Associations between perceptions of drinking water service delivery and measured drinking water quality in rural Alabama

Public perception on human exposure risk: A case study on endocrine disrupting compounds in the environment

Humans are exposed to environmental risks owing to the broad usage of endocrine disrupting compounds (EDCs). However, the subjective evaluation of risk levels and characteristics, as well as the variation in risk processing, have not been thoroughly examined. The objective was to understand the public's perception of the risk associated with human exposure to environmental EDCs and identify any variations in risk perception. In this pioneering study conducted within the distinctive social and cultural context of Malaysia, a developing nation, a quantitative analysis approach was employed to assess the subjective evaluation of risk levels and characteristics among the public while developing a risk perception model. Data gathered from surveys and questionnaires were analyzed to gather information on the public's perception of environmental and health issues pertaining to pesticides, hormones, plastics, medicines, and cosmetics. The analysis revealed that the majority of the public assessed the level of human exposure to environmental risks based on experiential processing, which was influenced by cognitive and affective variables. Interestingly, a higher proportion of individuals in the community had a low risk perception of environmental EDCs, surpassing the overall risk perception by 19.3%. Furthermore, the public showed significant awareness of environmental and health issues related to pesticides, hormones, and plastics but had a lesser inclination to acknowledge the vulnerability of humans to risks associated with medicines and cosmetics. These findings suggest that the public is likely to be exposed to environmental EDCs based on their current perceived risks, and that sociopsychological factors play a significant role in shaping perceptions and judgments. This understanding can inform the development of targeted risk management strategies and interventions to mitigate the potential harm caused by environmental EDCs.

Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA

We collected stool from school-age children from 352 households living in the Black Belt region of Alabama, USA, where sanitation infrastructure is lacking. We used quantitative reverse transcription PCR to measure key pathogens in stool that may be associated with water and sanitation, as an indicator of exposure. We detected genes associated with > 1 targets in 26% of specimens, most frequently Clostridioides difficile (6.6%), atypical enteropathogenic Escherichia coli (6.1%), and enteroaggregative E. coli (3.9%). We used generalized estimating equations to assess reported risk factors for detecting > 1 pathogen in stool. We found no association between lack of sanitation and pathogen detection (adjusted risk ratio 0.95 [95% CI 0.55–1.7]) compared with specimens from children served by sewerage. However, we did observe an increased risk for pathogen detection among children living in homes with well water (adjusted risk ratio 1.7 [95% CI 1.1–2.5]) over those reporting water utility service.

A three-staged framework for measuring water supply resilience in rural China based on PLS-SEM

China suffers from frequent large-scale earthquakes, posing a significant challenge to the development and integrity of its rural water supply system (RWSS). The earthquake resilience of water supply systems is understood to be a function of multifaceted factors, which are time- and space-dependent. Measuring the seismic-resilience of RWSS in China remains a challenge. This paper proposes a multi-stage comprehensive evaluation framework, focusing on the relationship between multi-dimensional factors and the seismic- resilience of RWSS in rural areas, across three stages: before, during and after earthquake events. This study comprises four steps: (1) Development of a multi-stage evaluation conceptual framework; (2) identification of seismic-resilience factors; (3) verification of the relationships between factors and stages; and (4) formation of the final evaluation framework. The relationship between multi-dimensional factors is confirmed by a method of triangulation through the quantitative analysis of PLS-SEM combined with the qualitative literature analysis, highlighting the causal approach of the resilience of RWSSs, so as to better understand the resilience state of each stage of disaster. Understanding these factors and their influence on the seismic capacity of RWSS will enable local authorities to recognize the existing advantages and disadvantages of these factors, so as to carry out better resilience practice in all stages of disasters.

Drinking Water Quality and Public Health in the Kathmandu Valley, Nepal: Coliform Bacteria, Chemical Contaminants, and Health Status of Consumers

Residents of Nepal’s Kathmandu Valley draw drinking water from tube wells, dug wells, and stone spouts, all of which have been reported to have serious water quality issues. In this study, we analyzed drinking water samples from 35 tube wells, dug wells, stone spouts, and municipal tap water for bacterial and chemical contaminants, including total and fecal coliform, aluminum, arsenic, barium, beryllium, boron, cadmium, cobalt, chromium, copper, fluoride, iron, mercury, manganese, molybdenum, nickel, lead, antimony, selenium, thallium, uranium, vanadium, and zinc. We also asked a sampling of households who used these specific water sources to rate the taste of their water, list any waterborne diseases they were aware of, and share basic health information about household members. This survey provided us with information from 146 households and 603 individuals. We found widespread bacterial contamination of water sources, with 94% of sources having detectable total or fecal coliform. Nepal Drinking Water Quality Standards and World Health Organization (WHO) Drinking-Water Guidelines or health-based values were exceeded for aluminum (max = 0.53 mg/L), arsenic (max = 0.071 mg/L), iron (max = 7.22 mg/L), and manganese (max = 3.229 mg/L). The distribution of water sources with high arsenic, iron, and manganese appeared to be associated with floodplain deposits. Mixed effects logistic regression models were used to examine the interactions between social factors and water contaminants and their effects on household members’ health. Consumers of water sources with both high and low concentrations of manganese were less likely to have a positive attitude towards school than those whose water sources had moderate concentrations of manganese. Social factors, especially education, played a large role in predicting individual health outcomes. Household taste ratings of drinking water were not correlated with iron or manganese concentrations, suggesting that WHO’s reliance on aesthetic criteria for these contaminants instead of formal drinking-water guidelines may not be sufficient to protect public health.

