In Pakistan, antimicrobial resistance (AMR) is expected to greatly increase the already high mortality and morbidity rates attributed to infections, making AMR surveillance and prevention a priority in the country. The aims of the project were to characterize the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare facility sink drains in Pakistan and to characterize how physical characteristics of sinks and healthcare facility rooms were associated with CRE in those sinks. The study took place in 40 healthcare facilities in Jamshoro Pakistan. Swabs were collected from sink drains in each facility that had a sink, and structured observations of sinks and facilities were performed at each facility. Swabs were plated on CHROMagar KPC to screen for carbapenem-resistant Enterobacteriaceae, which were then isolated on Mueller-Hinton agar plates. Antibiotic susceptibility was determined using the disk diffusion method to assess resistance to carbapenems, cephalosporins, and fluoroquinolones. Thirty-seven of the healthcare facilities had at least one sink, and thirty-nine total sinks were present and sampled from those healthcare facilities. Sinks in these facilities varied in quality; at the time of sampling 68% had water available, 51% had soap/alcohol cleanser at the sink, 28% appeared clean, and 64% drained completely. Twenty-five (64%) of the sink samples grew Enterobacteriaceae on CHROMagar KPC, sixteen (41%) of which were clinically non-susceptible to ertapenem. Seven of the 39 sampled sinks (18%) produced Enterobacteriaceae that were resistant to all three antibiotic classes tested. Several facilities and sink characteristics were associated with CRE. Sinks and drains can serve as undetected reservoirs for carbapenem-resistant Enterobacteriaceae. Control and remediation of such environments will require both systemic strategies and physical improvements to clinical environments.

We conducted a controlled before-and-after trial to evaluate the impact of an onsite urban sanitation intervention on the prevalence of enteric infection, soil transmitted helminth re-infection, and diarrhea among children in Maputo, Mozambique. A non-governmental organization replaced existing poor-quality latrines with pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1-48 months at baseline and measured outcomes before and 12 and 24 months after the intervention, with concurrent measurement among children in a comparable control arm. Despite nearly exclusive use, we found no evidence that intervention affected the prevalence of any measured outcome after 12 or 24 months of exposure. Among children born into study sites after intervention, we observed a reduced prevalence of Trichuris and Shigella infection relative to the same age group at baseline (<2 years old). Protection from birth may be important to reduce exposure to and infection with enteric pathogens in this setting.

A field study was conducted to test the effectiveness of faucet-mounted point of use (POU) water filters for removing high concentrations of lead in drinking water from premise plumbing sources and lead service lines (LSL). These filters were concurrently certified for total lead removal under NSF/ANSI Standard 53 (NSF/ANSI-53) and for fine particulate (Class I) reduction under NSF/ANSI Standard 42 (NSF/ANSI-42). In 2016, filtered and unfiltered drinking water samples were collected at over 345 locations in Flint, Michigan. Over 97% of filtered water samples contained lead below 0.5 µg/L. The maximum lead concentration in filtered water was 2.9 µg/L, well below the bottled water standard. The effectiveness of the POU activated carbon block filters in reducing lead concentrations, even above the 150 µg/L NSF/ANSI-53 challenge standard, is likely related to trapping particles due to the small effective pore size of the filters, in addition to ion-exchange or sorption removal of soluble lead. Properly installed and maintained POU filters, certified under both NSF/ANSI-53 (for total lead) and NSF/ANSI-42 (for fine particulate), can protect all populations, including pregnant women and children, by reducing lead in drinking water to levels that would not result in a significant increase in overall lead exposure.

OBJECTIVE: To explore the effectiveness of comprehensive schistosomiasis control interventions based on urban-rural integration system construction to carry out the schistosomiasis control in hilly schistosomiasis endemic areas, so as to offer a new mode to consolidate the achievements of schistosomiasis control in the new situation.
METHODS: Shouan Town and Changqiu Township in Pujiang County in hilly schistosomiasis endemic regions were selected as demonstration areas. The comprehensive schistosomiasis control interventions based on urban-rural integration system construction were implemented, including the land consolidation, centralized residence and so on. The effectiveness the interventions was evaluated.
RESULTS: In Shouan Town and Changqiu Township, the transformed environments with Oncomelania hupensis snail habitats were 1 330.61 hm2 and 1 456.84 hm2, the areas with snails decreased from 94.31 hm2 and 83.00 hm2 in 2000 to both 0 in 2015, the positive rates of serological tests for schistosomiasis decreased from 11.8% and 7.53% in 2000 to 1.01% and 1.86% in 2015, and the positive rates of parasitological tests decreased from 0.18% and 0.15% in 2000 to both 0 in 2015 respectively. The numbers of cattle decreased from 358 and 368 in 2000 to 4 and 6 in 2015 respectively. In 2000, the schistosome infection rates of cattle were 3.63% and 6.51% in Shouan Town and Changqiu Township respectively, and from 2004, no infected cattle were found.
CONCLUSIONS: The comprehensive schistosomiasis control interventions based on urban-rural integration system construction can decrease the schistosome infection rate and area with snails effectively, providing a new mode for schistosomiasis elimination.
[摘要]目的 探讨山丘型血吸虫病流行区依托城乡统筹体系建设开展血吸虫病防治的效果, 为新形势下巩固血防成 果提供新模式。 方法 选择四川省蒲江县山丘型血吸虫病流行区的寿安镇和长秋乡为示范区, 将城乡统筹体系建设和 血吸虫病防治工作相结合, 通过实施土地整理和集中居住等综合措施, 观察分析示范区综合防治措施实施后的人群血吸 虫病检查血清学阳性率、病原学阳性率、有螺面积等指标为变化。 结果 示范区寿安镇和长秋乡2个乡镇完成了集中居 住区建设, 分别改造、减少钉螺孳生环境1 330.61 hm2和1 456.84 hm2; 实有钉螺分布面积分别由2000年的94.31 hm2和 83.00 hm2 减少到2015 年的0; 人群血吸虫血清学阳性率由11.8%和7.53%下降到1.01%和1.86%, 感染率从0.18%和 0.15%下降至0; 耕牛存栏数分别由358头和368头减少为4头和6头, 2000年耕牛血吸虫感染率分别为3.63%和6.51%, 2004年以后未再发现血吸虫感染性耕牛。 结论 依托城乡统筹体系建设的血吸虫病综合防治策略可以有效降低人群 感染率、减少有螺面积, 为巩固防治成果、最终达到消除血吸虫的目标提供了新思路。.

Residential plumbing is critical for the health and safety of populations worldwide. A case study was conducted to understand fixture water use, drinking water quality and their possible link, in a newly plumbed residential green building. Water use and water quality were monitored at four in-building locations from September 2015 through December 2015. Once the home was fully inhabited average water stagnation periods were shortest at the 2nd floor hot fixture (90 percentile of 0.6-1.2 h). The maximum water stagnation time was 72.0 h. Bacteria and organic carbon levels increased inside the plumbing system compared to the municipal tap water entering the building. A greater amount of bacteria was detected in hot water samples (6-74,002 gene copy number/mL) compared to cold water (2-597 gene copy number/mL). This suggested that hot water plumbing promoted greater microbial growth. The basement fixture brass needle valve may have caused maximum Zn (5.9 mg/L), Fe (4.1 mg/L), and Pb (23 μg/L) levels compared to other fixture water samples (Zn ≤ 2.1 mg/L, Fe ≤ 0.5 mg/L and Pb ≤ 8 μg/L). At the basement fixture, where the least amount of water use events occurred (cold: 60-105, hot: 21-69 event/month) compared to the other fixtures in the building (cold: 145-856, hot: 326-2230 event/month), greater organic carbon, bacteria, and heavy metal levels were detected. Different fixture use patterns resulted in disparate water quality within a single-family home. The greatest drinking water quality changes were detected at the least frequently used fixture.

Wastewater systems are of crucial importance to the promotion of sustainable development. Through an integrated planning approach, the costs can be minimized and the resulting benefits maximized. A planning approach at regional level exploits the economies of scale, while achieving a better environmental performance. In this paper we set out a decision support approach for the planning of regional wastewater systems. Optimization models are used, aimed at finding optimal configurations for the location, type and size of the system\'s infrastructure: sewers, pump stations, and wastewater treatment plants. Solutions are evaluated in terms of the cost of installing, operating and maintaining the infrastructure, and the water quality in the river that receives the treated wastewater. The river water quality varies in accordance with the effluent discharges, and is assessed using environmental parameters. The models are solved with a simulated annealing algorithm complemented by a local improvement procedure. Its application is illustrated through a case study in the Una river basin region, in Brazil.

BACKGROUND: Saltwater intrusion and salinisation have contributed to drinking water scarcity in many coastal regions globally, leading to dependence on alternative sources for water supply. In southwest coastal Bangladesh, communities have few options but to drink brackish groundwater which has been associated with high blood pressure among the adult population, and pre-eclampsia and gestational hypertension among pregnant women. Managed aquifer recharge (MAR), the purposeful recharge of surface water or rainwater to aquifers to bring hydrological equilibrium, is a potential solution for salinity problem in southwest coastal Bangladesh by creating a freshwater lens within the brackish aquifer. Our study aims to evaluate whether consumption of MAR water improves human health, particularly by reducing blood pressure among communities in coastal Bangladesh.
METHODS: The study employs a stepped-wedge cluster-randomised controlled community trial design in 16 communities over five monthly visits. During each visit, we will collect data on participants\' source of drinking and cooking water and measure the salinity level and electrical conductivity of household stored water. At each visit, we will also measure the blood pressure of participants ≥20 years of age and pregnant women and collect urine samples for urinary sodium and protein measurements. We will use generalised linear mixed models to determine the association of access to MAR water on blood pressure of the participants.
BACKGROUND: The study protocol has been reviewed and approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Informed written consent will be taken from all the participants. This study is funded by Wellcome Trust, UK. The study findings will be disseminated to the government partners, at research conferences and in peer-reviewed journals.
BACKGROUND: NCT02746003; Pre-results.

Child feces represent a particular health risk to children due to increased prevalence of enteric agents and a higher risk of exposure owing to exploratory behaviors of young children. The safe management of such feces presents a significant challenge, not only for the 2.4 billion who lack access to improved sanitation, but also due to unhygienic feces collection and disposal and poor subsequent handwashing practices. We assessed potential sources of fecal exposure by documenting child feces management practices in a cross-sectional study of 851 children < 5 years of age from 694 households in 42 slums in two cities in Odisha, India. No preambulatory children and only 27.4% of ambulatory children defecated directly in the latrine. Children that did not defecate in a latrine mainly defecated on the ground, whether they were preambulatory or ambulatory. Use of diapers (1.2%) or potties (2.8%) was low. If the feces were removed from the ground, the defecation area was usually cleaned, if at all, only with water. Most children\'s feces were disposed of in surrounding environment, with only 6.5% deposited into any kind of latrine, including unimproved. Handwashing with soap of the caregiver after child feces disposal and child anal cleaning with soap after defecation was also uncommon. While proper disposal of child feces in an improved latrine still represents a major challenge, control of the risks presented requires attention to the full range of exposures associated to the management of child feces, and not simply the place of disposal.

Diarrhoea is a leading cause of death globally, mostly occurring as a result of insufficient or unsafe water supplies, inadequate sanitation and poor hygiene. Our study aims to investigate the impact of a community-level hygiene education program and a water quality intervention using riverbank filtration (RBF) technology on diarrhoeal prevalence.
We have designed a stepped wedge cluster randomised trial to estimate the health impacts of our intervention in 4 rural villages in Karnataka, India. At baseline, surveys will be conducted in all villages, and householders will receive hygiene education. New pipelines, water storage tanks and taps will then be installed at accessible locations in each village and untreated piped river water will be supplied. A subsequent survey will evaluate the impact of hygiene education combined with improved access to greater water volumes for hygiene and drinking purposes (improved water quantity). Villages will then be randomly ordered and RBF-treated water (improved water quality) will be sequentially introduced into the 4 villages in a stepwise manner, with administration of surveys at each time point. The primary outcome is a 7-day period prevalence of self-reported diarrhoea. Secondary outcomes include self-reported respiratory and skin infections, and reported changes in hygiene practices, household water usage and water supply preference. River, tank and tap water from each village, and stored water from a subset of households, will be sampled to assess microbial and chemical quality.
Ethics approval was obtained from the Monash University Human Research Ethics Committee in Australia and The Energy and Resources Institute Institutional Ethics Committee in India. The results of the trial will be presented at conferences, published in peer-reviewed journals and disseminated to relevant stakeholders. This study is funded by an Australian National Health and Medical Research Council (NHMRC) project grant.
ACTRN12616001286437; pre-results.

  Detention ponds are one type of stormwater best management practices (BMPs) that can be used for the quantity control of stormwater. The pond works by reducing peak discharge downstream through temporary storage and gradual release. In this paper, a new experimental procedure using particle image velocimetry (PIV) is introduced for a two-dimensional study of the hydrodynamic behavior of fine particles in a specially designed sediment basin. The hydrodynamic behavior of fine particles under different hydraulics parameters was achieved by shifting outlet placement, using different particle-size diameters, varying the distance of the inlet from the water surface, and varying the flow rate. The same inlet and outlet level reduced fine-particle dispersion and a lower flow rate assisted with controlling high siltation. Furthermore, smaller spherical particles had more influence on fine particle suspension. Therefore, controlling the hydraulic parameters can decrease the siltation problem level.