A planetary health model for reducing exposure to faecal contamination in urban informal settlements: Baseline findings from Makassar, Indonesia

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Background The intense interactions between people, animals and environmental systems in urban informal settlements compromise human and environmental health. Inadequate water and sanitation services, compounded by exposure to flooding and climate change risks, expose inhabitants to environmental contamination causing poor health and wellbeing and degrading ecosystems. However, the exact nature and full scope of risks and exposure pathways between human health and the environment in informal settlements are uncertain. Existing models are limited to microbiological linkages related to faecal-oral exposures at the individual level, and do not account for a broader range of human-environmental variables and interactions that affect population health and wellbeing. Methods We undertook a 12-month health and environmental assessment in 12 flood-prone informal settlements in Makassar, Indonesia. We obtained caregiver-reported health data, anthropometric measurements, stool and blood samples from children < 5 years, and health and wellbeing data for children 5–14 years and adult respondents. We collected environmental data including temperature, mosquito and rat species abundance, and water and sediment samples. Demographic, built environment and household asset data were also collected. We combined our data with existing literature to generate a novel planetary health model of health and environment in informal settlements. Results Across the 12 settlements, 593 households and 2764 participants were enrolled. Two-thirds (64·1%) of all houses (26·3–82·7% per settlement) had formal land tenure documentation. Cough, fever and diarrhoea in the week prior to the survey were reported among an average of 34.3%, 26.9% and 9.7% of children aged < 5 years, respectively; although proportions varied over time, prevalence among these youngest children was consistently higher than among children 5–14 years or adult respondents. Among children < 5 years, 44·3% experienced stunting, 41·1% underweight, 12.4% wasting, and 26.5% were anaemic. There was self- or carer-reported poor mental health among 16.6% of children aged 5–14 years and 13.9% of adult respondents. Rates of potential risky exposures from swimming in waterways, eating uncooked produce, and eating soil or dirt were high, as were exposures to flooding and livestock. Just over one third of households (35.3%) had access to municipal water, and contamination of well water with E. coli and nitrogen species was common. Most (79·5%) houses had an in-house toilet, but no houses were connected to a piped sewer network or safe, properly constructed septic tank. Median monthly settlement outdoor temperatures ranged from 26·2 °C to 29.3 °C, and were on average, 1·1 °C warmer inside houses than outside. Mosquito density varied over time, with Culex quinquefasciatus accounting for 94·7% of species. Framed by a planetary health lens, our model includes four thematic domains: (1) the physical/built environment; (2) the ecological environment; (3) human health; and (4) socio-economic wellbeing, and is structured at individual, household, settlement, and city/beyond spatial scales. Conclusions Our planetary health model includes key risk factors and faecal-oral exposure pathways but extends beyond conventional microbiological faecal-oral enteropathogen exposure pathways to comprehensively account for a wider range of variables affecting health in urban informal settlements. It includes broader ecological interconnections and planetary health-related variables at the household, settlement and city levels. It proposes a composite framework of markers to assess water and sanitation challenges and flood risks in urban informal settlements for optimal design and monitoring of interventions.https://doi.org/10.1016/j.envint.2021.106679155pubpu

Stormwater constructed wetlands:A source or a sink of Campylobacter spp.

Stormwater constructed wetlands are not well characterised for their ability to remove pathogens which can pose public health risks during stormwater harvesting activities. This study investigated the behaviour of faecal indicator organism Escherichia coli (E. coli) and reference pathogen Campylobacter spp. in stormwater constructed wetlands, using a case study system located in Melbourne, Australia. Grab sampling and event-based monitoring revealed influent concentrations of E. coli were typical of other urban stormwater studies, yet Campylobacter concentrations were orders of magnitude above those urban stormwater studies used to develop the Australian Guidelines for Water Recycling, reached levels typical of raw domestic wastewater. The wetland consistently removed E. coli from stormwater (mean log removal 0.96, range 0.19–1.79), while Campylobacter spp. concentrations were often higher in outflow than inflow (mean log removal 0.05, range −0.9-1.25). These results indicate that E. coli is a poor indicator for this reference pathogen. The log reductions of both organisms also failed to meet the criteria specified for any end-use, as listed in the Australian Guidelines for Water Recycling, suggesting further treatment is required prior to harvesting. Finally, this study proposed that direct faecal deposition by waterfowl faeces was a microbial source to stormwater wetlands and that this was partly responsible for the varied microbial removal rates observed. Overall, this work validates the need for further characterisation of pathogens in raw urban stormwater, and the ability for water sensitive urban design features, such as wetlands, to remove both indicator and pathogenic microorganisms.</p

A Low-Cost Radar-Based IoT Sensor for Noncontact Measurements of Water Surface Velocity and Depth

