Intermittent Domestic Water Supply: A Critical Review and Analysis of Causal-Consequential Pathways

Water Supply Interruptions Are Associated with More Frequent Stressful Behaviors and Emotions but Mitigated by Predictability: A Multisite Study

Water supply interruptions contribute to household water insecurity. Unpredictable interruptions may particularly exacerbate water insecurity, as uncertainty limits households' ability to optimize water collection and storage or to modify other coping behaviors. This study used regression models of survey data from 2873 households across 10 sites in 9 middle-income countries to assess whether water supply interruptions and the predictability of interruptions were related to composite indicators of stressful behaviors and emotional distress. More frequent water service interruptions were associated with more frequent emotional distress (β = 0.49, SE = 0.05, P < 0.001) and stressful behaviors (β = 0.39, SE = 0.06, P < 0.001). Among households that experienced interruptions, predictability mitigated these respective relationships by approximately 25 and 50%. Where the provision of continuous water supplies is challenged by climate change, population growth, and poor management, water service providers may be able to mitigate some psychosocial consequences of intermittency through scheduled intermittency and communication about water supply interruptions. Service providers unable to supply continuous water should optimize intermittent water delivery to reduce negative impacts on users, and global monitoring regimes should account for intermittency and predictability in post-2030 water service metrics to better reflect household water insecurity experiences.

Access to Drinking Water, Sanitation, and Hand Hygiene Facilities in the Peri-Urban and Informal Settlements of Hosanna Town, Southern Ethiopia

Access to water, sanitation, and hygiene (WASH) facilities and practices have been extensively studied in urban and rural areas. However, there is a paucity of information on the coverage of water, sanitation, and hygiene facilities in the peri-urban and informal settlement areas, which could potentially exacerbate the spread of water, sanitation, and hygiene-related diseases. Therefore, this study was designed to examine access to drinking water, sanitation, and hand hygiene facilities and their determinant factors in the peri-urban and informal settlements of Hosanna town. A community-based cross-sectional study involving 292 households was conducted in 3 kebeles of Hosanna town. The primary data was collected using a pretested structured questionnaire and an observational checklist. Bivariate and multivariable logistic regressions were used to analyze the data. All the households (100%) had access to piped water on and off-premises, but the reliability of the water sources was a big challenge. Findings revealed that only 35.1% and 16.8% of the households had basic sanitation and basic handwashing facilities, respectively. Households with a middle income were identified as a determinant factor for the presence of piped water on premises (AOR = 2.23; 95% CI = 1.24-4.00), improved sanitation (AOR = 2.17; 95% CI = 1.17-4.03) and handwashing facilities (AOR = 4.36; 95% CI = 1.98-9.62). Piped water on premises was also another strong predictor of the availability of improved sanitation (AOR = 3.34; 95% CI = 1.99-5.62) and handwashing facilities (AOR = 8.18; 95% CI = 4.08-16.42). The majority of the studied households living in the selected peri-urban and informal settlements had access to unreliable drinking water sources. The study also revealed that households had poor access to basic sanitation and basic handwashing facilities. Hence, the findings call for solid government interventions to improve the reliability of the drinking water sources, basic sanitation coverage, and availability of basic handwashing facilities.

Pathways to consumer demand and payment for professional rural water infrastructure maintenance across low-income contexts

Systems for regular, preventive maintenance of infrastructure are needed to ensure safe water access globally. Emerging and growing across rural sub-Saharan Africa, professionalized maintenance arrangements feature legal, regulated service providers who maintain infrastructure in exchange for consumer payment through contracts. However, little is understood about the conditions that enable service providers to retain consumer contracts, an important component of their sustainability that indicates consistent demand and payment. This paper uses fuzzy-set Qualitative Comparative Analysis to identify combinations of operational, natural, physical, political, and social conditions enabling high contract retention across 22 implementation cases in Uganda, uncovering 2 pathways to success. In both pathways, consistent expansion by the service provider normalizes concepts such as tariff payment and local government participation increases trust and accountability between the service provider and consumers. The predominant pathway features one additional condition, coordinated sector aid, ensuring consistent implementation and mitigating harmful dependencies. The alternative pathway relies on large user communities and ease of access to those communities to counteract uncoordinated aid. Thus, operational, social, and political conditions may be sufficient to enable high contract retention irrespective of natural and physical conditions. This paper uncovers the combined efforts required of service providers, service authorities, international donors, and local aid actors to ensure the sustainable maintenance of rural water infrastructure for reliable safe water access.

