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Vibrio cholera, the bacteria that cause cholera, is endemic in Haiti with a presence in both cities and remote areas. Improved access to drinking water testing and treatment in remote areas may reduce the impact of the disease. This case study uses correlation and regression analysis to identify the main factors that hinder access to water testing and that lead to high cholera infection rates among communities in the Northern Corridor of Haiti. Poor road conditions, mountainous terrain, and limited transportation options lead to high travel times up to 5.7 min/km between remote communities and drinking water testing facilities. The presence of springs in a community has a significant positive correlation with cholera infection rates in the Northern Corridor. However, socioeconomic factors had no significant correlation with cholera infection rate. The results of this study will be used to plan the implementation of a new drinking water testing laboratory near the city of Cap-Haitian and other programs for vulnerable remote areas. PRACTITIONER POINTS: Topography and road conditions may be more important than distance in determining the accessibility of water testing facilities for rural communities. A lack of access to private vehicles is a substantial challenge for many rural communities in accessing water testing. The presence of springs in a community had a significant positive correlation with cholera infection rate.

The 2018 Camp Fire in Butte County, California, was the state’s most destructive wildfire in history, destroying more than 14,600 homes. The wildfire caused widespread drinking water system chemical contamination resulting in acute and chronic health risks, requiring water use restrictions. Six months after the fire, the research team conducted a rapid community survey of attitudes and experiences that were specific to building water safety. The validated surveys represented 233 households. Amid the disaster response, 54% of the respondents self-reported that at least one member in their household had anxiety, stress, or depression directly related to the water contamination issues. Uncertainty about water and plumbing safety prompted respondents to alter water use in the home (83%), install in-home water treatment technologies (47%), and/or seek alternate water sources (85%). To provide affected households with answers to plumbing testing and safety questions, the research team designed and conducted a community education event. Many community members had technical questions about how to conduct water testing to determine whether their plumbing was safe. The research team identified several significant public health information gaps and a need for clear recommendations. This work illustrates the advantages of community involvement for resolving ambiguities in how households can respond to water safety issues following a natural disaster. Further, the authors posit that strong community engagement in this context can reduce both psychological distress and exposure risks.

Nowadays many emerging countries have seen a substantial increase in supply for fresh water. In present scenario water comes into a drought. This paper represents converting of sea water into Drinking water processing machine. To reach the demands of the basic needs filtration and purification of water has been investigated. This paper presents on the effects of purifying water in behavior of activation carbon in comparison to conventional method. Activated carbon is used to investigate the efficiency in the water filtration mechanism Activated Carbon frequently used to extract water contaminants from tap water and salt water in water treatment. In domestic water filters, activated carbon is used because of its excellent ability of adsorption. In this research, the grades A of Activated Coal are used to analyze their efficiency in the filters. Ultraviolet radiation is used for the purification of water without abandoning hazardous chemicals. Prototype is produced through the use of a water treatment with activated carbon and ultraviolet radiation. Two activated carbons perform surface region and porosity observation. The magnified image of Granulized Activated Carbon is used for the contrast between ground structures by Scanning Electron Microscopy (SEM). Before and after water treatment, two forms of water tests investigated, the ground water and the bore-well water are evaluated. The pH test, total suspended solid particle test, biochemical oxygen requirement check, and Chemical Oxygen Demand (COD) experiment were used to evaluate the water samples. The assessment conducted is an initial effort to deal with such an issue. The maximum intensity of the radiation is 256 nm which is the most effective wavelength in inactivating bacteria. The UV-C portion is totally blocked out with prevalent bottles. A fraction of UV-C radiation exits. However, the purified water layer that implemented in larger containers. Thus, paper examines an effectiveness of technology and economics in future studies.

Nosocomial Legionnaires’ disease, caused by the waterborne bacterial species Legionella, is a potentially preventable hospital-associated infection. Legionella bacteria are ubiquitous in both natural water sources and manmade potable water systems. Exposure of vulnerable hospitalized patients to Legionella bacteria in a hospital’s potable water system can result in clinically significant and potentially mortal disease. Testing a healthcare system’s potable water system is always indicated in the workup of healthcare-associated Legionnaires’ disease cases and may be performed for primary and secondary prevention. Legionella require specific conditions to grow, and culture methodology may affect the sensitivity of testing. The timing, methodology, and follow-up of water testing for Legionella in the healthcare setting remain controversial.

Ensuring access to safe drinking water is a challenge in many parts of the world for reasons including, but not limited to, infrastructure age, source water impairment, limited community finances and limitations in Federal water protections. Water quality crises and the prevalence of impaired waters globally highlight the need for investment in the expansion of drinking water testing that includes public and private water systems, as well as community outreach. We provide justification including a case example to argue the merits of developing drinking water testing and community outreach programs that include drinking water testing and non-formal education (i.e., public outreach) regarding the importance of drinking water quality testing for human well-being and security. Organizers of drinking water testing programs should: (1) test drinking water quality; (2) develop drinking water quality databases; (3) increase public awareness of drinking water issues; (4) build platforms for improved community outreach; and (5) publish program results that illustrate successful program models that are spatially and temporally transferrable. We anticipate that short-term and intermediate outcomes of this strategy would improve access to drinking water testing, facilitate greater understanding of water quality and increase security through inclusive and equitable water quality testing and outreach programs.

Majority African-American neighborhoods on the edges of North Carolina municipalities are less likely than white peri-urban neighborhoods to be served by a community system regulated under the Safe Drinking Water Act. These households rely on unregulated private wells, which are at much higher risk of contamination than neighboring community water supplies. Yet, risk awareness of consuming well water is low, and no prior research has tested risk communication interventions for these communities. We present a randomized-controlled trial of an oversized postcard to promote water testing among this audience. The postcard design followed the mental models approach to risk communication. To our knowledge, this is the first U.S. randomized-controlled trial of a mailed communication to promote water testing in any audience and one of few trials of the mental models approach. We evaluated the postcard's effects on self-reported water testing with and without a free water test offer (vs. no-intervention control) via a survey mailed one month after the interventions. The combined communication and free test doubled the odds of self-reported water testing, compared to the control group (p = 0.046). It increased the odds of testing by 65%, compared to the free test alone. Recall of receiving a postcard about water testing increased the odds of self-reported testing twelve-fold (p < 0.001). Although these results suggest that targeted risk information delivered by mail can promote water testing when paired with a free test, the mechanism remains unclear. Additional research on beliefs influencing perceptions about well water may yield interventions that are even more effective.