We designed an out-of-water radar water velocity and depth sensor, which is unique due to its low cost and low power consumption. The sensor is a first at a cost of less than USD 50, which is well suited to previously cost-prohibited high-resolution monitoring schemes. This use case is further supported by its out-of-water operation, which provides low-effort installations and longer maintenance-free intervals when compared with in-water sensors. The inclusion of both velocity and depth measurement capabilities allows the sensor to also be used as an all-in-one solution for flowrate measurement. We discuss the design of the sensor, which has been made freely available under open-hardware and open-source licenses. The design uses commonly available electronic components, and a 3D-printed casing makes the design easy to replicate and modify. Not before seen on a hydrology sensor, we include a 3D-printed radar lens in the casing, which boosts radar sensitivity by 21 dB. The velocity and depth-sensing performance were characterised in laboratory and in-field tests. The depth is accurate to within ±6% and ±7 mm and the uncertainty in the velocity measurements ranges from less than 30% to 36% in both laboratory and field conditions. Our sensor is demonstrated to be a feasible low-cost design which nears the uncertainty of current, yet more expensive, velocity sensors, especially when field performance is considered.</p

Effect of environmental parameters on pathogen and faecal indicator organism concentrations within an urban estuary

Current World Health Organisation figures estimate that ~2.5 million deaths per year result from recreational contact with contaminated water sources. Concerns about quantitative risk assessments of waterways using faecal indicator organisms (FIOs) as surrogates to infer pathogenic risk currently exist. In Melbourne, Australia, the Yarra River has come under public scrutiny due to perceived public health risks associated with aquatic recreation; a characteristic shared with urban estuaries worldwide. A 10-month study of the Yarra estuary investigated the processes that affect FIOs and pathogens within this system. A total of 74 samples were collected from three estuarine and two upstream, freshwater, locations under different climatic and hydrological conditions, and the levels of Escherichia coli, enterococci, Clostridium perfringens, fRNA coliphages, Campylobacter spp. Cryptosporidium oocysts, Giardia cysts, adenoviruses, and enteroviruses were monitored. Reference pathogenic bacteria, protozoa, and viruses were detected in 81%, 19%, and 8% of samples, respectively. Variations in FIO concentrations were found to be associated with changes in specific climatic and hydrological variables including: temperature, flow, humidity and rainfall. In contrast, pathogen levels remained unaffected by all variables investigated. Limitations of current national and international culture-based standard methods may have played a significant role in limiting the identification of correlative relationships The data demonstrate the differences between FIOs and microbial pathogens in terms of sources, sinks, and survival processes within an urban estuary and provide further evidence of the inadequacy of FIO inclusion in the development of worldwide regulatory water quality criteria and risk assessment models.</p

A low‐cost water depth and electrical conductivity sensor for detecting inputs into urban stormwater networks

High‐resolution data collection of the urban stormwater network is crucial for future asset management and illicit discharge detection, but often too expensive as sensors and ongoing frequent maintenance works are not affordable. We developed an integrated water depth, electrical conductivity (EC), and temperature sensor that is inexpensive (USD 25), low power, and easily implemented in urban drainage networks. Our low‐cost sensor reliably measures the rate‐of‐change of water level without any re‐calibration by comparing with industry‐standard instruments such as HACH and HORIBA’s probes. To overcome the observed drift of level sensors, we developed an automated re‐calibration approach, which significantly improved its accuracy. For applications like monitoring stormwater drains, such an approach will make higher‐resolution sensing feasible from the budget control considerations, since the regular sensor re‐calibration will no longer be required. For other applications like monitoring wetlands or wastewater networks, a manual re‐calibration every two weeks is required to limit the sensor’s inaccuracies to ±10 mm. Apart from only being used as a calibrator for the level sensor, the conductivity sensor in this study adequately monitored EC between 0 and 10 mS/cm with a 17% relative uncertainty, which is sufficient for stormwater monitoring, especially for real‐time detection of poor stormwater quality inputs. Overall, our proposed sensor can be rapidly and densely deployed in the urban drainage network for revolutionised high‐density monitoring that cannot be achieved before with high‐end loggers and sensors.ISSN:1424-822

Evaluation of techniques for measuring microbial hazards in bathing waters:A comparative study

