Rural Groundwater Research Articles

Antifungal resistance profile and genetic relatedness of moulds from rural groundwater sources

Antifungal resistance remains a significant public health threat, yet poorly investigated. This study for the first time investigated the antifungal profile of moulds isolated from groundwaters in a rural community of Osun State, Southwest Nigeria. Groundwater samples were collected during dry and rainy seasons, and processed for mould isolation using standard methods. The isolates were presumptively identified and screened for in vitro susceptibility using 4 antifungals conventionally employed in clinical cases. Multiple antifungal resistance phenotypes and indices were equally evaluated. Representative of each putatively identified species were confirmed using molecular techniques. A total of 29 and 27 moulds were obtained during the dry and rainy seasons, respectively. Genus Aspergillus was the most prevalent (30.4%). Of the 56 isolates subjected to antifungal susceptibility testing, 55(98%) were resistant to fluconazole, followed by flucytosine 49(88%), ketoconazole 45(80%) and amphotericin B 31(55%). Exactly 46 isolates were multidrug-resistant, 23(50%) each, to 3 and 4 drugs, respectively. The multiple antifungal resistance index (MARI) evaluated was 1 in all the samples A-Q, except C (0.75), transcending the threshold limit of 0.2, indicating the isolates to be of high antifungal usage origin. The molecularly identified species had 99–100% similarity with reference strains from GenBank and evolutionary relationship of taxa revealed 10 distinct clades. The outcome of this study reveals a rise in the frequency of antifungal resistance in moulds towards standard drugs, thus, advocating for adequate investigations targeted at monitoring antifungal resistance in groundwater milieus.

Geographical analysis of fluoride and nitrate and its probabilistic health risk assessment utilizing Monte Carlo simulation and GIS in potable water in rural areas of Mathura region, Uttar Pradesh, northern India

Human health is being increasingly exposed to fluoride and nitrate ingestion globally due to anthropogenic alternations in groundwater resources. In the present research work, a hazard quotient (HQ), Monte Carlo simulation (MCS), and geographic information systems (GIS) have been used to estimate the non-carcinogenic health risk of nitrate and fluoride in vulnerable adults, teenagers, and children living in far-flung areas of Uttar Pradesh, Northern India. About 110 samples from some nearby populations were collected and analyzed for nitrates by ion chromatography and fluoride by a fluoride-selective electrode. The results indicated that the concentrations of fluoride and nitrate in the sampling areas ranged from 0.21 to 1.71 mg/L and 0.4–183.54 mg/L, respectively, with mean concentrations of about 1.20 mg/L and 51.52 mg/L for fluoride and nitrate, respectively. The results indicated that 27.27 % of the fluoride samples (27 out of 110) and 45.45 % of the nitrate samples (44 out of 110) were above the standard limits set by WHO. The calculated average HQ values fluoride and Nitrate for children, teenagers and adults were 1.88, 0.98, 0.90 and 3.02, 1.57, 1.45 respectively The 95th percentile HQ values for fluoride were 2.87 for children and 1.03 for adults, while those for nitrate were 4.10 for children and 1.98 for adults. Results of the health risk assessment show that there is a high potential for both non-carcinogenic and cancer risks from fluoride and nitrate through the consumption of groundwater. The Monte Carlo simulation showed the uncertainties and increased risks for children; therefore, one can infer that rural groundwater of the Mathura region, Uttar Pradesh, India, must be treated to make it potable for consumption.

Quantitative microbial risk assessment for ingestion of antibiotic resistance genes from private wells contaminated by human and livestock fecal sources.

