The Water & Health Nexus – Understanding water controls on human health and wellbeing in a drastically changing world

The global pandemic of SARS-CoV-2 has once more highlighted in an agonising way how closely human health and well-being are connected to the global water cycle and safe access to clean and affordable water in order to sustain our needs for food, sanitation and hygiene, as well as energy production, cooling and transport. Unequal access to safe and clean water for hand hygiene has been identified by WHO as a major obstacle for safely handling the risk of the global health crisis unfolding across the world since 2020 and international efforts on interdisciplinary approaches to sustaining fair access to water for sanitation and hygiene are urgently needed to control the course of this, and potential future pandemics.

In addition to representing a precious commodity, water on the Earth’s surface and in the subsurface acts as a transport vector for a wide range of water borne pollutants and pathogens causing diseases such as Cholera, Typhoid, Dysentery or Gardia. Public health concerns regarding these waterborne diseases are high in particular in areas with insufficient or failing water and sanitation infrastructure, with diarrhetic disease representing the second leading cause of death in infants under the age of five and causing higher numbers of infant deaths than malaria, measles and HIV/AIDS together. In addition, drinking water contaminated with critically high concentrations of pollutants such as arsenic, mercury or pesticides represents a global public health concern.

Advances to the mechanistic understanding of water as a transport vector for pathogens and disease are therefore urgently required in order to reduce the risk of pathogen dispersal and associated spread of spread waterborne disease. This involves detailed understanding of how the time dynamic evolution of hydrological connectivity and associated transport flow paths control the spread of waterborne diseases by potentially connecting pathogen sources across and within communities as well as how environmental conditions such as water levels, water temperature and chemistry status control the growth of pathogen concentrations or populations of vector-borne disease transmitting insects (e.g., mosquitos transmitting Dengue, Malaria or West-Nile virus). In addition, optimising the efficiency of water sanitation and hygiene measures and advancing the predictive capacity for epidemiological forecasting will require detailed understanding of hydrometeorological and water pollution pressures on water and sanitation infrastructure as well as adaptation and mitigation management.
The capacity of hydrological models and analysis tools to support predictions of both, pathogen source developments, contaminant activation and their spread is perhaps still underutilised when assessing public health risks associated with waterborne and vestor-borne diseases and pollutants. This session therefore calls for interdisciplinary contributions from the global water and health communities that demonstrate challenges, advances and solutions to:
• The risks posed by waterborne and vector-borne diseases under the influence of global environmental change and resulting pressures on water infrastructure, governance and management
• Water, sanitation and hygiene (WASH) practices, including in the context of conflicts, displacements and temporary settlements
• Wastewater-based epidemiology to provide predictive capacity and early warning of pathogen dispersal and associated public health risks
• Assessments of hydrological controls of health risks related to contaminant source activation and exposure
• Community-based approaches to water governance and safe access to clean water for all
• Economic, technological, behavioural and cultural approaches to educating high-risk communities about water sanitation and hygiene practices
• High-tech to off-grid solutions to providing water treatment opportunities

Conveners: Stefan Krause, Christophe Cudennec, Laura Richards
| Thu, 02 Jun, 13:30–15:00|Room Rondelet 1

Orals: Thu, 02 Jun | Room Rondelet 1

Chairpersons: Stefan Krause, Laura Richards
Patricia Licznar-Fajardo, Nicolas Bernaud, Ayad Almakki, Aboubakar Diaby, Iman Bouazizi, Fabien Aujoulat, Mylene Toubiana, Agnes Masnou, Jean-Louis Perrin, Luc Seguis, Kalpy Julien Coulibaly, and Estelle Jumas-Bilak

The screening wastewater for SARS-CoV-2 RNA has emerged in over 50 countries as a tool for tracking COVID-19 in population alongside traditional clinical monitoring, highlighting the usefulness of (waste)water-based epidemiology (WBE). Facing the significant problem of antimicrobial resistance (AMR), the monitoring of environmental AMR in epidemiologic aim is still poorly documented. As for COVID-19, WBE could be a proxy of AMR epidemiology in the context of lack of biological data i) at the community level in high income-country and ii) in lower middle-income country when resistance is often non-documented in human infections.

The aim of the study is to explore AMR from surface water running in or in the vicinity of two contrasted densely urbanized areas: Lez watershed, Montpellier, France and Djibi watershed, Abidjan, Cote d’Ivoire.

From June to November 2015, we collected 24 water samples, on 2 urban rivers in the Heart of Montpellier city: 2 sampling sites around the university hospital of Montpellier, 1 site downstream a public park and 1 site in a residential area. From July 2018 to November 2019, we collected 11 water samples in Djibi watershed (n = 11): 2 peri-urban sampling sites just outside of the Abidjan-urban area, 1 site downstream a wetland area and 1 site upstream the Aghien Lagoon.

In both cities, 100% of samples were positive for blaTEM, an endemic beta-lactamase-encoding gene. In Montpellier, blaSHV and blaCTX-M were positive in 21% of samples. In Djibi watershed, 54% and 27% of samples were positive to both blaSHV and blaCTX-M, respectively. For carbapenemase-encoding genes which confer emerging resistance to last resort antibiotics, data were more contrasted between Montpellier and Abidjan. These genes were sparingly detected in Montpellier when the carbapenemase-encoding genes blaKPC, blaNDM, blaOXA-48 were each detected in 27% of samples in Djibi watershed samples.

The worrisome epidemiology of AMR requires to identify AMR environmental reservoirs. AMR in urban settings could represent a hot spot in the dynamics of the epidemiological cycle of AMR. The development of WBE could help to cartography AMR at a small-territory scale to help for medical decisions, alerts and implementation of preventive measures.

How to cite: Licznar-Fajardo, P., Bernaud, N., Almakki, A., Diaby, A., Bouazizi, I., Aujoulat, F., Toubiana, M., Masnou, A., Perrin, J.-L., Seguis, L., Coulibaly, K. J., and Jumas-Bilak, E.: Water based epidemiology: a new wave?, IAHS-AISH Scientific Assembly 2022, Montpellier, France, 29 May–3 Jun 2022, IAHS2022-250, 2022.

Jo-Anne Geere and Bruce Lankford

Many people in low-income countries and fragile states struggle to access the foundations of family and community health which we see as a three-way nexus of; access to safe water and sanitation, a sufficient and balanced diet and effective health services. These factors interact with each other to affect personal and community health in different ways mediated by environmental and social factors specific to local and national contexts. Our paper conceptually explores the hydrological foundations of safe water, food and health interactions that underpin individual, community and global health. In doing so we recognise the recursive dynamics of water and sanitation and health (WASH), food and diet systems, climate change, emergent diseases, conflict and freshwater ecosystems degradation, loss of biodiversity and migration.  Outbreaks of Ebola and the COVID-19 pandemic have demonstrated that localised community health problems, and the local freshwater needed to combat them, can emerge and quickly escalate to have global health, economic, social, and political consequences. Therefore, a focus on improving the foundations of health (improved water access, food and nutrition security and health services) in low-income communities (LIC) and fragile or conflict affected states (FCS) not only targets populations in greatest need and most likely to benefit but creates opportunities to strengthen and protect global health.

How to cite: Geere, J.-A. and Lankford, B.: The Water-Food-Health Nexus; Exploring the Water Foundations of Family to Community to Global Health., IAHS-AISH Scientific Assembly 2022, Montpellier, France, 29 May–3 Jun 2022, IAHS2022-595, 2022.

A model approach for spatial assessment of the human health risk associated with pollution of river waters with heavy metals
Yury Motovilov and Tatiana Fashchevskaia
Patricia Licznar-Fajardo, Fabien Aujoulat, Magalie Robert, Christelle Batiot-Guilhe, Lara Guillerez, Isabelle Zorgniotti, stefanyia Hantova, and Estelle Jumas-Bilak

By 2050, bacterial infections could become the leading cause of death due to the emergence and spread of antimicrobial resistant-bacteria (ARB) and -genes (ARG). Faced to this global problem, an integrative approach (human animal environment) is encouraged by the WHO. However, environmental antimicrobial resistance (AMR) remains insufficiently investigated, with a focus on wastewater and a disregard to current or emerging clinical concerns.

ARB and ARGs could be found in water intended for human consumption. Like many Mediterranean cities, Montpellier and surroundings (southeastern France) are predominantly supplied by water from karst aquifers that are vulnerable to contaminations above all in climatic changes context. In France, although the microbiological quality of drinking water is strictly monitored, AMR is not. This study is conducted at a local scale to i) test the concept of the use of the regulatory surveillance of drinking water to monitor AMR in a French area and ii) evaluate the dynamics of AMR in drinking water in relation with climatic events.

From 2024 samples (sanitary surveillance Aude and Hérault) conducted from January to April 2021, 85 Escherichia coli were isolated according to the regulatory protocol and studied for their antimicrobial resistance profile. blaTEM, blaSHV, blaCTX-Mthat are the most frequent beta-lactamases-encoding ARG in human infections were researched in 37 cultivable Gram-negative community. Water was also sampled at the entering of drinking water treatment plant (Montpellier), under contrasted hydroclimatic conditions.

blaTEM was found in 14% of E. coli while no E. coli carried blaSHV or blaCTX-M. blaTEM, blaSHV, blaCTX-M were encountered in 43%, 3% and 0% of cultivable Gram-negative community respectively. The E. coli strains carrying the blaTEM gene and the communities positive for blaSHVcame mainly from karst aquifers.

Antibiotic resistance in drinking water in France had never been explored on this large scale. We showed the wide diffusion of TEM producing E. coli in drinking water as described in human samples. With this preliminary study we prove that the existing nation-wide regulatory surveillance network could be used with slight modifications to monitor AMR in an environmental compartment that directly expose human populations.