Mapping and Visualizing Global Knowledge on Intermittent Water Supply Systems

Intermittent water supply systems (IWSSs) are prevalent in most developing countries and some developed ones. Their usage is driven by necessity rather than as a principal objective, mostly due to technical and economic deficiencies. Major health risks and socio-economic inequities are associated with such systems. Their impacts are aggravated by climate changes and the COVID-19 crisis. These are likely to have profound implications on progress toward advancing sustainable development goals (SDGs). Motivated by providing a comprehensive overview of global knowledge on IWSSs, the present work proposed to track and analyze research works on IWSSs utilizing bibliometric techniques and visual mapping tools. This includes investigating the trends and growth trajectories of research works on IWSSs and analyzing the various approaches proposed to expand our understanding with respect to the management, modeling, optimization, and impacts of IWSSs. The national and international contributions and collaboration figures are further analyzed at country, institution, author, and source levels. This analysis indicates that research works conducted on IWSSs have certain expectations in terms of productivity (total global productivity; 197 documents). The United States was the best country in terms of productivity (58 documents; 29.4%), while the Water Switzerland journal was the most productive journal (19 documents; 9.6%). The impacts of IWSSs on health and well-being have attracted considerable attention. The outcomes showed deep and justified worries in relation to the transition from intermittent to continuous supply, equity, and mitigating the health risks associated with IWSSs in the foreseen future. The utilization of artificial intelligence techniques and expert systems will drive and shape future IWSS-related research activities. Therefore, investments in this regard are crucial.

Measurement invariance of a household water insecurity metric in Greater Accra, Ghana: Implications for test-retest reliability

The mitigation of household water insecurity is recognized as an important component of global poverty alleviation, but until recently was difficult to measure. Several new metrics of household water insecurity have been proposed and validated, but few have been field-tested for reliability in diverse contexts. We used confirmatory factor analysis to test the psychometric equivalence of one such metric-the Household Water Insecurity Experiences (HWISE) scale-across two survey waves administered 18 months apart in similar climatic conditions among households in a peri-urban community outside of Accra, Ghana. The HWISE metric was not equivalent across survey waves, which may be attributable to the metric itself, sample size, subtle instrumentation changes, or other unobserved factors. Test-retest reliability may also be difficult to achieve given the dynamic nature of household water use, and we discuss the implications of using household water insecurity metrics as longitudinal measures of well-being in global anti-poverty programs.

Heavy metal concentrations in rivers and drinking water of Esmeraldas (Ecuador) under an intermittent water supply service

Universal access to safe water is a major global goal, but these efforts could be at stake because drinking water sources are becoming polluted in many developing countries. Chlorine, major ions, and heavy metals were measured in rivers and drinking water of Esmeraldas because potential pollution sources raise concerns about the quality of the water supply, and because users have developed strategies to cope with water shortages including collecting river water and water distributed by tankers, storing water at home, and consuming commercial bottled water. We sampled water from the water distribution system (WDS) and the Esmeraldas and Teaone rivers including the intake to the potabilization plant, water distributed by tankers, and commercial bottled water. Most of the samples collected from the Esmeraldas and Teaone rivers, the WDS, and tankers complied with drinking water standards, but higher concentration of cadmium and other metals in the eastern part of the city is an indication of corrosion inside the WDS. Commercial bottled and WDS water showed similar heavy metal concentrations, but regular consumption of some brands may lead to higher exposure to arsenic and mineral deficiencies. Chlorine concentrations in the water supplied by the WDS were below the values required for safe disinfection, and in-house chlorination is uncommon in the city. Strengthening pollution control in the Esmeraldas river, monitoring corrosion of the WDS, and promoting point-use chlorination and better water handling practices are required to secure a safer water supply in the long term.