Consumers’ Perceptions of the Supply of Tap Water in Crisis Situations

This paper first presents the results of polling on the subject of potable water in crisis situations, with respondents from south-eastern Poland’s Subcarpathian region asked for their opinions on the level of nuisance associated with water supply interruptions and water quality, levels of consumption and water companies’ quality of service. Among the respondents 53% regard the quality of the water they receive as satisfactory, while a quarter see it as only average. However, respondents are relatively satisfied with the corporate response when supplies are interrupted, as methods and means of notification are judged effective by 60%. Continuing with work to assess possibilities for water companies to improve their performance in crisis situations, the present study generates an Analytical Hierarchy Process allowing recipients to determine importance criteria where quality of service is concerned. This could facilitate management by water companies, providing for centralised control and comparison that help secure services of appropriate quality. The process can also help protect different groups of recipients, as safety is evaluated through analysis of functioning, and of failures and losses.

Assessing the quality of service for drinking water supplies in rural settings: A synthetic index approach

In rural settings, the presence of water supply infrastructure does not guarantee that people will have access to dependable and high-quality drinking water. To evaluate deficiencies, an assessment of quality of service of rural drinking water supply systems (RDWSS) should be examined from a multi-criteria perspective, one that integrates economic, technical, administrative, and operational components of supplying water, which includes a variety of stakeholders to integrate their preferences in the development of a synthetic index. In this study, we followed a pioneering approach to evaluate the quality of service for RDWSS based on analytic hierarchy process (AHP) and Monte Carlo simulations. We empirically applied the approach to 40 RDWSS in Chile. The weights of a set of 14 performance indicators were allocated by representatives of the communities that manage the RDWSS and experts on technical and administrative issues revelling the different preferences of decision-makers. We found that there are significant differences in the quality of service provided by the RDWSS evaluated. The information provided by the synthetic indicator would be very helpful in supporting decision makers needing to prioritize investments among drinking water supplies in rural settings.

Water quality, availability, and acute gastroenteritis on the Navajo Nation - a pilot case-control study

The Navajo Nation includes approximately 250,000 American Indians living in a remote high desert environment with limited access to public water systems. We conducted a pilot case-control study to assess associations between acute gastroenteritis (AGE) and water availability, use patterns, and quality. Case patients with AGE and non-AGE controls who presented for care to two Indian Health Service hospitals were recruited. Data on demographics and water use practices were collected using a standard questionnaire. Household drinking water was tested for presence of pathogens, coliforms, and residual chlorine. Sixty-one subjects (32 cases and 29 controls) participated in the study. Cases and controls were not significantly different with respect to water sources, quality, or patterns of use. Twenty-one percent (n = 12) of study participants resided in dwellings not connected to a community water system. Eleven percent (n = 7) of subjects reported drinking hauled water from unregulated sources. Coliform bacteria were present in 44% (n = 27) of household water samples, and 68% (n = 40) of samples contained residual chlorine concentrations of <0.2 mg/L. This study highlights issues with water availability, quality, and use patterns within the Navajo Nation, including sub-optimal access to community water systems, and use of water hauled from unregulated sources.

Effects of inequality of supply hours on consumers' coping strategies and perceptions of intermittent water supply in Kathmandu Valley, Nepal

To investigate the effects of unequal supply hours on consumers' coping strategies and perceptions of the intermittent water supply (IWS) in the Kathmandu Valley (KV), Nepal we conducted a randomized household survey (n=369) and on-site water quality tests. Half of the households received piped water for 6 or fewer hours per week. To augment or cope with the inadequate supply, 28% of the households used highly contaminated and expensive tanker-delivered water. Half of the piped water samples (n=13) were contaminated with Escherichia coli. Free chlorine concentration in all piped water samples was below the national standards (0.1-0.2mg/L), but combined chlorine was detected at an average of 0.24mg/L, indicating ingression of contaminants in the network. Point-of-use devices could increase access to safe water in the KV from 42% to 80%. The use of Lorenz curves and Gini coefficients revealed inequality of piped water supply hours per week both between and within service areas in the KV, due mainly to a small percentage of households who receive longer supply hours. To cope with reduced supply hours, home owners pay more to get water from alternative sources, while tenants compromise their water consumption. Under IWS, expectations for improvements in piped water quality and supply regularity are higher than those for supply volume. Consumers' perceptions of the piped water services worsen with the reduction in supply hours, but perceptions of piped water tariff are independent of supply hours.

Association between perceptions of public drinking water quality and actual drinking water quality: A community-based exploratory study in Newfoundland (Canada)

Studying public perception on drinking water quality is crucial for managing of water resources, generation of water quality standards, and surveillance of the drinking-water quality. However, in policy discourse, the reliability of public perception concerning drinking water quality and associated health risks is questionable. Does the public perception of water quality equate with the actual water quality? We investigated public perceptions of water quality and the perceived health risks and associated with the actual quality of public water supplies in the same communities. The study was conducted in 45 communities of Newfoundland (Canada) in 2012. First, a telephone survey of 100 households was conducted to examine public perceptions of drinking water quality of their respective public sources. Then we extracted public water quality reports of the same communities (1988-2011) from the provincial government's water resources portal. These reports contained the analysis of 2091 water samples, including levels of Disinfection By-Products (DBPs), nutrients, metals, ions and physical parameters. The reports showed that colour, manganese, total dissolved solids, iron, turbidity, and DBPs were the major detected parameters in the public water. However, the majority of the respondents (>56%) were either completely satisfied or very satisfied with the quality of drinking water. Older, higher educated and high-income group respondents were more satisfied with water quality than the younger, less educated and low-income group respondents. The study showed that there was no association with public satisfaction level and actual water quality of the respective communities. Even, in the communities, supplied by the same water system, the respondents had differences in opinion. Despite the effort by the provincial government to make the water-test results available on its website for years, the study showed existing disconnectedness between public perception of drinking water quality and actual quality. We had little scope to explore the possible explanations, and hence further studies are required to verify the age, gender educational status and income differential about the satisfaction of public service like water supply.

Social Perception of Public Water Supply Network and Groundwater Quality in an Urban Setting Facing Saltwater Intrusion and Water Shortages

Perceptions developed by consumers regarding the quality of water reaching their household can affect the ultimate use of the water. This study identified key factors influencing consumers' perception of water quality in a highly urbanized coastal city, experiencing chronic water shortages, overexploitation of groundwater, and accelerated saltwater intrusion. Household surveys were administered to residents to capture views and perceptions of consumed water. Concomitantly, groundwater and tap water samples were collected and analyzed at each residence for comparison with perceptions. People's rating of groundwater quality was found to correlate to the measured water quality both in the dry and wet seasons. In contrast, perceptions regarding the water quality of the public water supply network did not show any correlation with the measured tap water quality indicators. Logistic regression models developed to predict perception based on salient variables indicated that age, apartment ownership, and levels of total dissolved solids play a significant role in shaping perceptions regarding groundwater quality. Perceptions concerning the water quality of the public water supply network appeared to be independent of the measured total dissolved solids levels at the tap but correlated to those measured in the wells. The study highlights misconceptions that can arise as a result of uncontrolled cross-connections of groundwater to the public supply network water and the development of misaligned perceptions based on prior consumption patterns, water shortages, and a rapidly salinizing groundwater aquifer.

Associations between Self-Reported Gastrointestinal Illness and Water System Characteristics in Community Water Supplies in Rural Alabama: A Cross-Sectional Study

BACKGROUND

Community water supplies in underserved areas of the United States may be associated with increased microbiological contamination and risk of gastrointestinal disease. Microbial and health risks affecting such systems have not been systematically characterized outside outbreak investigations. The objective of the study was to evaluate associations between self-reported gastrointestinal illnesses (GII) and household-level water supply characteristics.

METHODS

We conducted a cross-sectional study of water quality, water supply characteristics, and GII in 906 households served by 14 small and medium-sized community water supplies in Alabama's underserved Black Belt region.

RESULTS

We identified associations between respondent-reported water supply interruption and any symptoms of GII (adjusted odds ratio (aOR): 3.01, 95% confidence interval (CI) = 1.65-5.49), as well as low water pressure and any symptoms of GII (aOR: 4.51, 95% CI = 2.55-7.97). We also identified associations between measured water quality such as lack of total chlorine and any symptoms of GII (aOR: 5.73, 95% CI = 1.09-30.1), and detection of E. coli in water samples and increased reports of vomiting (aOR: 5.01, 95% CI = 1.62-15.52) or diarrhea (aOR: 7.75, 95% CI = 2.06-29.15).

CONCLUSIONS

Increased self-reported GII was associated with key water system characteristics as measured at the point of sampling in a cross-sectional study of small and medium water systems in rural Alabama in 2012 suggesting that these water supplies can contribute to endemic gastro-intestinal disease risks. Future studies should focus on further characterizing and managing microbial risks in systems facing similar challenges.

Acute gastrointestinal illness following a prolonged community-wide water emergency

The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1-5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4-9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts.