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Access to a sufficient quantity of safe water is widely recognized as fundamental to ensure health and prevent water- and excreta-related diseases. The objective of this study is to analyze seasona...

Billions of people globally gained access to improved drinking water sources and sanitation in the last decades, following effort towards achieving the Millennium Development Goals. Global progress remains a general indicator as it is unclear if access is equitable across groups of the population. Agenda 2030 calling for `leaving no one behind', there is a need to focus on the variations of access in different groups of the population, especially in the context of low- and middle-income countries including Malawi. We analyzed data from Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) to describe emerging trends on progress and inequalities in water supply and sanitation services over a 25-year period (1992–2017), as well as to identify the most vulnerable populations in Malawi. Data were disaggregated with geographic and socio-economic characteristics including regions, urban and rural areas, wealth and education level. Analysis of available data revealed progress in access to water and sanitation among all groups of the population. The largest progress was generally observed in the groups that were further behind at the baseline year, which likely reflects good targeting in interventions/improvements to reduce the gap in the population. Overall, results demonstrated that some segments of the population – foremost poorest Southern rural populations – still have limited access to water and are forced to practise open defecation. Finally, we suggest including standardized indicators that address safely managed drinking water and sanitation services in future surveys and studies to increase the accuracy of national estimates.

More than 50 million people living in the Arctic nations remain without access to safely managed drinking water services. Remote northern communities, where large numbers of Indigenous peoples live, are disproportionally affected. Recent research has documented water and health-related problems among Indigenous communities, including poor water quality and insufficient quantities of water.The objective of this scoping review is to examine the extent of available water security evidence as well as identify research gaps and intervention priorities to improve access to domestic water in the Arctic and Subarctic regions of the eight Arctic nations (Canada, the Kingdom of Denmark (Greenland), Finland, Iceland, Norway, Sweden, Russia, and the United States (Alaska)).An extensive literature review was conducted to retrieve relevant documentation. ArcticAntarctic Regions, Compendex, Geobase, Georef, MEDLINE and Web of Science databases were searched to identify records for inclusion. The initial searches yielded a total of 1356 records. Two independent reviewers systematically screened identified records using selection criteria. Descriptive analyses were used to summarize evidence of included studies.A total of 55 studies, mostly conducted in Canada and the United States, were included and classified by four predetermined major dimensions: 1) Water accessibility and availability; 2) Water quality assessment; 3) Water supply and health; 4) Preferences and risk perceptions.This scoping review used a global approach to provide researchers and stakeholders with a summary of the evidence available regarding water security and domestic access in the Arctic. Culturally appropriate health-based interventions are necessary to ensure inclusive water services and achieve the Sustainable Development Goals (SDG) targets for universal access to water.

Lack of access to safe drinking water on premises remains widespread in low- and middle-income countries. Interventions to improve access to safe water at the point of collection are essential, but water safety at the point of consumption is also an important consideration. This research aimed to 1) improve understanding of household practices in collecting water with respect to seasonality, and 2) to further assess risk associated with post-collection contamination from the point of collection to the point of consumption. A seasonal cohort study, including 115 households, was conducted in Malawi. Along with household surveys and observations, samples of water were tested for microbial water quality at four different stages of water collection: water source, collection container, storage container, cup of drinking water. Using E. coli as an indicator of contamination (cfu/100 ml), the risk of post-collection contamination was assessed. The results indicate that most water sources were free from contamination; contamination was proportionally lower in the dry season when more sources were found to be classified as having a very low risk of contamination. However, the level of risk of contamination was more likely to increase following collection in water sources that were initially free from contamination. Results show that the degradation in water quality from the point of collection to the point of consumption was more important in the rainy season, which is likely to be driven by the effect of seasonality on the household environment. Filling the collection container at the point of collection and storage at the point of consumption were found to be critical stages for an increased risk of E. coli contamination. Understanding household practices in accessing and handling water during both rainy and dry season is necessary to target appropriate interventions to reduce post-collection contamination.

Monitoring access to drinking water is complex, especially in settings where on premises water supply is not available. Although self-reported data are generally used to estimate coverage of access to drinking water, the relationship between self-reported time travelled and true time travelled is not well known in the context of water fetching. Further, water fetching is likely to impact the quantity and quality of water a household uses, but data and measures supporting this relationship are not well documented. The objective of this study was to appraise the validity and reliability of self-reported measurements used to estimate access coverage. A case study was conducted in Malawi to enhance understanding of the self-reported measures and alternatives available to assess and monitor access to drinking water in view of generating global estimates. Self-reported data were compared with objective observations and direct measurements of water quantity, quality and accessibility. Findings from this study highlight the variations between different measures such as self-reported and recorded collection time and raise awareness with regard to the use of self-reported data in the context of fetching water. Alternatives to self-reported indicators such as GPS-based or direct observations could be considered in surveys in view of improving data accuracy and global estimates.

Background Increasing the quantity of water available for consumption and hygiene is recognized to be among the most efficient interventions to reduce the risk of water-related infectious diseases in low and middle-income countries. Such impacts are often associated with water supply accessibility (e.g. distance or collection time) and used to justify investment in improving access. Objective To assess the relationship between the water source location and the quantity of water available in households from low and middle-income countries by identifying the effects of interventions aiming to improve access, and to compare the indicators and measures used to collect information. Methods We systematically searched seven databases (i.e. Cairn, Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Women's Studies International) along with grey literature for articles reporting indicators and measures of accessibility and quantity. We found 6492 records, of which 20 studies were retained that met the review's inclusion criteria. Results Most studies were conducted in rural settings and provided suggestive findings to describe an inverse relationship between accessibility and quantity. Overall, a wide range of indicators and measures were used to assess water accessibility and quantity in the selected studies along with their association. The lack of consistency raised concerns regarding comparability and reliability of these methods. Conclusions The review findings support the hypothesis that the quantity of water available in households is a function of the source location, but the inconsistency in study outcomes highlights the need to further investigate the strength and effects of the relationship.

To monitor safely managed drinking water services, an increasing number of countries have integrated water quality testing for Escherichia coli into nationally-representative household surveys such as the Multiple Indicator Cluster Surveys (MICS). However, plastic waste generated during such water quality testing programs, mostly through the use of pre-sterilized disposable materials, is non-negligible. The objective of this study was to evaluate several re-use protocols for disposable filter funnels used by the MICS water quality test kits. Decontamination and re-use protocols were assessed in centralized laboratory and decentralized field settings and neither yielded positive results. Re-use of 100 mL sterile funnels decontaminated with an alcohol wipe resulted in a higher incidence of false positive results (i.e., positive contamination when processing sterile water), both in the laboratory and field; therefore, a higher proportion of positives tests can be expected if these components are re-used. Further improvements to the decontamination technique and training are needed before material re-use can be reliably adopted. Autoclaving the funnels for re-use is feasible, provided that there is capacity to re-package and distribute funnels in a sterile manner., Environmental Health Insights, 15, ISSN:1178-6302

Despite the reported achievement of the Millennium Development Goals (MDGs) with respect to drinking water, lack of access to water remains widespread worldwide. The indicator used there to measure access to water in the MDGs refers to the use of an improved water source. However, the amount of time spent in collecting water is high in countries where access to drinking water supplies located on premises is not common. 26.3% of the world's population did not have such access in 2015. Thus the need to travel to a water point, possibly queue, fill water containers, and carry them home is prevalent. The amount of time and effort used in water collection can be considerable, and household surveys increasingly provide data on collection time. This study aims to demonstrate the effect of adding a 30-minute collection time component to monitor access to drinking water. This study draws on household surveys from 17 countries to highlight the widespread burden of fetching water and its significant impact on estimates of coverage. The proportion of the population with access decreased by 13% on average for these 17 countries when collection time was added as a consideration.

Background Universal and equitable access to safe and affordable drinking water for all by 2030 is one target stipulated in the Sustainable Development Goals (SDGs). As of 2015, 92% of the population in Malawi did not have access to water on premises and needed to fetch it. Thus, the issue of water accessibility warrants further research, particularly since the time/energy expenditure needed can impact the affordability of water and thus the quality of life and health of the population. This is perhaps the inverse problem of wealthy developed nations where greater active travel is required for improved health. Methods Malaria Indicator Survey (MIS) 2014 Household survey datasets from Health Surveys program was analysed in STATA MP 14 for the aim of this study (n=3405). Time to fetch water was applied as a proxy of the distance to estimate energy expenditure. Results Two models were created to show the quality of life impacts of the distance to access water. First, by using the indicator initially apply by JMP to monitor the MDG target (i.e. proportion of the population with access to an improved water source irrespective of the time), the proportion of the population with access would be 86%. However, by adding a 30 minutes round-trip distance as a key threshold to the proportion of the population using an improved water source the proportion of the population with access would decrease to 72% (p Conclusions In order to develop appropriate interventions to improve drinking water access and overall quality of life, the distance between the source and the point of use must be quantified to determine where thresholds and limits may exist.