We used quantitative microbial risk assessment to estimate ingestion risk for intI1, erm(B), sul1, tet(A), tet(W), and tet(X) in private wells contaminated by human and/or livestock feces. Genes were quantified with five human-specific and six bovine-specific microbial source-tracking (MST) markers in 138 well-water samples from a rural Wisconsin county. Daily ingestion risk (probability of swallowing ≥1 gene) was based on daily water consumption and a Poisson exposure model. Calculations were stratified by MST source and soil depth over the aquifer where wells were drilled. Relative ingestion risk was estimated using wells with no MST detections and >6.1 m soil depth as a referent category. Daily ingestion risk varied from 0 to 8.8 × 10-1 by gene and fecal source (i.e., human or bovine). The estimated number of residents ingesting target genes from private wells varied from 910 (tet(A)) to 1,500 (intI1 and tet(X)) per day out of 12,000 total. Relative risk of tet(A) ingestion was significantly higher in wells with MST markers detected, including wells with ≤6.1 m soil depth contaminated by bovine markers (2.2 [90% CI: 1.1-4.7]), wells with >6.1 m soil depth contaminated by bovine markers (1.8 [1.002-3.9]), and wells with ≤6.1 m soil depth contaminated by bovine and human markers simultaneously (3.1 [1.7-6.5]). Antibiotic resistance genes (ARGs) were not necessarily present in viable microorganisms, and ingestion is not directly associated with infection. However, results illustrate relative contributions of human and livestock fecal sources to ARG exposure and highlight rural groundwater as a significant point of exposure.IMPORTANCEAntibiotic resistance is a global public health challenge with well-known environmental dimensions, but quantitative analyses of the roles played by various natural environments in transmission of antibiotic resistance are lacking, particularly for drinking water. This study assesses risk of ingestion for several antibiotic resistance genes (ARGs) and the class 1 integron gene (intI1) in drinking water from private wells in a rural area of northeast Wisconsin, United States. Results allow comparison of drinking water as an exposure route for antibiotic resistance relative to other routes like food and recreational water. They also enable a comparison of the importance of human versus livestock fecal sources in the study area. Our study demonstrates the previously unrecognized importance of untreated rural drinking water as an exposure route for antibiotic resistance and identifies bovine fecal material as an important exposure factor in the study setting.

Occurrence characteristics and influencing factors of antibiotic resistance genes in rural groundwater in Henan Province.

This study determined the antibiotic-resistant gene (ARG) contents of 34 groundwater samples in Henan Province collected from September to October 2022, then assessed the roles of both water quality parameters and intI1 in ARG propagation in groundwater. The results show that there existed universal ARG pollution in groundwater, and sulfonamides-, β-lactem-, and tetracycline-resistance genes were the most prevalent gene types during the time. Sul1 contributed the majority proportion of the total resistance genes (TARGs). The prevalence of ESBLs gene blaTEM and the occurrence of Carbapenems resistant gene blaOXA-1 suggests the pollution of high-risk ARGs in groundwater demands more attention. IntI1 is prevalent and had a significantly positive correlation with almost 50% ARGs, indicating its contribution to ARG propagation in groundwater. Well types contribute little to ARG propagation in rural groundwater of Henan, which means the protective facilities established by the local government for public wells can effectively prevent contamination from exogenous ARGs. However, the economic level has no impact on the abundance of ARGs in rural groundwater, which suggests the local government should pay greater attention to investment in controlling ARG pollution in Henan rural areas.

An assessment tool to improve rural groundwater access: Integrating hydrogeological modelling with socio-technical factors

Sustainable exploitation of groundwater resources for drinking water provision in rural communities in sub-Sahara Africa remains elusive due to the limited knowledge of these hydrogeological systems. This is exacerbated by poor maintenance of existing infrastructure, limited technical capacity, the socio-economic characteristics of the area and poor governance. Assessing the likelihood of a given individual user experiencing water shortage calls for an interdisciplinary approach. After a preliminary multifactorial analysis incorporating a range of variables from technical to societal, it was found that most of the overall risk of water shortage for an individual household could be attributed to three factors; (1) Proximity, specified as the distance to the closest supply well (determined by geographical parameters), (2) Availability of good quality water in the wells (determined by hydrogeological understanding and modelling), and (3) Sustainability (determined by socio-technical and socio-economic parameters). In the latter case, a distinction was made between hardware functionality- the water point's performance considering a sufficient yield and reliability through time- and software functionality, based on a combination of socioeconomic data from surveys and analysed using Multiple Factor Analysis (MFA). All three factors are eventually mapped onto indicators in the range of [0–1] and then represented in a Geographical Information System based on the partition of the entire spatial domain (e.g., counties, villages, and neighbourhoods). The three indicators are then combined in a final index based on the product of the three factors, thus mapping time-dependent overall risk and allowing the assessment of temporal risk-evolution scenarios. The methodology is applied to Kwale County, Kenya, where community handpumps and groundwater points comprise the main water supply system. Apart from mapping the present situation, the methodology is finally used to assess the impact of future climate scenarios.

Efficient purification of high-salt rural groundwater in the areas along the Yellow River in Henan Province, China, by hollow fiber membrane distillation process

The vast rural drinking water sources along the Yellow River basin in Henan Province mainly come from the local high-salinity groundwater, which cannot be directly drunk. Zeolitic imidazolate framework-71/polyvinylidene fluoride hollow fiber composite membrane was applied to treat rural groundwater through membrane distillation technology. The variations of water quality parameters from 12 different rural regions after membrane distillation treatment were well analyzed and compared. Membrane separation performance for water samples from different regions during the membrane distillation process was investigated, including water flux and salt rejection. During a continuous 24-h membrane distillation process for the treatment of these water samples, hollow fiber membrane exhibits high solute retention rates (>99%) for salt ions, suspended solids and total dissolved solids, which are within the limits of national standards (GB 5749-2006), meanwhile membrane permeation water flux can remain stable. After the acid-cleaning for 180 min, all hollow fiber membranes can recover water flux well with a flux recovery rate above 98%. Even if the concentration ratio continued to increase, the water production rate of membrane distillation was basically maintained between 50% and 60%, which was obviously higher than the 30% of the reverse osmosis process. The economic analysis confirmed that the water production cost varied between US$0.45 and US$0.29/m3. With the extension of membrane service life, the specific membrane cost decreased rapidly in the first 6 years and then leveled off. The proposed vacuum membrane distillation process proved to be a promising water purification method for treating rural high-salinity groundwater.

Effects of 66 years of water management and hydroclimatic change on the urban hydrology and water quality of the Panke catchment, Berlin, Germany

Long-term records of combined stream flow and water chemistry can be an invaluable source of information on changes in the quantity and quality of water resources. To understand the effect of hydroclimate and water management on the heavily urbanized Panke catchment in Berlin, Germany, an extensive search, collation and digitization of historic data from various sources was undertaken. This integrated a unique 66-year spatially distributed record of stream water quality, a 21-year record of groundwater quality and a 31-year stream flow record. These data were analysed in the context of hydroclimatic variability, as well as the history and technological evolution of water resource management in the catchment. To contextualize the effect of droughts, “average” and wet years the Standard Precipitation Index (SPI) was applied. As upstream sites have been less regulated by human impacts, the flow regime is most sensitive to changes in hydroclimatic conditions, while downstream sites are more influenced by wastewater effluents, urban storm drains and inter-basin transfers for flood alleviation. However, at all sites, a general increase in maximum event discharge was observed until a recent drought, starting in 2018. In general, water quality in the catchment has gradually improved as a result of management change and increasingly effective wastewater treatment, though in some places legacy and/or contemporary urban and rural groundwater contamination may be affecting the stream. Hydroclimatic changes, particularly drought years can affect water quality classes, and alter the chemostatic/dynamic behaviour of catchment export patterns. These insights from the Panke catchment underline the importance of strategic adaptation and improvement of water treatment and water resource management in order to enhance the quality of urban water courses. It also demonstrates the importance of long-term integrated data sets.