Effective Demand for In-Line Chlorination Bundled with Rental Housing in Dhaka, Bangladesh

Delivering safe water in cities of lower- and middle-income countries remains elusive even where there is a piped supply. Passive, in-line chlorination upstream of the point of water collection reduces child diarrhea without the behavior change required for point-of-use water treatment products or manual chlorine dispensers. We conducted a price experiment to measure effective demand (willingness and ability to pay) for an in-line chlorination service using tablet chlorinators among 196 landlords of rental housing properties in Dhaka, Bangladesh. We offered a 12-month subscription using Becker-DeGroot-Marschak auctions with real money payments. The service consistently delivered chlorinated water and satisfied tenants. Landlords' effective demand for in-line chlorination was similar to or greater than that for point-of-use treatment products and manual chlorine dispensers previously documented among Dhaka households. Over the service period, landlords renting to low-income households had lower effective demand than those renting to middle-income households despite similar initial rates of payment across both groups. Making in-line chlorination financially viable for the lowest-income consumers would likely require service cost reductions, subsidies, or both. Our findings suggest that even revealed preference experiments may overestimate the effective demand needed to sustain water supply improvements, especially in low-income populations, if they only measure demand once.

Effects of hydraulically disconnecting consumer pumps in an intermittent water supply

We estimate 250 million people receive water using private pumps connected directly to intermittently pressurized distribution networks. Yet no previous studies have quantified the presumed effects of these pumps. In this paper, we investigate the effects of installing pressure-sustaining valves at consumer connections. These valves mimic pump disconnection by restricting flow. Installing these valves during the dry season at 94% of connections in an affluent neighborhood in Delhi, India, cut the prevalence of samples with turbidity > 4 NTU by two thirds. But considering the poor reputation of pumps, installed valves had surprisingly small average effects on turbidity (-8%; p<0.01) and free chlorine (+0.05 mg/L; p<0.001; N = 1,031). These effects were much smaller than the high variability in water quality supplied to both control and valve-installed neighborhoods. Site-specific responses to this variability could have confounded our results. At the study site, installed valves increased network pressure during 88% of the typical supply window; valves had a maximum pressure effect of +0.62 m (95% CI [0.54, 0.71]; a 40% increase vs. control). Further research is needed to generalize beyond our study site. Nevertheless, this paper provides unique evidence showing how the deployed valves mitigated pump effects, increased network pressure and improved water safety.

Effect of operational strategies on microbial water quality in small scale intermittent water supply systems: The case of Moamba, Mozambique

Intermittent drinking water supply affects the health of over 300 million people globally. In Mozambique, it is largely practiced in cities and small towns. This results in frequent microbial contamination of the supplied drinking water posing a health risk to consumers. In Moamba, a small town in Southern Mozambique with 2,500 water connections, the impact of changes in operational strategies, namely increased chlorine dosage, increased supply duration and first-flush, on the microbial water quality was studied to determine best practices. To that aim, water quality monitoring was enhanced to provide sufficient data on the microbial contamination from 452 samples under the different strategies. The water at the outlet of the water treatment plant during all strategies was free of E. coli complying to the national standards. However, E. coli could be detected at household level. By increasing the chlorine dosage, the number of samples that showed E. coli absence increased at the two sampling locations in the distribution network: in Cimento from 72% to 83% and in Matadouro from 52% to 86%. Modifying the number and duration of supply cycles showed a different impact on the water quality at both locations in the distribution network. A positive effect was shown in Cimento, where the mean concentrations decreased slightly from 0.54 to 0.23 CFU/100 mL and 16.7 to 7.3 CFU/100 mL for E. coli and total coliforms respectively. The percentage of samples positive for bacteria was, however, similar. In contrast, a negative effect was shown in Matadouro where the percentage of positive samples increased and the mean bacterial concentrations increased slightly: E. coli from 0.9 to 1.5 CFU/100 mL and total coliforms 17.6 to 23.0 CFU/100 mL. Enhanced water quality monitoring improved operational strategies safeguarding the microbial water quality. The E. coli contamination of the drinking water at household level could point at recontamination in the distribution or unsafe hygienic practices at household level. Presence of faecal contamination at household level indicates potential presence of pathogens posing a health risk to consumers. Increasing chlorine dosage ensured good microbiological drinking water quality but changing the number of supply cycles had no such effect.

