Human and Animal Fecal Contamination of Community Water Sources, Stored Drinking Water and Hands in Rural India Measured with Validated Microbial Source Tracking Assays

Validation and application of high-throughput quantitative PCR for the simultaneous detection of microbial source tracking markers in environmental water

No single microbial source tracking (MST) marker can be applied to determine the sources of fecal pollution in all water types. This study aimed to validate a high-throughput quantitative polymerase chain reaction (HT-qPCR) method for the simultaneous detection of multiple MST markers. A total of 26 fecal-source samples that had been previously collected from human sewage (n = 6) and ruminant (n = 3), dog (n = 6), pig (n = 6), chicken (n = 3), and duck (n = 2) feces in the Kathmandu Valley, Nepal, were used to validate 10 host-specific MST markers, i.e., Bacteroidales (BacHum, gyrB, BacR, and Pig2Bac), mitochondrial DNA (mtDNA) (swine, bovine, and Dog-mtDNA), and viral (human adenovirus, porcine adenovirus, and chicken/turkey parvovirus) markers, via HT-qPCR. Only Dog-mtDNA showed 100 % accuracy. All the tested bacterial markers showed a sensitivity of 100 %. Nine of the 10 markers were further used to identify fecal contamination in groundwater sources (n = 54), tanker filling stations (n = 14), drinking water treatment plants (n = 5), and river water samples (n = 6). The human-specific Bacteroidales marker BacHum and ruminant-specific Bacteroidales marker BacR was detected at a high ratio in river water samples (83 % and 100 %, respectively). The results of HT-qPCR were in agreement with the standard qPCR. The comparable performances of HT-qPCR and standard qPCR as well as the successful detection of MST markers in the fecal-source and water samples demonstrated the potential applicability of these markers for detecting fecal contamination sources via HT-qPCR.

Bacterial strain sharing between humans, animals, and the environment among urban households

Identifying bacterial transmission pathways is crucial to inform strategies aimed at curbing the spread of pathogenic and antibiotic-resistant bacteria, especially in rapidly urbanizing low- and middle-income countries. In this study, we assessed bacterial strain-sharing and dissemination of antibiotic resistance across humans, domesticated poultry, canines, household soil, and drinking water in urban informal settlements in Nairobi, Kenya. We collected 321 samples from 50 households and performed Pooling Isolated Colonies-seq (PIC-seq) by sequencing pools of up to five Escherichia coli colonies per sample to capture strain diversity, strain-sharing patterns, and overlap of antibiotic-resistant genes (ARGs). Bacterial strains isolated from the household environment carried clinically relevant ARGs, reinforcing the role of the environment in antibiotic resistance dissemination. Strain-sharing rates and resistome similarities across sample types were strongly correlated within households, suggesting clonal spread of bacteria is a main driver of dissemination of ARGs in the domestic urban environment. Within households, E. coli strain-sharing was rare between humans and animals but more frequent between humans and drinking water. E. coli contamination in stored drinking water was also associated with higher strain-sharing between humans in the same household. Our study demonstrates that contaminated drinking water facilitates human to human strain sharing and water treatment can disrupt transmission.

The mediatory role of water quality on the association between extreme precipitation events and infectious diarrhea in the Yangtze River Basin, China

Extreme precipitation is exacerbating the burden of infectious diarrhea in the context of climate change, it is necessary to identify the critical and easy-to-intervene intermediate factors for public health strategies. Water quality may be the most important mediator, while relevant empirical evidence is limited. This study aimed to examine the role of water quality in the process of infectious diarrhea caused by extreme precipitation. Weekly infectious diarrhea cases, meteorological factors and water quality data in Yangtze River Basin in China between October 29, 2007 to February 19, 2017 were obtained. Two-stage statistical models were used to estimate city-specific extreme precipitation, water quality and infectious diarrhea relationships that were pooled to derive regional estimates. A causal mediation analysis was used to assess the mediation effect of water quality. In Yangtze River Basin, extreme precipitation events had a significant impact on infectious diarrhea (Incidence Rate Ratios [IRR]: 1.027, 95% Confidence Interval [CI]: 1.013∼1.041). After extreme precipitation events, the dissolved oxygen (DO) in surface water decreased (-0.123 mg/L, 95%CI: -0.159 mg/L∼-0.086 mg/L), while the un-ionized ammonia (NH(3)-N) increased (0.004 mg/L, 95%CI: 0.001 mg/L∼0.006 mg/L). The combined overall effect of DO and NH(3)-N on infectious diarrhea showed that both low and high concentrations were associated with an increased risk of infectious diarrhea. The causal mediation analysis showed that the mediation proportion of the two water quality indexes (DO and NH(3)-N) is 70.54% (P < 0.001). To reduce the health effects of extreme precipitation, in contrast to current population-oriented health strategies, those that take into account more direct and easy-to-intervene water quality indicators should be encouraged by future policies.

Animal Handling Practice Among Rural Households in Northwest Ethiopia Increases the Risk of Childhood Diarrhea and Exposure to Pathogens From Animal Sources

Background

In Ethiopia, domestic animals and their feces are not properly contained. However, the risk of exposure to zoonotic pathogens is not well documented. This study was conducted to assess animal handling practices and the risk of childhood diarrhea among rural households in northwest Ethiopia.

Methods

This study was done among 403 randomly selected households. Information on animal handling was collected using a questionnaire and spot-check observation. The occurrence of childhood diarrhea in 14 days prior to the survey was assessed based on the reports of female head of households. Multivariable binary logistic regression analysis was performed to identify the association between animal handling practices and childhood diarrhea.

Results

All the female head of households had contact with animal feces when preparing fuel disks and plastering the house components with animal dung. Domestic animals shared a corral within the living space of the humans in 20% of the households. Animals entered the human living quarters and accessed foods in 32% of the households. Moreover, 24% of the children aged 24 to 59 months had diarrhea in a 2-week period prior to the survey. Childhood diarrhea was associated with domestic animals sharing the same house as humans (AOR: 3.3, 95% CI: 1.3, 8.6), presence of animal excreta in child playing areas (AOR: 2.4, 95% CI: 1.2, 4.6), contact of domestic animals with stored foods (AOR: 3.5, 95% CI: 2.0, 5.9), trapped dirt under fingernails of female heads (AOR: 3.7, 95% CI: 1.9, 7.5), open defecation (AOR: 3.24, 95% CI: 1.8, 5.9), and unprotected sources (AOR: 4.2, 95% CI: 1.1, 15.3).

Conclusion

Domestic animals and their excreta are not hygienically contained in the area. Animal handling practices including their excreta and the hygiene behavior of female head of households (eg, handwashing and food handling practices) should be improved to prevent childhood diarrhea.

Identification of fecal contamination sources of groundwater in rural areas of Vhembe District Municipality, Limpopo Province, South Africa

Groundwater is a valuable source of drinking water worldwide, recognized as an improved drinking water source. However, on-site sanitation systems may put groundwater at risk of fecal contamination. In the present study, two approaches were used to ascertain the sources of fecal contamination in groundwater used by communities of the Vhembe District Municipality. Overall, 87.5% of boreholes (n = 70) in the wet and 72.5% in the dry season were contaminated with Escherichia coli, and septic tank (n = 18) wastewaters displayed up to 104  cfu/mL E. coli. Host-specific Bacteroidales quantitative polymerase chain reaction (qPCR) assays established the presence of human (BacHum and HF183) and animal (Cytb, BacCan, and Pig-2Bac) genetic markers in groundwater from 15.7% of boreholes (wet) and 10% of boreholes (dry). No strong associations were founded between culturable E. coli counts and the presence/absence of marker genes for all the markers except for Cytb marker, which showed a weak significant correlation (r = 0.217; p = <0.01) between E. coli and the Cytb marker under dry seasonal conditions. Human markers and Cytb were present in the household septic tank wastewater samples. Significant differences in marker genes distribution in wastewater were observed using the Chi-squared test: HF183 (p = <0.001) and BacHum (p = <0.001). Overall, no association was recorded between markers in groundwater and in wastewater for 18 households' septic tanks. A combined culturable E. coli and host-specific Bacteroidales qPCR assays remain an appropriate approach for the identification of fecal contamination of groundwater. PRACTITIONER POINTS: Households primarily used private boreholes for drinking water, as a primary source. Most households used on-site sanitation systems, including ventilated improved pit latrines and flush toilets connected to septic tanks. Escherichia coli was detected in groundwater, and the sources of fecal contamination were humans and animals (pigs, dogs, and chickens). The presence of human and animal markers in groundwater suggests that humans and animals are liable for fecal contamination. Fecal contamination in drinking water sources poses a significant concern due to pathogenic microorganisms posing potential human health risks.