Assessing antimicrobial and metal resistance genes in Escherichia coli from domestic groundwater supplies in rural Ireland

Natural ecosystems can become significant reservoirs and/or pathways for antimicrobial resistance (AMR) dissemination, with the potential to affect nearby microbiological, animal, and ultimately human communities. This is further accentuated in environments that provide direct human exposure, such as drinking water. To date, however, few studies have investigated AMR dissemination potential and the presence of co-selective stressors (e.g., metals/metalloids) in groundwater environments of human health significance. Accordingly, the present study analysed samples from rural (drinking) groundwater supplies (i.e., private wells) in the Republic of Ireland, where land use is dominated by livestock grazing activities. In total, 48 Escherichia coli isolates tested phenotypically for antimicrobial susceptibility in an earlier study were further subject to whole genome sequencing (WGS) and corresponding water samples were further analysed for trace metal/metalloid concentrations. Eight isolates (i.e., 16.7%) were genotypically resistant to antimicrobials, confirming prior phenotypic results through the identification of ten antimicrobial resistance genes (ARGs); namely: aph(3″)-lb (strA; n=7), aph(6)-Id (strA; n = 6), blaTEM (n = 6), sul2 (n = 6), tetA (n = 4), floR (n = 2), dfrA5 (n = 1), tetB (n = 1), and tetY (n = 1). Additional bioinformatic analysis revealed that all ARGs were plasmid-borne, except for two of the six sul2 genes, and that 31.2% of all tested isolates (n = 15) and 37.5% of resistant ones (n = 3) carried virulence genes. Study results also found no significant relationships between metal concentrations and ARG abundance. Additionally, just one genetic linkage was identified between ARGs and a metal resistance gene (MRG), namely merA, a mercury-resistant gene found on the same plasmid as blaTEM, dfrA5, strA, strB, and sul2 in the only isolate of inferred porcine (as opposed to bovine) origin. Overall, findings suggest that ARG (and MRG) acquisition may be occurring prior to groundwater ingress, and are likely a legacy issue arising from agricultural practices.

Voluntary metering of rural groundwater extractions: understanding and resolving the challenges

Understanding the rate of extraction from bores (or wells) can be essential in estimating groundwater discharge at a regional scale and understanding pressures on sustainable use. The challenges in doing so include the impracticality of directly measuring extractions from all, or even a large proportion of, operating bores using flow meters, especially in rural and remote areas. This challenge may be addressed by metering a representative sample of bores and generalising results to develop estimation methods; however, even achieving this presents considerable obstacles. While the benefits of metering a subset of bores to progress groundwater science and management are recognised, the obstacles to implementing metering and guidance on overcoming them are not well documented. In the Surat Basin, Australia, most groundwater bores are used for stock watering and domestic purposes, with less than 0.1% metered. As part of a research program to understand regional groundwater extraction in this area, a voluntary bore metering program has been undertaken. In this paper the challenges that arose when recruiting participants, installing and maintaining flow metering equipment, and interpreting and using data collected are described. Lessons learnt during implementation of the program that can guide other voluntary metering of rural groundwater extractions are discussed.

Retraction Note to: Characteristics of heavy metal pollutants in groundwater based on fuzzy decision making and the effect of aerobic exercise on teenagers

Due to its abundant reserves and pure water quality, groundwater is an important water resource on the earth, which is widely distributed and easy to use, so it is widely used in industrial production, agricultural production, and domestic drinking. Most urban and rural areas in China use groundwater as drinking water source, and the quality of groundwater is closely related to the life of residents. Indiscriminate use of agricultural fertilizers, wanton discharge of industrial wastewater, and untreated wastewater will cause heavy metal pollution in groundwater. Groundwater is polluted by characteristic pollutants, which makes it difficult to deal with, and the deeper the water layer is, the lower the self-purification capacity will be, threatening the health of residents. In this paper, the groundwater samples of 58 towns in l area were collected as the investigation area, and the contents of fluorine ion and 16 kinds of metals and nonmetals were analyzed and discussed by ICP-MS and other equipment, as well as the characteristics of rural groundwater pollution in dry period. At the same time, the index model fuzzy decision making and single factor of health risk assessment model were used to evaluate the carcinogenic and non-carcinogenic risk. Obesity among Chinese adolescents is also a very worrying problem. The current literature supports many weight loss methods. Exercise weight loss can not only reduce fat, but also improve physical strength. In the long run, it can make us gain synergy. In life, people are aware of the impact of aerobic exercise on weight loss, so they rarely use high-intensity temporary strength for training. According to the research of fuzzy decision making, it is applied to groundwater and aerobic movement, so that it can be effectively improved.

