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Zhu K, Hill C, Muirhead A, Basu M, Brown J, Brinton MA, Hayat MJ, Venegas-Vargas C, Reis MG, Casanovas-Massana A, Meschke JS, Ko AI, Costa F, Stauber CE. Zika virus RNA persistence and recovery in water and wastewater: An approach for Zika virus surveillance in resource-constrained settings. Water Res 2023; 241:120116. [PMID: 37270953 PMCID: PMC10330535 DOI: 10.1016/j.watres.2023.120116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
During the 2015-2016 Zika virus (ZIKV) epidemic in the Americas, serological cross-reactivity with other flaviviruses and relatively high costs of nucleic acid testing in the region hindered the capacity for widespread diagnostic testing. In such cases where individual testing is not feasible, wastewater monitoring approaches may offer a means of community-level public health surveillance. To inform such approaches, we characterized the persistence and recovery of ZIKV RNA in experiments where we spiked cultured ZIKV into surface water, wastewater, and a combination of both to examine the potential for detection in open sewers serving communities most affected by the ZIKV outbreak, such as those in Salvador, Bahia, Brazil. We used reverse transcription droplet digital PCR to quantify ZIKV RNA. In our persistence experiments, we found that the persistence of ZIKV RNA decreased with increasing temperature, significantly decreased in surface water versus wastewater, and significantly decreased when the initial concentration of virus was lowered by one order of magnitude. In our recovery experiments, we found higher percent recovery of ZIKV RNA in pellets versus supernatants from the same sample, higher recoveries in pellets using skimmed milk flocculation, lower recoveries of ZIKV RNA in surface water versus wastewater, and lower recoveries from a freeze thaw. We also analyzed samples collected from Salvador, Brazil during the ZIKV outbreak (2015-2016) that consisted of archived samples obtained from open sewers or environmental waters thought to be contaminated by sewage. Although we did not detect any ZIKV RNA in the archived Brazil samples, results from these persistence and recovery experiments serve to inform future wastewater monitoring efforts in open sewers, an understudied and important application of wastewater monitoring.
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Affiliation(s)
- Kevin Zhu
- Department of Civil and Environmental Engineering, College of Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Cailee Hill
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
| | - Aaron Muirhead
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
| | - Mausumi Basu
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta, GA 303034, USA
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margo A Brinton
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta, GA 303034, USA
| | - Matthew J Hayat
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA
| | - Cristina Venegas-Vargas
- Department of Large Animal Clinical Sciences, College Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Mitermayer G Reis
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador Bahia, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06511, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06511, USA
| | - J Scott Meschke
- Department of Environmental and Occupational Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Albert I Ko
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador Bahia, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06511, USA
| | - Federico Costa
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Rua Waldemar Falcão, 121, Salvador Bahia, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06511, USA; Institute of Collective Health, Federal University of Bahia, Canela, Salvador 40110-040, Brazil
| | - Christine E Stauber
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
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2
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Cremonese C, Souza FN, Palma FAG, Sodré JFA, Brito RL, Ribeiro PDS, Santana JO, Coelho RH, Ticona JPA, Nazaré RJ, de Oliveira D, Silva CQ, Eyre MT, Mendes VDA, Knee J, Ristow P, Stauber CE, López YAA, Giorgi E, Diggle PJ, Reis MGG, Cumming O, Ko A, Costa F. Simplified sewerage to prevent urban leptospirosis transmission: a cluster non-randomised controlled trial protocol in disadvantaged urban communities of Salvador, Brazil. BMJ Open 2023; 13:e065009. [PMID: 37355266 PMCID: PMC10314607 DOI: 10.1136/bmjopen-2022-065009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/31/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION Leptospirosis is a globally distributed zoonotic and environmentally mediated disease that has emerged as a major health problem in urban slums in developing countries. Its aetiological agent is bacteria of the genus Leptospira, which are mainly spread in the urine of infected rodents, especially in an environment where adequate sanitation facilities are lacking, and it is known that open sewers are key transmission sources of the disease. Therefore, we aim to evaluate the effectiveness of a simplified sewerage intervention in reducing the risk of exposure to contaminated environments and Leptospira infection and to characterise the transmission mechanisms involved. METHODS AND ANALYSIS This matched quasi-experimental study design using non-randomised intervention and control clusters was designed to assess the effectiveness of an urban simplified sewerage intervention in the low-income communities of Salvador, Brazil. The intervention consists of household-level piped sewerage connections and community engagement and public involvement activities. A cohort of 1400 adult participants will be recruited and grouped into eight clusters consisting of four matched intervention-control pairs with approximately 175 individuals in each cluster in baseline. The primary outcome is the seroincidence of Leptospira infection assessed through five serological measurements: one preintervention (baseline) and four postintervention. As a secondary outcome, we will assess Leptospira load in soil, before and after the intervention. We will also assess Leptospira exposures before and after the intervention, through transmission modelling, accounting for residents' movement, contact with flooding, contaminated soil and water, and rat infestation, to examine whether and how routes of exposure for Leptospira change following the introduction of sanitation. ETHICS AND DISSEMINATION This study protocol has been reviewed and approved by the ethics boards at the Federal University of Bahia and the Brazilian National Research Ethics Committee. Results will be disseminated through peer-reviewed publications and presentations to implementers, researchers and participating communities. TRIAL REGISTRATION NUMBER Brazilian Clinical Trials Registry (RBR-8cjjpgm).
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Affiliation(s)
- Cleber Cremonese
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Fabio Neves Souza
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
- Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Fabiana Almerinda Gonçalves Palma
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
| | | | - Ricardo Lustosa Brito
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Priscyla Dos Santos Ribeiro
- Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil
- Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- National Institute of Science and Technology in Interdisciplinary and Transdisciplinary Studies in Ecology and Evolution (INCT IN-TREE), Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Juliet Oliveira Santana
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
- Institute of Geosciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Juan P Aguilar Ticona
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
| | - Romero J Nazaré
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
| | - Daiana de Oliveira
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
| | - Cainã Queiroz Silva
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Max T Eyre
- London School of Hygiene & Tropical Medicine, Faculty of Infectious Tropical Diseases, Disease Control Department, London, UK
| | | | - Jackie Knee
- London School of Hygiene & Tropical Medicine, Faculty of Infectious Tropical Diseases, Disease Control Department, London, UK
| | - Paula Ristow
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
- Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil
- National Institute of Science and Technology in Interdisciplinary and Transdisciplinary Studies in Ecology and Evolution (INCT IN-TREE), Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Christine E Stauber
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | | | - Emanuele Giorgi
- Lancaster University Lancaster Medical School, Lancaster, UK
| | - Peter J Diggle
- Lancaster University Lancaster Medical School, Lancaster, UK
| | - Mitermayer Galvão G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
- Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Oliver Cumming
- London School of Hygiene & Tropical Medicine, Faculty of Infectious Tropical Diseases, Disease Control Department, London, UK
| | - Albert Ko
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Federico Costa
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil
- Lancaster University Lancaster Medical School, Lancaster, UK
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, USA
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3
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Zhu K, Suttner B, Knee J, Capone D, Moe CL, Stauber CE, Konstantinidis KT, Wallach TE, Pickering AJ, Brown J. Elevated Fecal Mitochondrial DNA from Symptomatic Norovirus Infections Suggests Potential Health Relevance of Human Mitochondrial DNA in Fecal Source Tracking. Environ Sci Technol Lett 2022; 9:543-550. [PMID: 35719858 PMCID: PMC9202355 DOI: 10.1021/acs.estlett.2c00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
An end goal of fecal source tracking (FST) is to provide information on risk of transmission of waterborne illnesses associated with fecal contamination. Ideally, concentrations of FST markers in ambient waters would reflect exposure risk. Human mtDNA is an FST marker that is exclusively human in origin and may be elevated in feces of individuals experiencing gastrointestinal inflammation. In this study, we examined whether human mtDNA is elevated in fecal samples from individuals with symptomatic norovirus infections using samples from the United States (US), Mozambique, and Bangladesh. We quantified hCYTB484 (human mtDNA) and HF183/BacR287 (human-associated Bacteroides) FST markers using droplet digital polymerase chain reaction. We observed the greatest difference in concentrations of hCYTB484 when comparing samples from individuals with symptomatic norovirus infections versus individuals without norovirus infections or diarrhea symptoms: log10 increase of 1.42 in US samples (3,820% increase, p-value = 0.062), 0.49 in Mozambique (308% increase, p-value = 0.061), and 0.86 in Bangladesh (648% increase, p-value = 0.035). We did not observe any trends in concentrations of HF183/BacR287 in the same samples. These results suggest concentrations of fecal mtDNA may increase during symptomatic norovirus infection and that mtDNA in environmental samples may represent an unambiguously human source-tracking marker that correlates with enteric pathogen exposure risk.
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Affiliation(s)
- Kevin
J. Zhu
- School
of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Brittany Suttner
- School
of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Jackie Knee
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, London WC1E 7HT,United Kingdom
| | - Drew Capone
- Department
of Environmental Sciences and Engineering, Gillings School of Global
Public Health, University of North Carolina
at Chapel Hill, Chapel
Hill, North Carolina 27599, United States
| | - Christine L. Moe
- Center
for Global Safe Water, Sanitation, and Hygiene, Rollins School of
Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Christine E. Stauber
- Department
of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia 30302, United States
| | - Kostas T. Konstantinidis
- School
of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Thomas E. Wallach
- Division
of Pediatric Gastroenterology, SUNY Downstate
Health Sciences University, Brooklyn, New York 11203, United States
| | - Amy J. Pickering
- Department
of Civil and Environmental Engineering, University of California, Berkeley, California 94720, United States
| | - Joe Brown
- Department
of Environmental Sciences and Engineering, Gillings School of Global
Public Health, University of North Carolina
at Chapel Hill, Chapel
Hill, North Carolina 27599, United States
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4
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E. Stauber C, Brown J, Bourgeois AG, Palma F, A. Spears C, White C, Costa F. Mobile Health Technologies Are Essential for Reimagining the Future of Water, Sanitation, and Hygiene. Am J Trop Med Hyg 2022; 106:1017-1021. [PMID: 35130490 PMCID: PMC8991350 DOI: 10.4269/ajtmh.21-1040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/08/2021] [Indexed: 11/07/2022] Open
Abstract
The new Lancet Commission on water, sanitation, and hygiene (WASH) hopes to reimagine and guide global WASH efforts. This comes at a time when unequal living conditions and global disparities in response and recovery have been highlighted by the COVID-19 pandemic and recent large impact trials have delivered mostly disappointing results suggesting the need for radically more effective interventions to improve global public health. We find ourselves at an inflection point in global WASH with an opportunity to build new approaches with potentially more equitable, cost-effective, and scalable solutions. Mobile health (mHealth) technology is an important and innovative tool for WASH advances. Yet, the use of mHealth has not been equally distributed in terms of its benefits nor is its impact guaranteed. In resource-constrained settings, where technology can increase inequalities, special attention should be paid to structural and systemic hierarchies during the development of mHealth programs along with the acknowledgment and understanding of how these systems can reinforce the systematic exclusion of those most vulnerable. The WASH sector needs to adapt to a future that is innovative and inclusive with a commitment to rethinking the resources needed to enhance scope and impact. We highlight urban sanitation in Brazil as a case study to demonstrate that mHealth can support and enhance publicly funded infrastructure and to help reimagine WASH for postpandemic and beyond.