Optimizing Household Water Decisions for Managing Intermittent Water Supply in Mexico City

One billion people worldwide experience intermittent water supply (IWS), in which piped water is delivered for limited durations. Households with IWS must invest in water storage infrastructure and often rely on multiple sources of water; therefore, these household-level purchasing and infrastructure decisions is a critical component of water access. Informed by interviews with IWS households, we use radial basis function networks, a type of artificial neural network, to determine optimal household water management decisions that maximize reliability of water supply while minimizing costs for a representative household in Mexico City that uses municipal piped water, trucked water, and rainwater. We find that securing reliable water supply for IWS households is greatly assisted by installation of household storage tanks of at least 2500 L. In the case of IWS households with limited storage options, the overall cost for water supply is reduced by scheduling water deliveries on nonconsecutive days. Rainwater harvesting systems were shown to be economically viable for households with limited water supply. This study demonstrates the importance of considering the management of multiple sources and household storage infrastructure when evaluating water investments in cities with IWS.

Cross-sectional study to measure household water insecurity and its health outcomes in urban Mexico

OBJECTIVE

To assess the links between structural and household determinants of household water insecurity and test three water insecurity measures against self-reported diarrhoea, dengue fever and perceived stress in the middle-income and low-income urban areas of Torreón, Mexico.

DESIGN

Cross-sectional household survey conducted in two waves (rainy and dry seasons).

PARTICIPANTS

500 households selected via multistage cluster sample in selected communities. Socioeconomic status determined the selection of participant neighbourhoods; five were identified in low socioeconomic status neighbourhoods and five in low-medium socioeconomic status neighbourhoods. We examine how the context of urban water provision is related to a new cross-culturally valid Household Water Insecurity Experiences (HWISE) Scale.

PRIMARY OUTCOME MEASURES

The HWISE Scale, self-reported diarrhoea, dengue fever and the Perceived Stress Scale.

RESULTS

Water system intermittency (adjusted OR (AOR) 3.96, 95% CI 2.40 to 6.54, p<0.001), unpredictability (AOR 2.24, 95% CI 1.34 to 3.74, p=0.002) and the dry season (AOR 3.47, 95% CI 2.18 to 5.52, p<0.001) were structural correlates of the HWISE Scale. This study also found that the HWISE Scale was associated with two health outcomes, self-reported diarrhoea (AOR 1.09, 95% CI 1.03 to 1.15, p=0.002) and perceived stress (β=0.28, SE=0.07, t=4.30, p<0.001), but not self-reported dengue fever (AOR 1.02, 95% CI 0.98 to 1.06). A 3-item hygiene subscore and a 3-item water worry subscore were also both positively associated with self-reported diarrhoea and perceived stress.

CONCLUSION

Short-form screeners of water insecurity may be useful for assessing certain health risks by lay survey workers in settings with limited healthcare resources, particularly in lieu of more expensive microbiological tests that require specialised training and facilities.

