Association of Supply Type with Fecal Contamination of Source Water and Household Stored Drinking Water in Developing Countries: A Bivariate Meta-analysis

BackgroundAccess to safe drinking water is essential for health. Monitoring access to drinking water focuses on water supply type at the source, but there is limited evidence on whether quality differences at the source persist in water stored in the household.ObjectivesWe assessed the extent of fecal contamination at the source and in household stored water (HSW) and explored the relationship between contamination at each sampling point and water supply type.MethodsWe performed a bivariate random-effects meta-analysis of 45 studies, identified through a systematic review, that reported either the proportion of samples free of fecal indicator bacteria and/or individual sample bacteria counts for source and HSW, disaggregated by supply type.ResultsWater quality deteriorated substantially between source and stored water. The mean percentage of contaminated samples (noncompliance) at the source was 46% (95% CI: 33, 60%), whereas mean noncompliance in HSW was 75% (95% CI: 64, 84%). Water supply type was significantly associated with noncompliance at the source (p < 0.001) and in HSW (p = 0.03). Source water (OR = 0.2; 95% CI: 0.1, 0.5) and HSW (OR = 0.3; 95% CI: 0.2, 0.8) from piped supplies had significantly lower odds of contamination compared with non-piped water, potentially due to residual chlorine.ConclusionsPiped water is less likely to be contaminated compared with other water supply types at both the source and in HSW. A focus on upgrading water services to piped supplies may help improve safety, including for those drinking stored water.CitationShields KF, Bain RE, Cronk R, Wright JA, Bartram J. 2015. Association of supply type with fecal contamination of source water and household stored drinking water in developing countries: a bivariate meta-analysis. Environ Health Perspect 123:1222–1231; http://dx.doi.org/10.1289/ehp.140900

Household, neighbourhood and service provider risk factors for piped drinking-water intermittency in urban and peri-urban Zambia: a cross-sectional analysis

Given nearly one third of sub-Saharan Africa’s population lack access to an improved water source that is available when needed, service continuity restricts access to safely managed services. Household surveys, water regulators, and utilities all gather data on service continuity, but few studies have integrated these disparate datasets to quantify continuity-related risk factors and inequalities. This study aimed to assess the added value of utility and regulator data for international monitoring by assessing factors affecting piped water availability in urban and peri-urban Zambia. Household ‘user’ data from the 2018 Demographic and Health Survey (n = 3047) were spatially linked to provider data from an international utility database and regulator reports. Multilevel modelling quantified provider-related and socio-economic risk factors for households reporting water being unavailable for at least one day in the previous fortnight. 47% (95% CI: 45%, 49%) of urban and peri-urban households reported water being unavailable for at least one full day, ranging from 18% (95% CI: 14%, 23%) to 76% (95% CI: 70%, 81%) across providers. Controlling for provider, home ownership (odds ratio (OR) = 1.31;

Disposable diaper consumption in sub-Saharan Africa: Estimating the risks of associated unsafe waste

Disposable diaper use is widespread in many low- and middle-income countries whilst waste collection services are scarce. Despite the potential environmental and public health impacts of disposable diaper consumption by households lacking waste services, an international system for monitoring such consumption is lacking. This study therefore aims to develop and evaluate a method for estimating disposable diaper use based on secondary data, specifically nationally representative household expenditure surveys. Disposable diaper expenditure reported via household expenditure surveys for Nigeria (from 2018–19), Kenya (2015–16) and Ghana (2016–17) was used to estimate national disposable diaper consumption among households lacking waste collection services. To assess plausibility of reported expenditure, consumption-smoothing was examined, and Receiver Operating Curve analysis was used to infer mean toilet-training age. In Ghana, Kenya and Nigeria, households lacking appropriately managed waste services consumed an estimated 19 million, 210 million and 285 million disposable diapers per year (292 child/year, 433 child/year and 59 child/year among nappy-consuming households), respectively. Mean toilet-training ages were 24 to 30 months. Disposable diaper purchasing patterns showed evidence of consumption-smoothing among poorer households. Where commodity coding allows, household expenditure surveys can be used to construct internationally comparable indicators depicting disposable diaper consumption among households lacking waste services. Such indicators could be used to advocate for accelerated diaper product innovation, and target areas with high disposable diaper consumption but low waste service coverage

Association of Supply Type with Fecal Contamination of Source Water and Household Stored Drinking Water in Developing Countries: A Bivariate Meta-analysis

BACKGROUND: Access to safe drinking water is essential for health. Monitoring access to drinking water focuses on water supply type at the source, but there is limited evidence on whether quality differences at the source persist in water stored in the household. OBJECTIVES: We assessed the extent of fecal contamination at the source and in household stored water (HSW) and explored the relationship between contamination at each sampling point and water supply type. METHODS: We performed a bivariate random-effects meta-analysis of 45 studies, identified through a systematic review, that reported either the proportion of samples free of fecal indicator bacteria and/or individual sample bacteria counts for source and HSW, disaggregated by supply type. RESULTS: Water quality deteriorated substantially between source and stored water. The mean percentage of contaminated samples (noncompliance) at the source was 46% (95% CI: 33, 60%), whereas mean noncompliance in HSW was 75% (95% CI: 64, 84%). Water supply type was significantly associated with noncompliance at the source (p < 0.001) and in HSW (p = 0.03). Source water (OR = 0.2; 95% CI: 0.1, 0.5) and HSW (OR = 0.3; 95% CI: 0.2, 0.8) from piped supplies had significantly lower odds of contamination compared with non-piped water, potentially due to residual chlorine. CONCLUSIONS: Piped water is less likely to be contaminated compared with other water supply types at both the source and in HSW. A focus on upgrading water services to piped supplies may help improve safety, including for those drinking stored water. CITATION: Shields KF, Bain RE, Cronk R, Wright JA, Bartram J. 2015. Association of supply type with fecal contamination of source water and household stored drinking water in developing countries: a bivariate meta-analysis. Environ Health Perspect 123:1222–1231; http://dx.doi.org/10.1289/ehp.140900

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p&lt;0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons