Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality. Trop Med Intl Health, Feb 2014.
Authors – Lenka Benova, Oliver Cumming and Oona M. R. Campbell
Objective – To assess whether the lack of water or the lack of sanitation facilities in either the home or in health facilities is associated with an increased risk of maternal mortality and to quantify the effect sizes.
Methods – Systematic review of published literature in Medline, Embase, Popline and Africa Wide EBSCO since 1980.
Results – Fourteen articles were found. Four of ﬁve ecological studies that considered sanitation found that poor sanitation was associated with higher maternal mortality. Meta-analysis of adjusted estimates in individual-level studies indicated that women in households with poor sanitation had 3.07 (95% CI 1.72–5.49) higher odds of maternal mortality. Four of six ecological studies assessing water environment found that poor water environment was associated with higher maternal
mortality. The only individual-level study looking at the adjusted effect of water showed a signiﬁcant association with maternal mortality (OR = 1.50, 95% CI 1.10–2.10). Two ecological and one facility-based study found an association between a combined measure of water and sanitation environment and maternal mortality.
Conclusions – There is evidence of association between sanitation and maternal mortality and between water and maternal mortality. Both associations are of substantial magnitude and are maintained after adjusting for confounders. However, these conclusions are based on a very small number of studies, few of which set out to examine sanitation or water as risk factors, and only some of which adjusted for potential confounders. Nevertheless, there are plausible pathways through
which such associations may operate.
Evaluation of the Compartment Bag Test for the Detection of Escherichia coli in Water. J Microbiol Methods. 2014 Feb 21.
Authors: Stauber C, Miller C, Cantrell B, Kroell K
AIMS: Annually, more than 2 million diarrheal disease deaths can be attributed to the lack of access to water, sanitation and hygiene. These deaths occur mostly in developing countries where water quality testing resources are limited. Several tests are currently used to detect and quantify E. coli and other fecal bacteria in drinking water, however they can be expensive, complex, and technically demanding. There is a need for a simple, reliable, low-cost water quality test that can be used in resource limited settings. Therefore, the purpose of this research was to perform a rigorous evaluation of the recently developed compartment bag test for detection and quantification of E. coli against the standard method of membrane filtration.
Methods And Results: A total of 270 water samples were collected from forty-five various naturally contaminated water sources around metro-Atlanta from August 2011 through April 2012. Samples were processed using the compartment bag test and membrane filtration with mI agar. Concentrations of E. coli were significantly correlated with a correlation coefficient of 0.904 (95% CI 0.859 – 0.950). Sensitivity and specificity were 94.9% and 96.6%, respectively.
CONCLUSIONS: These results suggest that the compartment bag test produces results consistent with those produced by membrane filtration on mI agar. Based upon its performance, the compartment bag test has the potential to be used as a reliable, affordable drinking water quality test globally where other microbial water quality testing resources are not readily available, and can be implemented in monitoring activities for microbial water quality to provide reliable and actionable data.
Impact of Rainfall on Diarrheal Disease Risk Associated with Unimproved Water and Sanitation. Am J Trop Med Hyg. 2014 Feb 24.
Bhavnani D, Goldstick JE, Cevallos W, Trueba G, Eisenberg JN.
Diarrheal disease remains a leading cause of morbidity in areas with limited access to safe water and sanitation. As water and sanitation interventions continue to be implemented, it will be important to understand the ecological context in which they can prevent diarrhea. We conducted six serial case control studies in Ecuador to estimate the risk of diarrhea from unimproved water and sanitation and the potential for effect modification by rainfall.
Unimproved water source and unimproved sanitation increased the adjusted odds of diarrhea (odds ratio [OR] = 3.6, 95% confidence interval [95% CI] = 1.7-7.8 and OR = 1.7, 95% CI = 1.2-2.5, respectively). The OR associated with an unimproved water source was highest after maximum rainfall (OR = 6.8, 95% CI = 1.9-24.5), whereas the OR associated with unimproved sanitation was highest after minimal rainfall (OR = 2.9, 95% CI = 1.3-6.6).