Drought Stress Impacts on Plants and Different Approaches to Alleviate Its Adverse Effects

Drought stress, being the inevitable factor that exists in various environments without recognizing borders and no clear warning thereby hampering plant biomass production, quality, and energy. It is the key important environmental stress that occurs due to temperature dynamics, light intensity, and low rainfall. Despite this, its cumulative, not obvious impact and multidimensional nature severely affects the plant morphological, physiological, biochemical and molecular attributes with adverse impact on photosynthetic capacity. Coping with water scarcity, plants evolve various complex resistance and adaptation mechanisms including physiological and biochemical responses, which differ with species level. The sophisticated adaptation mechanisms and regularity network that improves the water stress tolerance and adaptation in plants are briefly discussed. Growth pattern and structural dynamics, reduction in transpiration loss through altering stomatal conductance and distribution, leaf rolling, root to shoot ratio dynamics, root length increment, accumulation of compatible solutes, enhancement in transpiration efficiency, osmotic and hormonal regulation, and delayed senescence are the strategies that are adopted by plants under water deficit. Approaches for drought stress alleviations are breeding strategies, molecular and genomics perspectives with special emphasis on the omics technology alteration i.e., metabolomics, proteomics, genomics, transcriptomics, glyomics and phenomics that improve the stress tolerance in plants. For drought stress induction, seed priming, growth hormones, osmoprotectants, silicon (Si), selenium (Se) and potassium application are worth using under drought stress conditions in plants. In addition, drought adaptation through microbes, hydrogel, nanoparticles applications and metabolic engineering techniques that regulate the antioxidant enzymes activity for adaptation to drought stress in plants, enhancing plant tolerance through maintenance in cell homeostasis and ameliorates the adverse effects of water stress are of great potential in agriculture.

Place-Based Citizen Science for Assessing Risk Perception and Coping Capacity of Households Affected by Multiple Hazards

Since hazards act upon vulnerability and exposure to become disasters, the understanding of societal challenges is key for disaster risk reduction. This condition is even more critical when more than one hazard is in place. Taking the case of flooding and water shortage, this study is built upon the premise that disasters are a social phenomenon; therefore, it is essential to comprehend the social context in which they occur. Particularly, this study aims to evaluate the similarities and differences in risk perception and the coping capacity of residents in the multiple-hazard context. For this, a place-based citizen science approach was developed in this study in Campina Grande, a semiarid region of Brazil, with the collaboration of 199 participants. Risk perception and coping capacity were analysed through the citizens’ participation, while combining subjective and objective methods. The results indicate that even though residents have experienced severe flooding and water shortages in the past, they still have low coping capacity. The findings highlight the need to combine a triad of societal challenges, namely information, trust, and incentives, to improve coping capacity in the future and increase resilience. This study underlines the need to understand multiple hazards according to social, spatial, and temporal scales in a socio-spatial perspective.

The nexus between improved water supply and water-borne diseases in urban areas in Africa: a scoping review protocol

Introduction: Currently, an estimated two thirds of the world population is water insufficient. As of 2015, one out of every five people in developing countries do not have access to clean sufficient drinking water. In an attempt to share the limited resource, water has been distributed at irregular intervals in cities in developing countries. Residents in these cities seek alternative water sources to supplement the inadequate water supplied. Some of these alternative sources of water are unsafe for human consumption, leading to an increased risk in water-borne diseases. Africa contributes to 53% of the diarrheal cases reported globally, with contaminated drinking water being the main source of transmission. Water-borne diseases like diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus are a major public health concern. The main objective of this scoping review is to map the available evidence to understand the sources of water among residents in cities in Africa and the relationship between clean water sufficiency and water-borne diseases in urban Africa.

Methods and analysis: The search strategy will identify studies published in scientific journals and reports that are directly relevant to African cities that have a population of more than half a million residents as of 2014 AND studies on the ten emerging water-borne diseases, which are diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus.

Ethics and dissemination: This scoping review did not require any formal ethical approval. The findings will be published in a peer-reviewed journal.