RETRACTED ARTICLE: Characteristics of heavy metal pollutants in groundwater based on fuzzy decision making and the effect of aerobic exercise on teenagers

Due to its abundant reserves and pure water quality, groundwater is an important water resource on the earth, which is widely distributed and easy to use, so it is widely used in industrial production, agricultural production, and domestic drinking. Most urban and rural areas in China use groundwater as drinking water source, and the quality of groundwater is closely related to the life of residents. Indiscriminate use of agricultural fertilizers, wanton discharge of industrial wastewater, and untreated wastewater will cause heavy metal pollution in groundwater. Groundwater is polluted by characteristic pollutants, which makes it difficult to deal with, and the deeper the water layer is, the lower the self-purification capacity will be, threatening the health of residents. In this paper, the groundwater samples of 58 towns in l area were collected as the investigation area, and the contents of fluorine ion and 16 kinds of metals and nonmetals were analyzed and discussed by ICP-MS and other equipment, as well as the characteristics of rural groundwater pollution in dry period. At the same time, the index model fuzzy decision making and single factor of health risk assessment model were used to evaluate the carcinogenic and non-carcinogenic risk. Obesity among Chinese adolescents is also a very worrying problem. The current literature supports many weight loss methods. Exercise weight loss can not only reduce fat, but also improve physical strength. In the long run, it can make us gain synergy. In life, people are aware of the impact of aerobic exercise on weight loss, so they rarely use high-intensity temporary strength for training. According to the research of fuzzy decision making, it is applied to groundwater and aerobic movement, so that it can be effectively improved.

Application of HMTL and novel IWQI models in rural groundwater quality assessment: a case study in Nigeria

Heavy metal toxicity load (HMTL) and novel integrated-weight water quality index (IWQI) were utilized in groundwater quality assessment of the Lower Cretaceous Abakaliki aquifer in Ameka area, Nigeria. Physicochemical analyses followed standard methods. Analysis of the water elemental composition showed high toxicity of elements. Hierarchical clusters showed the spatiotemporal demarcations of groundwater quality. IWQI result indicated that all the analyzed groundwater samples are unsuitable for drinking. Similarly, the HMTL revealed that all the samples are highly laden with toxic elements (As-Pb-Cd-Ni-Co-Cu-Mn-Zn) and further indicated that removing these elements from groundwater would reduce pollution by 97%, 92%, 60%, 89%, 98%, 50%, 98% and 94%, respectively.

WITHDRAWN: Health risk assessment on heavy metal pollutants of groundwater on human safety in rural areas.

Ahead of Print article withdrawn by publisher.

Supporting Sustainable Rural Groundwater Demand Management with Fuzzy Decision Analysis: A Case Study in Iran

Insufficient clean freshwater has become a growing concern for sustainable development in countries with arid and semi-arid regions. Co-production of knowledge through active communication of experts, government, and local stakeholders can serve as a strategy to cope with water scarcity. Water consumption behavior is a key component of water resource management. This study aims to understand water consumption factors and behavior in a rural area with arid conditions. The study is a mixed-method one conducted through fuzzy decision analysis (i.e., selecting criteria with Fuzzy Delphi and rating them with Fuzzy Analytic Network Process). An empirical case study was conducted on the Akramieh rural area located in Yazd Province, Iran. The results indicate that a change in consumers' culture can have a significant effect in reducing water consumption. Recommendations have been made to encourage the adaptation of farming families to water scarcity. Through public schools and mosques, people can become aware of the conditions and consequences of drought as a crisis, and alternative methods of irrigation can be taught to farmers.

The material foundations of a low-carbon economy

The material foundations of a low-carbon economy

Drinking water quality from rural handpump-boreholes in Africa

Groundwater provides a vital source of drinking water for rural communities in many parts of Africa, particularly in the dry season when there are few safe alternative sources. This paper summarises results from a study (n = 428) assessing dry season water quality, both microbiological and inorganic chemistry, in handpump equipped boreholes (HPBs) across the Ethiopia Highlands (n = 142), Malawi (n = 162) and Uganda (n = 124) using a stratified, randomised sampling design. This study seeks to examine general water quality by randomly sampling rural groundwater supplies across larger areas with different geology and climate. The majority, 72%, of HPBs surveyed provide good quality dry season drinking water as defined by WHO drinking water quality criteria. Within this overall picture, the most notable constraints were from thermotolerant coliforms (TTCs), which exceeded the WHO drinking water guideline of zero colony forming units (cfu/100 ml) in 21% of sites (range 0–626 cfu/100 ml). TTC contamination was found to have a significant and positive correlation with annual average rainfall (ρ = 0.2, p = 0.00003). Across all three countries, WHO health based chemical drinking water quality values were exceeded at 9% of sites and were found for manganese (4%), fluoride (2.6%) and nitrate (2.5%); arsenic concentrations were below the guideline value of 10 μg l−1 (range < 0.5–7 μg l−1). The high percentage of Mn exceedances (14% ± 5.2% >400 μg l−1) found in drinking water sources in Uganda challenges the decision by WHO not to formalise a health-based guideline for Mn. While the overall level of microbiological contamination from HPBs is low, results from this study strongly suggest that at a national and regional level, microbiological contamination rather than chemical contamination will provide a greater barrier to achieving targets set for improved drinking water quality under the UN-SDG 6. Efforts should be made to ensure that boreholes are properly sited and constructed effectively to reduce pathogen contamination.

Process Design For Removal of Heavy Metals By A Bio-sorbent Trickle Bed System: A Proof of Concept

Most heavy metals are well-known toxic and carcinogenic agents and when discharged into the wastewater represent a serious threat to the human population and the fauna and flora of the receiving water bodies. The development of a novel biofilter was aimed in this project. The various parameters of the biofiltration processes, their mechanism for heavy metals removal along with the efficiency of the biofilters and its scale up aspects have been studied. The work was targeted towards removal of Iron (Fe) and Chromium (Cr), two very common contaminant in urban as well as rural ground water. These are also found in industrial spent waters. The efficiency of the biofiltration process for heavy metals removal have been critically analysed. In a proof-of-concept study, a laboratory-scale closed biofilter system employing the trickle bed process was operated to remove Iron (Fe) and Chromium (Cr) from a synthetic waste water sample at a load of 1000mg/L of the heavy metal. Gravel, citrus peels and spent tea leaves after proper pre-treatment was used as filter media. Depth profile analysis of the filter bed showed the reduction of a steep gradient of Iron and Chromium from the top layer to the bottom layer of filter media in the biofilter. Iron and Chromium level at the bottom of the biofilter decreased over 85% over a period of 6-8 hours of experiment. With these observations we have scaled up the process from a 0.050 L to 15.0 L operating volume. The results were consistent.

The analysis of groundwater nitrate pollution and health risk assessment in rural areas of Yantai, China

BackgroundNitrate is one of the most common chemical contaminants of groundwater, and it is an important unqualified factor of rural groundwater in Yantai. In order to assess the risk of exposure to drinking water nitrate for adults and juveniles, in recent years, we monitored the nitrate concentrations in rural drinking water,a model was also used to assess the human health risk of nitrate pollution in groundwater.MethodsFrom the year 2015 to 2018, the drinking water in rural areas of Yantai was tested according to the “Sanitary Standard for Drinking Water” (GB5749–2006). The principal component analysis was used to analyze the relationship between groundwater chemicals and nitrate. The model was used to assess human health risks of groundwater nitrate through the drinking water and skin contact.ResultsA total of 2348 samples were tested during the year 2015–2018.Nitrate and total dissolved solids, total hardness, chloride are all relevant, the above indicators may come from the same source of pollution; The median nitrate content (CEXP50) was 17.8 mg / L; the risk of exposure in each group was ranked as: Juveniles > Adult female > Adult male;the median health risk (HQ50) for minors and adults exceed 1.ConclusionsThe concentrations of nitrate is stable and does not change over time. The high concentration of nitrate in rural areas of Yantai may be the result of the interaction of fertilizers and geological factors. The risk of exposure to nitrate in juveniles and adults is above the limit, so it is necessary to be on the alert for the high levels of nitrate.