Effects of an integrated poultry value chain, nutrition, gender and WASH intervention (SELEVER) on hygiene and child morbidity and anthropometry in Burkina Faso: A secondary outcome analysis of a cluster randomised trial

Nutrition-sensitive agriculture programmes have the potential to improve child nutrition outcomes, but livestock intensification may pose risks related to water, sanitation and hygiene (WASH) conditions. We assessed the impact of SELEVER, a nutrition- and gender-sensitive poultry intervention, with and without added WASH focus, on hygiene practices, morbidity and anthropometric indices of nutrition in children aged 2-4 years in Burkina Faso. A 3-year cluster randomised controlled trial was implemented in 120 villages in 60 communes (districts) supported by the SELEVER project. Communes were randomly assigned using restricted randomisation to one of three groups: (1) SELEVER intervention (n = 446 households); (2) SELEVER plus WASH intervention (n = 432 households); and (3) control without intervention (n = 899 households). The study population included women aged 15-49 years with an index child aged 2-4 years. We assessed the effects 1.5-years (WASH substudy) and 3-years (endline) post-intervention on child morbidity and child anthropometry secondary trial outcomes using mixed effects regression models. Participation in intervention activities was low in the SELEVER groups, ranging from 25% at 1.5 years and 10% at endline. At endline, households in the SELEVER groups had higher caregiver knowledge of WASH-livestock risks (∆ = 0.10, 95% confidence interval [CI] [0.04-0.16]) and were more likely to keep children separated from poultry (∆ = 0.09, 95% CI [0.03-0.15]) than in the control group. No differences were found for other hygiene practices, child morbidity symptoms or anthropometry indicators. Integrating livestock WASH interventions alongside poultry and nutrition interventions can increase knowledge of livestock-related risks and improve livestock-hygiene-related practices, yet may not be sufficient to improve the morbidity and nutritional status of young children.

Designing nutrition-sensitive agriculture (NSA) interventions with multi-criteria decision analysis (MCDA): a review

Despite the efforts to end malnutrition through intensive agriculture of caloric crops, micronutrient deficiencies and other forms of malnutrition persist in vulnerable communities worldwide. Nutrition-sensitive agriculture (NSA) interventions are recognized as chances to address the causes of malnutrition. In this work, the different types of NSA interventions were explored, as well as the pathways through which they can improve nutrition (e.g., increasing biofortified crops and income generation via agricultural sales for a positive impact on access to nutritious foods, and simultaneously involving nutrition education to improve care practices and eventually nutritional status). Some NSA interventions focus on one pathway. Well-designed interventions, however, should follow multi-pathway approaches targeting the underlying causes of undernutrition within the selected population. The circumstances in which certain indicators should be used to measure the impact of an NSA intervention in each stage of the full pathway were also explained, as well as the need of enhancing the design of such interventions. Multi-criteria decision analysis (MCDA) has been employed to solve agriculture-related issues, but it has not been used to identify the optimal types of NSA interventions, metrics, and indicators based on the context of the community, priorities and objectives of the project managers and designers, etc.

Measurement in the study of human exposure to animal feces: A systematic review and audit

BACKGROUND

Human exposure to animal feces is increasingly recognized as an important transmission route of enteric pathogens. Yet, there are no consistent or standardized approaches to measurement of this exposure, limiting assessment of the human health effects and scope of the issue.

OBJECTIVE

To inform and improve approaches to the measurement of human exposure to animal feces, we audited existing measurement in low- and middle-income countries.

METHODS

We systematically searched peer-reviewed and gray literature databases for studies with quantitative measures of human exposure to animal feces and we classified measures in two ways. First, using a novel conceptual model, we categorized measures into three 'Exposure Components' identified a priori (i.e., Animal, Environmental, Human Behavioral); one additional Component (Evidence of Exposure) inductively emerged. Second, using the exposure science conceptual framework, we determined where measures fell along the source-to-outcome continuum.

RESULTS

We identified 1,428 measures across 184 included studies. Although studies overwhelmingly included more than one single-item measure, the majority only captured one Exposure Component. For example, many studies used several single-item measures to capture the same attribute for different animals, all of which were classified as the same Component. Most measures captured information about the source (e.g. animal presence) and contaminant (e.g. animal-sourced pathogens), which are most distal from exposure on the source-to-outcome continuum.

DISCUSSION

We found that measurement of human exposure to animal feces is diverse and largely distal from exposure. To facilitate better assessment of the human health effects of exposure and scope of the issue, rigorous and consistent measures are needed. We recommend a list of key factors from the Animal, Environmental, and Human Behavioral Exposure Components to measure. We also propose using the exposure science conceptual framework to identify proximal measurement approaches.

Enteric infections and management practices among communities in a rural setting of northwest Ethiopia

Infections with enteric pathogens have a high mortality and morbidity burden, as well as significant social and economic costs. Poor water, sanitation, and hygiene (WASH) conditions are the leading risk factors for enteric infections, and prevention in low-income countries is still primarily focused on initiatives to improve access to improved WASH facilities. Rural communities in developing countries, on the other hand, have limited access to improved WASH services, which may result in a high burden of enteric infections. Limited information also exists about the prevalence of enteric infections and management practices among rural communities. Accordingly, this study was conducted to assess enteric infections and management practices among communities in a rural setting of northwest Ethiopia. A community-based cross-sectional study was conducted among 1190 randomly selected households in a rural setting of northwest Ethiopia. Data were collected using structured and pretested interviewers-administered questionnaire and spot-check observations. We used self-reports and medication history audit to assess the occurrence of enteric infections among one or more of the family members in the rural households. Multivariable binary logistic regression model was used to identify factors associated with enteric infections. Statistically significant association was declared on the basis of adjusted odds ratio with 95% confidence interval and p value < 0.05. Out of a total of 1190 households, 17.4% (95% CI: 15.1, 19.7%) of the households reported that one or more of the family members acquired one or more enteric infections in 12 months period prior to the survey and 470 of 6089 (7.7%) surveyed individuals had one or more enteric infections. The common enteric infections reported at household-level were diarrhea (8.2%), amoebiasis (4.1%), and ascariasis (3.9%). Visiting healthcare facilities (71.7%), taking medications without prescriptions (21.1%), and herbal medicine (4.5%) are the common disease management practices among rural households in the studied region. The occurrence of one or more enteric infections among one or more of the family members in rural households in 12 months period prior to the survey was statistically associated with presence of livestock (AOR: 2.24, 95% CI:1.06, 4.75) and households headed by uneducated mothers (AOR: 1.62, 95% CI: (1.18, 2.23). About one-fifth of the rural households in the studied region reported that one or more of the family members had one or more enteric infections. Households in the study area might acquire enteric infections from different risk factors, mainly poor WASH conditions and insufficient separation of animals including their feces from human domestic environments. It is therefore important to implement community-level interventions such as utilization of improved latrine, protecting water sources from contamination, source-based water treatment, containment of domestic animals including their waste, community-driven sanitation, and community health champion.

Sources and microbiological quality of domestic water in three rural communities in the southern Caribbean

This study investigated the sources and microbiological quality of domestic water used by rural communities of Speightstown, Barbados; Carriacou, Grenada; and Nariva, Trinidad. The primary water source was harvested rainwater in Carriacou, and the public water supply for Nariva and Speightstown. Secondary water supplies of the communities came from untreated sources including rainwater, wells, boreholes and springs. E. coli was detected at higher frequencies in water from Carriacou (41.3%) and Nariva (47.4%) than Speightstown (3.6%). Generally, more untreated samples of rainwater (44.6%) and surface/ground water (58.3%) were E. coli positive than treated water obtained from the public supply (9.9%). These findings demonstrate the increased risk to residents in rural communities of the Caribbean who utilize untreated rainwater and environmental sources such as springs and wells. These results demonstrate the usefulness of traditional methods such as the compartment bag test in determining the microbiological quality of domestic water in resource-challenged rural communities of the Caribbean.

Exploring the determinants and indicators of poultry feces management behaviors in rural Western Uganda

Animal ownership has reported financial and nutritional benefits but has also been associated with enteric and respiratory infections, and inadequate sanitation and hygiene can lead to children touching and ingesting animal fecal matter. We identified key indicators for poultry feces management and investigated their social determinants using data from a baseline survey of a randomized-controlled trial of a poultry management training program in rural Western Uganda. The baseline survey was conducted in the Masindi and Kiryandongo districts of Uganda in September 2019, and data collected from 609 households were used. We evaluated indicators for poultry feces management behaviors using scale development methods, including descriptive statistics, bivariate correlation analyses, and Factor Analysis of Mixed Data. We also investigated social determinants of key poultry feces management behaviors using logistic and multinomial logistic regression models. A significant increase in odds of having free-roaming poultry was found for each additional poultry owned (OR = 1.18, P < 0.001). The odds of a household having an observed enclosure for poultry increased by 5% with each incremental poultry owned (OR = 1.05, P < 0.001), and by 4% with increasing wealth with each additional point on the poverty probability index score (OR = 1.04, P < 0.001). Our results also suggest enclosures are intermittently used and constructing them without further intervention likely will not be sufficient for effectively managing animal fecal contamination. We recommend that future studies on animal feces management measure indicators for corralling and feces disposal practices and evaluate their relationship to enteric pathogen exposure and health outcomes. Insights from this work can inform the development of robust indicators of poultry feces management behaviors that can be used for monitoring and evaluation purposes.