Exposure to inorganic arsenic in drinking water has known cancer and non-cancer health effects. However, no prior studies have addressed response to well water testing for arsenic during pregnancy, a time of known heightened risk perception. Using a US pregnancy cohort, we assessed the impact of receiving well water arsenic test results on subsequent use of arsenic-contaminated tap water. Study participants were 24–28 weeks’ gestation at study entry and reported living in a residence served by a private, unregulated well. Upon enrollment participants provided a tap water sample which was tested for arsenic using ICP-MS. During pregnancy and every four months after, participants were asked their extent of tap water use for drinking, cooking and mixing infant formula. Logistic regression was used to estimate the odds of tap water use at one year post-partum in relation to baseline tap water use and arsenic concentration. Compared to those who used tap water 50% of time in their prenatal questionnaire had 8.54 times the odds of using their tap water at 1-year postpartum (95% CI: 5.37, 13.60). After adjusting for frequency of prenatal tap water use, mothers were less likely to use tap water for drinking and cooking (OR = 0.34, 95% CI: 0.19, 0.60) and for mixing formula (OR = 0.45, 95% CI: 0.24, 0.86) if the high arsenic concentration (>10 μg/L) was known to them. Our findings suggest that providing well water test results during pregnancy may reduce subsequent maternal use of iAs contaminated tap water for drinking, cooking, and mixing infant formula. Public health implications are discussed.

Background Haemato-oncology patients are at increased risk of infection from atypical mycobacteria such as Mycobacterium chelonae which are commonly found in both domestic and hospital water systems. Aims To describe the investigation and control measures following two patient cases of M. chelonae and positive water samples in our hospital. Methods Water testing was undertaken from outlets, storage tanks and mains supply. We utilised whole genome sequencing (WGS) to compare patient and positive water samples. We describe the subsequent infection control measures implemented. Findings The WGS results showed two main populations of M. chelonae within the group of sampled isolates. The results showed that the patient strains were unrelated to each other but that the isolate from one patient was closely related to environmental samples from water outlets, supporting nosocomial acquisition. Conclusions We describe the utility of WGS in the investigation of two patient cases of M. chelonae, and positive water samples from a hospital water supply. We discuss relevant control measures and the potential for chemical dosing of water systems to enhance proliferation of atypical mycobacteria. Postprint

Introduction Recent legislation requires public and charter schools in California to test drinking water for lead. Our objective was to describe 1) results from this testing program in the context of other available water safety data and 2) factors related to schools and water utilities associated with access to safe drinking water in schools. Methods Our study focused on a random sample of 240 California public and charter schools. We used multivariable logistic regression, accounting for clustering of tested water sources in schools, to examine school-level factors associated with failure to meet lead-testing deadlines and any history of water utility noncompliance. Results Of the 240 schools, the majority (n = 174) tested drinking water for lead. Of the schools tested, 3% (n = 6) had at least 1 sample that exceeded 15 parts per billion (ppb) (California action level) and 16% (n = 28) exceeded 5 ppb (bottled water standard). Suburban schools had lower odds of being served by noncompliant water systems (OR = 0.17; CI, 0.05-0.64; P = .009) than city schools. Compared with city schools, rural schools had the highest odds of not participating in the water testing program for lead (OR = 3.43; CI, 1.46-8.05; P = .005). Hallways and common spaces and food services areas were the most frequent school locations tested; one-third of all locations sampled could not be identified. Conclusion In our study, geography influenced access to safe drinking water in schools, including both water utility safety standards and school lead-testing practices. Considerations for improving the implementation of state lead-testing programs include establishing priority locations for sampling, precisely labeling samples, and developing well-defined testing and reporting protocols.

Summary Background Cupriavidus pauculus is rare cause of clinical infection. We describe an outbreak of C. pauculus and other Gram-negative bacteraemias in a paediatric haemato-oncology unit secondary to a contaminated water supply and drainage system. Aim To describe the investigation and control measures implemented for a waterborne infection outbreak in a new build hospital. Methods Extensive water testing from various points within the water system was undertaken. Taps, showerheads and components including flow straighteners underwent microbiological analysis. Drains were also swabbed. Surveillance for Gram-negative infections was established on the unit. Findings Water testing revealed widespread contamination of the water and drainage system. Outlets were also heavily contaminated, including flow straighteners. Drains were found to have underlying structural abnormalities. Water testing enabled us to detect high-risk components within the water system such as the expansion vessels and outlets and the results assisted with hypotheses generation. Review of commissioning data and risk assessments revealed extensive risks present within the water system prior to and after hospital opening. Conclusion Careful design, adequate control measures and maintenance are essential for hospital water systems in order to prevent infections due to waterborne organisms. We discuss what can be learned from this incident with a view to future prevention.

Background Nitrate contamination in groundwater disproportionately impacts agricultural Latino communities, creating a significant hazard for Latinos that rely on private wells. Private well users must conduct water testing and other well stewardship behaviors to ensure that their well water is safe to drink. This study sought to identify the key factors impacting private well water testing behavior in rural, agricultural Latino communities. Methods We conducted 4 focus groups with private well users, 2 in Spanish and 2 in English. We recruited 37 participants from the Lower Yakima Valley, Washington State, a rural, agricultural community with a large Latino population and elevated nitrate concentrations in groundwater. A semi-structured interview guide was developed to capture factors impacting testing as guided by the Risk, Attitudes, Norms, Ability, and Self-Regulation (RANAS) model. Inductive thematic analysis was conducted by two coders to identify common themes. Results Themes emerged around the factors impacting well stewardship, including well water testing, treatment, and maintenance, and were not specific to nitrate contamination. Private well users reported many of the same factors reported in other communities, with the exception of home repair experience and challenges around landlords and neighbors on shared wells, which have not been reported previously. In addition to landlords and neighbors, lack of actionable information, economic limitations, and lack of technical support emerged as factors that made well stewardship burdensome for individuals. The majority of participants reported using bottled water, including many who used point-of-use or point-of-entry water treatment systems. Conclusions The burden of well stewardship in rural, agricultural Latino communities may suggest the need for interventions at the community, county, or state levels and not at the individual level alone. Additionally, the role of landlords, neighbors on shared wells, and home repair experience in well stewardship represent important areas of exploration for researchers and public health practitioners.

Introduction Previous interventions to increase water access and consumption have focused on school settings, have shown mixed results on sugar-sweetened beverage (SSB) consumption, and have rarely addressed tap water safety. Our randomized controlled trial examined how improving access and appeal of water in recreation centers in low-income neighborhoods affected counts of SSBs carried by youth attending summer camp. Methods Recreation centers (N = 28) matched on their characteristics were randomly assigned to control or intervention groups. Intervention centers received a new water fountain with a bottle filler (hydration station), water testing services, reusable water bottles, and water promotion and education training and materials. Primary outcomes were 1-year changes in center-level average daily gallons of water from fountains and hydration stations (flowmeter readings). Secondary outcomes were counts of SSBs observed, use of bottled water and reusable water bottles, staff SSB consumption, and hydration station maintenance. Results Results showed increased water use (b = 8.6, 95% CI, 4.2-13.0) and reusable bottle counts (b = 10.2, 95% CI, 4.2-16.1) in intervention centers compared with control centers. No change occurred in youth carrying SSBs at camp, but center staff's past 30-day SSB consumption frequency decreased (b = -34.8, 95% CI, -67.7 to -1.9). Intervention sites had marginally lower odds of maintenance problems (OR = 0.09; 95% CI, 0.004-0.76, P = .06) than control sites. Conclusion Although providing hydration stations along with water testing, reusable water bottles, education, and promotion increased water consumption among youth at recreation centers, it had no effect on the number of SSBs observed during camp. Future strategies to increase water consumption should also address reducing SSB intake.

Role-playing scenarios in science education offer students an active way to engage in learning as well as to discover how their decisions as citizens, voters, or policymakers can affect environmental and public health. In this activity, students take on the role of environmental consultants, helping city planners decide the best location for a new recreation area located on the fictional community's major waterway. The objective of the game is to engage the students in critical thinking to determine the most relevant water tests needed to accept or reject the four proposed locations, given their knowledge of possible pollutants from different land-use activities. Students work in teams to integrate methods used in determining water quality, such as chemical testing, macroinvertebrate surveys, and bacterial monitoring, into a defendable decision for their recommendation. This activity was designed for and tested by high school students enrolled in AP Environmental Sciences and could be modified for undergraduate ecology or biology courses.

Drinking water treatment plants rely on purification of contaminated source waters to provide communities with potable water. One group of possible contaminants are enteric viruses. Measurement of viral quantities in environmental water systems are often performed using polymerase chain reaction(PCR) or quantitative PCR (qPCR). However, these results can often be underestimated due to challenges involved in a multi-step viral concentration process and PCR inhibition. In this study, water samples were concentrated from 25 drinking water treatment plants (DWTPs) across the US to study the occurrence of enteric viruses in source water and removal after treatment. The five different types of viruses studied were adenovirus, norovirus GI, norovirus GII, enterovirus, and polyomavirus. Quantitative PCR was performed on all samples to determine presence or absence of these viruses in each sample. Ten DWTPs showed presence of one or more viruses in source water, with four DWTPs having treated drinking water testing positive. Furthermore, PCR inhibition was assessed for each sample using an exogenous amplification control, which indicated that all of the DWTP samples, including source and treated water samples, had some level of inhibition, confirming that inhibition plays an important role in PCR based assessments of environmental samples. PCR inhibition measurements, viral recovery, and other assessments were incorporated into a Bayesian model to more accurately determine viral load in both source and treated water. Results of the Bayesian model documented that viruses are present in source water and treated water. By using a Bayesian framework that incorporates inhibition, as well as many other parameters that affect viral detection, this study offers an approach for more accurately estimating the occurrence of viral pathogens in environmental waters.

Summary Pseudomonas aeruginosa is an important nosocomial pathogen widely colonizing hospital water supplies. The Department of Health (England) Health Technical Memorandum (HTM) 04-01 addresses the risk posed by recommending water-testing in augmented care areas including outpatient haemodialysis. We discuss how two teaching hospitals independently reviewed the risk to outpatient haemodialysis patients, drawing the same conclusion. The highest number of infection episodes with P. aeruginosa was observed in critical care followed by burns and haematology, with the lowest in haemodialysis. Based on these results, we suggest that water sampling should be undertaken in areas such as critical care, burns, and haematology, but not in outpatient haemodialysis.

Introduction Reverse osmosis (RO), a major advance in hemodialysis (HD) safety, effectively clears most water organisms. Delftia acidovorans is an environmental water-borne pathogen that is rarely reported to cause human infections. We report a pseudo outbreak caused by colonization of RO machines with D acidovorans with no reported human infections and interventions to improve HD safety. Methods Repeated positive RO product water cultures triggered our hospital to initiate an investigation, RO machines were examined for mechanical integrity by biomedical engineers. Cultures of product water as well as RO parts were done. Testing for bacterial relatedness after identification was performed. An investigation was conducted in a systematic fashion to determine the cause and the extent of the problem. Results Upon formal review of policies and procedures, there were minor deficiencies. Rectifying these deviations from policies did not stop the repeated positive water cultures. A 7-step investigation and correction was successfully conducted. City water testing with filtration and concentration methods was positive for D acidovorans. Major renovation of the HD unit with replacement of all RO machines and a 2-step water filtration resulted in elimination of the pseudo outbreak. Conclusion City water was the source of biofilm formation of D acidovorans in RO machines that was not possible to eradicate. Application of incoming water filters was an effective preventive strategy. Replacement of RO machines after 4 failed disinfection attempts is the most cost-effective strategy as well for persistent positive water cultures. The HD remains RO water culture negative 2 years after changes.

Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water-associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971-2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water-associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971-2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency's (USEPA) public ground water system regulations.† Individual water systems, which are not required to meet national drinking water standards,§ were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995-2009. No waterborne outbreaks were reported during 2009-2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.

The current paper estimates the arsenic-contaminated drinking water and its associated effects on human health. The result is based on a primary survey of 173 households from five arsenic contaminated villages from Shahpur block in the Bhojpur district from Bihar state, India. A field test kit was used to test the concentration levels of arsenic in households’ drinking water. The results of the water tests revealed that more than 60% of the drinking water has excess arsenic concentration levels (more than 0.01 mg/L of WHO standards). The incidence rate due to arsenicosis (arsenic poisoning) was more among females than males. From the survey, it was also found that skin-lesions and other health issues due to arsenic induced-problems were more acute among children and women compared to men. More than half of the respondents (51%) did not hear about arsenic poisoning, and around 13.29% of the surveyed respondents know the serious health issues due to arsenic-contaminated drinking water.

Background An estimated four million and 43 million people in Canada and the USA use private water supplies. Private water supplies are vulnerable to waterborne disease outbreaks. Private water supplies in Canada and the USA are often unregulated and private water management is often a choice left to the owner. Perceptions of water quality become important in influencing the adoption of private water stewardship practices, therefore safeguarding public health. Methods We conducted a systematic literature review to understand factors that shape perceptions of water quality among private water users. We searched six computer databases (Web of science, Medline, Scopus, EBSCO, PubMed and Agricola). The search was limited to primary peer-reviewed publications, grey literature and excluded conference proceedings, review articles, and non-peer review articles. We restricted the search to papers published in English and to articles which published data on surveys of private water users within Canada and the USA. The search was also restricted to publications from 1986 to 2017. The literature search generated 36,478 records. Two hundred and four full text were reviewed. Results Fifty-two articles were included in the final review. Several factors were found to influence perceptions of water quality including organoleptic preferences, chemical and microbiological contaminants, perceived risks, water well infrastructure, past experience with water quality, external information, demographics, in addition to the values, attitudes, and beliefs held by well owners. Conclusions Understanding the factors that shape perceptions of water quality among private water users is an important step in developing private water management policies to increase compliance towards water testing and treatment in Canada and the USA. As many jurisdictions in Canada and the USA do not have mandatory private water testing or treatment guidelines, delineating these factors is an important step in informing future research and guiding policy on the public health of private water systems. Electronic supplementary material The online version of this article (10.1186/s13643-019-1013-9) contains supplementary material, which is available to authorized users.

Over 43 million U.S. residents rely on private unregulated wells for their drinking water, raising public health concerns, particularly in regions like northern New England where widespread groundwater arsenic contamination is now recognized. Children are particularly vulnerable to adverse health effects from arsenic exposure. Despite AAP Guidelines, approaches to engage pediatric clinicians in promoting private well testing have not been previously described. We sought to determine the most effective practice approaches to achieve successful well water testing in routine pediatric care. 12 primary care clinics were block randomized to one of four study arms. Two intervention variables were assessed: (1) test results access (parent only vs. parent and clinic) and (2) follow up approaches (yes/no). Parents of children under 12 months using a private well were eligible. Prepaid water tests were provided. Primary outcome was parental water test completion. Eleven clinics successfully implemented processes identifying well users. 240 testing kits were dispensed. Completion rates averaged 29% (range 10 to 61%). The study arm with both clinic results access and staff follow up system was 2.3 times more likely to achieve test completion than other arms (95% CI 1.12–4.86, p = .03). Kit distribution by clinicians versus nursing staff, irrespective of study arm, had 2.4 times greater completion (95% CI 1.13–5.11, p = .02). Systematic drinking water source screening can be improved in pediatric care. Higher testing completion was found in practices randomized to reminders and structured follow up versus single visit discussion, but clinician involvement was the most predictive factor.

Approximately 12% of the Canadian population uses private wells for daily water consumption; however, well water testing rates are on the decline, resulting in an increased risk of waterborne acute gastrointestinal illness. To date, limited research has explored the determinants influencing well testing practices. Accordingly, the current study sought to investigate the drivers of “one-off” and repeat well water testing in southern Ontario during the 5-year period 2012–2016, using the worlds largest private groundwater testing data-frame. Data from >400,000 wells were geospatially integrated with all tests conducted by the provincial laboratory in southern Ontario. The Ontario Marginalization Index (ON-Marg) was used as a proxy measure of socioeconomic status (SES), with rurality, based on population density, season, and index (1st) test results assessed as effect modifiers. Multivariate analysis was undertaken using log-binomial regression. Approximately 27.5% of wells (n = 417,406) were tested during the study period, 66.7% of which were sampled more than once; 3% of all samples tested positive for E. coli (>0 colony forming unit/100 mL). In rural regions (400 people/km2) and peri-urban regions (>150 and

Exposure to naturally occurring arsenic in groundwater is a public health concern, particularly for households served by unregulated private wells. At present, one of the greatest barriers to exposure reduction is a lack of private well testing due to difficulties in motivating individual private well owners to take protective actions. Policy and regulations requiring testing could make a significant contribution towards universal screening of private well water and arsenic exposure reduction. New Jersey’s Private Well Testing Act (PWTA) requires tests for arsenic during real estate transactions; however, the regulations do not require remedial action when maximum contaminant levels (MCLs) are exceeded. A follow-up survey sent to residents of homes where arsenic was measured above the state MCL in PWTA-required tests reveals a range of mitigation behavior among respondents (n = 486), from taking no action to reduce exposure (28%), to reporting both treatment use and appropriate maintenance and monitoring behavior (15%). Although 86% of respondents recall their well was tested during their real estate transaction, only 60% report their test showed an arsenic problem. Treatment systems are used by 63% of households, although half were installed by a previous owner. Among those treating their water (n = 308), 57% report that maintenance is being performed as recommended, although only 31% have tested the treated water within the past year. Perceived susceptibility and perceived barriers are strong predictors of mitigation action. Among those treating for arsenic, perceived severity is associated with recent monitoring, and level of commitment is associated with proper maintenance. Mention of a treatment service agreement is a strong predictor of appropriate monitoring and maintenance behavior, while treatment installed by a previous owner is less likely to be maintained. Though the PWTA requires that wells be tested, this study finds that not all current well owners are aware the test occurred or understood the implications of their arsenic results. Among those that have treatment installed to remove arsenic, poor monitoring and maintenance behaviors threaten to undermine intentions to reduce exposure. Findings suggest that additional effort, resources, and support to ensure home buyers pay attention to, understand, and act on test results at the time they are performed may help improve management of arsenic water problems over the long term and thus the PWTA’s public health impact.