Chronic kidney disease and household behaviors in Sri Lanka: Historical choices of drinking water and agrochemical use

This paper examines whether there are systematic differences in the historical behaviors of households that are affected and unaffected by chronic kidney disease (CKD) in Sri Lanka pertaining to their water source choices, water treatment practices, and agrochemical use. This analysis is motivated by the Sri Lankan government’s largest policy response to this epidemic – to encourage communities to switch from untreated well water to publicly provided alternatives. We use recall methods to elicit information on the drinking water source and treatment choices of households over an 18-year period from 2000–2017. Our analysis is based on a survey of 1497 rural ground-water dependent households in the most CKD-affected areas of the 10 districts of Sri Lanka with the highest prevalence of CKD. Our main findings are that (a) households that have ever used a pump to extract (typically deep) drinking water from a household well are more likely to be affected by CKD; (b) we fail to find a relationship between disease status and households’ use of buckets to extract (typically shallow) groundwater from their wells; and (c) those who have ever treated their shallow well water by boiling it are less likely to be affected by CKD. We also find that a greater share of CKD affected households historically used agrochemicals, used wells that were geographically removed from surface water sources, and displayed lower proxies of wealth. The implications of these findings are fourfold. First, since the systematic differences in the historical patterns of water sources and treatments used by CKD affected and non-affected households are modest, the sources of water and the treatment practices themselves may not be the sole risk factors in developing CKD. Second, although we find a negative association between boiling water and the probability of CKD, it is not obvious that a public policy campaign to promote boiling water is an appropriate response. Third, the hydrochemistry of deep and shallow well water needs to be better understood in order to shed light on the positive relationship between deep well water and disease status, and on why boiling shallow but not deep well water is associated with a lower probability of CKD. Fourth, there is a need for a deeper understanding of other risk factors and of the efficacy of preventative programs that provide alternative sources of household drinking water.

Evidence, ideology, and the policy of community management in Africa

This study examines the performance of the policy of community management for rural groundwater supply in Africa. Across the continent, policies that promote community management have dominated the rural water supply sector for decades. As a result, hundreds of thousands of village-level committees have been formed to manage community boreholes equipped with handpumps. With a significant proportion of these handpumps non-functional at any one time, increasing effort is targeted toward understanding the interacting social and physical determinants of this ‘hidden crisis’. We conducted a survey of community management arrangements across six hundred sites in rural Ethiopia, Malawi, and Uganda, examining the extent to which management capacity is related to borehole functionality whilst accounting for a range of contextual variables. The capacity of water management arrangements (WMAs) was assessed according to four dimensions: finance system; affordable maintenance and repair; decision making, rules, and leadership; and external support. The survey reveals that 73.3% of WMAs have medium or high capacity. However, we found no strong relationship between the capacity of the WMA and the functionality of the borehole. Of the four management dimensions, affordable maintenance and repair was the best predictor of borehole functionality. However, the capacity of this dimension was seen to be the lowest overall, with 61.9% of sites weak or non-existent. Our results provide very limited support for the policy of community management, and we suggest that evidence alone has not accounted for its persistence over decades. After a short historical analysis, we conclude that explanation for the endurance of this model can be found in the nexus between evidence, ideology, and policy. We argue that it is this same nexus that will likely ensure the popularity of community management for some time to come, despite new ideas and evidence to the contrary.