EFFECTS OF POINT OF USE PRACTICES ON DRINKING WATER QUALITY IN A RURAL PERUVIAN VILLAGE Aimee J. Barrett University of Oklahoma Health Sciences

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1 EFFECTS OF POINT OF USE PRACTICES ON DRINKING WATER QUALITY IN A RURAL PERUVIAN VILLAGE Aimee J. Barrett University of Oklahoma Health Sciences Center Industrial Hygiene and Environmental Health Sciences

2 Background Four preliminary sampling trips occurred during June 2009 and June 2010 Sampling trips were in northeastern Peru Samples obtained from indigenous Shipibo villages living near the Ucalayi River

3 Trip 1 June 2009 Assessed drinking water for presence absence of total coliform and E. coli Initial preliminary water samples showed 85.1% positive for total coliform and 62.9% positive for E. coli

4 Trip 2 December 2009 Evaluated newly drilled wells for bacteriological quality compared to an older well Tests demonstrated that two new water wells were free of coliform and E. coli while an older well had high levels of coliform and E. coli (>200 and 53 cfu/100 ml, respectively)

5 Trip 2 December 2009 Analysis of point of use indicated transport and storage practices contaminated the water as 100% of samples from the new well tested at the point of use contained E. coli (mean = 121 cfu/100 ml)

6 Trip 3 March 2010 Demonstrated that the study community that received the two new water wells in December 2009 continued to contaminate the water at point of use Water samples taken directly from the two new wells showed E. coli enumeration of 45 cfu/100 ml and 50 cfu/100 ml

7 Trip 3 March 2010 Water samples taken at point of use contained E. coli (mean value = cfu/100 ml)

8 Trip 4 June 2010 Sampling was two-fold: (1) E. coli enumeration of two recently installed water wells (drilled in June 2010) and point of use water drawn from the two new water wells and (2) conducting a public health survey

9 Trip 4 June 2010 Tests demonstrated that two new water wells (drilled in June 2010) near the community health post were free of E. coli Homes where point of use safe water handling practice literature was posted showed E. coli levels of 63 cfu/100 ml Water samples taken from homes that did not have safe water handling practice literature exceeded 200 cfu/100 ml of E. coli

10 Trip 4 June 2010 Survey data indicated that 52% of people collected their drinking water from a water well 35.1% stated that drinking water was prepared by chlorine treatment 45.9% said that they boiled the water before drinking

11 Point of Use Practices

12 Current Work Created water point of use video, coloring book, and community presentation Developing a matrix of 8 treatments systems using 9 criteria to quantify optimal treatment system Develop a decision tool to determine the appropriate drinking water treatment system for underdeveloped rural regions

13 Evaluation Criteria Matrix throughput (volume) efficacy (treatment efficiency) cost bacteria reduction in-country supplies community acceptability power requirements chemical requirements maintenance

14 Treatment Systems solar (SODIS) chlorination & hypochlorite disinfection drilling water wells household filtration buckets Lifestraw Family ceramic household system rain-water catchment biosand filtration

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23 Uh Oh, the germs got us.

24 Questions

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27 Problem Statement My data indicated that the Shipibo people lack safe drinking water The literature review examines multiple engineering approaches for meeting the safe drinking water needs of underdeveloped rural regions Despite multiple engineering options in existence few will meet the unique needs of the Shipibo people Currently no decision tool exists to determine the optimal treatment systems for underdeveloped rural villages

28 Purpose and Scope Assess eight water treatment system options The water treatment system options will be evaluated using nine criteria and preliminary data from the Shipibo study population Develop a decision tool to determine the appropriate drinking water treatment system for underdeveloped rural regions

29 Decision Tree (Tool) The decision tree (tool) will systematically address the nine criteria and will provide the means to choose the optimal treatment system for an undeveloped rural village

30 Research Process Step #1 Literature Review of eight systems and nine criteria Literature Review of social and psychological needs of underdeveloped rural villages Step #2 Develop the nine-criteria matrix using literature review information and preliminary Shipibo data Step #3 Create a decision tree (tool) to determine the appropriate system for a particular underdeveloped rural village

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34 Current Situation Nearly 90 percent of all diseases in the world are caused by unsafe drinking water, inadequate sanitation, and poor hygiene. An estimated 1.1 billion people do not have access to safe drinking sources, and more than 2.6 billion people lack adequate sanitation.

35 Current Situation In the poorest countries of the world, one out of every five children born will die from a preventable, water-borne diseases. The United Nations indicates that half of the underdeveloped world lives without sanitation.

36 UN Millennium Development Goals United Nations Millennium Development Goals. The United Nation has eight Millennium Development Goals. The goals span from child/maternal health to combating HIV/AIDS.

37 UN Millennium Development Goals The seventh UN Millennium Development Goal is Environmental Sustainability. Target 7.C UN Millennium Goal is to halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation. A targeted effort to UN seeks to bring significant improvement to at least 100 million slum dwellers, particularly focusing on sub-saharan Africa.

38 Quantity of water does not mean it is safe water Water containing viruses, parasites, heavy metals, and bacteria can cause morbidity and even mortality.

39 Rotavirus Rotavirus is commonly found in drinking water Rotavirus is known for being a global killer of children. Rotavirus can cause severe gastroenteritis in infants and children worldwide.

40 Rotavirus It is estimated that half a million infants and young childhood deaths occur worldwide from rotavirus. Rotavirus causes intestinal illness resulting in severe diarrhea that leads to dehydration and electrolyte and acid-base disruption. Rotavirus can be found in water wells or other water sources where rotavirus contamination has occurred from infected human feces. Killing or inactivating rotavirus is possible by simply boiling water for one minute or boiling water for 3 minutes if elevation exceeds 6,500 feet.

41 Parasites Cryptosporidium, Giardia, and Cyclospora, Ascaris, and Trichuris are parasites commonly known for causing waterborne disease in the developing world.

42 Parasites Children often have distended abdomens because of parasitical infestation. WHO recommends every person in the developing world be treated annually with an antiparasite pharmaceutical.

43 Toxic Elements Arsenic, Cadmium, and Mercury can be found in drinking water Petroleum drilling Improper waste management Crop fertilizing processes Various industrial practices

44 Toxic Elements The impact of chronic heavy metal exposure is felt in the developing world where people are vulnerable to exploitation from petroleum and mining exploration. Also, public water systems in underdeveloped countries can be poorly designed due to a lack of knowledge. Cheaper supplies are sometimes used to cut costs but heavy metal leaching occurs.

45 Bangladesh Bangladesh, one of the poorest countries in the world, unknowingly exposed people to dangerously high levels of arsenic. In an effort to reduce mortality and morbidity rates of water-borne disease, Bangladesh installed millions of tube wells. Inadvertently, the tube wells drew water from underground aquifers containing arsenic.

46 Bangladesh Chronic arsenic exposure above 500 µg per liter of water show increased incidences of lung, bladder, and skin cancer. Beyond cancer incidences, dermatological characteristics such as pigmentation changes and skin lesions have been identified as chronic arsenic exposure symptoms. Additionally, acute arsenic exposure can lead to neurological disorders, pulmonary disease, diabetes mellitus, and peripheral vascular disease. (7) Women chronically exposed to arsenic during pregnancy have higher preterm births, stillbirths, and spontaneous abortions than women not exposed to arsenic in drinking water. (8)

47 Bacteria Bacteria of various types can be found in drinking water. For example, drinking water can contain genera from the coliform group, including Klebsiella, Enterobacter, Serratia, Citrobacter, and Escherichi Other than Escherichia, the other genera are found in the environment, decaying vegetation, and soil.

48 Bacteria Testing for total coliform does not determine disease pathogen presence in drinking water. Escherichia determines fecal drinking water contamination. (11) E. coli presence in drinking water can lead to diarrheal diseases.

49 Diarrheal Disease is a Global Killer The WHO estimates that 5,000 children under the age of five die every day from water-borne disease, mostly in the underdeveloped world. One of the primary ways to improve diarrheal disease rates is to reduce the levels of bacteria in drinking water by supplying clean water from water wells.

50 Bangladesh Autopsies 20% of autopsies conducted in Bangladesh on children under the age of 5 years old are due to diarrheal disease. (12) One of the primary ways to improve diarrheal disease rates is to reduce the level of bacteria in drinking water.

51 E. Coli as the best indicator for biological drinking water quality The rationale for focusing solely on E. coli is because it is considered the best indicator for biological drinking water quality. E. coli testing is inexpensive E. coli can survive in various drinking water circumstances, making it ideal for water drinking quality testing in underdeveloped countries.

52 Water Quality Testing Challenges The challenge in testing for viruses, parasites, and heavy metals is cost, complexity, and sensitivity. Measuring for viruses, parasites, and heavy metals usually requires stool samples, blood tests, hair samples, or fingernail samples.

53 E. coli testing Water samples can easily be tested for E. coli presence and absence and also can be enumerated by parts per billion (ppb) of bacteria colony forming units (cfu). According to WHO examination for fecal indicator bacteria in drinking water provides a very sensitive method of quality assessment.

54 Challenges of Developing Countries Limited knowledge of disease transmission sanitation hygiene practices health illiteracy

55 Health Illiteracy

56 Bridging the Gap Particular engineering controls and systems designed to reduce water-borne disease are solar Chlorination Sodium hypochlorite Drilling new water wells, Straw filtration devices Ceramic household systems Household filtration buckets

57 Solar In solar water disinfection (SODIS), microbes are destroyed by temperature and UVA radiation provided by the sun. Water is placed in a transparent plastic PET bottles, which is first oxygenated by shaking partially-filled capped bottles prior to filling the bottles all the way.

58 Chlorination

59 Sodium hypochlorite disinfection Bleach

60 Water wells

61 Water Filtration Straws

62 Ceramic Systems

63 Household Systems

64 Challenges to Engineering Practices Engineering controls and systems demonstrate a capacity to reduce or eliminate E. coli presence in drinking water. Limiting factors in E. coli reduction using these engineering controls and systems are maintenance broken equipment lack of equipment repair knowledge not having in-country maintenance supplies

65 More Challenges: Point of Use Practices Beyond the failure of engineering technologies and the inability to maintain the technologies, engineers and public health practitioners must face the reality that E.coli presence in drinking water can occur due to point of use water handling practices. Poor point of use water handling practices are exacerbated by disease transmission, sanitation, and hygiene illiteracy.

66 Point of use recontamination Point of use recontamination can occur at any of the following phases: Collection Transportation Storage Usage

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68 Collection and Transportation It is worth noting that the collection and transportation phases are mainly conducted by females, particularly girls, and that not only is their health compromised by water-borne disease but girls educational opportunities are inhibited because of water inaccessibility. UNICEF reports that over half of all schools worldwide lack safe water and sanitation, jeopardizing the health and education of millions of schoolchildren. Most of the 115 million children currently out of school are girls. Many are denied their place in the classroom by lack of access to decent toilets at school, or the daily chore of walking miles to collect water. (18) This is a good use of a quote.

69 Transportation Additionally, The UN Development Program stated that households in Uganda spend an average of 660 hours annually collecting water.

70 The Bottom Billion

71 Storage Contamination can be reintroduced at the storage phase Household Buckets non-sealed buckets Vectors Biofilm presence in water storage containers Storing water near areas of open defecation Animals sitting on water storage containers Using a common rag for cleaning buckets and for cleaning children.

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73 The Study Community The study community was part of the indigenous Shipibo people living near the Ucayali River in Peru. The Ucayali River is a tributary to the Amazon River. Estimated Shipibo population: 40,000 people living in over three hundred villages concentrated in the Pucallpa region and is situated to the north and south of the city of Pucallpa.

74 Do the work.

75 The Study Community Shipibo villages report chronic sheshow The Shipibo People do not have a written form of their language. Primary tools of the Shipibo people are machetes and spears. Virtually none of the Shipibo villages have electricity.

76 Initial Study- June 2009 In an initial study, 85.1% and 62.9% of water samples in the study area tested positive for total coliform and E. coli respectively.

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78 Santa Clara

79 January 2010 In this study, we evaluated newly drilled wells for bacteriological quality compared to an older well

80 Questions

81 New Water Wells Water Well Drilling Method: Well #1: 36 meters Well #2: 72 meters

82 Water Well Drilling Process mud rotary drilling technology

83 January 2010 Subsequent tests demonstrated that two new water wells were free of coliform or E. coli while an older well had high levels of coliform and E. coli (>200 and 53 cfu/100 ml).

84 Subsequent Tests Analysis of water at the point of use indicated that transport and storage practices contaminated the water as 100% of samples from the new well tested at the point of use contained E. coli (mean value = 121 cfu/100ml).

85 Data The data indicate that is not sufficient to just drill new water wells in undeveloped countries sanitary practices for point of use handling must be implemented to reduce bacteria and to maximize the effects of drilling water wells.

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87 Point of Use Practices

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