Community-led total sanitation (CLTS) is an intervention that strives to end the practice of open defaecation. This study measured the effectiveness of CLTS in Nyando District by examining the association between community open defaecation-free (ODF) status and childhood diarrhoeal illness. A cross-sectional study design was used among households with children ⩽5 years old to ascertain information on acute diarrhoea in the past year (outcome), sanitation and health behaviours. Water testing was conducted to determine Escherichia coli and turbidity levels for 55 water sources. Data were obtained from 210 parents or caregivers from an ODF community and 216 parents or caregivers in a non-ODF community. The non-ODF participants reported a non-significant 16% increased risk of diarrhoea compared with the participants from the ODF community. Children's HIV positivity (adjusted prevalence ratio (aPR) = 2.29; 95% CI 2.07–2.53), unsafe child stool disposal (aPR = 1.92; 95% CI 1.74–2.12) and low household income (aPR = 1.93; 95% CI 1.46–2.56) were associated with diarrhoea, in the non-ODF community. The ODF location had a higher percentage of E. coli in the drinking water compared with the non-ODF location (76.7% vs. 60%). Diarrhoeal disease rates in children ⩽5 years old did not differ by whether a latrine intervention was implemented. Water sampling findings suggest water safety may have decreased the effectiveness of the CLTS’ improvement of childhood diarrhoea. Improved water treatment practices, safe stool disposal and education may improve the CLTS intervention in ODF communities and therefore reduced the risk of childhood diarrhoea.

In Canada, over 400,000 enteric diseases related to drinking water occur each year, highlighting the importance of understanding sources of Canadians’ drinking and recreational water exposures. To address this need, a population-based telephone survey of 10,942 Canadians was conducted between 2014 and 2015, assessing Canadian's drinking water sources and recreational water exposures using a seven-day recall method. Results were analyzed by province/territory, season, age group, gender, income, education, and urban/rural status. Store-bought bottled water was reported by nearly 20% of survey respondents as their primary drinking water source, while approximately 11% of respondents reported private well. The proportion of private well users was significantly greater than the national average in the Maritime Provinces where approximately 40–56% of respondents reported this as their primary drinking water source. As expected, Canadians’ recreational water activities and exposures (e.g., swimming, pool, lake, and waterpark) peaked during summer and were most commonly reported among children aged 0–9 years. Waterborne disease in Canada requires a multi-faceted public health approach. Canadian baseline data on water exposures can inform policy and public health strategies (e.g., recreational water guidelines, private well water testing recommendations) and support research and risk assessment related to mitigating waterborne illness.

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families’ financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources.

National and sub-national governments develop and enforce regulations to ensure the delivery of safe drinking water in the United States (US) and countries worldwide. However, periodic contamination events, waterborne endemic illness and outbreaks of waterborne disease still occur, illustrating that delivery of safe drinking water is not guaranteed. In this study, we examined the potential added value of a preventive risk management approach, specifically, water safety plans (WSPs), in the US in order to improve drinking water quality. We undertook a comparative analysis between US drinking water regulations and WSP steps to analyze the similarities and differences between them, and identify how WSPs might complement drinking water regulations in the US. Findings show that US drinking water regulations and WSP steps were aligned in the areas of describing the water supply system and defining monitoring and controls. However, gaps exist between US drinking water regulations and WSPs in the areas of team procedures and training, internal risk assessment and prioritization, and management procedures and plans. The study contributes to understanding both required and voluntary drinking water management practices in the US and how implementing water safety plans could benefit water systems to improve drinking water quality and human health.

Inland plain shallow saline water has great exploitation potentiality. Based on field water testing, water level monitoring, pumping test, as well as indoor leaching experiment, applying mathematical statistics, Pipers trilinear nomograph and PHREEQC chemistry simulation methods, saline water area of the town of Sungeng Jiyang was studied. The results showed as follows: (1) Inland shallow groundwater presents “weather-evaporative” dynamic type; (2)The shallow saline water and middle-deep groundwater belonging to different flow system; (3) Because of the creeping flow and aqueous medium riched in clay, inland shallow groundwater mineralized significantly. In saline water area inland plain, the unique features of groundwater circulation result in brackish water dynamic relative stability.

Recent research indicates that investments in infrastructure for safe water and sanitation provision do not significantly reduce the incidence of water-borne diseases in the developing world unless they are accompanied by education in water handling and hygiene practices. School-based hygiene education initiatives are popular, but there is little evidence that they are effective in teaching students about safe water-handling practices. This study compared the outcomes of two approaches to teaching schoolchildren about the links between hygiene, water handling, and water-borne diarrhea. One approach combined messages about safe water handling and hygiene practices with water testing; the other used messages alone. A quasi-experimental design was used with 120 middle-school students. Forty students received messages alone, 40 received messages and tested water quality, and 40 served as a control group. An evaluation 1 week after the interventions measured students’ hygiene knowledge. Results showed significant improvement in knowledge among students who received messages and tested water, compared to their counterparts who received intervention through hygiene messages only. Evaluation after 12 months showed that the hygiene knowledge gained in both groups was retained. Including participatory water testing in hygiene education interventions can improve students’ knowledge about safe water handling and hygiene practices.

Significant volumes of research over the past four decades has sought to elucidate the social, infrastructural, economic, and human health effects of climate change induced surface flooding. To date, epidemiological and public health studies of flooding events have focused on mental health effects, vector-borne diseases, and infectious enteric disease due to floodwater contact (i.e. typically low consumption rates). The inherent nature of groundwater (i.e. out of sight, out of mind) and the widely held belief that aquifers represent a pristine source of drinking water due to natural attenuation may represent the "perfect storm" causing direct consumption of relatively large volumes of surface flood-contaminated groundwater. Accordingly, the current study sought to systematically identify and synthesize all available peer-reviewed literature pertaining to the nexus between surface flooding, groundwater contamination and human gastroenteric outcomes. Just 14 relevant studies were found to have been published during the period 1980-2017, thus highlighting the fact that this potentially significant source of climate-related exposure to environmental infection has remained understudied to date. Studies differed significantly in terms of type and data reporting procedures, making it difficult to discern clear trends and patterns. Approximately 945 confirmed cases of flood-related enteric disease were examined across studies; these concurred with almost 10,000 suspected cases, equating to approximately 20 suspected cases per confirmed case. As such, no regional, national or global estimates are available for the human gastrointestinal health burden of flood-related groundwater contamination. In light of the demonstrable public health significance of the concurrent impacts of groundwater susceptibility and climate change exacerbation, strategies to increase awareness about potential sources of contamination and motivate precautionary behaviour (e.g. drinking water testing and treatment, supply interruptions) are necessary. Mainstreaming climate adaptation concerns into planning policies will also be necessary to reduce human exposure to waterborne sources of enteric infection.

Karst aquifers account for up to 20% of the world land area and are a source of drinking water for much of the world. Despite the critical value of these aquifers as a drinking water source, there are a growing number of incidences of karst aquifer contamination worldwide, including inadvertent spills, dumping, industrial discharges, or sewage seepage events. Given the porous nature of carbonate rocks, the hydrogeology of karstic aquifers is extremely complex, making it difficult to predict movement of contamination in these aquifers and to identify exposure risks. These contamination events—together with emerging issues such as climate change, exposures to infectious agents, as well as the increase in informal mining practices—indicate the need to explore linkages between karst groundwater, contamination, and health. Accordingly, the issue of karst groundwater contamination presents a unique global public health challenge requiring a multidisciplinary problem-solving approach. The National Institute of Environmental Health Sciences (NIEHS) Superfund Research Program’s (SRP) multidisciplinary approach serves as a model for integrating expertise across health, engineering, geological, and community-based approaches to solve problems. Using examples relevant to karst contamination, NIEHS SRP grantees are engaged in research endeavors to address issues of drinking water safety—from remediation to well-testing best practices. It is recommended that continued research addresses karst contamination, with particular attention given to identifying people at risk of exposures and to developing proactive means to prevent further exposures. This is particularly important in the USA, where two-fifths of the population’s drinking water comes from karst aquifers. Furthermore, over 40 million US citizens are on private well water for drinking, yet testing for contamination in these wells is often not required. Given the challenges predicting contaminant transport in karst and the lack of uniform private well water testing regulations, there is a need to promote awareness of risks for people living in karst areas among public health, hydrogeology, and government officials, and to use community-based approaches as models for intervention and exposure prevention.

In 2015, a typhoid fever outbreak began in downtown Kampala, Uganda, and spread into adjacent districts. In response, an environmental survey of drinking water source types was conducted in areas of the city with high case numbers. A total of 122 samples was collected from 12 source types and tested for Escherichia coli , free chlorine, and conductivity. An additional 37 grab samples from seven source types and 16 paired large volume (20 liter) samples from wells and springs were also collected and tested for the presence of Salmonella enterica serovar Typhi. Escherichia coli was detected in 60% of kaveras (drinking water sold in plastic bags) and 80% of refilled water bottles; free chlorine was not detected in either source type. Most jerry cans (68%) contained E. coli and had free chlorine residuals below the WHO-recommended level of 0.5 mg/liter during outbreaks. Elevated conductivity readings for kaveras, refilled water bottles, and jerry cans (compared to treated surface water supplied by the water utility) suggested that they likely contained untreated groundwater. All unprotected springs and wells and more than 60% of protected springs contained E. coli . Water samples collected from the water utility were found to have acceptable free chlorine levels and no detectable E. coli . While S . Typhi was not detected in water samples, Salmonella spp. were detected in samples from two unprotected springs, one protected spring, and one refilled water bottle. These data provided clear evidence that unregulated vended water and groundwater represented a risk for typhoid transmission. IMPORTANCE Despite the high incidence of typhoid fever globally, relatively few outbreak investigations incorporate drinking water testing. During waterborne disease outbreaks, measurement of physical-chemical parameters, such as free chlorine residual and electrical conductivity, and of microbiological parameters, such as the presence of E. coli or the implicated etiologic agent, in drinking water samples can identify contaminated sources. This investigation indicated that unregulated vended water and groundwater sources were contaminated and were therefore a risk to consumers during the 2015 typhoid fever outbreak in Kampala. Identification of contaminated drinking water sources and sources that do not contain adequate disinfectant levels can lead to rapid targeted interventions.

The World Bank estimates that 21% of all communicable diseases in India are related to unsafe water with diarrhoea alone causing more than 0.1 million deaths annually. The WHO drinking water surveillance parameters of quality, quantity, accessibility, affordability and continuity were assessed in one vulnerable ward of Ahmedabad—a fast growing city in Western India. Interviews with key informants of the ward office, health centre and water supply department, secondary analysis and mapping of field test reports and a questionnaire-based survey of different household types were conducted. We found that Ahmedabad Municipal Corporation (AMC) supplies water to the ward intermittently for two hours during the day. Housing society clusters supplement their AMC water supply with untested bore-well water. The water quality surveillance system is designed for a twenty-four-hour piped distribution of treated surface water. However, in order to maintain surveillance over an intermittent supply that includes ground water, the sampling process should include periodic surveys of water actually consumed by the citizens. The laboratory capacity of the Central Water Testing Laboratory should expand to include more refined tests for microbial and chemical contamination.

Unregulated, privately owned water supplies, including groundwater wells, are relied upon extensively, particularly in rural and remote regions. While adequate stewardship behaviors (water testing, treatment, and maintenance) have been shown to decrease the incidence and frequency of faecal indicator organism (FIO) presence and, by extension, the risk of pathogenic ingress, contaminated private water supplies continue to constitute a significant public health risk. Recognizing that innovative approaches are needed to bolster well stewardship, this paper identifies and assesses 35 tools (smartphone and web-based applications) to better understand components, functionality, strengths, and weaknesses. Applications for both data collection and risk communication were identified; however, none adequately assess(ed) risk using space-, time- or source-specific inputs (local hydrogeology, climate, groundwater reliance). Well designed applications integrated with crowd-sourced data, environmental data, and models of risk provide an opportunity for enhanced stewardship of private well water resources.

The United States Environmental Protection Agency (EPA) has the authority to regulate the public water systems. The EPA does not have the jurisdiction to regulate private drinking water wells. This leaves approximately fifteen percent of the nation’s population without any regulation being held in place to protect their source of drinking water. With that fifteen percent of the US population having private wells for drinking water, it makes the number of people whose drinking water is unprotected by regulation at a little over 15 million US households. This concern is even more acute in areas with groundwater that is close to the surface. Delaware residents live in a region with low elevation which is very close to the coast with low elevation and the shallow groundwater makes us concern about contaminated well water even more intense. As one of the Water Resources Program partners, we have offered free Drinking Water Quality Clinics to local well owners over the past 4 years in Delaware State University. Since 2009, over 400 Delaware residents have benefited from these clinics. At each clinic, an information session was offered in the evening, with an opportunity to hear from and speak with a drinking water well expert. Participants were given sample bottles and water testing performed the following day included pH, nitrite, nitrate, sulfate, alkalinity, fluoride, hardness, iron, lead, cadmium, arsenic, Total Coliform, and E. coli. Over half of the samples returned out of range values for pH, while 72 returned results positive for Total Coliform and Escherichia coli bacterium. Data are examined for correlations, and improved understanding of local well owners. These tests shared with local well owners insights into what may be wrong with their water. In addition, any tests that came back outside of the normal range were reported to homeowners in writing. Mailed with the written reports were also information specific to what test results were outside of the limits, and actions to take to correct the exact problem the well owners encountered. The data reported here are examined to discuss the correlations of information, and ways that the Drinking Water Quality Clinics have improved our understanding of local wells and ownerships. In conclusion, regular testing on a yearly basis is the most effective way to ensure that public health is maintained.

Background An outbreak of hepatitis E in Raipur, capital of Chhattisgarh, was reported by press in April 2014. Outbreaks of hepatitis were also reported from the towns of Durg and Bhilai at the same time. In the neighbouring state of Orissa, several towns witnessed hepatitis outbreaks and the High Court of Orissa also intervened after deaths were reported. Methods We conducted a study in Raipur to understand both outbreak and response. Data were collected from government laboratories, community health workers (CHWs, known as Mitanins ) and 600 clinically confirmed hepatitis patients. Supervisors of CHWs were interviewed to understand the perspective of the cadre responsible for health education and mobilising referrals at community level. Maps of affected areas were drawn with help of CHWs and community leaders. Given the faeco-oral transmission of hepatitis E, maps covered drinking water sources, patient locations and dates of symptoms appearing. Water testing of various types of sources was done by CHWs using hydrogen sulfide kits. Contaminated sources were plotted on a city map. Findings The Medical College Raipur tested 264 patients with jaundice symptoms for hepatitis E (blood serum ELISA) and hepatitis A, confirming 114 hepatitis E and three hepatitis A cases. CHWs reported 2,070 cases of hepatitis (including 74 pregnant women) and 32 deaths (including eight of pregnant women). The media started covering the outbreak after two deaths were reported from an upper-class locality in April 2014. According to the data collected from CHWs, the outbreak started as early as December 2013 when around 30 persons from an impoverished slum locality showed jaundice. An NGO did water testing of 32 households (using hydrogen sulfide kits) in the mentioned slum in January 2014 and found that 17 of the households were drinking water presenting faecal contamination. Later CHWs also reported a large swine population in the same slum area. According to survey conducted by the Mitanins , around 30% of hepatitis cases had happened between December 2013 and March 2014, though the departments started adressing Hepatitis only after mid April. Most of the cases were in the ago group above 14 years; the age group 20–49 years accounted for 60% of the cases; 30% of the water sources contributed to 90% of the caseload. Water testing by Mitanins at 800 points across the city showed that 53% of sources including big pumping stations, hand pumps and the alternative water supply tankers presented faecal contamination. Another outbreak was experienced from January 2015 onwards, though in different areas. A repeat round of water testing was done by CHWs in April 2015, highlighting the spread of contamination. Media attention got shifted to swine flu outbreak in 2015 and on-going hepatitis outbreaks were ignored. Discussion & recommendations Hepatitis E outbreaks happened because conditions were conducive to high faeco-oral transmission. Leakages in drinking water pipelines and ingress of sewage into them took place and pumping stations were close to sewage in some areas. Swine population could have acted as reservoir. Civic administration swung into action late April after media uproar on upper-class deaths. It organised daily reviews, medical camps and chlorine-tablet distribution. Poorer habitations were still largely ignored as upper-class areas dominated their attention. There was undue emphasis on hospitalisation of all patients and inadequate attention on managing dehydration. The actions were guided by the imperative to be seen as ‘doing something’. The civic administration was reluctant to accept that drinking water supplied by it was contaminated. Intersectoral action encountered severe governance issues with blame game between the health department and municipal bodies. There was ignorance in departments about existing protocols on water testing. Even the use of hydrogen sulfide kits was unknown, though eventually CHWs were equipped by the health department to conduct testing. The response of media reflected deep socio-economic inequity. Hepatitis outbreaks in urban areas need to be recognised as a critical public health problem demanding urgent intersectoral action. Governance reforms are needed to allow search and implementation of technical solutions by departments to prevent and contain contamination of drinking water supplies. No competing interest .

Water quality information is important for guiding water safety management and preventing water-related diseases. To assess the current status of regulated water quality monitoring in sub-Saharan Africa, we evaluated testing programs for fecal contamination in 72 institutions (water suppliers and public health agencies) across 10 countries. Data were collected through written surveys, in-person interviews, and analysis of microbial water quality testing levels. Though most institutions did not achieve the testing levels specified by applicable standards or World Health Organization (WHO) Guidelines, 85% of institutions had conducted some microbial water testing in the previous year. Institutions were more likely to meet testing targets if they were suppliers (as compared to surveillance agencies), served larger populations, operated in urban settings, and had higher water quality budgets (all p < 0.05). Our results indicate that smaller water providers and rural public health offices will require greater attention and additional resources to achieve regulatory compliance for water quality monitoring in sub-Saharan Africa. The cost-effectiveness of water quality monitoring should be improved by the application of risk-based water management approaches. Efforts to strengthen monitoring capacity should pay greater attention to program sustainability and institutional commitment to water safety.

The use of alternative methods within the food and water testing industries requires new ways of thinking and new ways of working for most laboratories. Changes are often needed which set the foundations from which new alternative methods can be validated and accredited. Challenges include developing technical expertise, establishing suitable laboratory facilities, adapting existing quality systems, and laboratory validation of new methods. This chapter highlights the considerations that should be made prior to setting up these methods and the steps required to achieve accreditation. The cornerstones of accreditation: validation, reference materials, and proficiency testing are discussed from an alternative method perspective. Best practices are discussed in a practical, usable fashion.

