Rethinking the Economics of Rural Water in Africa

Rural Africa lags behind global progress to provide safe drinking water to everyone. Decades of effort and billions of dollars of investment have yielded modest gains, with high but avoidable health and economic costs borne by over 300m people lacking basic water access. We explore why rural water is different for communities, schools, and healthcare facilities across characteristics of scale, institutions, demand, and finance. The findings conclude with policy recommendations to (i) network rural services at scale, (ii) unlock rural payments by creating value, and (iii) design and test performance-based funding models at national and regional scales, with an ambition to eliminate the need for future, sustainable development goals

Modelling Welfare Transitions to Prioritise Sustainable Development Interventions in Coastal Kenya

Welfare transitions are weakly understood in sub-Saharan Africa due to limited panel data to analyze trajectories of household escaping from, falling into, or remaining out of deprivation. We model data from 3500 households in coastal Kenya in three panels from 2014 to 2016 to evaluate determinants of welfare by multidimensional and subjective measures. Findings indicate that more than half of the households are deprived, with female-headed households being the most vulnerable and making the least progress. The subjective welfare measure identified three times more chronically poor households than the multidimensional metric (27% vs. 9%); in contrast, the multidimensional metric estimated twice as many ‘never poor’ households than the subjective measure (39% vs. 16%). The ‘churning poor’ were broadly consistent for both measures at roughly half the sample. Four welfare priorities converged from modelling welfare transitions. Broadening access to secondary education and energy services, improving the reliability and proximity of drinking water services, and ending open defecation improve welfare outcomes. While the policy implications do not align neatly with Kenya’s national and county government mandates, we argue that prioritising fewer but targeted sustainable development goals may improve accountability, feasibility, and responsibility in delivery if informed by local priorities and political salience

Groundwater and Welfare: A Conceptual Framework Applied to Coastal Kenya

The links between groundwater and welfare are highly contested, unclear and confounded by political, environmental and economic factors. The lack of understanding of these links has wider implication on policies and strategies aimed at accelerating the sustainable development goals of safely-managed drinking water services and eradicating poverty. This study provides empirical evidence of the existing links between groundwater and poverty using welfare metrics versus productive uses of water, groundwater table depth, drinking water services and groundwater dependency with data obtained from a household socio-economic survey (n = 3349), a water audit of water infrastructure (n = 570) and volumetric usage from water data transmitters (n = 300). Results show that the bottom welfare households are characterized by greater dependency on shallow groundwater, less acceptable drinking water services by taste, reliability, affordability or accessibility but not quantity. Productive use of groundwater for livestock accrues to the middle welfare quintiles with the bottom and top welfare quintiles by choice or exclusion having little engagement. Groundwater productive uses, services and characteristics explain at least 17% of the variation in a households' welfare with productive uses particularly benefiting female headed households. These findings suggest that ancillary investments to improve affordability and reliability of rural water services will be needed to enhance welfare of the poor who depend on groundwater systems. Further, such knowledge of the relationships between water and welfare can support the formulation of policies and strategies aimed at poverty reduction, inclusive growth and access to safe water for all

A Cultural Theory of Drinking Water Risks, Values and Institutional Change

Global progress towards the goal of universal, safely managed drinking water services will be shaped by the dynamic relationship between water risks, values and institutions. We apply Mary Douglas’ cultural theory to rural waterpoint management and discuss its operationalisation in pluralist arrangements through networking different management cultures at scale. The theory is tested in coastal Kenya, an area that typifies the challenges faced across Africa in providing rural communities with safely managed water. Drawing on findings from a longitudinal study of 3500 households, we examine how different management cultures face and manage operational, financial, institutional and environmental risks. This paper makes the case for cooperative solutions across systems where current policy effectively separates communities from the state or markets. The contribution of this research is both a theoretical and empirical case to consider pluralist institutional arrangements that enable risks and responsibilities to be re-conceptualised and re-allocated between the state, market and communities to create value for rural water users

Telemonitoring in patients with chronic heart failure and moderate depressed symptoms: results of the Telemedical Interventional Monitoring in Heart Failure (TIM‐HF) study