Our finding that use of safe water sources and improved sanitation facilities are most protective under opposing rainfall conditions highlights the need for integrated interventions to reduce the burden of diarrheal disease.
Efficacy of Moringa oleifera leaf powder as a handwashing product: a crossover controlled study among healthy volunteers. BMC Complementary and Alternative Medicine 2014, 14:57.
Belen Torondel, et al.
Background – Moringa oleifera is a plant found in many tropical and subtropical countries. Many different uses and properties have been attributed to this plant, mainly as a nutritional supplement and as a water purifier. Its antibacterial activity against different pathogens has been described in different in vitro settings. However the potential effect of this plant leaf as a hand washing product has never been studied. The aim of this study is to test the efficacy of this product using an in vivo design with healthy volunteers.
Methods – The hands of fifteen volunteers were artificially contaminated with Escherichia coli. Moringa oleifera leaf powder was tested as a hand washing product and was compared with reference non-medicated liquid soap using a cross over design following an adaptation of the European Committee for Standardization protocol (EN 1499). In a second part of tests, the efficacy of the established amount of Moringa oleifera leaf powder was compared with an inert powder using the same protocol.
Results – Application of 2 and 3 g of dried Moringa oleifera leaf powder (mean log10-reduction: 2.44 +/- 0.41 and 2.58 +/- 0.34, respectively) was significantly less effective than the reference soap (3.00 +/- 0.27 and 2.99 +/- 0.26, respectively; p < 0.001). Application of the same amounts of Moringa oleifera (2 and 3 g) but using a wet preparation, was also significantly less effective than reference soap (p < 0.003 and p < 0.02, respectively). However there was no significant difference when using 4 g of Moringa oleifera powder in dried or wet preparation (mean log10-reduction: 2.70 +/- 0.27 and 2.91 +/- 0.11, respectively) compared with reference soap (2.91 +/- 0.28). Application of calcium sulphate inert powder was significantly less effective than the 4 g of Moringa oleifera powder (p < 0.01).
Conclusion – Four grams of Moringa oleifera powder in dried and wet application had the same effect as non-medicated soap when used for hand washing. Efficacious and available hand washing products could be useful in developing countries in controlling pathogenic organisms that are transmitted through contaminated hands.
Household Effectiveness vs. Laboratory Efficacy of Point-of-use Chlorination. Water Research, Jan 2014.
Karen Levy, et al.
- The effectiveness of chlorine water treatment under household conditions was lower than laboratory efficacy.
- Only 39-51% of stored water was safe for consumption and only 35-53% achieved recommended residual levels of chlorine.
- Chlorine treatment was not protective against diarrhea by WHO standards.
- Point-of-use interventions should take source water conditions such as baseline contamination and turbidity into account.
Treatment of water at the household level offers a promising approach to combat the global burden of diarrheal diseases. In particular, chlorination of drinking water has been a widely promoted strategy due to persistence of residual chlorine after initial treatment. However, the degree to which chlorination can reduce microbial levels in a controlled setting (efficacy) or in a household setting (effectiveness) can vary as a function of chlorine characteristics, source water characteristics, and household conditions. To gain more understanding of these factors, we carried out an observational study within households in rural communities of northern coastal Ecuador. We found that the efficacy of chlorine treatment under controlled conditions was significantly better than its effectiveness when evaluated both by ability to meet microbiological safety standards and by log reductions. Water treated with chlorine achieved levels of microbial contamination considered safe for human consumption after 24 hours of storage in the household only 39 – 51% of the time, depending on chlorine treatment regimen.
Chlorine treatment would not be considered protective against diarrheal disease according to WHO log reduction standards. Factors that explain the observed compromised effectiveness include: source water turbidity, source water baseline contamination levels, and in-home contamination. Water in 38% of the households that had low turbidity source water (< 10 NTU) met the safe water standard as compared with only 17% of the households that had high turbidity source water (> 10 NTU). A 10 MPN/100mL increase in baseline E. coli levels was associated with a 2.2% increase in failure to meet the E. coli standard. Higher mean microbial contamination levels in 54% of household samples in comparison to their matched controls, which is likely the result of in-home contamination during storage. Container characteristics (size of the container mouth) did not influence chlorine effectiveness.
We found no significant differences between chlorine treatment regimens in ability to meet the safe water standards or in overall log reductions, although chlorine dosage did modify the effect of source conditions. These results underscore the importance of measuring both source water and household conditions to determine appropriate chlorine levels, as well as to evaluate the appropriateness of chlorine treatment and other point-of-use water quality improvement interventions.
Intermittent versus continuous operation of biosand filters. Water Research, Feb 2014.
Candice Young-Rojanschi, et al.
- Biosand columns were operated either continuously or intermittently.
- Continuous operation of biosand filters is more effective at removing Escherichia coli and MS2.
- E. coli removal occurs during the pause period throughout the filter, up to 20 h.
- Anoxic conditions can occur within the first 10 cm of filter media in intermittenly operated filters.
- Hydraulic conductivity decreased at all media depths over the experimental period.
The biosand filter is a household-scale point-of-use water filtration system based on slow sand filtration, but modified for intermittent operation. Studies on slow sand filters show that intermittent operation reduces filter effectiveness. However, continuous versus intermittent operation of biosand filters has never been compared. Eight 10-cm diameter columns were constructed to represent field biosand filters. Five were operated intermittently with a 24-h residence period, while the remaining three were operated continuously. Continuous operation of the filters resulted in significantly better reduction of Escherichia coli (3.71 log10versus 1.67 log10), bacteriophage MS2 (2.25 log10 versus 0.85 log10), and turbidity (96% versus 87%). Dissolved oxygen levels at 5 and 10 cm of media depth in intermittent filters reached an average of 0 mg/L by 24 h of residence time on day 60 of the experiment. A simple numerical model was developed to describe E. coli removal during ripening from days 0–58 for continuously operated versus intermittent filters. This research confirms that although biosand filters were developed for intermittent operation, the filters perform significantly better when operated continuously. However, both operational modes resulted in a significant reduction of microbial indicators.
Risk Assessment of the Schmutzdecke of Biosand Filters: Identification of an Opportunistic Pathogen in Schmutzdecke Developed by an Unsafe Water Source. Int. J. Environ. Res. Public Health 2014, 11(2), 2033-2048.
Hyun Gyu Hwang, et al.
The biosand filter (BSF) is widely applied in developing counties as an appropriate technology-based product for supplying “safe” water. Biosand filters exhibit relatively high purifying efficiency because of the schmutzdecke (biofilm) embedded in them. However, schmutzdecke should be cleaned or discarded on a regular basis to maintain the purifying efficiency of the BSF. Due to its role in BSFs, the purifying function of schmutzdecke, rather than its potential risk when not properly discarded, has so far been the primary focus of research. This study aims to provide a risk assessment of schmutzdecke in an attempt to draw attention to a wholly new angle of schmutzdecke usage. We conducted 16S rRNA gene sequencing and phylogenetic analysis to identify opportunistic pathogens in schmutzdecke developed using water from the Hyung-San River. The results reveal that the schmutzdecke derived from this water source contains diverse and relatively high portions of opportunistic pathogen strains; 55% of all isolates collected from schmutzdecke were identified as opportunistic pathogens. Moreover, the diversity of microorganisms is increased in the schmutzdecke compared to its water source in terms of diversity of genus, phylum and opportunistic pathogen strain. As a whole, our study indicates a potential risk associated with schmutzdecke and the necessity of a solid guideline for the after-treatment of discarded schmutzdecke.
NAVIGATING THE WATER, SANITATION, AND HYGIENE (WASH) SECTOR: A GUIDE FOR CORPORATE GRANTMAKERS. WASH Advocates, February 2014.
The opportunities for the corporate sector to demonstrate leadership in WASH are widespread and allow for great returns on investment. This guide, developed by WASH Advocates, presents an overview of opportunities for corporations to leverage resources and meet goals effectively.
- WASH programs offer a return of $4 in increased economic productivity and reduced healthcare costs for every $1 invested.
- Tangible benefits for corporations looking to invest in WASH solutions include access to new marketplaces, mitigation of risk, increased brand recognition, and improved employee morale.
- Strategic philanthropy, corporate social responsibility, cause-related marketing, and employee motivation campaigns are among the variety of channels available to corporations for supporting WASH.
- Eleven case studies featured in the guide profile the winning strategies employed by recognized corporate leaders in the sector, including Coca-Cola, Procter & Gamble, and General Electric.
- A number of organizations bring together the public and private sectors to address the WASH challenge, including: WASHfunders.org, WASH Grantmakers Network, CEO Water Mandate, Global Water Challenge, and several water-related trade associations.
- Many corporations are finding success working in partnership with the U.S. Government, particularly the United States Agency for International Development (USAID), which is the largest single donor to WASH programs in the world.
Issue 134 February 14, 2014 | Focus on WASH and Small Towns
More people now live in urban rather than rural areas. As this traditional balance has changed, a new and significant category of human settlement is emerging—small towns. This issue of the Weekly contains reports and manuals published in 2013 on WASH issues in small towns. Included are a December 2013 report from IRC International Water and Sanitation Center on small town WASH trends and models; country reports from Ghana, Indonesia, and Uganda; and links to a WaterAid website that features a series of videos on WASH issues in small towns.
We welcome your suggestions for future issues of the Weekly; upcoming issues will be on World Water Day 2014, WASH and nutrition, behavior change, CLTS, household water treatment, and menstrual hygiene management.
April 7–9, 2014 Seminar on Monitoring of Decentralised WASH Services in West Africa. (Link)
This is a seminar to bring stakeholders from West Africa up to speed with the latest thinking on WASH monitoring, and provide a venue for emphasizing experiences in the field of monitoring WASH services at the municipal level. It will take place in Ouagaoudou, Burkina Faso. IRC International Water and Sanitation Center and PS-Eau organized the event with the political support of ECOWAS and the Government of Burkina Faso.
Small Town Water Services: Trends, Challenges and Models, 2013. M Adank, IRC.(Link)
This paper presents the main features and explains what constitutes “small towns” to determine the most appropriate water service arrangement for this new phenomenon. Findings of the paper point to challenges in developing a clear typology for small towns and assigning one single model for delivering small town water services. The paper draws examples from different countries and provides compelling evidence that: different models and arrangements have been tested and have worked; there is a growing role for private sector involvement; and there is a need to revisit institutional and regulatory frameworks, as well as funding models, to finance capital maintenance.
Full-Chain Sanitation Services that Last: Non-Sewered Sanitation Services, 2013. J Verhagen. IRC. (Link)
This paper sets out a framework for the delivery of non-sewered sanitation services that last, are accessible to all, and are at scale. The framework identifies four key parameters for sustainable sanitation services: 1) easy and safe access to a sanitary latrine that offers user privacy and operates throughout the year; 2) hygienic use of the latrine (equipped with an accessible hand washing facility) by all, when in and around the house; 3) adequate operation and maintenance and repair and replacement to ensure that the latrine is usable; and 4) safe and final disposal of fecal sludge to ensure environmental protection.
Thinking Beyond the ‘Usual Questions’: Small Towns, 2013. (Video)
Ken Kaplan of Building Partnerships for Development discusses the Small Towns Project with WaterAid and how small towns are different from larger urban and rural areas. One “aha” moment was realizing how far a small town was from a large urban center and how this may force innovation.
Urban Sanitation Review: A Call to Action, 2013. The World Bank. (Link)
This study summarizes the main challenges to scaling up access to sustainable sanitation services in the urban areas of three countries in the East Asia and Pacific region—Indonesia, Philippines, and Vietnam—and proposes the main steps these countries need to take to redress the status quo.