID-19 in low-income countries can lead to a devastating problem.

METHOD

A systematic search of published articles was identified using PubMed, Web of Science, and Google Scholar, on relevant studies of COVID-19 and WASH services. Published articles were identified using abstracts and titles of the articles, followed by assessed for eligibility, and screening of the full text reports of relevant studies.

RESULTS

Electronic database search identified 798 articles from which 28 full text articles were included in the systematic review. A lack of access to WASH services in households, schools, health care facilities, and other public spaces were the main identified COVID-19 related public health risks. A lack of adequate data and financial shortages were the challenges for mitigating the problems of COVI-19 and WASH services.

CONCLUSION

This systematical review identified the impacts and challenges of COVID-19 in the provision of WASH services. The results implied that COVID-19 has significant impacts on WASH services that can affect the health of the public. Therefore, strengthening and ensuring access to WASH services are important for preventing COVID-19 and realizing human rights. Community engagement also can be used to support for prevention and control of COVID-19. Countries need to be expand their investment in WASH services as an important mechanism for mitigating COVID-19.

Health system's response to the COVID-19 pandemic in conflict settings: Policy reflections from Palestine

As the COVID-19 pandemic spreads, concerns are particularly serious in conflict and humanitarian settings. Tackling the pandemic in those countries is challenging due to the fragility of socioeconomic and health systems. Palestine is one of those countries that is facing compounding challenges, instability, fragility, living conditions, poverty, and mobility, all of which are caused by multifactorial etiology. The Pandemic shows triple tragedies; virus (COVID-19 Pandemic), ongoing Israeli occupation (Politics), and Intra-Palestinian divide (Policies). Yet, Palestine's response to the pandemic is outperforming many countries in the region. The early preventative lockdown measures in the West Bank found effective and not overwhelming the already over-stretched health system. While in the Gaza Strip, the response was slow. Prisoners, labours, besieged people, socioeconomic-disadvantaged classes, and refugees were put at additional high risk. Nonetheless, measures taken were unconsolidated in both regions largely due to the political factors. A little collaboration and inter-agency task forces in preparedness and response was observed, and the mechanisms and governance remain ambiguous. A consolidated and evidence-based nation-wide plan is required, whereby state and non-state actors have a clear and transparent exit strategy. A new thinking approach to promote the public health system and evidence-informed policies in Palestine is an urgent national priority.

Comprehensive Risk Assessment of Health-Related Hazardous Events in the Drinking Water Supply System from Source to Tap in Gaza Strip, Palestine

Background

The traditional approach in the management of the quality drinking water, and relying on end-product testing, has proven ineffective in protecting public health. Therefore, the transition to a systematic approach in drinking water supply systems management from the source to the consumer tap was taken as a water safety plan (WSP).

Objective

The study aims to investigate the health-related hazardous events in order to decide on the best risk-reduction strategies in the supply of drinking water in the Gaza strip.

Methods

A semiquantitative matrix method for risk assessment was applied. Also, chlorine residual, electrical conductivity, and nitrate concentration further tested in 109 water wells, 109 small-scale water desalination plants, 197 tanker trucks, and 384 households distributed over five governorates of the Gaza strip.

Results

The mean of the measured chlorine residual values was less than the recommended national and international limits (0.2–1 mg/liter). The mean of electrical conductivity at catchment points and household municipal water taps was 2165.1 μS·cm⁻¹ and 2000 μS·cm⁻¹, respectively. Furthermore, zero percent of water samples met the recommended criteria, indicating that the groundwater in the Gaza strip is nonpotable. Only 12.8% and 8.8% of water samples met the permissible levels at catchment areas and municipal water at household, respectively, indicating sever health impacts on the public. Moreover, the most hazardous events were related to high levels of groundwater salinity, the low level of disinfection, the effect of electricity outages on the efficiency of the desalination process, and leakage of water from the tanker truck tank reservoirs. Therefore, urgent interventions are required to improve the quality of water and to mitigate the possible health effects.

Conclusion

The prioritization of hazardous events that are proportional to the degree of their attributed risk could help guide in making the right risk-reduction decisions. Urgent interventions are required to improve the quality of water and to mitigate the possible health effects.

Water, sanitation, and hygiene risk factors of acute diarrhea among children under five years in the Gaza Strip

This cross-sectional community household-based study aims to evaluate the water, sanitation, and hygiene facilities in the Gaza Strip and to investigate their associations with the occurrence of acute diarrhea among children under five years. A survey using a structured questionnaire was conducted on 1,857 households with an child under five years from August 2017 to June 2018. About 69.7% of heads of households reported a diarrheal episode among their children during the two months preceding the survey. Multivariable logistic regression showed that sewage water observed around the households was associated with an increased risk of acute diarrhea (AOR = 2.45; P < 0.001; 95% CI: 1.83–3.27). Nevertheless, the allocation of a special water tank for desalinated drinking water at home (AOR = 0.3; P = 0.02; 95% CI: 0.1–0.8), the connection of households to a closed sewerage system (AOR = 0.56; P < 0.001; 95% CI: 0.43–0.73), and handwashing practices before and after eating (AOR = 0.42; P = 0.003; 95% CI: 0.24–0.74 and AOR = 0.50; P = 0.03; 95% CI: 0.26–0.94, respectively), as well as using desalinated water sources for drinking purposes, were inversely associated with the incidence of acute diarrhea among children under five. Further improvements in the existing sewerage system and the intensification of sanitation and hygiene promotion programs at the household levels may reduce the risk of acute diarrhea among children under five years in the Gaza Strip.

Prevalence of diarrheal illness and healthcare-seeking behavior by age-group and sex among the population of Gaza strip: a community-based cross-sectional study

BACKGROUND

In the Gaza strip, diarrhea is one of main reasons for children visiting primary healthcare centers. Hence, we investigate predictors of the diarrheal illness and health care-seeking behavior among different age groups.

METHODS

This community-based cross-sectional survey was conducted from August 2017 to June 2018 among 1857 households. A pretested structured questionnaire included information about socio-demographic, sanitation, hygiene, source of water, diarrheal illness, and seeking healthcare in households was administered to head of household. To achieve representativeness for the five Gaza's governorates, a cluster random sampling was applied.

RESULTS

Of the 1857 household's heads, 421 (22.7%) reported an episode of diarrhea during the 48 h preceding the interview resulting an overall prevalence rate of 3.8 per 100 individuals. The prevalence of diarrhea was statistical significant greater in males (5.4/100) compared to females (1.3/100) in all age groups (p <  0.05). Socio-demographic, economic, water, sanitation, and hygiene factors were predictors of the diarrheal illness and seeking of non-professional healthcare for diarrhea illness treatment among. A transition behavior from professional to non-professional and vice versa in seeking healthcare in each diarrheal episode was found.

CONCLUSIONS

We recommend improving the status of water, sanitation, and hygiene in the Gaza strip's households to reduce diarrhea among the population of Gaza strip. Community sensitization about the importance of seeking care at primary health centers because treatment of children is available for free or in low costs.