Aims: Depression is a frequent comorbidity in patients with chronic heart failure (CHF). Telemonitoring has emerged as a novel option in CHF care. However, patients with depression have been excluded in most telemedicine studies. This pre-specified subgroup analysis of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial investigates the effect of telemonitoring on depressive symptoms over a period of 12 months. Methods and results: The TIM-HF study randomly assigned 710 patients with CHF to either usual care (UC) or a telemedical intervention (TM) using non-invasive devices for daily monitoring electrocardiogram, blood pressure and body weight. Depression was evaluated by the 9-item Patient Health Questionnaire (PHQ-9) with scores ≥10 defining clinically relevant depressive symptoms. Mixed model repeated measures were performed to calculate changes in PHQ-9 score. Quality of life was measured by the Short Form-36. At baseline, 156 patients had a PHQ-9 score ≥10 points (TM: 79, UC: 77) with a mean of 13.2 points indicating moderate depressiveness. Patients randomized to telemedicine showed an improvement of their PHQ-9 scores, whereas UC patients remained constant (P = 0.004). Quality of life parameters were improved in the TM group compared to UC. Adjustment was performed for follow-up, New York Heart Association class, medication, age, current living status, number of hospitalizations within the last 12 months and serum creatinine. In the study population without depression, the PHQ-9 score was similar at baseline and follow-up. Conclusion: Telemedical care improved depressive symptoms and had a positive influence on quality of life in patients with CHF and moderate depression

On-Surface Carbon Nitride Growth from Polymerization of 2,5,8-Triazido-s-heptazine

Carbon nitrides have recently come into focus for photo- and thermal catalysis, both as support materials for metal nanoparticles as well as photocatalysts themselves. While many approaches for the synthesis of three-dimensional carbon nitride materials are available, only top-down approaches by exfoliation of powders lead to thin film flakes of this inherently two-dimensional material. Here, we describe an in situ on-surface synthesis of monolayer 2D carbon nitride films, as a first step towards precise combination with other 2D materials. Starting with a single monomer precursor, we show that 2,5,8-triazido-s-heptazine (TAH) can be evaporated intact, deposited on a single crystalline Au(111) or graphite support, and activated via azide decomposition and subsequent coupling to form a covalent polyheptazine network. We demonstrate that the activation can occur in three pathways, via electrons (X-ray illumination), photons (UV illumination) and thermally. Our work paves the way to coat materials with extended carbon nitride networks which are, as we show, stable under ambient conditions

Exploring drought‐to‐flood interactions and dynamics: A global case review

This study synthesizes the current understanding of the hydrological, impact, and adaptation processes underlying drought‐to‐flood events (i.e., consecutive drought and flood events), and how they interact. Based on an analysis of literature and a global assessment of historic cases, we show how drought can affect flood risk and assess under which circumstances drought‐to‐flood interactions can lead to increased or decreased risk. We make a distinction between hydrological, socio‐economic and adaptation processes. Hydrological processes include storage and runoff processes, which both seem to mostly play a role when the drought is a multiyear event and when the flood occurs during the drought. However, which process is dominant when and where, and how this is influenced by human intervention needs further research. Processes related to socio‐economic impacts have been studied less than hydrological processes, but in general, changes in vulnerability seem to play an important role in increasing or decreasing drought‐to‐flood impacts. Additionally, there is evidence of increased water quality problems due to drought‐to‐flood events, when compared to drought or flood events by themselves. Adaptation affects both hydrological (e.g., through groundwater extraction) or socio‐economic (e.g., influencing vulnerability) processes. There are many examples of adaptation, but there is limited evidence of when and where certain processes occur and why. Overall, research on drought‐to‐flood events is scarce. To increase our understanding of drought‐to‐flood events we need more comprehensive studies on the underlying hydrological, socio‐economic, and adaptation processes and their interactions, as well as the circumstances that lead to the dominance of certain processes. This article is categorized under: Science of Water > Hydrological Processes Science of Water > Water Extreme

