Household water management: refining the dominant paradigm.

Dr Greg Allgood with orphans in Orongo. More children die from diarrheal illness − about 1.8 million each year − than from HIV/AIDS and malaria combined. The vast majority of these needless deaths in the developing world can be eliminated by improved water quality, hygiene, and sanitation. Water quality, in particular, has been largely ignored in public health efforts during the last two decades, yet research has shown that water purification technologies used at the household level can save a huge number of lives. Nurses are providing a critical role in the education and training needed for community acceptance of the new technologies. A policy shift towards household water treatment can provide a rapid and cost effective approach that can be scaled up to prevent the 4000 deaths of children that occur every day. The majority of efforts in the water and sanitation sector during the last several decades were focused on providing water access to reduce the burden of collecting water; building latrines to prevent the contamination of water sources by human feces; and promotion of hand washing and other hygiene measures to prevent the spread of infectious diarrhea such as following defecation. A review by Esrey et al. (1985) showed that interventions of improved water quality provided less diarrhea reduction than improved water access, sanitation, and hygiene. However, the Esrey review examined improved water quality based on the point of collection, such as provision of standpipes, and did not examine the impact of improving water quality at the point that it is used, such as in the home. During the last decade, more than 30 randomized controlled studies involving more than 53 000 people have been conducted with a variety of interventions that improve water quality at the point-of-use or household level. A recent review of these studies by Clasen et al. (2006) demonstrated conclusively that improving water quality at the household level dramatically reduces diarrheal illness and, therefore, can save lives. The four types of proven interventions include: (1) solar disinfection or SODIS, (2) chlorination through a product typically named Waterguard or Sur L'Eau, (3) ceramic or biosand filtration, and (4) combined coagulation-disinfection through a Procter & Gamble (P&G) product called PUR Purifier of Water. A variety of technologies are needed, given the different needs of more than a billion people without safe drinking water. The technologies are all relatively low cost and are being provided inclusive of education, training, and the technology at a cost of less than US$0.01 per liter. In 2004, a number of organizations joined together under the leadership of the World Health Organization to create the International Network to Promote Household Water Treatment and Safe Storage (WHO 2007). This Network focuses on research, implementation, communication, and advocacy for household water treatment. The International Council of Nurses (ICN) was a founding member of the Network and has played a leading role in advocating these new technologies to nurses. P&G and ICN created a strategic alliance in 2002 to improve health with safe drinking water. P&G provides PUR Purifier of Water as a not-for-profit program called the Children's Safe Drinking Water Program, the signature program of P&G's global cause – Live, Learn and Thrive – aimed at improving the lives of children in need. P&G has committed to provide 3.5 billion liters of safe drinking water via the Children's Safe Drinking Water Program by 2012. As part of the P&G and ICN alliance, ICN developed a fact sheet entitled, ‘Safe Household Water: Prevents Disease, Saves Lives’, and has held scientific sessions at each of its Congresses since 2003 (International Council of Nurses 2003). In addition, ICN has partnered with P&G to provide safe drinking water in Guatemala, Malawi, Uganda, and Kenya. Together, we have learned that successful implementation of household water treatment requires credible sustained communication on proper use as well as reinforcing the benefits of improved water quality. Similar to the way that engineers have been on the front lines of providing water access through digging wells, nurses have been effective on the front lines of the effort to educate people on household water treatment. Importantly, we have discovered some of the most effective communication venues both for enabling sustained habit change as well as serving the most vulnerable. Specifically, the most effective strategies include the education of mothers on safe drinking water at health clinics such as during immunization days; provision of safe drinking water to people living with AIDS; the education of children as positive catalysts for community change; the provision of safe drinking water to malnourished children; and the use of household water treatment for cholera prevention. While each of these strategies involves nurses, some of the greatest successes targeting safe drinking water to the most vulnerable has involved health clinics, schools, and HIV/AIDS programs. Infant children are particularly vulnerable to the pathogens in contaminated drinking water. The time from weaning to development of a full immune system is the time that providing safe drinking water provides the greatest benefit. Because of this, reaching the caregivers of children at health clinics during immunization days and well-baby visits is one of the most effective strategies for the adoption of household water treatment. Anyone who has visited a health clinic in Africa knows that a mother who brings her child typically has a long day of travel and waiting. The mothers are usually nervous about their child receiving the vaccination but they understand that this bit of pain provides long-term protection. Through the work of nurses, we have learned that a visit to the health clinic can also provide mothers with education on the use of household water treatment. The mothers enjoy seeing the lively demonstrations conducted by nurses in which dirty and contaminated water is turned to clear and clean water. In addition, the demonstrations relieve the mothers' tension caused by the immunizations their babies are receiving. Research by the Centers for Disease Control (CDC) (Parker et al. 2006) showed that one year following a nurse recommendation, 71% of mothers reached in a Kenyan health clinic were still using household water treatment. School children can be catalysts for change in communities and we have found that they can be very effective in leading the adoption of household water treatment. P&G and our partners will have reached more than one million school children in the developing world by the end of 2009 with safe drinking water. These classroom sessions are demonstrated by nurses in programs with World Vision, Save the Children, PSI, CARE, and others. One of these programs in Malawi with World Vision and PSI measured a 57% decrease in school absenteeism, a 53% decrease in diarrheal disease among the community, and a 75% increase in pit latrine coverage in schools (World Vision 2008). In addition, through a partnership with ICN, safe drinking water is being provided to orphans, many of whom were orphaned from HIV/AIDS, in Kenya, Malawi, and Uganda. We found that safe drinking water and hygiene education not only reduced diarrheal illness, but led to improved social status of the orphanages in the communities because of the availability of purified water. Similar to infants, people with HIV/AIDS are particularly vulnerable to pathogens in drinking water and frequently have severe and persistent diarrhea. Water-borne parasitic infections caused by Cryptosporidium and Giardia are a particular problem, and while these infections are generally self-limiting in healthy individuals, they are frequently fatal in people with AIDS. Nurses in western Kenya started providing household water treatment products of chlorination (Waterguard) or coagulation/disinfection (PUR) to people with AIDS in 2003. The nurses began reporting anecdotally, the Lazarus type of recovery that occurs following administration of antiretroviral drugs. Based on these reports and more careful documentation of the quality of life improvement by the CDC (Lule et al. 2005), we began scaling up provision of safe drinking water to people with AIDS and have seen dramatic impacts on health through implementation programs with a dozen partners. Provision of safe drinking water for people with AIDS is a critical intervention since the absorption of antiretroviral drugs will be impaired if there is persistent diarrhea. The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is helping to provide more than 100 million liters of safe drinking water to people with HIV/AIDS in Ethiopia and Cote d'Ivoire through collaboration with CARE, Population Services International, P&G, and a number of other partners. Because safe drinking water for a person with AIDS can be provided at only US$0.02 per day, it is essential that this effort be scaled up in areas where people drink contaminated water. Due largely to the efforts of nurses in the developing world, and important new public private partnerships, household water treatment is being scaled up to save thousands of lives. There is great urgency to do more so that children do not die needlessly from lack of something as simple as clean water. Greg Allgood, PhD. is the Director of the Children's Safe Drinking Water Program at Procter and Gamble (P&G). He has a PhD in toxicology and Master of Science in Public Health. He is chair of the Communication and Advocacy Working Group of WHO's International Network to Promote Household Water Treatment and Safe Storage, and is also on the Advisory Board of the Clinton Global Initiative Health Track.

PurposeThe purpose of this study was to explore the relationship of feasibility analysis of health indicators with the microbiological quality of refill drinking water.MethodThe study used a descriptive design with a cross-sectional analytic approach. The dependent variable was the microbiological quality of refill drinking water. The independent variables were the following health indicators: raw water quality, equipment and processing method, operator behavior, and sanitation of depot building. ResultsThere were significant correlations between variables of health indicator, equipment and processing method with E.coli microbiological quality. There was no significant correlation between quality of raw water, behavior of the operator, and sanitation buildings with microbiological quality.ConclusionAlmost fifty percent of DAMIU refill drinking water is not qualified for microbiological quality of coliform and microbiological quality of Escheria coli. The most dominant factors affecting microbiological quality of drinking water refills are equipment and processing.

The Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program focuses on identifying exposure pathways to faecal pathogens for young children in the Democratic Republic of the Congo (DRC) and on developing scalable interventions to reduce faecal contamination from these pathways. A prospective cohort study of 690 participants was conducted to investigate the association between hand, food, and environmental faecal contamination and diarrhoeal disease prevalence among young children in Walungu Territory, South Kivu, DRC. A total of 1923 hand rinse, soil, food, object, surface, stored water and water source samples were collected during unannounced spot checks after baseline enrolment and analysed for Escherichia coli. Caregiver reports of diarrhoea were obtained from children<5years at a 6-month follow-up. E.coli was detected in 73% of child and caregiver hand-rinse samples, 69% of soil samples from child play spaces, 54% of child food samples, 38% of objects and surfaces children were observed putting in their mouths, 74% of stored water samples, and 40% of source water samples. Children<5years with E. coli on their hands had significantly higher odds of diarrhoea at the 6-month follow-up (odds ratio: 2.03 (95% confidence interval: 1.05, 3.92)). The cohort study findings from the REDUCE program have shown that child hand contamination is associated with diarrhoeal disease in rural DRC, and that there is high faecal contamination in child plays spaces and food. These findings provide evidence demonstrating the urgent need to provide clean play spaces for young children and interventions targeting hand hygiene to reduce paediatric exposure to faecal pathogens.

To evaluate the performance of domestic water purification units with respect to contaminating enteric viruses. Eight domestic water purification systems widely used in India were evaluated using hepatitis E virus (HEV) as a model virus. For HEV concentration and detection, membrane filtration and real-time PCR were used respectively. Viral log reduction value (LRV) was calculated for each unit. Viral log reduction value was 0.21 for unit 6 (polyester + carbon), 1.45 for unit 4 (filter + UV), 1.52 for unit 3 (filter + chlorine), 1.70 for a carbon + exhaust indication contact disinfection unit, 2.20 for an iodine resin unit, 2.51 for a dual filter unit and 6.53 for a hollow fibre membrane unit and a gravity-fed filter unit. Thus, only the technologies employed by the latter two were efficient in complete removal of HEV. The majority of the water purifiers under use are inadequate. Virological standards in evaluating such devices need to be established urgently, in order to help manufacturers to improve the performance of such products and most importantly, to help consumers.

Interventions to improve water quality, particularly when deployed at the household level, are an effective means of preventing endemic diarrhoeal disease, a leading cause of mortality and morbidity. Following a national survey indicating widespread faecal contamination of drinking water in Indian cities, a point-of-use water treatment unit was developed, which combines filtration and disinfection, does not require power or water pressure and has an operating cost of Rs. 0.25 (US$0.0057) per litre. We assessed the microbiological performance of the unit in the laboratory over the full 1500 l design life of the unit's consumable components. Geometric mean reductions for the units were more than 6 logs (99.9999%) for bacteria, more than 7 logs (99.99999%) for viruses and more than 3 logs (99.9%) for the test surrogate for protozoan cysts. Geometric mean reductions exceeded levels established for microbial water purifiers. The product water was free of detectable chlorine. If these results are validated in field trials, the deployment of the unit on a wide scale among vulnerable populations may make an important contribution to public health efforts to control intractable waterborne diseases.

ABSTRACK Background: Water represents an absolute medium to human life and other living things. However, water can also be the best media of diseases to spread. Therefore, before consumed, water has to be processed drinking to eliminate or degrade impure materials up to the safest level. As water becomes more problematic these days, it attracts the attention of drinking water refill depots to. Furthermore, dringking water that produce is not yet legalized and standardized in terms of its process. This research to know determine factors related to bacteriological quality of drinking water product drinking water refill in Semarang City. Methods :This research was an Explanatory Research. Using observation with a cross sectional approach. Samples are determined with standard error of 10% from 49 depots divided proportionally towards the spreading of depots throughout Semarang city. The variables used are a parameter of the bacteriologic number of coliform, E_Coli germs. Data analysis using Test correlation of kontingensi chi-square to know relation between variable. Results: The result of this research shows the relation to the variables using Chi-square test, it is shown that the condition of standard water and the condition of Bacteria of refill drinking water are C = 0,494, p = 0,0001, consequently Ho rejects it. Correlation test of instrument condition and the bacteriologic quality of refill drinking water showed that when C = 0,178, p = 0,447, Ho accepts it. While correlation test of processing of drinking water and the bacteriologic quality of refill drinking water showed that when C = 0,346, p = 0,035, Ho rejects it. Correlation test of hygienic officer of depot and the bacteriologic quality of refill drinking water shows that when C = 0,263, p = 0,162, so Ho accepts it. And correlation test of DAMIU sanitation and the bacteriologic quality of refill drinking water showed that C = 0,512, p = 0,0001, so Ho rejects it. Conclusions : All depots have not yet met the requirements of producing standard water as requested by Department of Health. The hygienic behavior of workers is still poor. The bacteriologic quality of refill drinking water based on the result of lab. test indicates that 34 samples ( 69,4%) have fulfilled the requirements of standard drinking water but the rest have not yet reached the minimum standard of drinking water. This matter is caused by the standard water which is used, the procedure of processing and the environmental condition of depot. Keyword; drinking water, refill depots, bacteriology quality

Purpose. The purpose of the study is to reveal and evaluate the influence of different types of mineral fertilisers on drinking water quality, providing recommendations for mitigating environmental risks in European countries. Methodology / approach. The approach includes a panel analysis using fixed and random effects models, which allowed the identification of dependencies between fertiliser consumption levels and water quality indicators. The input data for the study covered indicators from 39 European countries, including EU member states, countries with harmonised legislation, and nations in the process of joining the EU. The analysis period covers 2006–2021, ensuring a balanced data panel with the same number of observations for each country over time. Key variables included the amounts of fertilisers (nitrogen, phosphorus, and potassium) used per hectare and capita, as well as food export and import indicators, enabling an estimation of the overall effect of agricultural activity on water quality. Results. The study results of random effects models demonstrate that pesticide use per unit of cropland area and per capita area positively impacts the Unsafe Drinking Water Index (UDWI). Pooling models indicated fertiliser consumption reduced water safety overall (β = -0.0143, p = 0.0026). Increased nitrogen fertiliser use per hectare demonstrated a slight positive relationship with the UDWI (β = 0.0491, p = 0.048), indicating marginal improvement in water quality. Conversely, phosphate fertilisers (per hectare and capita) had a significant negative impact, with a 1 kg/ha increase associated with a reduction of UDWI by 0.2261 units (p &lt; 0.001) and a per capita increase by 1.2815 units accordingly, underscoring risks to water safety. The intensity of agricultural exports also had a negative impact on drinking water safety, particularly when combined with broader economic export activities (interaction effect β = -0.0147, p &lt; 0.001). In contrast, imports showed a positive relationship with drinking water safety. Originality / scientific novelty. The novelty of the study lies in identifying a quantitative relationship between mineral fertiliser use in agriculture and drinking water quality in European countries, using panel analysis to develop recommendations for mitigating environmental risks. Practical value / implications. The study’s findings underscore the need for differentiated policies in managing fertiliser application, particularly recommending stricter regulation of phosphate use due to its pronounced negative impact on drinking water quality. Policymakers should encourage sustainable agricultural practices, such as precision farming and regulated nutrient application, especially in regions with intensive export-driven agriculture. Additionally, fostering the development and adoption of environmentally friendly alternatives, including biopesticides and controlled-release fertilisers, could significantly mitigate the adverse environmental impacts identified in this research.

On February 25, 2003, more than 30 representatives from United Nations agencies, international nongovernmental organizations, research institutions, professional associations, and private companies met in Geneva, Switzerland, to establish the International Network to Promote Household Water Treatment and Safe Storage, sponsored by the World Health Organization (WHO) (Figure). The group has since convened at the Kyoto World Water Forum, Kyoto, Japan, in Washington, D.C., and in Cape Town, South Africa. At the next plenary meeting, in Nairobi, Kenya, on June 14–15, 2004, participants will consider a 5-year strategic plan to reduce waterborne disease through specific actions in research, advocacy, communication, and implementation. Figure Cover and inside page of brochure, The Network. This first phase has seen progress in the organization and expansion of the network's participant base and real work in the field, building on the evidence that household water management can significantly contribute to meeting the Millennium Development Goals for child survival and water security. This fieldwork has reaffirmed the conclusion of a WHO-sponsored review: simple, low-cost interventions for home water treatment and storage lead to dramatic improvements in drinking water quality and reductions in diarrheal disease (1). The Safe Water System, developed by the Centers for Disease Control and Prevention (CDC), the Pan American Health Organization (PAHO), and WHO, combines point-of-use water disinfection with locally produced sodium hypochlorite, safe storage in narrow-mouth containers, and community education and has consistently been effective in preventing diarrhea (2,3). In recently published trials, the Safe Water System reduced diarrhea by 24% in Bangladesh (4) and 25% in Guatemala (5). In a 2003 study, the Safe Water System reduced diarrhea by 30% among persons with HIV infection in rural Uganda (6). In 2003, accounts of field trials of a household-based flocculant-disinfectant for water treatment were published for the first time. Developed by the Procter & Gamble Company and CDC, the intervention combines a chemical flocculant with a timed-release hypochlorite disinfectant. Through precipitation, coagulation, and flocculation, the combined product physically removes a broad range of microbial pathogens and chemicals, including arsenic, and concurrently inactivates remaining microbes with free chlorine (7,8). In a randomized, controlled trial in Guatemala, use of the product reduced the incidence of diarrhea among intervention households by 24%, or 29% when the treated water was stored in a vessel designed specifically for safe storage (5). In 2003, considerable progress was made in evaluating the impact of household-based filtration. In a large field trial, Rita Colwell and colleagues showed that simple filters made from sari cloth or nylon, combined with appropriate education, reduced cholera by 48% compared to controls (9). Locally produced slow sand and ceramic filters were evaluated by Massachusetts Institute of Technology postgraduate students (10–12). In a trial in Bolivia, locally fabricated filters that used imported ceramic candles eliminated all detectable fecal coliform bacteria in household drinking water and reduced levels of diarrhea by 64% (13). In 2004, a systematic review of 57 studies assessed the extent and causes of microbiological contamination of household drinking water between the source and the consumer (14). The reviewers concluded that water quality declines substantially after collection and recommended household treatment and safe storage of water. A systematic review of the health impact of improved water quality is under way, driven in part by the burgeoning evidence indicating that substantial health gains result when water is treated in households and protected against recontamination (15,16). In Nairobi, network members will review recent progress and plan their next steps for advancing household-based water management. Stakeholders from all organizations are urged to participate in, contribute to, and take full advantage of, this important new movement in the battle against waterborne disease. For more information on the network and to register for the Nairobi meeting, readers are referred to: http://www.cdc.gov/safewater/network.htm

This study assesses the effect of drinking water quality on diarrheal disease in good and poor sanitary conditions using a random sample of 2,355 Filipino infants over the first year of life. The study provides powerful confirmation of the importance of environmental factors on diarrhea: The effects of water quality, household sanitation, and community sanitation are strong, consistent, and statistically significant. The positive impact of improved water quality is greatest for families living under good sanitary conditions, with the effect statistically significant when sanitation is measured at the community level but not significant when sanitation is measured at the household level. Improving drinking water quality would have no effect in neighborhoods with very poor environmental sanitation; however, in areas with better community sanitation, reducing the concentration of fecal coliforms by two orders of magnitude would lead to a 40 percent reduction in diarrhea. Providing private excreta disposal would be expected to reduce diarrhea by 42 percent, while eliminating excreta around the house would lead to a 30 percent reduction in diarrhea. The findings suggest that improvements in both water supply and sanitation are necessary if infant health in developing countries is to be improved. They also imply that it is not epidemiologic but behavioral, institutional, and economic factors that should correctly determine the priority of interventions.

Water Supply, Sanitation, and Hygiene

Governments in developing countries face financial constraints to ensure supply of clean drinking water. They may benefit from increasing water charges for those who are be willing to pay little extra in lieu of their demand for improvement in water quality and service. To check the plausibility of this proposal, we investigated drinking water supply and quality, and well- off consumers demand for improved service delivery in Shah-Rukun-e-alam and Mumtazabad towns in Multan city of Pakistan. Qualitative data obtained through a questionnaire survey was analyzed using descriptive and regression techniques. Qualitative information obtained through semi structured interviews was helpful in designing survey questionnaire and to elaborate quantitative results. Results reveal that the respondents accord high importance to the provision of safe drinking water than to other daily household needs. The demand for improvement in water supply parameters exceeds the demand for improvements in water quality parameters, with the reliable supply being the most demanded improvement. Majority realize the government’s budget constraints in improving service delivery. Most respondents would pay PKR 100 in addition to what they are paying now. Their willingness to pay (WTP) this amount correlates with their awareness on water and health nexus, and depends household income, number of children under 14 years age and awareness of actual water quality tested through laboratory. Besides recommending raise of water charges by PKR 100 per month per household in both towns, the service quality improvement may consider interventions such as mobile water testing laboratory and awareness campaigns motivate citizens to pay for safe drinking water.

Governments in developing countries face financial constraints to ensure supply of clean drinking water. They may benefit from increasing water charges for those who are be willing to pay little extra in lieu of their demand for improvement in water quality and service. To check the plausibility of this proposal, we investigated drinking water supply and quality, and welloff consumers demand for improved service delivery in Shah-Rukun-e-alam and Mumtazabad towns in Multan city of Pakistan. Qualitative data obtained through a questionnaire survey was analyzed using descriptive and regression techniques. Qualitative information obtained through semi structured interviews was helpful in designing survey questionnaire and to elaborate quantitative results. Results reveal that the respondents accord high importance to the provision of safe drinking water than to other daily household needs. The demand for improvement in water supply parameters exceeds the demand for improvements in water quality parameters, with the reliable supply being the most demanded improvement. Majority realize the government’s budget constraints in improving service delivery. Most respondents would pay PKR 100 in addition to what they are paying now. Their willingness to pay (WTP) this amount correlates with their awareness on water and health nexus, and depends household income, number of children under 14 years age and awareness of actual water quality tested through laboratory. Besides recommending raise of water charges by PKR 100 per month per household in both towns, the service quality improvement may consider interventions such as mobile water testing laboratory and awareness campaigns motivate citizens to pay for safe drinking water.

Waterborne disease outbreaks caused by various pathogens have been reported from all over the world. They also play an important role in industrialized countries, despite good sanitation and high standards of hygiene. In Switzerland, waterborne disease outbreaks are uncommon but faecal contamination of springs occurs quite frequently in some areas. As a consequence, microbiological quality of drinking water is not constantly sufficient and there is potential for improvement. Based on the hygiene ordinance, cantonal authorities contribute with control actions to the supply of safe water to consumers. Microbiological quality assessment based on current drinking water guidelines do not discriminate between human and animal sources of contamination. However, methods for discriminating between human and animal faecal contamination are needed to identify sources of contamination and to provide specific scientific data as a basis for risk management measures and for the implementation of remedial interventions. The main goal of this thesis was to establish approaches for the identification of human and animal faecal contamination in surface and drinking water and to develop concepts for future investigations. A number of methods can be used to help identify sources of faecal contamination in water. The general concept is referred to as microbial source tracking (MST). Different methodologies for MST were previously used mainly for analysis of faecal samples and recreational waters such as streams, lakes and beaches. Prior to this study, MST was not applied in Switzerland. In the present thesis, source tracking approaches never before used in MST as well as methods previously described in scientific literature were tested for their potential to indicate human or animal faecal contamination in Switzerland. Two bacterial strains (Bacteroides thetaiotaomicron ARABA 84 and B. fragilis ARABA 19) specific for bacteriophages present in human faecal contamination and three strains (B. caccae RBA 63 and RBA 64 as well as B. fragilis KBA 60) specific for bacteriophages indicating animal faecal contamination were isolated from human wastewater and animal faecal specimens. Thereafter they were used to determine the source of surface and spring water faecal contamination. In addition, the potential of Streptococcus agalactiae was tested as a new human MST indicator. Different methods of detecting these bacteria in domestic and slaughterhouse wastewater were compared. Three DNA extraction methods and five polymerase chain reaction (PCR) assays were tested to identify the most suitable combination. The most sensitive detection method, a LightCycler real-time PCR assay, detected S. agalactiae in human wastewater but not in animal samples and showed that this bacteria is potentially useful as human MST indicator. Rhodococcus coprophilus was previously used in MST to indicate animal faecal contamination in water. For the detection of this organism, a culture-dependent method and a conventional as well as a TaqMan real-time PCR assay were previously published. The evaluation of these existing approaches, however, did not reveal any satisfactory result. A novel LightCycler real-time PCR assay was therefore designed and validated in the course of the present thesis. Compared with previously used assays, this new molecular approach showed advantages such as improved sensitivity and specificity and was much faster than the culture-based method. Sorbitol-fermenting bifidobacteria and phages infecting the Bacteroides host strains GA-17 and GB-124 were previously described to indicate human faecal contamination. Together with the newly developed and validated approaches, these established MST indicators were included in a comparative study and their potential to indicate human or animal faecal contamination in Swiss surface and spring water was tested. Based upon this assessment, sorbitol-fermenting bifidobacteria and phages of the human host strains B. thetaiotaomicron ARABA 84 and B. ovatus GB-124 can be recommended for detecting human faecal contamination in Swiss surface and drinking water. The above-mentioned approaches give evidence of the faecal input sites of contamination. To localize possible faecal input sites, they can be followed by an additional approach described in this thesis. This approach is based on the screening of multiresistant Escherichia coli and on the characterisation of selected isolates by antibiotic resistance profiles and pulsed field gel electrophoresis in order to identify identical strains. Thereby, a well equipped toolbox could be provided not only to discriminate sources of faecal contamination but also to localize possible faecal input sites.

Background and Aims: Evaluation of the microbial quality of drinking water can help to prevent the diseases in different times and regions that transmitted through water. So the aim of this study is the survey of microbial quality of drinking water and cross-sectional outbreaks of its related diseases in Kangavar city. Materials and Methods: To accomplish this study, first the results of the microbial quality of drinking water in Kangavar city and cases of diseases from all rural and urban health centers within five years (2005-2009) were received. For determination of the relationship between disease and microbial quality of water, the Pearson correlation coefficient (Correlation instructions) in each studied variable (season and location of samples) was used. Results: Results showed that prevalence of all considered diseases (except hepatitis A) in terms of area (urban or rural) and seasons had significant relationship with microbial contamination of drinking water (P value < 0.05). This relationship was stronger in rural areas than urban areas (except for simple diarrhea) and warm seasons compared to cold seasons. Conclusion: According to significant relationship between microbial quality of drinking water and prevalence of dysentery and typhoid diseases in different areas and seasons, it is necessary to keep up the quality of drinking water in the high susceptible regions and times (rural areas and warm seasons). Key words: Microbial quality, Cross-sectional outbreak, Water borne diseases, Kangavar *Corresponding Author: Instrctor of Environmental Health Eng., Kermanshah University of Medical Sciences, Kermanshah, Iran. Tel: +98 8314311007 Email: Kio.sharafi@gmail.com Received: 27 Jun. 2013 Accepted: 17 Sep. 2013

The Third World Water Forum takes place in Kyoto, Japan, this month. It will be the first major meeting of the sector since the Johannesburg Summit on Sustainable Development, which endorsed the Millennium Development Goal of halving the number of people without access to improved water supply (estimated at 1.1 billion in 2000) and adopted the further goal of halving the 2.4 billion without sanitation. It is to be hoped that the Kyoto meeting will lay to rest three important and harmful misconceptions which have beset the water supply and sanitation sector in recent years. The first two of these are helpfully debunked in a book prepared for the Kyoto meeting (Satterthwaite & McGranahan 2003). Misconception number one is the perception that water supply is largely constrained by water resource limitations. A number of authors have dwelt on the imbalance between available supplies of fresh water and the population’s growing requirements. It has been estimated that by 2025 the share of the world’s population living in regions subject to water stress will reach 35% (Hinrichsen et al. 1998). Some have described the issue in more dramatic terms: