Domestic access to water in a decentralized truck-to-cistern system: a case study in the Northern Village of Kangiqsualujjuaq, Nunavik (Canada).

Municipal water supply through truck-to-cistern systems is common in northern Canada. Household satisfaction and concerns about water services likely impact user preferences and practices. This case study explores household perspectives and challenges with regard to domestic access to water in a decentralized truck-to-cistern system. A case study was conducted in the Northern Village of Kangiqsualujjuaq, Nunavik (Quebec, Canada). A paper-based questionnaire was completed by 65 households (one quarter of the population). Many households (37%) reported not drinking tap water from the truck-to-cistern system. Chlorine taste was a frequently reported concern, with those households being significantly less likely to drink water directly from the tap (p = 0.002). Similarly, households that reported a water shortage in the previous week (i.e., no water from the tap at least once) (33%) were more likely to express dissatisfaction with delivered water quantity (rs = 0.395, p = 0.004). Interestingly, 77% of households preferred using alternative drinking water sources for drinking purposes, such as public tap at the water treatment plant, natural sources or bottled water. The study underscores the importance of considering household perspectives to mitigate the risks associated with service disruptions and the use of alternative sources for drinking purposes.

A bibliometric analysis of global research on drinking water and health in low- and lower-middle-income countries.

Heightened interest in drinking water research in recent decades has been aimed at narrowing the knowledge gaps surrounding water and health in a global pursuit to provide safely managed drinking water services to populations who continue to lack access. This study used bibliometrics and network analysis to produce a global overview of publications and groups that have contributed to research on drinking water and health in low- and lower-middle-income countries (LLMICs). The United States and the United Kingdom, which have historically dominated the field based on the production and impact of scientific literature, remain at the center of international collaborative research partnerships with emerging countries. However, in recent years, the volume of publications produced by India has surpassed that of the United States while Bangladesh is ranked third for the strongest international collaborations. Iran and Pakistan are also emerging as major producers of research, yet publications out of these countries and India remain disproportionately restricted behind paywalls. Contamination, diarrheal disease, and water resources are the themes that characterize the majority of research on water and health. These findings may be used to accelerate equitable, inclusive research in the realm of water and health, thereby enabling gaps in global drinking water inequalities to be filled.

Domestic water security in the Arctic: A scoping review.

INTRODUCTION: 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. OBJECTIVE: 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)). METHODS: An extensive literature review was conducted to retrieve relevant documentation. Arctic & Antarctic 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. RESULTS: 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. CONCLUSIONS: 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.

Water supply emergency preparedness and response in health care facilities: A systematic review on international evidence.

Introduction: Enabling health care facilities to deal with impairments or outages of water supply and sewage systems is essential and particularly important in the face of growing risk levels due to climate change and natural hazards. Yet, comprehensive assessments of the existing preparedness and response measures, both in theory and practice, are lacking. The objective of this review is to assess water supply and wastewater management in health care facilities in emergency settings and low-resource contexts. It thereby is a first step toward knowledge transfer across different world regions and/or contexts. Method: A systematic review was performed to identify published articles on the subject using online MEDLINE and Web of Science. The initial searches yielded a total of 1,845 records. Two independent reviewers screened identified records using selection criteria. A total of 39 relevant studies were identified. Descriptive analyses were used to summarize evidence of included studies. Results: Overall, water supply was far more discussed than wastewater management. Studies on emergency preparedness identified back-up water storage tank, additional pipelines, and underground wells as key sources to supply health care facilities with water during an emergency. In emergency response, bottled of water, followed by in-situ back-up water storage tanks previously installed as part of disaster preparedness measures, and tanker trucks to complete were most used. Questions on how to improve existing technologies, their uptake, but also the supplementation by alternative measures remain unanswered. Only few guidelines and tools on emergency preparedness were identified, while multiple studies formulated theoretical recommendations to guide preparedness. Recovery planning was rarely discussed, despite many studies mentioning the importance of the reconstruction and restoration phases. Literature focus on recovery is mostly on technical aspects, while organizational ones are largely absent. Despite their key role for preparedness and response, citizens and patients' perspectives are hugely underrepresented. This fits into the bigger picture as communication, awareness raising and actor cooperation in general is addressed comparatively little. Discussion: Combining organizational and technical aspects, and intersecting theory and practice will be necessary to address existing gaps. Improving both, preparedness and response, is key to maintaining public health and providing primary care.

Assessment of Decontamination and Reuse of Disposable Filter Funnels Used in Microbiological Water Quality Tests.

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.

Evaluating self-reported measures and alternatives to monitor access to drinking water: A case study in Malawi.

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.

Household practices in accessing drinking water and post collection contamination: A seasonal cohort study in Malawi.

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.

Trends in access to water and sanitation in Malawi: progress and inequalities (1992-2017).

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.

Drinking water accessibility and quantity in low and middle-income countries: A systematic review.

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.