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Affiliation(s)
- Christine E. Stauber
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Anu G. Bourgeois
- Department of Computer Science, College of Arts and Sciences, Georgia State University, Atlanta, Georgia
| | - Fabiana Palma
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Claire A. Spears
- Department of Health Policy and Behavioral Sciences, School of Public Healh, Georgia State University, Atlanta, Georgia
| | - Cassandra White
- Department of Anthropology, College of Arts and Sciences, Georgia State University, Atlanta, Georgia
| | - Federico Costa
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
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5
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Stauber CE, Person B, Otieno R, Oremo J, Schilling K, Hayat MJ, Ayers T, Quick R. A Cluster Randomized Trial of the Impact of Education through Listening (a Novel Behavior Change Technique) on Household Water Treatment with Chlorine in Vihiga District, Kenya, 2010-2011. Am J Trop Med Hyg 2020; 104:382-390. [PMID: 33146110 DOI: 10.4269/ajtmh.20-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Despite multiple studies demonstrating the effectiveness of household water treatment with chlorine in disinfecting water and preventing diarrhea, social marketing of this intervention in low- and middle-income countries has resulted in only modest uptake. In a cluster randomized trial in Vihiga district, western Kenya, we compared uptake of household water treatment with chlorine among six villages served by community vendors trained in standard social marketing plus education through listening (ETL), an innovative behavior change method, and six villages served by community vendors trained in standard social marketing only. Water treatment uptake, water quality, and childhood diarrhea were measured over 6 months and compared between the two groups of villages. During the 6-month period, we found no association between ETL exposure and reported and confirmed household water treatment with chlorine. In both groups (ETL and comparison), reported use of water treatment was low and did not change during our 6-month follow-up. However, persons confirmed to have chlorinated water had improved bacteriologic water quality. Study findings suggest that ETL implementation was suboptimal, which, along with unexpected changes in the supply and price of chlorine, may have prevented an accurate assessment of the potential impact of ETL on water treatment behavior. Taken together, these observations exemplify the complexities of habits, practices, attitudes, and external factors that can create challenging conditions for implementing behavioral interventions. As a consequence, in this trial, ETL had no measurable impact on water treatment behavior.
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Affiliation(s)
- Christine E Stauber
- 1Department of Population Health Sciences, School of Public Health, Atlanta, Georgia State University, Atlanta, Georgia
| | - Bobbie Person
- 2Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Katharine Schilling
- 2Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J Hayat
- 1Department of Population Health Sciences, School of Public Health, Atlanta, Georgia State University, Atlanta, Georgia
| | - Tracy Ayers
- 2Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Quick
- 2Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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6
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Schilling KA, Awuor AO, Rajasingham A, Moke F, Omore R, Amollo M, Farag TH, Nasrin D, Nataro JP, Kotloff KL, Levine MM, Ayers T, Laserson K, Blackstock A, Rothenberg R, Stauber CE, Mintz ED, Breiman RF, O'Reilly CE. Water, Sanitation, and Hygiene Characteristics among HIV-Positive Households Participating in the Global Enteric Multicenter Study in Rural Western Kenya, 2008-2012. Am J Trop Med Hyg 2019; 99:905-915. [PMID: 30084344 DOI: 10.4269/ajtmh.17-0774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Diarrheal illness, a common occurrence among people living with human immunodeficiency virus (PLHIV), is largely preventable through access to safe drinking water quality, sanitation, and hygiene (WASH) facilities. We examined WASH characteristics among households with and without HIV-positive residents enrolled in the Global Enteric Multicenter Study (GEMS) in rural Western Kenya. Using univariable logistic regression, we examined differences between HIV-positive and HIV-negative households in regard to WASH practices. Among HIV-positive households, we explored the relationship between the length of time knowing their HIV status and GEMS enrollment. No statistically significant differences were apparent in the WASH characteristics among HIV-positive and HIV-negative households. However, we found differences in the WASH characteristics among HIV-positive households who were aware of their HIV status ≥ 30 days before enrollment compared with HIV-positive households who found out their status < 30 days before enrollment or thereafter. Significantly more households aware of their HIV-positive status before enrollment reported treating their drinking water (odds ratio [OR] confidence interval [CI]: 2.34 [1.12, 4.86]) and using effective water treatment methods (OR [CI]: 9.6 [3.09, 29.86]), and had better drinking water storage practices. This suggests that within this region of Kenya, HIV programs are effective in promoting the importance of practicing positive WASH-related behaviors among PLHIV.
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Affiliation(s)
- Kathrine A Schilling
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alex O Awuor
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya
| | - Anu Rajasingham
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fenny Moke
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya
| | - Richard Omore
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya
| | - Manase Amollo
- Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya
| | - Tamer H Farag
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Dilruba Nasrin
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - James P Nataro
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Karen L Kotloff
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Myron M Levine
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland.,Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Tracy Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kayla Laserson
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.,Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya.,Centers for Disease Control and Prevention India, Delhi, India
| | - Anna Blackstock
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Eric D Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.,Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Ciara E O'Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Soros A, Amburgey JE, Stauber CE, Sobsey MD, Casanova LM. Turbidity reduction in drinking water by coagulation-flocculation with chitosan polymers. J Water Health 2019; 17:204-218. [PMID: 30942771 DOI: 10.2166/wh.2019.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Turbidity reduction by coagulation-flocculation in drinking water reduces microbes and organic matter, increasing effectiveness of downstream treatment. Chitosan is a promising household water coagulant, but needs parameters for use. This study tested the effects of chitosan dose, molecular weight (MW), degree of deacetylation (DD), and functional groups on bentonite and kaolinite turbidity reduction in model household drinking water. Higher MW or DD produced greater reductions. Highest reductions were at doses 1 and 3 mg/L by MW >50,000 or >70% DD (residual turbidity <5 NTU). Higher doses did not necessarily continually increase reduction. For functional groups, 3 mg/L produced the highest reductions by lactate, acetate, and HCl, and lower reductions of kaolinite than bentonite. Doses where the point of zero charge was observed clustered around 3 mg/L. Chitosan reduced clay turbidity in water; effectiveness was influenced by dose, clay type, MW, DD, and functional groups. Reduction did not necessarily increase with MW. Bentonite had a broader effective dose range and higher reduction at the optimal dose than kaolinite. Chitosans with and without functional groups performed similarly. The best of the studied doses was 3 mg/L. Chitosans are promising for turbidity reduction in low-resource settings if combined with sedimentation and/or filtration.
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Affiliation(s)
- Ampai Soros
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina Chapel Hill, CB 7431, Chapel Hill, NC 27599, USA
| | - James E Amburgey
- Civil and Environmental Engineering Department, William States Lee College of Engineering, University of North Carolina Charlotte, 9201 University City Boulevard, Charlotte, NC 28223-0001, USA
| | - Christine E Stauber
- Division of Environmental Health, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, USA E-mail:
| | - Mark D Sobsey
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina Chapel Hill, CB 7431, Chapel Hill, NC 27599, USA
| | - Lisa M Casanova
- Division of Environmental Health, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, USA E-mail:
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8
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Schilling KA, Omore R, Derado G, Ayers T, Ochieng JB, Farag TH, Nasrin D, Panchalingam S, Nataro JP, Kotloff KL, Levine MM, Oundo J, Parsons MB, Bopp C, Laserson K, Stauber CE, Rothenberg R, Breiman RF, O'Reilly CE, Mintz ED. Factors Associated with the Duration of Moderate-to-Severe Diarrhea among Children in Rural Western Kenya Enrolled in the Global Enteric Multicenter Study, 2008-2012. Am J Trop Med Hyg 2017; 97:248-258. [PMID: 28719331 DOI: 10.4269/ajtmh.16-0898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Diarrheal disease is a leading cause of death among young children worldwide. As rates of acute diarrhea (AD; 1-6 days duration) have decreased, persistent diarrhea (PD; > 14 days duration) accounts for a greater proportion of the diarrheal disease burden. We describe factors associated with the duration of moderate-to-severe diarrhea in Kenyan children < 5 years old enrolled in the Global Enteric Multicenter Study. We found 587 (58%) children experienced AD, 360 (35%) had prolonged acute diarrhea (ProAD; 7-13 days duration), and 73 (7%) had PD. We constructed a Cox proportional hazards model to identify factors associated with diarrheal duration. Risk factors independently associated with longer diarrheal duration included infection with Cryptosporidium (hazard ratio [HR]: 0.868, P = 0.035), using an unimproved drinking water source (HR: 0.87, P = 0.035), and being stunted at enrollment (HR: 0.026, P < 0.0001). Diarrheal illness of extended duration appears to be multifactorial; given its association with adverse health and development outcomes, effective strategies should be implemented to reduce the duration and severity of diarrheal illness. Effective treatments for Cryptosporidium should be identified, interventions to improve drinking water are imperative, and nutrition should be improved through exclusive breastfeeding in infants ≤ 6 months and appropriate continued feeding practices for ill children.
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Affiliation(s)
- Katharine A Schilling
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Omore
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Gordana Derado
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John B Ochieng
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Tamer H Farag
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Dilruba Nasrin
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Sandra Panchalingam
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.,Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Karen L Kotloff
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Myron M Levine
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Joseph Oundo
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Michelle B Parsons
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheryl Bopp
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kayla Laserson
- Centers for Disease Control and Prevention, Delhi, India.,Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | | | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia.,Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Ciara E O'Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Abstract
Progression of geographic disparities in social determinants of health is a global concern. Using an Urban Health Index (UHI) approach, we proposed a framework of examining the change of geographic disparities in social determinants in small areas. Using the City of Atlanta in Georgia (USA) as a case study, we standardized six census-based social determinant indicators in 2000 and in 2010, respectively, and calculated their geometric mean to assign each census tract a UHI value for 2000 and for 2010. We then evaluated the temporal change of the UHIs in relation to the demographic changes using spatial and statistical methods. We found that Atlanta experienced an improvement in social determinant status and a reduction of disparities in the 10 years. The areas that experienced improvement, however, underwent demographic changes as well. This analysis provides support for displacement, rather than improvement, as the underlying factor for apparent change in geographic disparities. Findings suggest the importance of local evaluation for future policies to reduce disparities in cities.
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Affiliation(s)
- Dajun Dai
- Department of Geosciences, College of Arts and Sciences, Georgia State University, 24 Peachtree Center Ave NE, Atlanta, GA, 30303, USA.
| | - Richard Rothenberg
- School of Public Health, Georgia State University, Atlanta, GA, 30302, USA
| | - Ruiyan Luo
- School of Public Health, Georgia State University, Atlanta, GA, 30302, USA
| | - Scott R Weaver
- School of Public Health, Georgia State University, Atlanta, GA, 30302, USA
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10
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Diem JE, Stauber CE, Rothenberg R. Heat in the southeastern United States: Characteristics, trends, and potential health impact. PLoS One 2017; 12:e0177937. [PMID: 28520817 PMCID: PMC5433771 DOI: 10.1371/journal.pone.0177937] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/05/2017] [Indexed: 11/18/2022] Open
Abstract
High summer temperatures in extratropical areas have an impact on the public's health, mainly through heat stress, high air pollution concentrations, and the transmission of tropical diseases. The purpose of this study is to examine the current characteristics of heat events and future projections of summer apparent temperature (AT)-and associated health concerns-throughout the southeastern United States. Synoptic climatology was used to assess the atmospheric characteristics of extreme heat days (EHDs) from 1979-2015. Ozone concentrations also were examined during EHDs. Trends in summer-season AT over the 37-year period and correlations between AT and atmospheric circulation were determined. Mid-century estimates of summer AT were calculated using downscaled data from an ensemble of global climate models. EHDs throughout the Southeast were characterized by ridging and anticyclones over the Southeast and the presence of moist tropical air masses. Exceedingly high ozone concentrations occurred on EHDs in the Atlanta area and throughout central North Carolina. While summer ATs did not increase significantly from 1979-2015, summer ATs are projected to increase substantially by mid-century, with most the Southeast having ATs similar to that of present-day southern Florida (i.e., a tropical climate). High ozone concentrations should continue to occur during future heat events. Large urban areas are expected to be the most affected by the future warming, resulting from intensifying and expanding urban heat islands, a large increase in heat-vulnerable populations, and climate conditions that will be highly suitable for tropical-disease transmission by the Aedes aegypti mosquito. This nexus of vulnerability creates the potential for heat-related morbidity and mortality, as well as the appearance of disease not previously seen in the region. These effects can be attenuated by policies that reduce urban heat (e.g., cool roofs and green roofs) and that improve infrastructure (e.g. emergency services, conditioned space).