Daily changes in household water access and quality in urban slums undermine global safe water monitoring programmes

Global drinking water monitoring programmes and studies on water quality in urban slums often overlook short-term temporal changes in water quality and health risks. The aim of this study was to quantify daily changes in household water access and quality in an urban slum in Malawi using a mixed-method approach. Household drinking water samples (n = 371) were collected and monitored for E. coli in tandem with a water access questionnaire (n = 481). E. coli concentrations in household drinking water changed daily, and no household had drinking water that was completely safe to drink every day. Seasonal changes in drinking water availability, intermittent supply, limited opening hours, and frequent breakdown of public water points contributed to poor access. Households relied on multiple water sources and regularly switched between sources to meet daily water needs. There were generally similar E. coli levels in water samples considered safe and unsafe by residents. This study provides the first empirical evidence that water quality, water access, and related health risks in urban slums change at much finer (daily) temporal scales than is conventionally monitored and reported globally. Our findings underscore that to advance progress towards Sustainable Development Goal (SDG) Target 6.1, it is necessary for global water monitoring initiatives to consider short-term changes in access and quality.

Intermittent Water Supply Management, Household Adaptation, and Drinking Water Quality: A Comparative Study in Two Chinese Provinces

Intermittent water supply (IWS) is a relatively common phenomenon across the world as well as in rural and peri-urban areas across China, though there has been little IWS-focused research from China published to date. IWS consumers typically adopt a range of strategies to cope with insufficient water supply, poor drinking water quality, and associated inconveniences. In this study, we collected a range of data from small-scale utilities and households in two IWS systems and two continuous water supply (CWS) systems, as well as from comparison groups, in Shandong and Hubei provinces. Data collection included water quality testing, interviews, and surveys on behavioral adaptations, coping strategies, water-related health perceptions, and other metrics of consumer satisfaction. Overall, we found that the IWS coping strategies employed in northern China (Shandong) were associated with generally safe, but inconvenient, water access, whereas adaptation strategies observed in southern China (Hubei) appeared to improve convenience, but not water quality. Compared to the CWS comparison groups, we did not observe significant differences in water- and sanitation-related behaviors in the IWS groups, suggesting interventions to increase adaptive and protective behaviors at the household level might further improve safe water access for households living with IWS. Overall, although the water supply infrastructure in these study areas appeared to be in relatively good condition, in contrast to reported data on IWS systems in other countries, we observed multiple risk factors associated with the water treatment and distribution processes in these IWS systems. Among policy recommendations, our results suggest that the implementation of Water Safety Plans in China would likely improve the management of drinking water treatment and, by extension, safe drinking water supply under conditions of IWS.

Measuring Human Water Needs

Water connects the environment, culture, and biology, yet only recently has it emerged as a major focus for research in human biology. To facilitate such research, we describe methods to measure biological, environmental, and perceptual indicators of human water needs. This toolkit provides an overview of methods for assessing different dimensions of human water need, both well‐established and newly‐developed. These include: (a) markers of hydration (eg, urine specific gravity, doubly labeled water) important for measuring the impacts of water need on human biological functioning; (b) methods for measuring water quality (eg, digital colorimeter, membrane filtration) essential for understanding the health risks associated with exposure to microbiological, organic, metal, inorganic nonmental, and other contaminants; and (c) assessments of household water insecurity status that track aspects of unmet water needs (eg, inadequate water service, unaffordability, and experiences of water insecurity) that are directly relevant to human health and biology. Together, these methods can advance new research about the role of water in human biology and health, including the ways that insufficient, unsafe, or insecure water produces negative biological and health outcomes.

Understanding the impacts of intermittent supply on the drinking water microbiome

Increasing access to piped water in low-income and middle-income countries combined with the many factors that threaten our drinking water supply infrastructure mean that intermittent water supply (IWS) will remain a common practice around the world. Common features of IWS include water stagnation, pipe drainage, intrusion, backflow, first flush events, and household storage. IWS has been shown to cause degradation as measured by traditional microbial water quality indicators. In this review, we build on new insights into the microbial ecology of continuous water supply systems revealed by sequencing methods to speculate about how intermittent supply conditions may further influence the drinking water microbiome, and identify priorities for future research.