<div><p>Recreational water quality is commonly monitored by means of culture based faecal indicator organism (FIOs) assays. However, these methods are costly and time-consuming; a serious disadvantage when combined with issues such as non-specificity and user bias. New culture and molecular methods have been developed to counter these drawbacks. This study compared industry-standard IDEXX methods (Colilert and Enterolert) with three alternative approaches: 1) TECTA™ system for <i>E</i>. <i>coli</i> and enterococci; 2) US EPA’s 1611 method (qPCR based enterococci enumeration); and 3) Next Generation Sequencing (NGS). Water samples (233) were collected from riverine, estuarine and marine environments over the 2014–2015 summer period and analysed by the four methods. The results demonstrated that <i>E</i>. <i>coli</i> and coliform densities, inferred by the IDEXX system, correlated strongly with the TECTA™ system. The TECTA™ system had further advantages in faster turnaround times (~12 hrs from sample receipt to result compared to 24 hrs); no staff time required for interpretation and less user bias (results are automatically calculated, compared to subjective colorimetric decisions). The US EPA Method 1611 qPCR method also showed significant correlation with the IDEXX enterococci method; but had significant disadvantages such as highly technical analysis and higher operational costs (330% of IDEXX). The NGS method demonstrated statistically significant correlations between IDEXX and the proportions of sequences belonging to FIOs, <i>Enterobacteriaceae</i>, and <i>Enterococcaceae</i>. While costs (3,000% of IDEXX) and analysis time (300% of IDEXX) were found to be significant drawbacks of NGS, rapid technological advances in this field will soon see it widely adopted.</p></div

Into the deep:Evaluation of SourceTracker for assessment of faecal contamination of coastal waters

Faecal contamination of recreational waters is an increasing global health concern. Tracing the source of the contaminant is a vital step towards mitigation and disease prevention. Total 16S rRNA amplicon data for a specific environment (faeces, water, soil) and computational tools such as the Markov-Chain Monte Carlo based SourceTracker can be applied to microbial source tracking (MST) and attribution studies. The current study applied artificial and in-laboratory derived bacterial communities to define the potential and limitations associated with the use of SourceTracker, prior to its application for faecal source tracking at three recreational beaches near Port Phillip Bay (Victoria, Australia). The results demonstrated that at minimum multiple model runs of the SourceTracker modelling tool (i.e. technical replicates) were required to identify potential false positive predictions. The calculation of relative standard deviations (RSDs) for each attributed source improved overall predictive confidence in the results. In general, default parameter settings provided high sensitivity, specificity, accuracy and precision. Application of SourceTracker to recreational beach samples identified treated effluent as major source of human-derived faecal contamination, present in 69% of samples. Site-specific sources, such as raw sewage, stormwater and bacterial populations associated with the Yarra River estuary were also identified. Rainfall and associated sand resuspension at each location correlated with observed human faecal indicators. The results of the optimised SourceTracker analysis suggests that local sources of contamination have the greatest effect on recreational coastal water quality.</p

Environmental monitoring of waterborne Campylobacter: Evaluation of the Australian standard and a hybrid extraction-free MPN-PCR method

Campylobacter is the leading agent of diarrheal disease worldwide. This study evaluates a novel culture-PCR hybrid (MPN-PCR) assay for the rapid enumeration of Campylobacter spp. from estuarine and wastewater systems. To first evaluate the current, culture-based, Australian standard, an inter-laboratory study was conducted on 69 subsampled water samples. The proposed Most-Probable Number (MPN)-PCR method was then evaluated, by analysing 147 estuarine samples collected over a 2 year period. Data for 14 different biological, hydrological and climatic parameters were also collated to identify pathogen-environment relationships and assess the potential for method specific bias. The results demonstrated that the intra-laboratory performance of the MPN-PCR was superior to that of AS/NZS (σ = 0.7912, P < 0.001; κ = 0.701, P < 0.001) with an overall diagnostic accuracy of ~94%. Furthermore, the analysis of both MPN-PCR and AS/NZS identified the potential for the introduction of method specific bias during assessment of the effects of environmental parameters on Campylobacter spp. numbers.</p

Pesticide occurrence and spatio-temporal variability in urban run-off across Australia

Stormwater is a major driving factor of aquatic ecosystem degradation as well as one of the largest untapped urban freshwater resources. We present results from a long-term, multi-catchment study of urban stormwater pesticides across Australia that addresses this dichotomous identity (threat and resource), as well as dominant spatial and temporal patterns in stormwater pesticide composition. Of the 27 pesticides monitored, only 19 were detected in Australian stormwater, five of which (diuron, MCPA, 2,4-D, simazine, and triclopyr) were found in >50% of samples. Overall, stormwater pesticide concentrations were lower than reported in other countries (including the United States, Canada and Europe), and exceedances of public health and aquatic ecosystem standards were rare (10% of samples). Spatio-temporal patterns were investigated with principal component analysis. Although stormwater pesticide composition was relatively stable across seasons and years, it varied significantly by catchment. Common pesticide associations appear to reflect 1) user application of common registered formulations containing characteristic suites of active ingredients, and 2) pesticide fate properties (e.g., environmental mobility and persistence). Importantly, catchment-specific occurrence patterns provide opportunities for focusing treatment approaches or stormwater harvesting strategies

Costs and processing times of the different methods, based on 2014–2015 summer monitoring.

<p>All values were estimated on the assumption that a batch of 15 samples are analysed. Consumable costs were estimated as a ratio in comparison to IDEXX consumables.</p