Themes / Topics Drinking Water
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December 27, 2023 In

Microbiological and chemical drinking water contaminants and associated health outcomes in rural Appalachia, USA: A systematic review and meta-analysis

Abstract/Summary: In rural areas of the United States, an estimated ~1.8 million people lack reliable access to safe drinking water. Considering the relative dearth of information on water contamination and health outcomes in Appalachia, we conducted a systematic review of primary data studies published from 2000-2019. Of the 3,452 records identified for screening, 85 met our eligibility criteria. Most studies were conducted in Northern (32%, n=27) and North Central (24%, n=20) Appalachia, and only 6% (n=5) in Central Appalachia. Across studies, E. coli were detected in 10.6% of samples. 32% (n=27) of studies assessed health outcomes, but only 4.7% (n=4) used case-control or cohort designs (all others were cross-sectional). The most commonly reported outcomes were detection of PFAS in blood serum (n=13), gastrointestinal illness (n=5), and cardiovascular-related outcomes (n=4). Overall, based on the number and quality of eligible studies identified, we could not reach clear conclusions about the state of water quality, or its impacts on health, in any of Appalachia’s subregions. More epidemiologic research is needed to understand contaminated water sources, exposures, and potentially associated health outcomes in Appalachia.

January 2, 2023 In

Drinking Water & Health in Rural Appalachia

We are working on a number of projects to better understand issues related to drinking water (access, quality, use), sanitation, and reported and measured health outcomes in the Appalachia region, with a focus on children and adults living in Central Appalachia. In 2020, we started a comprehensive systematic review and meta-analysis study to identify and synthesize published research on drinking water contamination and associated health outcomes in the Appalachian region over a 20-year time period. We pre-registered our study protocols, completed data extraction and analysis in 2022, and published our findings in 2023 – the limited number and nature of the studies identified demonstrated that more epidemiologic research is needed to understand exposures to drinking water contaminants in this region. From 2021 to 2023, in collaboration with UVA, ETSU, a regional non-profit, a local utility, and others, we conducted a water-and-health focused cross-sectional study and a prospective cohort study in southwest VA (an important component of these studies is that we also share water testing results with participating households). In 2022, we published findings from the cross-sectional study (a small community of households with private wells), and we anticipate publishing preliminary findings from the cohort study (rural households with utility-supplied and private well and spring water in two counties) in early 2024. Given the relatively high rates of bottled water use/reliance we observed in rural households, we also conducted a study to analyze the quality of bottled water sold in the region; we anticipate publishing those findings in 2024. Building on findings from these studies, in late 2023 (in collaboration with ETSU, a regional non-profit, and others) we initiated a prospective safe water intervention pilot study in rural regions of southwest VA and northeast TN.

January 2, 2023 In

The Human Right to Water: A 20-Year Comparative Analysis of Arsenic in Rural and Carceral Drinking Water Systems in California

Abstract/Summary: Access to safe drinking water is considered a universal human right. In the U.S., exposure to arsenic contamination in drinking water disproportionately impacts small, groundwater-reliant communities and communities of color. Limited research exists on water quality in prisons; however, prisons in the Southwestern U.S. have elevated arsenic concentrations compared to other community water systems (CWS) in the region. In this paper we present a comparative analysis of 20 years of data (2001-2021) on arsenic concentrations in the CWSs serving Kern Valley State Prison (KVSP) and three neighboring rural communities: Allensworth, Delano, and McFarland. Our objective was to better understand trends in water quality, compliance, and treatment following adoption of the revised arsenic MCL, and to elucidate differences, if any, between neighboring incarcerated and non-incarcerated populations.

July 21, 2022 In

Bottled and Well Water Quality in a Small Central Appalachian Community: Household-Level Analysis of Enteric Pathogens, Inorganic Chemicals, and Health Outcomes in Rural Southwest Virginia

Abstract/Summary: Consumption of unsafe drinking water is associated with a substantial burden of disease globally. In the US, ~1.8 million people in rural areas lack reliable access to safe drinking water. Our objective was to characterize and assess household-level water sources, water quality, and associated health outcomes in Central Appalachia. We collected survey data and water samples (tap, source, and bottled water) from consenting households in a small rural community without utility-supplied water in southwest Virginia. Water samples were analyzed for physicochemical parameters, total coliforms, E. coli, nitrate, sulfate, metals (e.g., arsenic, cadmium, lead), and 30+ enteric pathogens. Among the 69% (n = 9) of households that participated, all had piped well water, though 67% (n = 6) used bottled water as their primary drinking water source. Total coliforms were detected in water samples from 44.4% (n = 4) of homes, E. coli in one home, and enteric pathogens (Aeromonas, Campylobacter, Enterobacter) in 33% (n = 3) of homes. Tap water samples from 11% (n = 1) of homes exceeded the EPA MCL for nitrate, and 33% (n = 3) exceeded the EPA SMCL for iron. Among the 19 individuals residing in study households, reported diarrhea was 25% more likely in homes with measured E. coli and/or specific pathogens (risk ratio = 1.25, cluster-robust standard error = 1.64, p = 0.865). Although our sample size was small, our findings suggest that a considerable number of lower-income residents without utility-supplied water in rural areas of southwest Virginia may be exposed to microbiological and/or chemical contaminants in their water, and many, if not most, rely on bottled water as their primary source of drinking water.

July 21, 2022 In

Bottled water quality and associated health outcomes: A systematic review and meta-analysis of 20 years of published data from China

Abstract/Summary: Bottled water is a rapidly growing yet relatively understudied source of drinking water globally. In addition to concerns about the safety of bottled water, the adverse environmental health and social impacts associated with bottled water production, distribution, consumption, and reliance are considerable. Our objective was to comprehensively review, analyze, and synthesize ∼20 years of publicly available data on bottled water quality and associated health outcomes in China. We conducted a systematic review and meta-analysis of publicly available studies of bottled water quality and associated health outcomes in China published between 1995 and early 2016 (in Chinese and English). We pre-specified and registered our study protocol, independently replicated key analyses, and followed standardized reporting guidelines. Our search identified 7059 potentially eligible records. Following screening, after full-text review of 476 publications, 216 (reporting results from 625 studies) met our eligibility criteria. Among many findings, 93.7% (SD = 10.1) of 24 585 samples tested for total coliforms (n = 241 studies), and 92.6% (SD = 12.7) of 7261 samples tested for nitrites (n = 85 studies), were in compliance with China’s relevant bottled water standards. Of the studies reporting concentration data for lead (n = 8), arsenic (n = 5), cadmium (n = 3), and mercury (n = 3), median concentrations were within China’s standards for all but one study of cadmium. Only nine publications reported health outcome data, eight of which were outbreak investigations. Overall, we observed evidence of stable or increasing trends in the proportions of samples in compliance over the ∼20 year period; after controlling for other variables via meta-regression, the association was significant for microbiological but not chemical outcomes (p = 0.017 and p = 0.115, respectively). Bottled water is typically marketed as being safe, yet in most countries it is less well-regulated than utility-supplied drinking water. Given the trend of increasing bottled water use in China and globally—and the associated environmental health impacts—we hope this work will help to inform policies and regulations for improving bottled water safety, while further highlighting the need for substantially expanding the provision of safe and affordable utility-supplied drinking water globally.

October 18, 2021 In

Poverty, Water, Climate Change, & Health in Sub-Saharan Africa

As described below (see other project summaries), the Multidimensional Poverty Assessment Tool (MPAT) was created in two phases (from 2008 to 2014) via a collaborative, international initiative to develop, test, and pilot a new tool for local-level rural poverty assessment. The work was guided by a Sounding Board of experts from the International Fund for Agricultural Development (IFAD), other United Nations agencies, international and regional organizations, and universities around the world (see www.ifad.org/mpat). Following MPAT’s finalization and institutionalization in 2014, it was used in multiple countries including many in Sub-Saharan Africa. We are currently working on multiple desk-based studies with a variety of collaborators to analyze data from ~7,000 households across Eswatini, Kenya, Lesotho, Mali, Tanzania, and Zimbabwe. Because MPAT was developed based primarily on data from Bangladesh, China, India, and Mozambique, one study we are leading is an updated assessment and evaluation of MPAT’s indicator structure and robustness based on its use in the sub-Saharan region. Other studies we are working on focus on a cross-county analyses of MPAT’s water, climate change, and health focused components and sub-components, and related programs and interventions. We anticipate publishing a number of papers on this research in 2024.

October 18, 2021 In

Arsenic in Rural & Carceral Drinking Water Systems

Source: Adapted from www.USGS.gov

In the United States, millions of people lack reliable access to safe drinking water, a problem that is particularly acute in low-income rural areas. California legally recognized the human right to water in 2012, but this right remains unevenly realized. To better understand the status of the human right to water in rural communities, we analyzed 20 years of publicly available drinking water quality monitoring and violation data from 2001-2021, with a focus on arsenic contamination (a carcinogenic heavy metal) from a state prison as well as public water systems in three neighboring rural communities in southern California. We found that all four of these drinking water systems repeatedly exceeded the legal limit for arsenic during the study period, with mean served arsenic levels ranging from 3.4 (SD=6.7) to 9.3 (SD:=2.9) μg/L across the systems (based on 2,426 samples from four systems). In addition to arsenic-specific findings and comparisons across these four sites, our analyses demonstrate how publicly reported annually averaged water quality data (used to monitor system violations and to track progress toward the human right to water) provide only a partial guide to whether the right to safe water is being realized. We published our findings in 2022.

March 1, 2021 In

Water Supply Improvement & Health Promotion Campaigns in Rural Areas — China, 1949−2020

Abstract/Summary: In the 1950s, shortly after the founding of the People’s Republic of China (PRC), the central government created the Patriotic Health Campaign (PHC) in order to standardize and disseminate health focused educational materials intended to control and prevent infectious diseases (1). “Water improvement”, meaning measures aimed at providing safe drinking water for households in China, was an important part of the PHC. After 60 years of water improvement policies, programs, and investments, the rural water supply sanitation and hygiene in China has improved dramatically, and water-related diseases no longer negatively impact the rural population as they once did. In addition to improvements related to the quantity and quality of the rural water supply, water improvement programs also promoted improved hygiene, sanitation, and other health-related behaviors among rural households. Together, such initiatives have improved the quality of life and the health of hundreds of millions of rural residents, while also contributing to economic and social advancement across rural China (2). The purpose of this article is to describe how the PHC served as a foundation for the expansion and improvement of drinking water supply in rural China, and to summarize the key programs, projects, and initiatives that followed over the last 60 years.

March 1, 2021 In

Refinement & Finalization of the Multidimensional Poverty Assessment Tool (MPAT)

Following the release of the working-paper User’s Guide for the Multidimensional Poverty Assessment Tool (MPAT) in 2009, a number of agencies and universities used the beta-version of MPAT in a variety of settings. In order to finalize MPAT and develop a comprehensive User’s Guide and associated resources, we built on the lessons learned from early adopters of the the tool (e.g., an NGO in Kenya) and iteratively used and evaluated the tool with IFAD-supported projects in Bangladesh and Mozambique. Details on the participatory expert elicitation methods we used are provided in a Journal of Development Studies paper. We developed an Excel-based data entry platform so users could easily calculate MPAT’s indicators at household, village, and project levels. We also wrote a comprehensive, 300+ page, 2014 MPAT User’s Guide which provides step-by-step instructions for using MPAT as well as training modules and materials, all with the goal of making MPAT an accessible open-source tool. The User’s Guide and accompanying resources were presented at a 2014 launch event in Rome. Since its 2014 release, MPAT has been translated into a number of languages, an optional 11th component focused on climate change was added, and MPAT has been used by a variety of agencies and institutions around the world. MPAT publications and related resources are available at www.ifad.org/mpat.

March 1, 2021 In

Evaluating Household-level Drinking Water Treatment in Rural China

After extensive discussion and planning, we started a collaborative research project with colleagues at the NCRWSTG and China CDC to characterize and assess methods of household water treatment (HWT) in low-income regions of rural China. During the first phase of this research, in the summer of 2013, we collected drinking water samples and administered surveys to 450 households across 15 rural villages in Guangxi province. To assess seasonal factors, we undertook a second round of data collection in the winter of 2013/2014 during which time we also affixed remote temperature sensors to kettles and pots to help corroborate reported boiling data. In 2014, under the supervision of China CDC colleagues Director Tao Yong and Dr. Qing Luo, we replicated the study in Henan province, collecting data from 450+ rural households during the summer.  Using a variety of modeling approaches, we evaluated the microbiological effectiveness of the HWT methods used – including bottled water (large 19L bottles) – and isolated socioeconomic predictors associated with HWT and water-related beliefs and behaviors. Among other findings, we observed that indicators of fecal contamination were lowest in drinking water samples from households using electric kettles. Our analyses of boiling-associated air pollution indicated that switching from boiling with pots and solid fuels to boiling with electric kettles would result in a measurable reduction in indoor air pollution. We also observed relatively high rates of microbiological contamination in samples from households using bottled water; and our analyses of socioeconomic factors suggested that rural bottled water use will continue to increase in the future. Results from these studies – as well as a systematic review on boiling and health outcomes – were also used to support and inform the design of an intervention to promote the use of electric kettles in low-income rural communities (see project summary above).