Factors Associated with Water Service Continuity for the Rural Populations of Bangladesh, Pakistan, Ethiopia, and Mozambique

Access to continuous water supply is key for improving health and economic outcomes in rural areas of low- and middle-income countries, but the factors associated with continuous water access in these areas have not been well-characterized. We surveyed 4786 households for evidence of technical, financial, institutional, social, and environmental predictors of rural water service continuity (WSC), defined as the percentage of the year that water is available from a source. Multiple imputed fractional logistic regression models that account for the survey design were used to assess operational risks to WSC for piped supply, tube wells, boreholes, springs, dug wells, and surface water for the rural populations of Bangladesh, Pakistan, Ethiopia, and Mozambique. Multivariable regressions indicate that households using multiple water sources were associated with lower WSC in Bangladesh, Pakistan, and Mozambique. However, the possibility must be considered that households may use more than one water source because services are intermittent. Water scarcity and drought were largely unassociated with WSC, suggesting that service interruptions may not be primarily due to physical water resource constraints. Consistent findings across countries may have broader relevance for meeting established targets for service availability as well as human health.

Impacts of Intermittent Water Supply on Water Quality in Two Palestinian Refugee Camps

We investigated the quality of treated drinking water in Aida Camp and Alazzah Camp, two Palestinian refugee camps in the West Bank. Water supply in the two camps is intermittent: Water deliveries are first stored in a centrally located community tank before being pumped through distribution networks to users, who then store the water in rooftop tanks. Between March 2016 and June 2017, we examined water quality within the distribution system in the camps, testing 520 samples in Aida Camp and 198 samples in Alazzah Camp for total coliforms, Escherichia coli (E. coli) bacteria, and residual chlorine. We observed deterioration in water quality in both camps, but the deterioration was more pronounced in Aida Camp where 2.5% of community-tank samples, 5.0% of network samples, and 10% of rooftop-tank samples contained one or more colonies (per 100 mL) of total coliform bacteria. In Alazzah Camp, 3.7% of community-tank samples, 2.5% of network samples, and 5% rooftop-tank samples contained one or more colonies (per 100 mL) of total coliform bacteria. E. coli was detected in two samples from Aida Camp and one sample from Alazzah Camp. In both camps, average residual chlorine concentrations were higher in the community tanks than in rooftop tanks. The main factor influencing water quality deterioration in rooftop tanks in Aida Camp appears to be air temperature. We recommend more systematic water testing in the camps and greater transparency in reporting test results to camp residents.

Building a Methodology for Assessing Service Quality under Intermittent Domestic Water Supply

This document proposes a methodology for assessing the quality of water distribution service in the context of intermittent supply, based on a comparison of joint results from literature reviews and feedback from drinking water operators who had managed these networks, with standards for defining the quality of drinking water service. The paper begins by reviewing and proposing an analysis of the definition and characterization of intermittent water supply (IWS), highlighting some important findings. The diversity of approaches used to address the issue and the difficulty of defining a precise and detailed history of water supply in the affected systems broadens the spectrum of intermittency characterization and the problems it raises. The underlined results are then used to structure an evaluation framework for the water service and to develop improvement paths defined in the intermittent networks. The resulting framework highlights the means available to water stakeholders to assess their operational and management performance in achieving the improvement objectives defined by the environmental and socio-economic contexts in which the network operates. Practical examples of intermittent system management are collected from water system operators and presented for illustration purposes (Jeddah, Algiers, Port-au-Prince, Amman, Cartagena, Barranquilla, Mexico, Cancun, Saltillo, Mumbai, Delhi, Coimbatore …).

Dry Pipes: Associations between Utility Performance and Intermittent Piped Water Supply in Low and Middle Income Countries

Intermittent piped water supply impacts at least one billion people around the globe. Given the environmental and public health implications of poor water supply, there is a strong practical need to understand how and why intermittent supply occurs, and what strategies may be used to move utilities towards the provision of continuous water supply. Leveraging data from the International Benchmarking Network for Water and Sanitation Utilities, we discover 42 variables that have statistically significant associations with intermittent water supply at the utility scale across 2115 utilities. We categorized these under the following themes: Physical infrastructure system scale, coverage, consumer type, public water points, financial, and non-revenue water and metering. This research identifies globally relevant factors with high potential for cross-context, scaled impact. In addition, using insights from the analysis, we provide empirically grounded recommendations and data needs for improved global indicators of utility performance related to intermittent supply.

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.

Estimating Infection Risks and the Global Burden of Diarrheal Disease Attributable to Intermittent Water Supply Using QMRA

Intermittent water supply (IWS) is prevalent throughout low and middle-income countries. IWS is associated with increased microbial contamination and potentially elevated risk of waterborne illness. We used existing data sets to estimate the population exposed to IWS, assess the probability of infection using quantitative microbial risk assessment, and calculate the subsequent burden of diarrheal disease attributable to consuming fecally contaminated tap water from an IWS. We used reference pathogens Campylobacter, Cryptosporidium, and rotavirus as conservative risk proxies for infections via bacteria, protozoa, and viruses, respectively. Results indicate that the median daily risk of infection is an estimated 1 in 23 500 for Campylobacter, 1 in 5 050 000 for Cryptosporidium, and 1 in 118 000 for rotavirus. Based on these risks, IWS may account for 17.2 million infections causing 4.52 million cases of diarrhea, 109 000 diarrheal DALYs, and 1560 deaths each year. The burden of diarrheal disease associated with IWS likely exceeds the WHO health-based normative guideline for drinking water of 10^-6 DALYs per person per year. Our results underscore the importance water safety management in water supplies and the potential benefits of point-of-use treatment to mitigate risks.

Water quality effects of intermittent water supply in Arraiján, Panama

Intermittent drinking water supply is common in low- and middle-income countries throughout the world and can cause water quality to degrade in the distribution system. In this study, we characterized water quality in one study zone with continuous supply and three zones with intermittent supply in the drinking water distribution network in Arraiján, Panama. Low or zero pressures occurred in all zones, and negative pressures occurred in the continuous zone and two of the intermittent zones. Despite hydraulic conditions that created risks for backflow and contaminant intrusion, only four of 423 (0.9%) grab samples collected at random times were positive for total coliform bacteria and only one was positive for E. coli. Only nine of 496 (1.8%) samples had turbidity >1.0 NTU and all samples had ≥0.2 mg/L free chlorine residual. In contrast, water quality was often degraded during the first-flush period (when supply first returned after an outage). Still, routine and first-flush water quality under intermittent supply was much better in Arraiján than that reported in a previous study conducted in India. Better water quality in Arraiján could be due to better water quality leaving the treatment plant, shorter supply outages, higher supply pressures, a more consistent and higher chlorine residual, and fewer contaminant sources near pipes. The results illustrate that intermittent supply and its effects on water quality can vary greatly between and within distribution networks. The study also demonstrated that monitoring techniques designed specifically for intermittent supply, such as continuous pressure monitoring and sampling the first flush, can detect water quality threats and degradation that would not likely be detected with conventional monitoring.

How Do Households Respond to Unreliable Water Supplies? A Systematic Review

Although the Millennium Development Goal (MDG) target for drinking water was met, in many developing countries water supplies are unreliable. This paper reviews how households in developing countries cope with unreliable water supplies, including coping costs, the distribution of coping costs across socio-economic groups, and effectiveness of coping strategies in meeting household water needs. Structured searches were conducted in peer-reviewed and grey literature in electronic databases and search engines, and 28 studies were selected for review, out of 1643 potentially relevant references. Studies were included if they reported on strategies to cope with unreliable household water supplies and were based on empirical research in developing countries. Common coping strategies include drilling wells, storing water, and collecting water from alternative sources. The choice of coping strategies is influenced by income, level of education, land tenure and extent of unreliability. The findings of this review highlight that low-income households bear a disproportionate coping burden, as they often engage in coping strategies such as collecting water from alternative sources, which is labour and time-intensive, and yields smaller quantities of water. Such alternative sources may be of lower water quality, and pose health risks. In the absence of dramatic improvements in the reliability of water supplies, a point of critical avenue of enquiry should be what coping strategies are effective and can be readily adopted by low income households.