Molecular Characterization of Cryptosporidium Species and Giardia duodenalis from Symptomatic Cambodian Children

Background: In a prospective study, 498 single faecal samples from children aged under 16 years attending an outpatient clinic in the Angkor Hospital for Children, northwest Cambodia, were examined for Cryptosporidium oocysts and Giardia cysts using microscopy and molecular assays. Methodology/Principal Findings: Cryptosporidium oocysts were detected in 2.2% (11/498) of samples using microscopy and in 7.7% (38/498) with molecular tests. Giardia duodenalis cysts were detected in 18.9% (94/498) by microscopy and 27.7% (138/498) by molecular tests; 82% of the positive samples (by either method) were from children aged 1–10 years. Cryptosporidium hominis was the most common species of Cryptosporidium, detected in 13 (34.2%) samples, followed by Cryptosporidium meleagridis in 9 (23.7%), Cryptosporidium parvum in 8 (21.1%), Cryptosporidium canis in 5 (13.2%), and Cryptosporidium suis and Cryptosporidium ubiquitum in one sample each. Cryptosporidium hominis and C. parvum positive samples were subtyped by sequencing the GP60 gene: C. hominis IaA16R6 and C. parvum IIeA7G1 were the most abundant subtypes. Giardia duodenalis was typed using a multiplex real-time PCR targeting assemblages A and B. Assemblage B (106; 76.8% of all Giardia positive samples) was most common followed by A (12.3%) and mixed infections (5.1%). Risk factors associated with Cryptosporidium were malnutrition (AOR 9.63, 95% CI 1.67–55.46), chronic medical diagnoses (AOR 4.51, 95% CI 1.79–11.34) and the presence of birds in the household (AOR 2.99, 95% CI 1.16–7.73); specifically C. hominis (p = 0.03) and C. meleagridis (p<0.001) were associated with the presence of birds. The use of soap was protective against Giardia infection (OR 0.74, 95% CI 0.58–0.95). Conclusions/Significance: This is the first report to describe the different Cryptosporidium species and subtypes and Giardia duodenalis assemblages in Cambodian children. The variety of Cryptosporidium species detected indicates both anthroponotic and zoonotic transmission in this population. Interventions to improve sanitation, increase hand washing after defecation and before preparing food and promote drinking boiled water may reduce the burden of these two parasites

The FANCM:p.Arg658* truncating variant is associated with risk of triple-negative breast cancer

Abstract: Breast cancer is a common disease partially caused by genetic risk factors. Germline pathogenic variants in DNA repair genes BRCA1, BRCA2, PALB2, ATM, and CHEK2 are associated with breast cancer risk. FANCM, which encodes for a DNA translocase, has been proposed as a breast cancer predisposition gene, with greater effects for the ER-negative and triple-negative breast cancer (TNBC) subtypes. We tested the three recurrent protein-truncating variants FANCM:p.Arg658*, p.Gln1701*, and p.Arg1931* for association with breast cancer risk in 67,112 cases, 53,766 controls, and 26,662 carriers of pathogenic variants of BRCA1 or BRCA2. These three variants were also studied functionally by measuring survival and chromosome fragility in FANCM−/− patient-derived immortalized fibroblasts treated with diepoxybutane or olaparib. We observed that FANCM:p.Arg658* was associated with increased risk of ER-negative disease and TNBC (OR = 2.44, P = 0.034 and OR = 3.79; P = 0.009, respectively). In a country-restricted analysis, we confirmed the associations detected for FANCM:p.Arg658* and found that also FANCM:p.Arg1931* was associated with ER-negative breast cancer risk (OR = 1.96; P = 0.006). The functional results indicated that all three variants were deleterious affecting cell survival and chromosome stability with FANCM:p.Arg658* causing more severe phenotypes. In conclusion, we confirmed that the two rare FANCM deleterious variants p.Arg658* and p.Arg1931* are risk factors for ER-negative and TNBC subtypes. Overall our data suggest that the effect of truncating variants on breast cancer risk may depend on their position in the gene. Cell sensitivity to olaparib exposure, identifies a possible therapeutic option to treat FANCM-associated tumors