Water Access, Sanitation, and Hygiene Conditions and Health Outcomes among Two Settlement Types in Rural Far North Cameroon

Elevated levels of anthropogenic antibiotic resistance gene marker, sul1, linked with extreme fecal contamination and poor water quality in wastewater-receiving ponds

In several low- and middle-income countries, such as India, the rapid construction of toilets to combat open defecation has not been matched with adequate wastewater treatment, resulting in extreme fecal contamination of the receiving environments. The sewage-receiving surface water bodies, typically close to the residences, are a potential hotspot for disease transmission and antibiotic resistance. Water, soil, and sediment samples from seven wastewater-receiving ponds (WRPs) were analyzed for water quality, chlorophyll-a, fecal contamination (yccT for Escherichia coli), 16S rRNA gene copies, and anthropogenic antibiotic resistance gene markers-sul1 and intI1. These WRPs were contrasted with two ponds that did not directly receive sewage. The water quality in the WRPs was comparable to raw sewage (BOD: 210-380 mg/L; COD: 350-630 mg/L; total-N: 100-190 mg/L; and total-P: 6-21 mg/L), and the relative levels of the DNA marker of E. coli were very high (yccT: 0.1% to ∼100% of total bacterial count) indicating extreme fecal contamination. The relative levels of sul1 and intI1 were 1-3 orders of magnitude higher in WRPs (sul1: 0.32%-10% of total bacterial count; and intI1: 0.2%-5% of total bacterial count) compared to the ponds that did not receive sewage directly. The relative levels of sul1 correlated with the DNA marker for the fecal indicator, E. coli (p-value < 0.05; r = 0.50; Spearman's rank correlation), and poor water quality.

An Overview of Microbial Source Tracking Using Host-Specific Genetic Markers to Identify Origins of Fecal Contamination in Different Water Environments

Fecal contamination of water constitutes a serious health risk to humans and environmental ecosystems. This is mainly due to the fact that fecal material carries a variety of enteropathogens, which can enter and circulate in water bodies through fecal pollution. In this respect, the prompt identification of the polluting source(s) is pivotal to guiding appropriate target-specific remediation actions. Notably, microbial source tracking (MST) is widely applied to determine the host origin(s) contributing to fecal water pollution through the identification of zoogenic and/or anthropogenic sources of fecal environmental DNA (eDNA). A wide array of host-associated molecular markers have been developed and exploited for polluting source attribution in various aquatic ecosystems. This review is intended to provide the most up-to-date overview of genetic marker-based MST studies carried out in different water types, such as freshwaters (including surface and groundwaters) and seawaters (from coasts, beaches, lagoons, and estuaries), as well as drinking water systems. Focusing on the latest scientific progress/achievements, this work aims to gain updated knowledge on the applicability and robustness of using MST for water quality surveillance. Moreover, it also provides a future perspective on advancing MST applications for environmental research.

Public Willingness to Pay for and Participate in Sanitation Infrastructure Improvement in Western China's Rural Areas

The suitability and feasibility of public-private partnership (PPP) patterns in a rural context have not been well-documented and understood. To address this research gap and practical plight, this study aims to analyze the rural resident's willingness to pay for and participate in the improvement of rural sanitation facilities, and further explore the drivers and barriers affecting their decisions. This study was performed in rural areas of three western provinces, including Shaanxi, Ningxia, and Inner Mongolia, of western China's rural areas by conducting a survey on 1,248 rural residents. In Inner Mongolia, the proportion of respondents who were willing to pay was highest, while the proportion of respondents who may provide labor was lowest among the three provinces. Respondents from Ningxia had the least willing to pay, and respondents from Shaanxi had the highest willingness to participate. Overall, respondents' rural (living) duration time, personal interest in local government notice, and the latest time when the sanitation facilities were improved could significantly affect their willingness. In Inner Mongolia, occupation and water availability could significantly influence respondents' willingness, and both gender and health conditions had significant impacts. In Ningxia, respondents' personal interest in local government notice had a notable impact on willingness, and low-income respondents showed a more notable willingness to pay and participate. In Shaanxi, occupation and water availability could significantly influence respondents' willingness. Respondents' personal interest in local government notice had a notable impact on their willingness. This study is of significant importance to understand rural resident's participation in sanitation infrastructure improvement to support relevant PPP projects, and is important to solve poverty-caused dilemmas.

Health interventions among mobile pastoralists: a systematic review to guide health service design

OBJECTIVE

Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterised, we set out to fill this gap.

METHODS

We conducted a systematic search in PubMed/MEDLINE, Scopus, Embase, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilisation among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesised through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records.

RESULTS

Our search yielded 4884 non-duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub-Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilisation. Only two randomised controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n = 16), community engagement (n = 12) and service mobility (n = 11).

CONCLUSION

Without adaptations to account for mobile pastoralists' unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist-specific delivery strategies, such as combinations of mobile and 'temporary fixed' services informed by transhumance patterns, culturally acceptable waiting homes, community-directed interventions and combined joint human-animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.

Residential urban stormwater runoff: A comprehensive profile of microbiome and antibiotic resistance

Non-point stormwater runoff is a major contamination source of receiving waterbodies. Heightened incidence of waterborne disease outbreaks related to recreational use and source water contamination is associated with extreme rainfall events. Such extreme events are predicted to increase in some regions due to climate change. Consequently, municipal separate storm sewer systems (MS4s) conveying pathogens to receiving waters are a growing public health concern. In addition, the spread of antibiotic resistance genes (ARGs) and antibiotic resistant bacteria in various environmental matrices, including urban runoff, is an emerging threat. The resistome and microbiota profile of MS4 discharges has yet to be fully characterized. To address this knowledge gap, we first analyzed the relationship between rainfall depth and intensity and E. coli densities (fecal indicator) in stormwater from four MS4 outflows in Columbus, Ohio, USA during the spring and summer of 2017. Microbial source tracking (MST) was conducted to examine major fecal contamination sources in the study sewersheds. A subset of samples was analyzed for microbial and resistome profiles using a metagenomic approach. The results showed a significant positive relationship between outflow E. coli density and rainfall intensity. MST results indicate prevalent fecal contamination from ruminant populations in the study sites (91% positive among the samples tested). Protobacteria and Actinobacteria were two dominant bacteria at a phylum level. A diverse array of ARGs and potentially pathogenic bacteria (e.g. Salmonella enterica Typhimurium), fungi (e.g. Scedosporium apiospermum), and protists (e.g. Acanthamoeba palestinensis) were found in urban stormwater outflows that discharge into adjacent streams. The most prevalent ARGs among samples were β-lactam resistance genes and the most predominant virulence genes within bacterial community were related with Staphylococcus aureus. A comprehensive contamination profile indicates a need for sustainable strategies to manage urban stormwater runoff amid increasingly intense rainfall events to protect public and environmental health.

The microbiome and antibiotic resistance in integrated fishfarm water: Implications of environmental public health

Aquaculture, the production of farm-raised fish, is a major industry that employs and feeds millions of individuals across the globe, but which may also be a nexus of emerging public health threats. This study examined potential health risks associated with integrated aquaculture operations by with One Health approach using a suite of tools to study water contamination sources, pathogens, antibiotic resistant bacteria, and bacterial community in the water from fishponds. Water samples from 27 fishponds across 9 villages were collected in Jiangmen City, China. Microbial source tracking, pathogens (including Salmonella and Arcobacter), toxin-producing Microcystis, and antibiotic resistant bacteria (ARB) resistant to tetracycline, sulfonamide, and carbapenem were quantified with qPCR. Bacterial community was determined with next-generation sequencing. All ponds exceeded E. coli single-day maximum criteria of US, and 67% ponds exceeded World Health Organization (WHO) waste-fed aquaculture guidelines for protecting consumers and pond workers, representing a high degree of fecal contamination and potential pathogen risks in these ponds. The majority of the ponds were positive for human- (84%) and pig- (41%) associated fecal contamination. Salmonella and microcystin-producing Microcystis were detected in 37% and 15% of the ponds, respectively, while Arcobacter was not detected in any ponds. ARB were highly prevalent. Among the measured factors, canonical correspondence analysis and network analysis demonstrated that secchi depth, temperature and conductivity were the major environmental elements impacting the bacterial community structure, while Proteobacteria and Actinobacteria were the major biological factor. This study demonstrated the presence of intersecting health risk factors in aquaculture facilities and can lay the foundation for addressing these risks in aquaculture management in rural China, with potential applicability in other developing regions dependent on aquaculture.

Occurrence of norovirus infection in an asymptomatic population in Indonesia

Norovirus (NoV) is a major cause of nonbacterial acute gastroenteritis worldwide in all age groups, and asymptomatic individuals may contribute to NoV transmission as a reservoir. Nonetheless, little information is available regarding asymptomatic NoV infection in Indonesia. We performed an epidemiological analysis of NoV infection among asymptomatic healthy volunteers in the city of Surabaya, Indonesia (population ~2.75 million). A total of 512 stool samples from 18 individuals (age range 20-42years) collected from July 2015 to June 2016 were examined. The detection of NoV and the genotype classification were carried out by a reverse transcription-polymerase chain reaction (RT-PCR) direct sequencing method. NoV was detected in 14 of the 512 stool samples (2.7%), with 7 individuals (38.9%) having at least 1 positive stool sample. All 14 of the NoV strains detected belonged to genogroup GII. The phylogenetic analysis indicated that 10 strains (71.4%) were grouped with GII.2, 2 (14.3%) were GII.17, 1 was GII.4 Sydney 2012, and 1 was GII.1. The circulation of GII.Pg/GII.1 and GII.Pe/GII.4 Sydney 2012 recombinant variants was detected among an asymptomatic population in Surabaya, Indonesia. Of the 7 positive individuals, 2 were repeatedly infected with the same strain and heterogenous strains. Taken together, our results suggest that the excretion of NoV from healthy individuals is one of the sources of NoV outbreak.