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Affiliation(s)
- Jeremy E. Diem
- Department of Geosciences, Georgia State University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Christine E. Stauber
- School of Public Health, Division of Environmental Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Richard Rothenberg
- School of Public Health, Division of Epidemiology and Biostatistics, Georgia State University, Atlanta, Georgia, United States of America
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11
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Murphy JL, Ayers TL, Knee J, Oremo J, Odhiambo A, Faith SH, Nyagol RO, Stauber CE, Lantagne DS, Quick RE. Evaluating four measures of water quality in clay pots and plastic safe storage containers in Kenya. Water Res 2016; 104:312-319. [PMID: 27565116 PMCID: PMC11005072 DOI: 10.1016/j.watres.2016.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/27/2016] [Accepted: 08/12/2016] [Indexed: 06/06/2023]
Abstract
Household water treatment with chlorine can improve microbiological quality and reduce diarrhea. Chlorination is typically assessed using free chlorine residual (FCR), with a lower acceptable limit of 0.2 mg/L, however, accurate measurement of FCR is challenging with turbid water. To compare potential measures of adherence to treatment and water quality, we chlorinated recently-collected water in rural Kenyan households and measured total chlorine residual (TCR), FCR, oxidation reduction potential (ORP), and E. coli concentration over 72 h in clay and plastic containers. Results showed that 1) ORP served as a useful proxy for chlorination in plastic containers up to 24 h; 2) most stored water samples disinfected by chlorination remained significantly less contaminated than source water for up to 72 h, even in the absence of FCR; 3) TCR may be a useful proxy indicator of microbiologic water quality because it confirms previous chlorination and is associated with a lower risk of E. coli contamination compared to untreated source water; and 4) chlorination is more effective in plastic than clay containers presumably because of lower chlorine demand in plastic.
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Affiliation(s)
- Jennifer L Murphy
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Tracy L Ayers
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline Knee
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | - Daniele S Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Boston, MA, USA
| | - Robert E Quick
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Stauber CE, Wedgworth JC, Johnson P, Olson JB, Ayers T, Elliott M, Brown J. Associations between Self-Reported Gastrointestinal Illness and Water System Characteristics in Community Water Supplies in Rural Alabama: A Cross-Sectional Study. PLoS One 2016; 11:e0148102. [PMID: 26820849 PMCID: PMC4731071 DOI: 10.1371/journal.pone.0148102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Community water supplies in underserved areas of the United States may be associated with increased microbiological contamination and risk of gastrointestinal disease. Microbial and health risks affecting such systems have not been systematically characterized outside outbreak investigations. The objective of the study was to evaluate associations between self-reported gastrointestinal illnesses (GII) and household-level water supply characteristics. METHODS We conducted a cross-sectional study of water quality, water supply characteristics, and GII in 906 households served by 14 small and medium-sized community water supplies in Alabama's underserved Black Belt region. RESULTS We identified associations between respondent-reported water supply interruption and any symptoms of GII (adjusted odds ratio (aOR): 3.01, 95% confidence interval (CI) = 1.65-5.49), as well as low water pressure and any symptoms of GII (aOR: 4.51, 95% CI = 2.55-7.97). We also identified associations between measured water quality such as lack of total chlorine and any symptoms of GII (aOR: 5.73, 95% CI = 1.09-30.1), and detection of E. coli in water samples and increased reports of vomiting (aOR: 5.01, 95% CI = 1.62-15.52) or diarrhea (aOR: 7.75, 95% CI = 2.06-29.15). CONCLUSIONS Increased self-reported GII was associated with key water system characteristics as measured at the point of sampling in a cross-sectional study of small and medium water systems in rural Alabama in 2012 suggesting that these water supplies can contribute to endemic gastro-intestinal disease risks. Future studies should focus on further characterizing and managing microbial risks in systems facing similar challenges.
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Affiliation(s)
- Christine E. Stauber
- Division of Environmental Health, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
- * E-mail: (CES); (JB)
| | - Jessica C. Wedgworth
- Department of Biological Sciences, University of Alabama, Tuscaloosa, Alabama, United States of America
| | - Pauline Johnson
- Department of Civil, Construction and Environmental Engineering, University of Alabama, Tuscaloosa, Alabama, United States of America
| | - Julie B. Olson
- Department of Biological Sciences, University of Alabama, Tuscaloosa, Alabama, United States of America
| | - Tracy Ayers
- Division of Environmental Health, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Mark Elliott
- Department of Civil, Construction and Environmental Engineering, University of Alabama, Tuscaloosa, Alabama, United States of America
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- * E-mail: (CES); (JB)
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13
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Elliott M, Stauber CE, DiGiano FA, de Aceituno AF, Sobsey MD. Investigation of E. coli and Virus Reductions Using Replicate, Bench-Scale Biosand Filter Columns and Two Filter Media. Int J Environ Res Public Health 2015; 12:10276-99. [PMID: 26308036 PMCID: PMC4586611 DOI: 10.3390/ijerph120910276] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 11/16/2022]
Abstract
The biosand filter (BSF) is an intermittently operated, household-scale slow sand filter for which little data are available on the effect of sand composition on treatment performance. Therefore, bench-scale columns were prepared according to the then-current (2006-2007) guidance on BSF design and run in parallel to conduct two microbial challenge experiments of eight-week duration. Triplicate columns were loaded with Accusand silica or crushed granite to compare virus and E. coli reduction performance. Bench-scale experiments provided confirmation that increased schmutzdecke growth, as indicated by decline in filtration rate, is the primary factor causing increased E. coli reductions of up to 5-log10. However, reductions of challenge viruses improved only modestly with increased schmutzdecke growth. Filter media type (Accusand silica vs. crushed granite) did not influence reduction of E. coli bacteria. The granite media without backwashing yielded superior virus reductions when compared to Accusand. However, for columns in which the granite media was first backwashed (to yield a more consistent distribution of grains and remove the finest size fraction), virus reductions were not significantly greater than in columns with Accusand media. It was postulated that a decline in surface area with backwashing decreased the sites and surface area available for virus sorption and/or biofilm growth and thus decreased the extent of virus reduction. Additionally, backwashing caused preferential flow paths and deviation from plug flow; backwashing is not part of standard BSF field preparation and is not recommended for BSF column studies. Overall, virus reductions were modest and did not meet the 5- or 3-log10 World Health Organization performance targets.
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Affiliation(s)
- Mark Elliott
- Department of Civil, Construction and Environmental Engineering, University of Alabama, Tuscaloosa, AL 35487, USA.
| | | | - Francis A DiGiano
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC 27599, USA.
| | | | - Mark D Sobsey
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC 27599, USA.
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14
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Stauber CE, Kominek B, Liang KR, Osman MK, Sobsey MD. Correction: Stauber, C.E., et al. Evaluation of the Impact of the Plastic BioSand Filter on Health and Drinking Water Quality in rural Tamale, Ghana. Int. J. Environ. Res. Public Health 2012 ,9, 3806–3823. Int J Environ Res Public Health 2014; 11:9154-9155. [PMCID: PMC4199011 DOI: 10.3390/ijerph110909154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 06/11/2023]
Abstract
The authors wish to make the following amendments to their paper published in International Journal of Environmental Research and Public Health [1]: [...]
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Affiliation(s)
- Christine E. Stauber
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, USA
| | - Byron Kominek
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Campus Box 7431, Chapel Hill, NC 27599, USA; E-Mails: (B.K.); (K.R.L.); (M.D.S.)
| | - Kaida R. Liang
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Campus Box 7431, Chapel Hill, NC 27599, USA; E-Mails: (B.K.); (K.R.L.); (M.D.S.)
| | - Mumuni K. Osman
- Cowater International Inc., NORST, P.O. Box 1476, Tamale, Ghana; E-Mail:
| | - Mark D. Sobsey
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Campus Box 7431, Chapel Hill, NC 27599, USA; E-Mails: (B.K.); (K.R.L.); (M.D.S.)
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15
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Wedgworth JC, Brown J, Johnson P, Olson JB, Elliott M, Forehand R, Stauber CE. Associations between perceptions of drinking water service delivery and measured drinking water quality in rural Alabama. Int J Environ Res Public Health 2014; 11:7376-92. [PMID: 25046635 PMCID: PMC4113882 DOI: 10.3390/ijerph110707376] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/03/2014] [Accepted: 06/30/2014] [Indexed: 01/28/2023]
Abstract
Although small, rural water supplies may present elevated microbial risks to consumers in some settings, characterizing exposures through representative point-of-consumption sampling is logistically challenging. In order to evaluate the usefulness of consumer self-reported data in predicting measured water quality and risk factors for contamination, we compared matched consumer interview data with point-of-survey, household water quality and pressure data for 910 households served by 14 small water systems in rural Alabama. Participating households completed one survey that included detailed feedback on two key areas of water service conditions: delivery conditions (intermittent service and low water pressure) and general aesthetic characteristics (taste, odor and color), providing five condition values. Microbial water samples were taken at the point-of-use (from kitchen faucets) and as-delivered from the distribution network (from outside flame-sterilized taps, if available), where pressure was also measured. Water samples were analyzed for free and total chlorine, pH, turbidity, and presence of total coliforms and Escherichia coli. Of the 910 households surveyed, 35% of participants reported experiencing low water pressure, 15% reported intermittent service, and almost 20% reported aesthetic problems (taste, odor or color). Consumer-reported low pressure was associated with lower gauge-measured pressure at taps. While total coliforms (TC) were detected in 17% of outside tap samples and 12% of samples from kitchen faucets, no reported water service conditions or aesthetic characteristics were associated with presence of TC. We conclude that consumer-reported data were of limited utility in predicting potential microbial risks associated with small water supplies in this setting, although consumer feedback on low pressure—a risk factor for contamination—may be relatively reliable and therefore useful in future monitoring efforts.
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Affiliation(s)
- Jessica C Wedgworth
- Department of Biological Sciences, University of Alabama, 300 Hackberry Lane, Tuscaloosa, AL 35487, USA.
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA.
| | - Pauline Johnson
- Department of Civil and Environmental Engineering, University of Alabama, 245 7th Avenue, Tuscaloosa, AL 35487, USA.
| | - Julie B Olson
- Department of Biological Sciences, University of Alabama, 300 Hackberry Lane, Tuscaloosa, AL 35487, USA.
| | - Mark Elliott
- Department of Civil and Environmental Engineering, University of Alabama, 245 7th Avenue, Tuscaloosa, AL 35487, USA.
| | - Rick Forehand
- Barge Waggoner Sumner and Cannon Inc., 2047 West Main Street, Suite 1, Dothan, AL 36301, USA.
| | - Christine E Stauber
- Division of Environmental Health, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, USA.
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16
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Stauber CE, Walters A, de Aceituno AMF, Sobsey MD. Bacterial contamination on household toys and association with water, sanitation and hygiene conditions in Honduras. Int J Environ Res Public Health 2013; 10:1586-97. [PMID: 23598302 PMCID: PMC3709336 DOI: 10.3390/ijerph10041586] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/27/2013] [Accepted: 04/03/2013] [Indexed: 11/17/2022]
Abstract
There is growing evidence that household water treatment interventions improve microbiological water quality and reduce diarrheal disease risk. Few studies have examined, however, the impact of water treatment interventions on household-level hygiene and sanitation. This study examined the association of four water and sanitation conditions (access to latrines, improved sanitation, improved water and the plastic biosand filter) on the levels of total coliforms and E. coli on existing and introduced toys during an on-going randomized controlled trial of the plastic biosand filter (plastic BSF). The following conditions were associated with decreased bacterial contamination on children’s toys: access to a latrine, access to improved sanitation and access to the plastic BSF. Overall, compared to existing toys, introduced toys had significantly lower levels of both E. coli and total coliforms. Results suggest that levels of fecal indicator bacteria contamination on children’s toys may be associated with access to improved water and sanitation conditions in the home. In addition, the fecal indicator bacteria levels on toys probably vary with duration in the household. Additional information on how these toys become contaminated is needed to determine the usefulness of toys as indicators or sentinels of water, sanitation and hygiene conditions, behaviors and risks.
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Affiliation(s)
- Christine E. Stauber
- Institute of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-404-413-1128 (ext. 123); Fax: +1-404-413-1140
| | - Adam Walters
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Campus Box 7431, Chapel Hill, NC 27599, USA; E-Mails: (A.W.); (M.D.S.)
| | - Anna M. Fabiszewski de Aceituno
- Rollins School of Public Health, Emory University, 6000K Claudia Nance Rollins Building, 1518 Clifton Road NE, Atlanta, GA 30322, USA; E-Mail:
| | - Mark D. Sobsey
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Campus Box 7431, Chapel Hill, NC 27599, USA; E-Mails: (A.W.); (M.D.S.)
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17
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Fabiszewski de Aceituno AM, Stauber CE, Walters AR, Meza Sanchez RE, Sobsey MD. A randomized controlled trial of the plastic-housing BioSand filter and its impact on diarrheal disease in Copan, Honduras. Am J Trop Med Hyg 2012; 86:913-21. [PMID: 22665593 PMCID: PMC3366532 DOI: 10.4269/ajtmh.2012.11-0066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 01/31/2012] [Indexed: 11/07/2022] Open
Abstract
Point of use drinking water treatment with the BioSand filter (BSF) allows people to treat their water in the home. The purpose of this research was to document the ability of the Hydraid plastic-housing BSF to reduce diarrheal disease in households who received a BSF in a randomized controlled trial. The trial of the Hydraid plastic-housing BSF was carried out in rural, mountainous communities in Copan, Honduras during April of 2008 to February of 2009. A logistic regression adjusting for clustering showed that the incidence of diarrheal disease in children under 5 years was reduced by approximately 45% (odds ratio = 0.55, 95% confidence interval = 0.28, 1.10) in households that had a BSF compared with those households without a BSF, but this finding fluctuated depending on season and was not statistically significant. Households with a BSF had significantly better drinking water quality regardless of water source or season.
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Affiliation(s)
- Anna M Fabiszewski de Aceituno
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
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18
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Stauber CE, Printy ER, McCarty FA, Liang KR, Sobsey MD. Cluster randomized controlled trial of the plastic BioSand Water filter in Cambodia. Environ Sci Technol 2012; 46:722-728. [PMID: 22129231 DOI: 10.1021/es203114q] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
About half of the rural population of Cambodia lacks access to improved water; an even higher percentage lacks access to latrines. More than 35,000 concrete BioSand Water filters (BSF) have been installed in the country. However, the concrete BSF takes time to produce and weighs hundreds of pounds. A plastic BSF has been developed but may not perform to the same benchmarks established by its predecessor. To evaluate plastic BSF performance and health impact, we performed a cluster randomized controlled trial in 13 communities including 189 households and 1147 participants in the Angk Snoul district of Kandal Province from May to December 2008. The results suggest that villages with plastic BSFs had significantly lower concentrations of E. coli in drinking water and lower diarrheal disease (incidence rate ratio 0.41, 95% confidence interval: 0.24-0.69) compared to control villages. As one of the first studies on the plastic BSF in Cambodia, these are important findings, especially in a setting where the concrete BSF has seen high rates of continued use years after installation. The study suggests the plastic BSF may play an important role in scaling up the distribution/implementation of the BSF, potentially improving water quality and health in the region.
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Affiliation(s)
- C E Stauber
- Institute of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302-3995, United States.
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19
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Aiken BA, Stauber CE, Ortiz GM, Sobsey MD. An assessment of continued use and health impact of the concrete biosand filter in Bonao, Dominican Republic. Am J Trop Med Hyg 2011; 85:309-17. [PMID: 21813853 DOI: 10.4269/ajtmh.2011.09-0122] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The biosand filter (BSF) is a promising point of use (POU) technology for water treatment; however there has been little follow-up of initial implementation to assess sustainability. The purpose of this study was to examine continued use, performance, and sustainability of previously implemented concrete BSFs in Bonao, Dominican Republic. Of 328 households visited and interviewed, 90% of BSFs were still in use after approximately 1 year since installation. Water-quality improvement, measured by fecal indicator bacteria reduction, was found to be 84-88%, which is lower than reductions in controlled laboratory studies but similar to other field assessments. In a short prospective cohort study comparing BSF to non-BSF households, odds of reported diarrheal disease in BSF households were 0.39 times the odds of reported diarrheal disease in non-BSF households. These results document high levels of sustained and effective concrete BSF use and associated improvements in water quality and health.
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Affiliation(s)
- Benjamin A Aiken
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC, USA.
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20
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Russell MD, Correa MT, Stauber CE, Kase JA. North Carolina Hispanic farmworkers and intestinal parasitism: a pilot study of prevalence and health-related practices, and potential means of foodborne transmission. J Food Prot 2010; 73:985-8. [PMID: 20501054 DOI: 10.4315/0362-028x-73.5.985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Migrant and seasonal farmworkers provide much of the necessary labor to harvest and process agricultural commodities desired by consumers. Little is known about the health status (especially the parasitic burden) of farm laborers, who handpick agricultural items such as fruits and vegetables, despite being implicated as a means of foodborne pathogen transmission. The goal of this research was to develop a framework to investigate enteric parasitic infections among Hispanic farmworkers in Eastern North Carolina. Seventy-one interviews were conducted, 16 stool samples were collected, and two parasite-positive workers were found. In addition, some potentially harmful health practices (e.g., self-medication) were identified. Further research is necessary to fully understand the scope of farmworker health issues and the potential risk of disseminating foodborne pathogens to humans. The study model presented provides a geographically expandable format to allow for various types of health investigations including the prevalence of other pathogens.
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Affiliation(s)
- Mindi D Russell
- North Carolina State Laboratory of Public Health, Raleigh, North Carolina 27601, USA
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21
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Stauber CE, Ortiz GM, Loomis DP, Sobsey MD. A randomized controlled trial of the concrete biosand filter and its impact on diarrheal disease in Bonao, Dominican Republic. Am J Trop Med Hyg 2009; 80:286-293. [PMID: 19190228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
A number of household water treatment and safe storage technologies, such as chlorine disinfection, solar disinfection, and ceramic filtration, have been documented for their ability to reduce diarrheal disease and improve microbial water quality. The biosand filter (BSF) is a promising household water treatment technology in use by > 500,000 people globally. The purpose of this research was to document the ability of BSFs to improve water quality and to reduce diarrheal disease in user compared with non-user households in a randomized controlled trial in Bonao, Dominican Republic, during 2005-2006. During the 6-month intervention period, 75 BSF households had significantly improved drinking water quality on average compared with 79 control households (P < 0.001). Based on random intercepts logistic regression, BSF households had 0.53 times the odds of diarrheal disease as control households, indicating a significant protective effect of the BSF against waterborne diarrheal disease.
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Affiliation(s)
- Christine E Stauber
- Department of Environmental Science and Engineering, School of Public Health, The University of North Carolina, Chapel Hill, North Carolina 27599-7431, USA.
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Stauber CE, Ortiz GM, Sobsey MD, Loomis DP. A Randomized Controlled Trial of the Concrete Biosand Filter and Its Impact on Diarrheal Disease in Bonao, Dominican Republic. Am J Trop Med Hyg 2009. [DOI: 10.4269/ajtmh.2009.80.286] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sobsey MD, Stauber CE, Casanova LM, Brown JM, Elliott MA. Point of use household drinking water filtration: A practical, effective solution for providing sustained access to safe drinking water in the developing world. Environ Sci Technol 2008; 42:4261-7. [PMID: 18605542 DOI: 10.1021/es702746n] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The lack of safe water creates a tremendous burden of diarrheal disease and other debilitating, life-threatening illnesses for people in the developing world. Point-of-use (POU) water treatment technology has emerged as an approach that empowers people and communities without access to safe water to improve water quality by treating it in the home. Several POU technologies are available, but, except for boiling, none have achieved sustained, large-scale use. Sustained use is essential if household water treatment technology (HWT) is to provide continued protection, but it is difficult to achieve. The most effective, widely promoted and used POU HWTs are critically examined according to specified criteria for performance and sustainability. Ceramic and biosand household water filters are identified as most effective according to the evaluation criteria applied and as having the greatest potential to become widely used and sustainable for improving household water quality to reduce waterborne disease and death.
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Affiliation(s)
- Mark D Sobsey
- Department of Environmental Sciences and Engineering, CB#7431, University of North Carolina, Chapel Hill, North Carolina 27599-7431, USA.
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Elliott MA, Stauber CE, Koksal F, DiGiano FA, Sobsey MD. Reductions of E. coli, echovirus type 12 and bacteriophages in an intermittently operated household-scale slow sand filter. Water Res 2008; 42:2662-70. [PMID: 18281076 DOI: 10.1016/j.watres.2008.01.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 11/16/2007] [Accepted: 01/17/2008] [Indexed: 05/07/2023]
Abstract
Point-of-use (POU) drinking water treatment technology enables those without access to safe water sources to improve the quality of their water by treating it in the home. One of the most promising emerging POU technologies is the biosand filter (BSF), a household-scale, intermittently operated slow sand filter. Over 500,000 people in developing countries currently use the filters to treat their drinking water. However, despite this successful implementation, there has been almost no systematic, process engineering research to substantiate the effectiveness of the BSF or to optimize its design and operation. The major objectives of this research were to: (1) gain an understanding of the hydraulic flow condition within the filter (2) characterize the ability of the BSF to reduce the concentration of enteric bacteria and viruses in water and (3) gain insight into the key parameters of filter operation and their effects on filter performance. Three 6-8 week microbial challenge experiments are reported herein in which local surface water was seeded with E. coli, echovirus type 12 and bacteriophages (MS2 and PRD-1) and charged to the filter daily. Tracer tests indicate that the BSF operated at hydraulic conditions closely resembling plug flow. The performance of the filter in reducing microbial concentrations was highly dependent upon (1) filter ripening over weeks of operation and (2) the daily volume charged to the filter. BSF performance was best when less than one pore volume (18.3-L in the filter design studied) was charged to the filter per day and this has important implications for filter design and operation. Enhanced filter performance due to ripening was generally observed after roughly 30 days. Reductions of E. coli B ranged from 0.3 log10 (50%) to 4 log10, with geometric mean reductions after at least 30 days of operation of 1.9 log10. Echovirus 12 reductions were comparable to those for E. coli B with a range of 1 log10 to >3 log10 and mean reductions after 30 days of 2.1 log10. Bacteriophage reductions were much lower, ranging from zero to 1.3 log10 (95%) with mean reductions of only 0.5 log10 (70%). These data indicate that virus reduction by BSF may differ substantially depending upon the specific viral agent.
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Affiliation(s)
- M A Elliott
- University of North Carolina, CB 7431, Chapel Hill, NC 27599-7431, USA.
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Stauber CE, Elliott MA, Koksal F, Ortiz GM, DiGiano FA, Sobsey MD. Characterisation of the biosand filter for E. coli reductions from household drinking water under controlled laboratory and field use conditions. Water Sci Technol 2006; 54:1-7. [PMID: 17037125 DOI: 10.2166/wst.2006.440] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
More than a billion people in the developing world lack access to safe and reliable sources of drinking water. Point of use (POU) household water treatment technology allows people to improve the quality of their water by treating it in the home. One emerging POU technology is the biosand filter (BSF), a household-scale, intermittently operated slow sand filter. Laboratory and field studies examined Escherichia coli reductions achieved by the BSF. During two laboratory studies, mean E. coli reductions were 94% and they improved over the period of filter use, reaching a maximum of 99%. Field analysis conducted on 55 household filters near Bonao, Dominican Republic averaged E. coli reductions of 93%. E. coli reductions by the BSF in laboratory and field studies were less than those typically observed for traditional slow sand filters (SSFs), although as for SSFs microbial reductions improved over the period of filter use. Further study is needed to determine the factors contributing to microbial reductions in BSFs and why reductions are lower than those of conventional SSFs.
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Affiliation(s)
- C E Stauber
- University of North Carolina-Chapel Hill, Dept of Environmental Sciences and Engineering, 27599 Chapel Hill, NC, USA
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