New molecular-based methods for the detection of pathogens in food and water have a number of benefits over traditional culture-based assays, including ability to detect and enumerate pathogens rapidly, in real-time, the ability to negatively screen samples without the need for culture, the power to link detection with specific strain identification and confirmation, and the opportunity to detect only viable cells. However, with the introduction of such techniques, it is important to have an understanding of what exactly they are detecting, their limitations, and how the data from such assays can be interpreted. This chapter provides an outline and understanding of molecular methods used to evaluate the microbiological quality of water and food, with particular emphasis on real-time polymerase chain reaction (PCR), including quantitative real-time PCR. Issues addressed will include determining whether the microorganisms detected are viable, and the importance of correct interpretation of PCR-based results. The chapter will also discuss the steps that need to be taken by the food and water testing industry to ensure robust and meaningful assays are developed and utilized correctly, in order to provide accurate and reliably interpreted results in a timely manner to stakeholders.

Pharmaceutical microbiology is a specialist area of microbiology and one concerned with the use of microorganisms in pharmaceutical development and with maintaining contamination control. This chapter introduces the subject and outlines some the typical tests conducted within a pharmaceutical microbiology laboratory (such as microbial limits, sterility, endotoxin, water testing, and environmental monitoring). The chapter further considers the role of the microbiologist in relation to the pharmaceutical processing environment, and the necessary contribution that the microbiologist must make to an organization’s contamination control strategy.

Background Adequate water intake may have important health benefits for schoolchildren. Layers of federal, state, and local policy are relevant to provision of water within schools. Recently passed state and federal laws require free drinking-water access for students during mealtimes. Purpose To review Massachusetts local district wellness policies related to water access, provide estimates of costs for three water-provision strategies, and discuss implications for policy relevant to adequate drinking-water access. Methods Legal research was conducted using the LexisNexis legal database and government websites. Local wellness policies were double-coded using existing research tools. Costs of three water-delivery options were estimated using a 10-year school-district perspective. Results Prior to 2010, most Massachusetts public school district wellness policies (92%–94%) did not address access to free drinking water. Ten-year costs per school for providing water during mealtimes to students, including dispenser unit, installation, water testing, water, cups, and labor, range between $12,544 and $27,922 (depending on water-delivery option) assuming the average Massachusetts school enrollment. Water-provision strategies relying on tap water are more economical than bottled water in the long term. Conclusions Policy recommendations and cost considerations deserve attention at the local, state, and federal levels. Recommendations are discussed to ensure access to safe, free drinking water for all students.

A defined substrate method media in bacteriological water testing kit (BWTK) has been developed to recover and detect the presence/absence of total coliforms and emerging pathogens from drinking water without the need for the confirmatory or complete tests. This method is based on technology that uses a hydrolysable substrate as a specific indicator- nutrient for the target microbes. To perform the test, one only has to add water to the ingredients in the BWTK and incubate at room temperature for a time period of 48 hrs. The target microbes remain viable in the positive kit for at least 10 days and further bacterial isolates from BWTK were characterized phenotypically, molecular identified by sequencing of 16SrRNA gene and antibiotic sensitivity was determined. All of the emerging bacterial isolates were haemolytic and multiple resistant to antibiotics. The epidemiological surveillance of drinking water revealed the occurrence of emerging pathogens responsible for causing acute gastrointestinal illness, soft tissue infections, meningitis, enteritis to acute mesenteric lymphadenitis as Yersinia enterocolitica (94%) and Aeromonas hydrophila (79%). The conventional methods (IS-10500-1991 BIS New Delhi, India) cannot predict the presence of these potentially enteropathogenic microorganisms in drinking water. There are currently no suitable microbiological criteria for the detection of emerging pathogens. In response to these limitations a BWTK has been developed for regularly monitoring of drinking water quality for appraisal to public health officials and take corrective measures regarding health risk when desired.

Safe drinking water is a basic element of primary health care. The government of India in its Indian Public Health Standards recommends the hydrogen sulfide (H2S) strip test as a desirable component at primary health centers for screening water for fecal coliforms. The objective of the present study was to conduct a water, sanitation and hygiene (WASH) survey followed by a H2S strip test of drinking water in a village with ninety households. The test was positive in 88% at the source and the point of consumption, with 100% concordance between both the points of test. A subsample of water samples was subjected to testing in microbiology laboratory, and fecal contamination was confirmed in all of them. To conclude, H2S strip test can be conveniently used at field level, and its ease of use and visual nature of results make it a useful point-of-care test of environmental and public health.

The long history of poor water quality plaguing First Nations communities in Canada has received little public attention in comparison to the waterborne disease outbreaks in Walkerton, Ontario in 2000 and North Battleford, Saskatchewan in 2001. In recent years, initiatives from the federal government and considerable financial support have improved the quality of drinking water on some reserves. However, the challenges First Nations communities face in the provision of safe drinking water remain, and certain systems continue to pose health risks. As a result, there is an emerging interest in the ability of First Nations communities to effectively manage their drinking water resources. The purpose of this paper is to establish an analytical framework for assessing the capacity of a First Nations community to provide safe drinking water and to apply the framework to a First Nations reserve community in north-central Saskatchewan (SK). Through multiple data sources, including individual interviews, a public ...

Securing adequate safe drinking water and proper sanitation is a major challenge facing the developing world. The "Water for Life Decade" emphasizes the importance of upgrading national water quality and sanitation services. This study assessed the domestic water profile in the city of Beirut. Samples were collected from three types of household water sources (municipality, private wells, and vended water bottles) and assessed for their physiochemical and microbiological profile. At the same time, a cross-sectional survey assessing water consumption patterns and the prevalence of water-borne diseases was conducted. The results showed a deficient water quality profile in all three water sources. The measured physiochemical and bacteriological parameters reflected the high frequency of water-borne diseases. Action to secure a safe domestic water supply is essential. The plan should guarantee the protection of water sources, ensure sufficient treatment of domestic water and upgrade the national program for potable water quality control. Periodic quality monitoring and legislating the chaotic water-vending sector are indispensable. Additionally, the deterioration of private well sources by sea and wastewater infiltration necessitates the enforcement of legislation associated with the use and management of private wells. Consumer awareness and active contributions to promote and protect public health are important.