How to cite: Licznar-Fajardo, P., Aujoulat, F., Robert, M., Batiot-Guilhe, C., Guillerez, L., Zorgniotti, I., Hantova, S., and Jumas-Bilak, E.: Dynamics of antimicrobial resistance in drinking water: a territorial study, IAHS-AISH Scientific Assembly 2022, Montpellier, France, 29 May–3 Jun 2022, IAHS2022-181, 2022.

Elodie Robert, Manuela Grippa, Dayangnéwendé Edwige Nikiema, Laurent Kergoat, Hamidou Koudougou, Yves Auda, and Emma Rochelle-Newall

In 2017, diarrheal diseases were responsible for 1.57 million deaths, including 606 024 deaths in Sub-Saharan Africa. This situation is due to domestic use of polluted surface waters, deficits in hygiene, access to healthcare and drinking water, and to weak environmental and health monitoring infrastructures. Moreover, climate change is expected to impact water resources by boosting the presence, dissemination and transmission of pathogens. Finally, Sub-Saharan Africa is undergoing major changes in terms of land uses, and demographic growth especially in rural areas.

Escherichia coli (E. coli) is an indicator for the enteric pathogens that cause many diarrheal diseases. This case study, carried out Bagre Reservoir, aims at filling the knowledge gap by analyzing the environmental variables that play a role in the dynamics of E. coli, and cases of diarrhea in West Africa.

Samples of surface water were routinely collected to measure E. coli, enterococci and suspended particulate matter (SPM) at a monitoring point (Kapore) during one year. In addition, satellite data were used to estimate precipitation, water level, Normalized Difference Vegetation Index (NDVI) and SPM. Monthly epidemiological data for cases of diarrhea from three health centers were also collected and compared with microbiological and environmental data.

A positive correlation between E. coli and enterococci in surface waters was found indicating that E. coli is an acceptable indicator of fecal contamination in this region.

E. coli and diarrheal diseases were strongly correlated with monsoonal precipitation, in situ SPM, and Near Infra-Red (NIR) band between March and November. Partial least squares regression showed that E. coli concentration was strongly associated with precipitation, Sentinel-2 reflectance in the NIR and SPM, and that the cases of diarrhea were strongly associated with precipitation, NIR, E. coli, SPM, and to a lesser extent with NDVI.

Moreover, E. coli dynamics were reproduced using satellite data alone, particularly from February to mid-December (R² = 0.60) as were cases of diarrhea throughout the year (R² = 0.76). This implies that tele-epidemiology approach through the use of satellite data could provide an important contribution to water quality monitoring, and thus contribute to the establishment of warning systems.

How to cite: Robert, E., Grippa, M., Nikiema, D. E., Kergoat, L., Koudougou, H., Auda, Y., and Rochelle-Newall, E.: Bacterial water pollution and diarrheal diseases in West Africa, IAHS-AISH Scientific Assembly 2022, Montpellier, France, 29 May–3 Jun 2022, IAHS2022-151, 2022.

Seyram Sossou, Francois-Cedry Bidi, Bernadette Ouattara, and Elie Kabre

Drinking of safety water is of utmost importance for the good health of communities. Over years, in addition to tap water there has been an increase in the consumption of water packaging in bottles and sachets by the populations in Sahelian Africa.  This study aimed at assessing the safety of tap, bottle and sachet water produced and consumed in Ouagadougou, the capital city of Burkina Faso. A site inspection of the packaged water production units was carried out to assess the process and conditions for their production. The evaluation of water quality was made through household surveys by questionnaire according to the consumer and key informant interview. For assessing microbiological quality, a total of 330 samples water (including 257 packaged sachet water, 41 bottle water and 32 tap water) were submitted for laboratory analysis. With QMRA method, a quantitative estimate of the microbiological risk was carried out. The results showed a similar process and hygienic practices for the production of drinking water in Ouagadougou. However, possible hazardous events were found in the sachet water production units which may compromise water quality. The results of surveys have shown that, for all surveyed, the water produced at the tap and in the bottle is of good quality. While, for 49,52% of consumers packaged sachet water is not good quality. This opinion is confirmed by laboratory analyzes according to which 23% of the samples water in sachets do not comply with the standard respectively, do not comply with both Burkina Faso and WHO standard. Compared to the disease burden by Cryptosporidium parvum (7,37.10-7 DALY), the disease burden by Escherichia coli O157: H7 (1,42.10-1 DALY) and by rotavirus (4,79.10-3 DALY) are higher and exceed the reasonable level of reference risk established by WHO (10-6 DALY). Based on these, appropriate mitigation and monitoring were proposed for action in sachet water production units. This study will allow decisions to be made on the treatment and robust hygienic conditions for producing drinking water in Ouagadougou, Burkina Faso.

How to cite: Sossou, S., Bidi, F.-C., Ouattara, B., and Kabre, E.: Quantitative Microbiological Risk Assessment of drinking water produced in Ouagadougou, Burkina Faso, IAHS-AISH Scientific Assembly 2022, Montpellier, France, 29 May–3 Jun 2022, IAHS2022-708, 2022.