Differences in levels of E. coli contamination of point of use drinking water in Bangladesh

This study aimed to quantify the inequalities and identify the associated factors of the UN sustainable development goal (SDG) targets in relation to safe drinking water. The concentration of the gut bacterium Escherichia coli in drinking water at the point of use (POU) and other information were extracted from the latest wave of the nationally representative Bangladesh Multiple Indicator Cluster Survey (MICS 2019). Bivariate and multivariable multinomial logistic regression models were used to identify potential predictors of contamination, whereas, classification trees were used to determine specific combinations of background characteristics with significantly higher rates of contamination. A higher risk of contamination from drinking water was observed for households categorized as middle or low wealth who collected water from sources with higher concentrations of E. coli. Treatment of drinking water significantly reduced the risk of higher levels of contamination, whereas owning a pet was significantly associated with recontamination. Regional differences in the concentrations of E. coli present in drinking water were also observed. Interventions in relation to water sources should emphasize reducing the level of E. coli contamination. Our results may help in developing effective policies for reducing diarrheal diseases by reducing water contamination risks.

Fecal indicator bacteria along multiple environmental exposure pathways (water, food, and soil) and intestinal parasites among children in the rural northwest Ethiopia

BACKGROUND

Children in low-resource settings are exposed to multiple risk factors for enteropathogens. However, the probability of exposures may be different across exposure pathways. Accordingly, this study was conducted to assess environmental exposures of children to intestinal parasites in the east Dembiya district of Ethiopia.

METHODS

A cross-sectional study was conducted for 372 households with children aged 24-59 months. The potential for external exposure of children to intestinal parasites was assessed by determining the presence of fecal indicator organism (Escherichia coli (E. coli)) in drinking water at point of use, ready-to-eat foods, and courtyard soil from children's outdoor play areas. For internal exposure assessment, ova of parasites in stool samples was detected using wet mount and Kato-Katz techniques to estimate exposure to intestinal parasites. The external and internal exposure assessments were also complemented using questionnaire and spot-check observations to assess behaviors that result in high risk of exposure. Individual and community-level predictors of intestinal parasites were identified using a multilevel logistic regression model. Statistically significant variables were identified on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05.

RESULTS

Ova of one or more intestinal parasites was detected among 178 (47.8%) (95% CI 42.8, 52.6%) of the children. The most common intestinal parasites were A. lumbricoides (20.7%) and S. mansoni (19.1%). Furthermore, E. coli was detected in 69.1% of drinking water samples at point of use, 67.5% of ready-to-eat food samples, and 83.1% of courtyard soil samples from children's outdoor play areas. Exposure of children to intestinal parasites among children in the studied region was associated with poor hand hygiene of mothers (AOR 1.98, 95% CI (1.07, 3.66), poor hand hygiene of children (AOR 3.20, 95% CI (1.77, 5.77), mouthing of soil contaminated materials (AOR 2.31, 95% CI (1.26, 4.24), open defecation practices (AOR 2.22, 95% CI (1.20, 4.10), limited access to water (AOR 2.38, 95% CI (1.13, 5.01), water contamination (AOR 2.51, 95% CI (1.31, 4.80), food contamination (AOR 3.21, 95% CI (1.69, 6.09), and soil contamination (AOR 2.56, 95% CI (1.34, 4.90).

CONCLUSION

An extensive E. coli contamination of water, foods, and courtyard soil was found in the studied region and the potential sources of contamination were open defecation practices, unhygienic disposal of wastes, poor animal husbandry and keeping practices, and poor water and food safety measures at household level. Moreover, fecal contamination of water, foods, and soil linked to exposure of children to intestinal parasites in the studied region. Thus, it is critical to implement individual-level interventions (such as latrine utilization, hand hygiene promotion, food safety, home-based water treatment, and containment of domestic animals), plus community-level interventions (such as protecting water sources from contamination, source-based water treatment, and community-driven sanitation).

Water treatment at the point-of-use and treatment preferences among households in Ethiopia: A contemporaneous systematic review and meta-analysis

BACKGROUND

Water is essential for maintaining human life, health, and dignity. Untreated water consumption causes 1.8 million deaths annually, over 99.8% of which happen in developing nations and 90% of which include children. Point-of-use water treatment enables people without reliable access to safe drinking water to reduce contamination and minimize microbial risk levels. This Systematic Review and Meta-analysis was, therefore, used to identify, select, and critically appraise relevant evidence about water treatment practices and their associated factors among Ethiopian households.

METHODS

PubMed, Science Direct, Web of Science, Scopus, Embase, Google Scholar, ProQuest, and other databases were searched for studies published before May 5, 2022. The final synthesis included twelve investigations. Microsoft Excel was used to extract the data, and STATA 16 was used for the analysis. The Joanna Briggs Institute's Critical assessment checklist for prevalence studies was used to evaluate the quality of the included studies. Egger's test and funnel plot were used to assess publication bias. I2 statistics were calculated to check for study heterogeneity. The DerSimonian and Laird random-effects model was used to analyze the pooled effect size, odds ratios, and 95% confidence intervals across studies. Analysis of subgroups was done by publication year and geographic region.

RESULTS

Of the 550 identified articles, 12 studies were eligible for analysis (n = 4849 participants). The pooled prevalence estimate of point-of-use water treatment practice among Ethiopian homes was 36.07% (95% CI: 21.94-50.19, I2 = 99.5%). Receiving training from Community health workers (OR, 1.7; 95% CI: 1.33-2.08), female headship (OR, 2.52; 95% CI: 1.60-3.44), and household wealth (OR, 1.6; 95% CI: 1.19-2.16) were significantly associated with point-of-use water treatment practice.

CONCLUSION

Despite the absence of safely managed water sources, very few homes routinely treated their drinking water. Adoption of water treatment practices necessitates ongoing communication and assistance from health extension personnel. Moreover, program planners must be aware of the many user categories that households may fall under to guarantee that ongoing training messages and treatment products reach every home.

Potable water quality assessment of traditionally used springs in a hilly town of Bhaderwah, Jammu and Kashmir, India

The quality of spring water and its suitability for human consumption is determined by examining its physicochemical and microbiological characteristics. Preliminary investigations were conducted to determine the potability of seven traditionally used springs in the highly populated hill town of Bhaderwah in Union Territory of Jammu and Kashmir, India. The water analysis was performed for various physico-chemical and microbial parameters during April 2019-March 2020. Water temperature, TDS, EC, pH, DO, free CO₂, total alkalinity, total hardness, Ca²⁺, Mg²⁺, Na⁺, K⁺, CO₃^2-, HCOֿ₃, Cl‾, NOֿ_3, PO₄^3-, SO₄^2-, total coliforms, and thermotolerant coliforms were all measured. Eleven physical and chemical characteristics were used to generate the Water Quality Index. The Piper diagram demonstrated the predominance of Ca²⁺-HCOֿ₃ water types, whereas the Schoeller diagram indicated that all springs had a similar lithological origin. The chemical composition of springs tested met the required criteria for drinking water quality. The microbiological indicators, on the other hand, did not satisfy the criteria except for Eidgah spring, which lacked thermotolerant coliforms. Our results on spring water potability indicate that the town's most dependable springs are susceptible to anthropogenic contamination and therefore need treatment prior to use. Apart from frequent monitoring, the responsible municipal corporation is expected to develop comprehensive plans to rehabilitate and revitalise these vulnerable drinking water sources.

Household Water Treatment Practice and Associated Factors in Gibe District Southern Ethiopia: A Community Based Cross-Sectional Study

BACKGROUND

Household water treatment practice or managing water at the point-of-use provides a means of improving drinking water quality and preventing diarrheal diseases. However, evidence regarding household water treatment practice and associated factors in Ethiopia, particularly in Southern Ethiopia are limited. This study was, therefore, designed to assess household water treatment practice and associated factors among households in Southern Ethiopia.

METHODS

A community-based cross-sectional study design was conducted among 627 households in Southern Ethiopia. A stratified random sampling technique was used in this study and a pre-tested structured questionnaire was used to collect data about household water treatment practice and associated factors among selected households through face-to-face interviews. The data were analyzed using descriptive statistical tests and binary logistic regression was performed to assess the association between independent and dependent variables. Odds ratio with 95% confidence intervals were used to determine the level of association.

RESULTS

This study revealed that the level of household water treatment practice was 34.3% with 95% CI (30.7-38.1) and boiling was the most common method of household water treatment in the study area. Educational status of having formal education (AOR = 2.01, 95% CI = 1.34-3), withdrawing water from storage vessel by dipping (AOR = 1.86, 95% CI = 1.2-2.87) and frequency of fetching water 3 or more times and above a day (AOR = 2.65, 95% CI = 1.45-4.88) were significantly associated with household water treatment practice.

CONCLUSION

Household water treatment practice is low in the study area. Educational status of having a formal education, drawing water by dipping, and those who collect their drinking water 3 or more times a day were predictors of household water treatment practice. Thus, efforts should be made to increase the level of household water treatment practice especially among those with no formal education and further studies should be conducted to understand the behavioral factors associated with household water treatment practice.

Benefits and Risks of Smallholder Livestock Production on Child Nutrition in Low- and Middle-Income Countries

Livestock production may improve nutritional outcomes of pregnant women and children by increasing household income, availability of nutrient-dense foods, and women's empowerment. Nevertheless, the relationship is complex, and the nutritional status of children may be impaired by presence of or proximity to livestock and their pathogens. In this paper, we review the benefits and risks of livestock production on child nutrition. Evidence supports the nutritional benefits of livestock farming through income, production, and women's empowerment. Increasing animal source food consumption requires a combination of efforts, including improved animal management so that herd size is adequate to meet household income needs and consumption and addressing sociocultural and gendered norms. Evidence supports the inclusion of behavior change communication strategies into livestock production interventions to facilitate the sustainability of nutritional benefits over time, particularly interventions that engage women and foster dimensions of women's empowerment. In evaluating the risks of livestock production, evidence indicates that a broad range of enteric pathogens may chronically infect the intestines of children and, in combination with dietary deficits, may cause environmental enteric dysfunction (EED), a chronic inflammation of the gut. Some of the most important pathogens associated with EED are zoonotic in nature with livestock as their main reservoir. Very few studies have aimed to understand which livestock species contribute most to colonization with these pathogens, or how to reduce transmission. Control at the point of exposure has been investigated in a few studies, but much less effort has been spent on improving animal husbandry practices, which may have additional benefits. There is an urgent need for dedicated and long-term research to understand which livestock species contribute most to exposure of young children to zoonotic enteric pathogens, to test the potential of a wide range of intervention methods, to assess their effectiveness in randomized trials, and to assure their broad adaptation and sustainability. This review highlights the benefits and risks of livestock production on child nutrition. In addition to identifying research gaps, findings support inclusion of poor gut health as an immediate determinant of child undernutrition, expanding the established UNICEF framework which includes only inadequate diet and disease.

Is It Human or Animal? The Origin of Pathogenic E. coli in the Drinking Water of a Low-Income Urban Community in Bangladesh

This study aimed to investigate the origin of diverse pathotypes of E. coli, isolated from communal water sources and from the actual drinking water vessel at the point-of-drinking inside households in a low-income urban community in Arichpur, Dhaka, Bangladesh, using a polymerase chain reaction (PCR). Forty-six percent (57/125, CI 95%: 41−58) of the isolates in the point-of-drinking water and 53% (55/103, CI 95%: 45−64) of the isolates in the source water were diarrheagenic E. coli. Among the pathotypes, enterotoxigenic E. coli (ETEC) was the most common, 81% (46/57) of ETEC was found in the point-of-drinking water and 87% (48/55) was found in the communal source water. Phylogenetic group B1, which is predominant in animals, was the most frequently found isolate in both the point-of-drinking water (50%, 91/181) and in the source (50%, 89/180) water. The phylogenetic subgroup B2₃, usually of human origin, was more common in the point-of-drinking water (65%, 13/20) than in the source water (35%, 7/20). Our findings suggest that non-human mammals and birds played a vital role in fecal contamination for both the source and point-of-drinking water. Addressing human sanitation without a consideration of fecal contamination from livestock sources will not be enough to prevent drinking-water contamination and thus will persist as a greater contributor to diarrheal pathogens.

Library-independent source tracking of fecal contamination in selected stations and tributaries of Laguna Lake, Philippines

Laguna Lake is the largest inland freshwater body in the Philippines. Although it is classified to be usable for agricultural and recreational purposes by the country's Department of Environment and Natural Resources (DENR), studies looking at lake ecology revealed severe fecal contamination which contributes to the deterioration of water quality. Determining the sources of fecal contamination is necessary for lake protection and management. This study utilized a library-independent method of microbial source tracking (LIM-MST) to identify sources of fecal contamination in selected Laguna Lake stations and tributaries. Genetic markers of the host-associated Escherichia coli, heat-labile toxin (LTIIA) and heat-stable II (STII), were used to identify cattle and swine fecal contaminations, respectively. Meanwhile, human mitochondrial DNA (mtDNA) was used to identify human fecal contamination. Results identified the presence of agricultural and human fecal contamination in Laguna Lake Stations 1 and 5, Mangangate River, and Alabang River. The selected sites are known to be surrounded by residential and industrial complexes, and most of their discharges find their way into the lake. The identification of the specific sources of fecal contamination will guide management practices that aim to regulate the discharges in order to improve the water quality of Laguna Lake.

Impacts of an Urban Sanitation Intervention on Fecal Indicators and the Prevalence of Human Fecal Contamination in Mozambique

Fecal source tracking (FST) may be useful to assess pathways of fecal contamination in domestic environments and to estimate the impacts of water, sanitation, and hygiene (WASH) interventions in low-income settings. We measured two nonspecific and two human-associated fecal indicators in water, soil, and surfaces before and after a shared latrine intervention from low-income households in Maputo, Mozambique, participating in the Maputo Sanitation (MapSan) trial. Up to a quarter of households were impacted by human fecal contamination, but trends were unaffected by improvements to shared sanitation facilities. The intervention reduced Escherichia coli gene concentrations in soil but did not impact culturable E. coli or the prevalence of human FST markers in a difference-in-differences analysis. Using a novel Bayesian hierarchical modeling approach to account for human marker diagnostic sensitivity and specificity, we revealed a high amount of uncertainty associated with human FST measurements and intervention effect estimates. The field of microbial source tracking would benefit from adding measures of diagnostic accuracy to better interpret findings, particularly when FST analyses convey insufficient information for robust inference. With improved measures, FST could help identify dominant pathways of human and animal fecal contamination in communities and guide the implementation of effective interventions to safeguard health.

Evaluation of Low-Cost Phage-Based Microbial Source Tracking Tools for Elucidating Human Fecal Contamination Pathways in Kolkata, India

Phages, such as those infecting Bacteroides spp., have been proven to be reliable indicators of human fecal contamination in microbial source tracking (MST) studies, and the efficacy of these MST markers found to vary geographically. This study reports the application and evaluation of candidate MST methods (phages infecting previously isolated B. fragilis strain GB-124, newly isolated Bacteroides strains (K10, K29, and K33) and recently isolated Kluyvera intermedia strain ASH-08), along with non-source specific somatic coliphages (SOMCPH infecting strain WG-5) and indicator bacteria (Escherichia coli) for identifying fecal contamination pathways in Kolkata, India. Source specificity of the phage-based methods was first tested using 60 known non-human fecal samples from common animals, before being evaluated with 56 known human samples (municipal sewage) collected during both the rainy and dry season. SOMCPH were present in 40-90% of samples from different animal species and in 100% of sewage samples. Phages infecting Bacteroides strain GB-124 were not detected from the majority (95%) of animal samples (except in three porcine samples) and were present in 93 and 71% of the sewage samples in the rainy and dry season (Mean = 1.42 and 1.83 log10PFU/100mL, respectively), though at lower levels than SOMCPH (Mean = 3.27 and 3.02 log10PFU/100mL, respectively). Phages infecting strain ASH-08 were detected in 89 and 96% of the sewage samples in the rainy and dry season, respectively, but were also present in all animal samples tested (except goats). Strains K10, K29, and K30 were not found to be useful MST markers due to low levels of phages and/or co-presence in non-human sources. GB-124 and SOMCPH were subsequently deployed within two low-income neighborhoods to determine the levels and origin of fecal contamination in 110 environmental samples. E. coli, SOMCPH, and phages of GB-124 were detected in 68, 42, and 28% of the samples, respectively. Analyses of 166 wastewater samples from shared community toilets and 21 samples from sewage pumping stations from the same districts showed that SOMCPH were present in 100% and GB-124 phages in 31% of shared toilet samples (Median = 5.59 and <1 log10 PFU/100 mL, respectively), and both SOMCPH and GB-124 phages were detected in 95% of pumping station samples (Median = 5.82 and 4.04 log10 PFU/100 mL, respectively). Our findings suggest that GB-124 and SOMCPH have utility as low-cost fecal indicator tools which can facilitate environmental surveillance of enteric organisms, elucidate human and non-human fecal exposure pathways, and inform interventions to mitigate exposure to fecal contamination in the residential environment of Kolkata, India.

A One Health Approach to Child Stunting: Evidence and Research Agenda

Stunting (low height for age) affects approximately one-quarter of children aged < 5 years worldwide. Given the limited impact of current interventions for stunting, new multisectoral evidence-based approaches are needed to decrease the burden of stunting in low- and middle-income countries (LMICs). Recognizing that the health of people, animals, and the environment are connected, we present the rationale and research agenda for considering a One Health approach to child stunting. We contend that a One Health strategy may uncover new approaches to tackling child stunting by addressing several interdependent factors that prevent children from thriving in LMICs, and that coordinated interventions among human health, animal health, and environmental health sectors may have a synergistic effect in stunting reduction.

Colonization factor CS30 from enterotoxigenic Escherichia coli binds to sulfatide in human and porcine small intestine

The ability to adhere via colonization factors to specific receptors located on the intestinal mucosa is a key virulence factor in enterotoxigenic Escherichia coli (ETEC) pathogenesis. Here, the potential glycosphingolipid receptors of the novel human ETEC colonization factor CS30 were examined by binding of CS30-expressing bacteria to glycosphingolipids on thin-layer chromatograms. We thereby found a highly specific binding of CS30-expressing bacteria to a fast-migrating acid glycosphingolipid of human and porcine small intestine, while no binding was obtained with a mutant ETEC strain unable to express CS30 fimbriae. The CS30 binding glycosphingolipid from human small intestine was isolated and characterized by mass spectrometry as sulfatide (SO₃-3Galβ1Cer). Comparative binding studies using sulfatides with different ceramide compositions gave a preferential binding of CS30 to sulfatide with d18:1-h24:0 ceramide. This ceramide species of sulfatide was also isolated from human small intestine and characterized by mass spectrometry and antibody binding. These studies implicate sulfatide as candidate receptor for mediating attachment of CS30-fimbriated ETEC to human and porcine small intestinal cells. Our findings may be a basis for designing receptor saccharide analogues for inhibition of the intestinal adhesion of CS30-expressing E. coli.

Associations among Household Animal Ownership, Infrastructure, and Hygiene Characteristics with Source Attribution of Household Fecal Contamination in Peri-Urban Communities of Iquitos, Peru

Using previously validated microbial source tracking markers, we detected and quantified fecal contamination from avian species and avian exposure, dogs, and humans on household cooking tables and floors. The association among contamination, infrastructure, and socioeconomic covariates was assessed using simple and multiple ordinal logistic regressions. The presence of Campylobacter spp. in surface samples was linked to avian markers. Using molecular methods, animal feces were detected in 75.0% and human feces in 20.2% of 104 households. Floors were more contaminated than tables as detected by the avian marker Av4143, dog marker Bactcan, and human marker Bachum. Wood tables were consistently more contaminated than non-wood surfaces, specifically with the mitochondrial avian markers ND5 and CytB, fecal marker Av4143, and canine marker Bactcan. Final multivariable models with socioeconomic and infrastructure characteristics included as covariates indicate that detection of avian feces and avian exposure was associated with the presence of chickens, maternal age, and length of tenancy, whereas detection of human markers was associated with unimproved water source. Detection of Campylobacter in surface samples was associated with the avian fecal marker Av4143. We highlight the critical need to detect and measure the burden of animal fecal waste when evaluating household water, hygiene, and sanitation interventions, and the possibility of decreasing risk of exposure through the modification of surfaces to permit more effective household disinfection practices. Animals may be a more important source of household fecal contamination than humans in many low-resource settings, although interventions have historically focused almost exclusively on managing human waste.

Seasonality in faecal contamination of drinking water sources in the Jirapa and Kassena-Nankana Municipalities of Ghana

This paper examines seasonal variations in faecal contamination of drinking water sources in the Jirapa and Kassena-Nankana Municipalities of Ghana. Data collection involved a survey of 568 households, testing of faecal coliform concentrations in drinking water source samples (141 in the rainy season, 128 in the dry season), in-depth interviews with key water stakeholders, and field observation to identify sources of faecal contamination. From the water quality testing, faecal coliforms were detected in all source types, including 'treated' pipe-borne water. Contamination was significantly higher in the rainy season than in the dry season (P < 0.05) with 51.8% of water samples in the rainy season and 27.3% in the dry season failing to meet the World Health Organisation and Ghana Standard Authority guideline on faecal coliform concentrations in drinking water sources. The proportion of population at risk of faecal contamination in the rainy season was 41.5% compared to 33.1% in the dry season. We argue that in Ghana and Sub-Saharan Africa at large, water surveillance agencies risk underestimating population exposed to faecal contamination through drinking water sources if monitoring is only done in the dry season. To avoid this, we recommend seasonal monitoring of faecal concentration in drinking water sources. However, in periods of limited resources, monitoring is most appropriate in the rainy season when the risk of contamination is high.

A Structural Equation Model to Decipher Relationships among Water, Sanitation, and Health in Colonias-Type Unincorporated Communities

The colonias along the United States-Mexico border are generally self-built neighborhoods of low-income families that lack basic infrastructure. While some government assistance has provided roads and electricity, water and wastewater services are still lacking in many colonias. This research is the first to collect a comprehensive dataset on water, sanitation, health, and living conditions in these unincorporated neighborhoods through collection of water samples and surveys; 114 households in 23 colonias across three geographically diverse Texas counties are studied. Water quality is assessed via traditional microbial indicators, chlorine, and arsenic. This complex dataset requires an advanced statistical tool to disentangle relationships among diverse factors. Structural equation modeling is utilized to identify relationships among surveyed and measured variables. The model reveals that colonias residents with well/hauled water accurately predict their water quality, while those with treated+piped water tend to think that their water is worse than it actually is. Dwelling quality and connection to sanitary sewers influence perceived health risks and household health, respectively. Furthermore, these communities have an overwhelming need and desire for point-of-use water treatment. This model can inform decision making and may be adapted to probe other questions and social dynamics for water and sanitation in unincorporated communities elsewhere.

Shared bacterial communities between soil, stored drinking water, and hands in rural Bangladeshi households

Understanding household-level transmission pathways of fecal pathogens can provide insight for developing effective strategies to reduce diarrheal illness in low- and middle-income countries. We applied whole bacterial community analysis to investigate pathways of bacterial transmission in 50 rural Bangladeshi households. SourceTracker was used to quantify the shared microbial community in household reservoirs (stored drinking water, soil, and hands) and estimate the percentage of fecal-associated bacteria from child and mothers' feces in these reservoirs. Among the reservoirs studied, most bacterial transfer occurred between mothers' and children's hands and between mothers' hands and stored water. The relative percentage of human fecal-associated bacteria in all household reservoirs was low. We also quantified the number of identical amplicon sequence variants within and between individual households to assess bacterial community exchange in the domestic environment. Intra-household sharing of bacteria between mothers' and children's hands and between hands and soil was significantly greater than inter-household sharing.

Ingestion of Fecal Bacteria along Multiple Pathways by Young Children in Rural Bangladesh Participating in a Cluster-Randomized Trial of Water, Sanitation, and Hygiene Interventions (WASH Benefits)

Quantifying the contribution of individual exposure pathways to a child's total ingestion of fecal matter could help prioritize interventions to reduce environmental enteropathy and diarrhea. This study used data on fecal contamination of drinking water, food, soil, hands, and objects and second-by-second data on children's contacts with these environmental reservoirs in rural Bangladesh to assess the relative contribution of different pathways to children's ingestion of fecal indicator bacteria and if ingestion decreased with the water, sanitation, and hygiene interventions implemented in the WASH Benefits Trial. Our model estimated that rural Bangladeshi children <36 months old consume 3.6-4.9 log₁₀ most probable number E. coli/day. Among children <6 months, placing objects in the mouth accounted for 60% of E. coli ingested. For children 6-35 months old, mouthing their own hands, direct soil ingestion, and ingestion of contaminated food were the primary pathways of E. coli ingestion. The amount of E. coli ingested by children and the predominant pathways of E. coli ingestion were unchanged by the water, sanitation, and hygiene interventions. These results highlight contaminated soil, children's hands, food, and objects as primary pathways of E. coli ingestion and emphasize the value of intervening along these pathways.

Markers Specific to Bacteroides fragilis Group Bacteria as Indicators of Anthropogenic Pollution of Surface Waters

The aim of this study was to evaluate the applicability of markers specific to Bacteroides fragilis group (BFG) bacteria as indicators of anthropogenic pollution of surface waters. In addition, the impact of wastewater treatment plants (WWTPs) on the spread of genes specific to fecal indicator bacteria and genes encoding antimicrobial resistance in water bodies was also determined. Samples of hospital wastewater (HWW), untreated wastewater (UWW), and treated wastewater (TWW) evacuated from a WWTP were collected, and samples of river water were taken upstream (URW) and downstream (DRW) from the wastewater discharge point to determine, by qPCR, the presence of genes specific to BFG, Escherichia coli and Enterococcus faecalis, and the abundance of 11 antibiotic resistance genes (ARGs) and two integrase genes. The total number of bacterial cells (TCN) in the examined samples was determined by fluorescence in situ hybridization (FISH). Genes specific to BFG predominated among the analyzed indicator microorganisms in HWW, and their copy numbers were similar to those of genes specific to E. coli and E. faecalis in the remaining samples. The abundance of genes specific to BFG was highly correlated with the abundance of genes characteristic of E. coli and E. faecalis, all analyzed ARGs and intI genes. The results of this study indicate that genes specific to BFG can be used in analyses of human fecal pollution, and as indicators of environmental contamination with ARGs. A significant increase in the copy numbers of genes specific to BFG, E. coli, and seven out of the 11 analyzed ARGs was noted in samples of river water collected downstream from the wastewater discharge point, which suggests that WWTPs are an important source of these genes in riparian environments.

A longitudinal study of the association between domestic contact with livestock and contamination of household point-of-use stored drinking water in rural Siaya County (Kenya)

Background

Emerging evidence suggests close domestic proximity of livestock and humans may lead to microbiological contamination of hands, objects, food and water supplies within domestic environments, adversely impacting public health. However, evidence quantifying the relationship between livestock, domestic animals, humans and microbiological contamination of household stored water remains limited.

Aim

This longitudinal study aimed to examine the relationship between domestic contact with livestock and domestic animals on microbiological contamination of household Point-of-Use (POU) stored drinking water in rural Kenya and assess the influence of choice of faecal indicator on such associations.

Methodology

A survey was performed in 234 households in Siaya county, Kenya, to observe presence of livestock (cattle, goats, poultry) and domestic animals (cats, dogs) in household compounds, alongside other risk factors for contamination of POU stored drinking water such as sanitation, storage conditions and hygiene practices. Samples from water sources (e.g. piped, spring/wells, boreholes, surface and rainwater) and from POU storage containers were tested for E. coli and intestinal enterococci. Livestock-related risk factors for water contamination were examined through multinomial regression, controlling for confounders.

Results

Rainwater was the main POU water source and was found to be highly susceptible to contamination. Multivariate analysis showed greater risk of gross (>100 CFU/100 mL) water contamination (with E. coli) for households where goats were observed, and/or where poultry roosted in proximity to stored household water (relative risk RR = 2.71; p = 0.001 and RR = 2.02; p = 0.012 respectively). Presence of a poultry coop was also associated with elevated intestinal enterococci densities (RR = 4.46; p = 0.001). Associations between contamination and livestock risk factors were thus similar for both bacteria groups, but E. coli counts declined more rapidly following collection from surface waters than enterococci counts (p = 0.024).

Conclusion

The presence of livestock (particularly goats) and poultry within household compounds increases POU water contamination risk, suggesting the need for improved interventions to address cross-contamination within rural domestic settings. Within Siaya county, more effective community education is needed to raise awareness of POU water quality protection, particularly of rainwater.

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Poultry and goats are risk factors for household stored water contamination.

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Poultry are risk factors for both enterococci and E. coli contamination.

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Attenuation of enterococci in household stored water is lower than for E. coli.

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Residual free chlorine is mostly too low to prevent stored water recontamination.

Water quality for young children in Cambodia-High contamination at collection and consumption level

Unsafe drinking water is a leading cause of child morbidity, especially among young children in low‐income settings. Safe water consumption requires high‐quality water available at its source and at point of use. We examined the quality of drinking water at point of collection and point of use in 796 households in three provinces, in Cambodia. Microbiological testing for coliform and Escherichia coli contamination was conducted for samples collected. Bivariable analysis and multivariable logistic regression were used to examine associations between various factors and the deterioration in water quality (increase in the risk according coliform or E. coli concentration) between point of collection and point of use. Contamination with both coliforms and E. coli was higher at point of use than at point of collection, with contamination at point of collection to account for 76.6% (coliforms) and 46.3% (E. coli). Results suggest that child drinking water represents a considerable pathway for the ingestion of pathogens, in Cambodia. Area of residence, seasonality, type of water source, and water chlorination were associated with coliform concentration between the point of collection and point of use, whereas only seasonality was associated with E. coli contamination (OR = 1.46; 95% CI [1.05, 2.02]). Children living in rural settings were two times more likely to drink water with a deteriorating coliform concentration between the two‐time points than children living in urban settings (OR = 2.00; 95% CI [1.22, 3.30]). The increase in coliform and E. coli concentrations between point of collection and point of use indicates that water contamination mostly occurs within the household. Strengthening national legislation on water quality standards and promoting safe water management at the household are needed.

Diversity, virulence and antibiogram traits of Escherichia coli recovered from potable water sources in Gharbia, Egypt

This study aimed to assess the public health risk of coliforms and Escherichia coli contamination of potable water sources in Egypt. A total of 150 water samples (100 tap and 50 well) were collected from five districts in Gharbia governorate, Egypt. High rates of coliforms contamination were recorded in 52 and 76% of examined tap and well water samples, respectively. E. coli strains were detected in 16% of the water samples (15% tap water and 18% well water; 23.7% rural and 8.1% urban). Rural water sources were 3.5 times more likely to be contaminated than urban sources (P = 0.01). Eight (33.3%) E. coli isolates were Shiga toxin-producing E. coli (STEC). Multiple drug resistance (MDR) was observed for 62.5% of the isolates. Seven (29.2%) E. coli isolates harboured at least one of the extended-spectrum beta-lactamase (ESBL) genes. The majority (87.5%) of the STEC isolates were MDRs and harboured ESBL genes. STEC isolates were significantly more likely to resist six classes of antibiotics than non-STEC isolates. This is the first report of potable water contamination with MDR-STEC in Egypt. This study highlights an alarming public health threat that necessitates preventive interventions for public and environmental safety.

Determinants of Childhood Zoonotic Enteric Infections in a Semirural Community of Quito, Ecuador

Domestic animals in the household environment have the potential to affect a child's carriage of zoonotic enteric pathogens and risk of diarrhea. This study examines the risk factors associated with pediatric diarrhea and carriage of zoonotic enteric pathogens among children living in communities where smallholder livestock production is prevalent. We conducted an observational study of children younger than 5 years that included the analysis of child (n = 306) and animal (n = 480) fecal samples for Campylobacter spp., atypical enteropathogenic Escherichia coli, Shiga toxin-producing E. coli, Salmonella spp., Yersinia spp., Cryptosporidium parvum, and Giardia lamblia. Among these seven pathogens, Giardia was the most commonly identified pathogen among children and animals in the same household, most of which was found in child-dog pairs. Campylobacter spp. was also relatively common within households, particularly among child-chicken and child-guinea pig pairs. We used multivariable Poisson regression models to assess risk factors associated with a child being positive for at least one zoonotic enteric pathogen or having diarrhea during the last week. Children who interacted with domestic animals-a behavior reported by nearly three-quarters of households owning animals-were at an increased risk of colonization with at least one zoonotic enteric pathogen (prevalence ratio [PR] = 1.56, 95% CI: 1.00-2.42). The risk of diarrhea in the last seven days was elevated but not statistically significant (PR = 2.27, CI: 0.91, 5.67). Interventions that aim to reduce pediatric exposures to enteric pathogens will likely need to be incorporated with approaches that remove animal fecal contamination from the domestic environment and encourage behavior change aimed at reducing children's contact with animal feces through diverse exposure pathways.

Human fecal contamination of water, soil, and surfaces in households sharing poor-quality sanitation facilities in Maputo, Mozambique

Identifying the origin of fecal contamination can support more effective interventions to interrupt enteric pathogen transmission. Microbial source tracking (MST) assays may help to identify environmental routes of pathogen transmission although these assays have performed poorly in highly contaminated domestic settings, highlighting the importance of both diagnostic validation and understanding the context-specific ecological, physical, and sociodemographic factors driving the spread of fecal contamination. We assessed fecal contamination of compounds (clusters of 2-10 households that share sanitation facilities) in low-income neighborhoods of urban Maputo, Mozambique, using a set of MST assays that were validated with animal stool and latrine sludge from study compounds. We sampled five environmental compartments involved in fecal microbe transmission and exposure: compound water source, household stored water and food preparation surfaces, and soil from the entrance to the compound latrine and the entrances to each household. Each sample was analyzed by culture for the general fecal indicator Escherichia coli (cEC) and by real-time PCR for the E. coli molecular marker EC23S857, human-associated markers HF183/BacR287 and Mnif, and GFD, an avian-associated marker. We collected 366 samples from 94 households in 58 compounds. At least one microbial target (indicator organism or marker gene) was detected in 96% of samples (353/366), with both E. coli targets present in the majority of samples (78%). Human targets were frequently detected in soils (59%) and occasionally in stored water (17%) but seldom in source water or on food surfaces. The avian target GFD was rarely detected in any sample type but was most common in soils (4%). To identify risk factors of fecal contamination, we estimated associations with sociodemographic, meteorological, and physical sample characteristics for each microbial target and sample type combination using Bayesian censored regression for target concentration responses and Bayesian logistic regression for target detection status. Associations with risk factors were generally weak and often differed in direction between different targets and sample types, though relationships were somewhat more consistent for physical sample characteristics. Wet soils were associated with elevated concentrations of cEC and EC23S857 and odds of detecting HF183. Water storage container characteristics that expose the contents to potential contact with hands and other objects were weakly associated with human target detection. Our results describe a setting impacted by pervasive domestic fecal contamination, including from human sources, that was largely disconnected from the observed variation in socioeconomic and sanitary conditions. This pattern suggests that in such highly contaminated settings, transformational changes to the community environment may be required before meaningful impacts on fecal contamination can be realized.

Effect of Sanitation Improvements on Pathogens and Microbial Source Tracking Markers in the Rural Bangladeshi Household Environment

Diarrheal illnesses from enteric pathogens are a leading cause of death in children under five in low- and middle-income countries (LMICs). Sanitation is one way to reduce the spread of enteric pathogens in the environment; however, few studies have investigated the effectiveness of sanitation in rural LMICs in reducing pathogens in the environment. In this study, we measured the impact of a sanitation intervention (dual-pit latrines, sani-scoops, child potties delivered as part of a randomized control trial, WASH Benefits) in rural Bangladeshi household compounds by assessing prevalence ratios, differences, and changes in the concentration of pathogen genes and host-specific fecal markers. We found no difference in the prevalence of pathogenic Escherichia coli, norovirus, or Giardia genes in the domestic environment in the sanitation and control arms. The prevalence of the human fecal marker was lower on child hands and the concentration of animal fecal marker was lower on mother hands in the sanitation arm in adjusted models, but these associations were not significant after correcting for multiple comparisons. In the subset of households with ≥10 individuals per compound, the prevalence of enterotoxigenic E. coli genes on child hands was lower in the sanitation arm. Incomplete removal of child and animal feces or the compound (versus community-wide) scale of intervention could explain the limited impacts of improved sanitation.

Poultry Ownership Associated with Increased Risk of Child Diarrhea: Cross-Sectional Evidence from Uganda

Domestic animals have been associated with enteric infections in young children and can also be carriers of respiratory viruses. We conducted a cross-sectional assessment of health outcomes in children aged < 5 years associated with animal presence among 793 rural households in Uganda. We recorded the 2-week prevalence of diarrhea and respiratory infections in children, and the number of cows, poultry, sheep/goats, and pigs in the household. We used generalized linear models with robust standard errors to estimate the prevalence ratio (PR) for diarrhea and respiratory infections associated with households owning the above- versus below-median number of animals. We conducted unadjusted and adjusted analyses controlling for socioeconomic, water, sanitation, and hygiene indicators. Children in households with the above-median number (> 5) of poultry had 83% higher diarrhea prevalence than those with ≤ 5 poultry (adjusted PR = 1.83 [1.04, 3.23], P = 0.04). Children in households with the above-median number (> 2) of cows had 48% lower prevalence of respiratory infection than those with ≤ 2 cows (adjusted PR = 0.52 [0.35, 0.76], P < 0.005). There were no other significant associations between domestic animals and child health. Studies should assess if barring chickens from indoor living quarters and sanitary disposal of chicken and other animal feces can reduce childhood zoonotic infections.

Fieldwork-based determination of design priorities for point-of-use drinking water quality sensors for use in resource-limited environments

Improved capabilities in microfluidics, electrochemistry, and portable assays have resulted in the development of a wide range of point-of-use sensors intended for environmental, medical, and agricultural applications in resource-limited environments of developing countries. However, these devices are frequently developed without direct interaction with their often-remote intended user base, creating the potential for a disconnect between users' actual needs and those perceived by sensor developers. As different analytical techniques have inherent strengths and limitations, effective measurement solution development requires determination of desired sensor attributes early in the development process. In this work, we present our findings on design priorities for point-of-use microbial water sensors based on fieldwork in rural India, as well as a guide to fieldwork methodologies for determining desired sensor attributes. We utilized group design workshops for initial identification of design priorities, and then conducted choice-based conjoint analysis interviews for quantification of user preferences among these priorities. We found the highest user preference for integrated reporting of contaminant concentration and recommended actions, as well as significant preferences for mostly reusable sensor architectures, same-day results, and combined ingredients. These findings serve as a framework for future microbial sensor development and a guide for fieldwork-based understanding of user needs.

High Rates of Exposures to Waterborne Pathogens in Indigenous Communities in the Amazon Region of Ecuador

Waterborne pathogens, associated with poverty and poor sanitary conditions, are a major cause of morbidity and mortality worldwide. There are limited data on the epidemiology of waterborne pathogens in indigenous populations living in the Amazon region. We did a cross-sectional survey in two indigenous Shuar communities in the Amazon region of Ecuador in which we documented the presence of pathogens representing different sources of environmental contamination of water. We detected protozoa and soil-transmitted helminths by microscopy of fecal samples and the presence of IgG antibodies to hepatitis A and Leptospira spp. in blood samples from individuals older than 2 years and collected data by questionnaire on sociodemographic factors and knowledge of infectious diseases. Seroprevalence for hepatitis A and Leptospira spp. were 98.1% (95% CI: 97.0-99.8) and 50.0% (95% CI: 43.3-56.6), respectively, whereas 62.6% (95% CI: 55.8-69.4) had enteric parasites in stool samples. In participants older than 6 years, eight of 10 had evidence of infection with or exposure to at least one of the pathogens studied. Although prevalence of pathogens varied by age, it did not vary significantly by gender, temporal migration, illiteracy, perceived morbidity, receipt of conditional cash transfers, water boiling practices, poor housing conditions, and anthropometric status. These findings indicate a high level of contamination of drinking water by human pathogens in these indigenous communities and the need for interventions to improve access to and use of clean drinking water in these marginalized communities.

Ruminant Fecal Contamination of Drinking Water Introduced Post-Collection in Rural Kenyan Households

In sub-Saharan Africa, many families travel to collect water and store it in their homes for daily use, presenting an opportunity for the introduction of fecal contamination. One stored and one source water sample were each collected from 45 households in rural Kenya. All 90 samples were analyzed for fecal indicator bacteria (E. coli and enterococci) and species-specific contamination using molecular microbial source tracking assays. Human (HF183), avian (GFD), and ruminant (BacR) contamination were detected in 52, two, and four samples, respectively. Stored water samples had elevated enterococci concentrations (p < 0.01, Wilcoxon matched pairs test) and more frequent BacR detection (89% versus 27%, p < 0.01, McNemar's exact test) relative to source water samples. fsQCA (fuzzy set qualitative comparative analysis) was conducted on the subset of households with no source water BacR contamination to highlight combinations of factors associated with the introduction of BacR contamination to stored water supplies. Three combinations were identified: (i) ruminants in the compound, safe water extraction methods, and long storage time, (ii) ruminants, unsafe water extraction methods, and no soap at the household handwashing station, and (iii) long storage time and no soap. This suggests that multiple pathways contribute to the transmission of ruminant fecal contamination in this context, which would have been missed if data were analyzed using standard regression techniques.

Exposure to Livestock Feces and Water Quality, Sanitation, and Hygiene (WASH) Conditions among Caregivers and Young Children: Formative Research in Rural Burkina Faso

Livestock farming is common in low-income settings as a source of income and animal-sourced food. However, there is growing evidence of the harmful health effects of proximity of animals to infants and young children, especially through exposure to zoonotic pathogens. Poultry ownership is almost universal in rural Burkina Faso. Poultry feces are a significant risk factor for enteric diseases that are associated with child undernutrition. To investigate the extent of exposure to livestock feces among young children and caregivers, we conducted direct observations of 20 caregiver-child dyads for a total of 80 hours (4 hours per dyad) and recorded water quality, sanitation, and hygiene (WASH)-related behaviors. We also undertook in-depth interviews with these caregivers and focus group discussions with separate groups of men and women who were poultry farmers. Poultry and other livestock feces were visible in all 20 and 19 households, respectively, in both kitchen areas and in the household courtyards where children frequently sit or crawl. Direct soil ingestion by young children was observed in almost half of the households (45%). Poor handwashing practices were also common among caregivers and children. Although latrines were available in almost all households, child feces disposal practices were inadequate. This body of research suggests an urgent need to adapt conventional WASH and livestock interventions to reduce the exposure of infants and young children to livestock feces.

Fecal indicator dynamics at the watershed scale: Variable relationships with land use, season, and water chemistry

Tracking fecal contamination in surface waters is critical to remediating water quality; however, general and source-specific fecal indicators often provide conflicting results. To understand the spatial and temporal dynamics of multiple fecal indicators and the sources they represent, we measured weekly concentrations of two general fecal indicator bacteria (FIB), a genetic indicator of human-associated Bacteroides (HF183), and surface water chemistry in nine mixed land-use watersheds in southwest Virginia, USA. At the watershed scale, general and source-specific indicators were decoupled, with distinct spatial, temporal, and chemical patterns. Random Forest analysis of individual sample variability identified temperature, watershed, nutrients, and cations as top predictors of indicator concentrations. However, these patterns - and the specific nutrients and cations identified - varied by indicator type. Among watersheds, FIB increased with developed land cover and during the summer months, while HF183 increased during the winter and only in urban watersheds. Nutrients generally related poorly to FIB and HF183, except E. coli, which correlated with total nitrogen. In contrast, all fecal indicators showed strong correlations with cations. FIB were more strongly related to calcium, magnesium, and potassium concentrations, while HF183 was related to sodium. These results suggest that, even at the watershed scale, 1) HF183 detects mainly human fecal contamination, while FIB detect broader ecosystem fecal inputs, and 2) poor correlation between specific and generalist fecal indicators is caused by unique spatial, temporal, and transport dynamics of different fecal sources in watersheds.

Do domestic animals contribute to bacterial contamination of infant transmission pathways? Formative evidence from Ethiopia

Child stunting is associated with poor water, sanitation and hygiene (WASH), partly due to the effect of infection on intestinal nutrient absorption. WASH interventions, however, show little effect on growth. A hypothesis is that bacterial contamination of hands and floors from domestic animals and their faeces, and subsequent ingestion via infant hand-to-mouth behaviours, may explain this. This formative study used microbial testing and survey and observational data from 20 households in Ethiopia to characterise principle bacterial transmission pathways to infants, considering WASH facilities and practices, infant behaviours and animal exposure. Microbial swabbing showed the contamination of hands and floor surfaces from thermotolerant coliform bacteria. Animal husbandry practices, such as keeping animals inside, contributed significantly (all p < 0.005). There was no evidence that latrine facilities mitigated contamination across infant (p = 0.76) or maternal (p = 0.86) hands or floor surfaces (p = 0.36). This small study contributes to the evidence that animal faeces are an important source of domestic bacterial contamination. The results imply that interventions aiming to reduce pathogen transmission to infants should think beyond improving WASH and also consider the need to separate infants and animals in the home. Intervention studies will be required to determine whether this reduces infant infection and improves linear growth.

Poultry husbandry, water, sanitation, and hygiene practices, and child anthropometry in rural Burkina Faso

Poultry production in low income countries provides households with nutrient-rich meat and egg products, as well as cash income. However, traditional production systems present potential health and nutrition risks because poultry scavenging around household compounds may increase children's exposure to livestock-related pathogens. Data from a cross-sectional survey were analysed to examine associations between poultry, water, sanitation, and hygiene practices, and anthropometric indicators in children (6-59 months; n = 3,230) in Burkina Faso. Multilevel regression was used to account for the hierarchical nature of the data. The prevalence of stunting and wasting in children 6-24 months was 19% and 17%, respectively, compared with a prevalence of 26% and 6%, respectively, in children 25-60 months. Over 90% of households owned poultry, and chicken faeces were visible in 70% of compounds. Caregivers reported that 3% of children consumed eggs during a 24-hr recall. The presence of poultry faeces was associated with poultry flock size, poultry-husbandry and household hygiene practices. Having an improved water source and a child visibly clean was associated with higher height-for-age z scores (HAZ). The presence of chicken faeces was associated with lower weight-for-height z scores, and no associations were found with HAZ. Low levels of poultry flock size and poultry consumption in Burkina Faso suggest there is scope to expand production and improve diets in children, including increasing chicken and egg consumption. However, to minimize potential child health risks associated with expanding informal poultry production, research is required to understand the mechanisms through which cohabitation with poultry adversely affects child health and design interventions to minimize these risks.

Microbiological contamination of young children's hands in rural Bangladesh: Associations with child age and observed hand cleanliness as proxy

Background

Hands are a route of transmission for fecal-oral pathogens. This analysis aimed to assess associations between hand E. coli contamination and child age and determine if observed hand cleanliness can serve as a proxy for E. coli contamination on young children’s hands.

Methods

Trained field workers collected hand rinse samples from children aged 1–14 months in 584 households in rural Bangladesh and assessed the visual cleanliness of child hands (fingernails, finger pads and palms). Samples were analyzed using the IDEXX most probable number (MPN) methodto enumerate E. coli. We assessed if child age (immobile children aged 1–4 months vs. mobile children aged 5–14 months) is associated with log₁₀E. coli counts on hands using generalized estimating equations (GEE). We estimated the log₁₀ difference in hand E. coli counts associated with the cleanliness of different hand parts using a multivariable GEE model.We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for dirty fingernails, fingerpads, palms and overall hands (the three observed parts combined) against binary E. coli presence on hands.

Results

E. coli was detected on 43% of child hands. Children in the mobile age range had 0.17 log₁₀ MPN higher E. coli on hands than those in the immobile age range (Δlog₁₀ = 0.17, 95% CI = 0.02, 0.32, p = 0.03). Children with visible dirt particles on finger pads had 0.46 log₁₀ MPN higher E. coli on hands than those with clean finger pads (Δlog₁₀ = 0.46, 95% CI = 0.05, 0.87, p = 0.03). Dirty fingernails indicated binary E. coli presence with 81% sensitivity and 26% specificity while dirty fingerpads and palms indicated E. coli presence with 29% sensitivity and 75–77% specificity. The PPV was 45–48% and NPV 59–65% for all three types of observations.

Conclusion

Hand contamination with E. coli was prevalent among young children in rural Bangladesh, with higher levels of contamination among mobile children. Studies should assess if strategies to remove animal feces from the courtyard, provide designated hygienic play spaces for children and deliver targeted messaging to mothers to wipe or wash children’s hands after contact with animals and animal feces reduce child hand contamination. Visible hand cleanliness was a poor predictor of E. coli presence on young children’s hands so other low-cost field measurements are needed to accurately detect fecal contamination on hands.

Drinking Water Safety: Role of Hand Hygiene, Sanitation Facility, and Water System in Semi-Urban Areas of India

Poor drinking water quality is one of the main causes of acute diarrheal disease in developing countries. The study investigated the relationship between fecal contamination of hands, stored drinking water, and source waters in India. We further evaluated the environmental and behavioral factors associated with recontamination of water between collection and consumption. The bacterial contamination, that is, Escherichia coli (log₁₀ most probable number per two hands), found on mothers' hands (mean = 1.11, standard deviation [SD] = 1.2, N = 152) was substantially higher than that on their children younger than 5 years (mean = 0.64, SD = 1.0, and N = 152). We found a low level of E. coli (< 1 per 100 mL) in the source water samples; however, E. coli contamination in stored drinking water was above the recommended guidelines of the World Health Organization. The study also found that E. coli on hands was significantly associated with E. coli in the stored drinking water (P < 0.001). Moreover, E. coli was positively associated with gastrointestinal symptoms (odds ratio 1.42, P < 0.05). In the households with elevated levels (> 100 E. coli/100 mL) of fecal contamination, we found that 43.5% had unimproved sanitation facilities, poor water handling practices, and higher diarrheal incidences. The water quality deterioration from the source to the point of consumption is significant. This necessitates effective interventions in collection, transport, storage, and extraction practices when hand-water contact is likely to occur. These findings support the role of hands in the contamination of stored drinking water and suggest that clean source water does not guarantee safe water at the point of consumption.

Perceived water insecurity among adults from urban and peri-urban Haiti: A qualitative study

Water and sanitation services are fundamental in preventing the spread of waterborne and hygiene-related diseases. However, in developing countries, such as Haiti, access to clean water continues to pose major challenges despite efforts to improve quality and reduce distance. With Léogâne being the epicenter of the earthquake in Haiti in 2010, there were dozens of interventions aimed to improve access to clean water, specifically well construction and use of water treatment strategies. Using the socioecological framework, this study collected qualitative data to supplement a household water insecurity experiences (HWISE) survey in order to fully understand the narratives around water in Léogâne (urban) and its neighboring commune Gressier (peri-urban). The inclusion criteria for this study was that the participant must be a resident of either site, at least 18 years or older, and a female. Only females were included in this study so that researchers could better understand how perceived water insecurity impacts reproductive health, specifically gynecological infections. This cross-sectional study yielded 61 total in-depth interviews using a semi-structured open ended questionnaire to allow participants the ability to elaborate. Results suggest that there are common misconceptions about water and reproductive health specifically that engaging in sexual intercourse in saltwater will not result in pregnancy. Relevant narratives among the two communes included water acquisition, use of water, and bathing practices, among several others. Through understanding the local Haitian perspective and practices that surround water insecurity, we can better tailor public health interventions to improve access to water, female hygiene practices, and ultimately lower and prevent disease transmission.

Contamination Potentials of Household Water Handling and Storage Practices in Kirundo Subcounty, Kisoro District, Uganda

Introduction

Waterborne diseases constitute a major public health burden in developing and underdeveloped countries. Consumption of contaminated water causes health risk to the public, and the situation is alarming in rural areas. The objective of this study was to assess the contamination potentials of different house water handling and storage practices in the Kirundo subcounty, Kisoro District, Uganda.

Material and Methods

A cross-sectional and descriptive study in which 344 water samples were collected randomly and analysed for bacteriological contamination, total coliforms (TCs) and Escherichia coli per 100 ml, using the Most Probable Number (MPN) technique and reported in terms of CFU/100 ml.

Results

The 43.2% samples from unprotected water sources had total coliforms and 34.1% had Escherichia coli. In analysed household drinking water, 25% had total coliforms and 8.7% had Escherichia coli. Most drinking water sources were found to have coliform counts above the recommended national and international guidelines. There was a statistically significant difference among water sources with respect to total coliforms and Escherichia coli (p < 0.05).

Conclusion

The overall results indicated that there is a strong linkage between microbiological water quality and water source sanitation; hence, the protected water source was safer than unprotected water sources. For the unprotected water sources, protection strategies as well as monitoring are recommended for this community.

A Comparative Overview of the Livestock-Environment Interactions in Asia and Sub-saharan Africa

Understanding the interactions between livestock and the environment in Asia and Sub-Saharan Africa is essential to sustainable livestock sector development. In this comparative overview, we review the available evidence on the extent of grassland degradation, land, and water pollution by nutrients and microorganisms, water stress, biodiversity loss, and greenhouse gas emissions and their relation to livestock production in Asia and Sub-Saharan Africa. We also draw on Asia's past livestock development trajectories and their impacts to provide guidance for future sustainable livestock development in Sub-Saharan Africa. Forward-looking policies and programs that anticipate long-term changes in the livestock sector and that assess trade-offs between policies and investments in multiple environmental domains in Sub-Saharan Africa are required to support sustainable development and guide policy decisions in the years ahead, from an environmental, social and public health perspective.