Dissertations / Theses on the topic 'Drinking water – Health aspects – Zambia'

Thesis (M. Tech. (Environmental Health)) -- Central University of technology, Free State, 2013<br>Introduction: Drinking water of poor quality can cause a variety of diseases and may even result in death. The impact of poor drinking water is a course for concern even in South Africa. Therefore, the physical, chemical and microbiological drinking water quality was investigated in the peri-urban area of Bainsvlei and the Woodlands Hills Estate in Bloemfontein, Free State. Materials and Methods: The water quality was assessed in 20 identified sampling sites for three series with ten weeks apart. These sites use treated municipal and untreated borehole water for drinking. The determinants analysed for were pH, electrical conductivity (EC), turbidity, temperature, Ca, Mg, Na, F, Cl, N, SO₄,N, Free chlorine, Al, As, CN, Fe, Mn, Pb, Hg, total coliforms and E. coli. The water samples were collected and analysed on site and in the laboratory. Both the physical and chemical determinants were measured using standard methods whereas the microbiological determinants were measured using the Defined Substrate Technology (DST) method. The measurements were first compared to the SANS 241 (2011) for compliance. The ANOVA tests were used to investigate if any seasonal variations existed in the water quality as well as to compare the levels of the determinants between borehole and municipal water. In the assessment of the overall drinking water quality of different water sampling sites the water quality index (WQI) was used. Results and Discussions: Significant effects were believed to exist if the p-values of the ANOVA and Scheffe tests were at a significance level of 5% (p < 0.05). The study results revealed that of the four physical determinants that were measured turbidity exceeded the standard in many sampling sites in the three series. Of all the chemical determinants, nitrates exceeded the standard. In the same way coliforms exceeded the standard in a number of sampling sites while E. coli was found in a few sampling sites in the first series. ANOVA tests revealed that seasonal variations existed between pH, EC, temperature, cyanide and iron at a significant level of 5% (p < 0.05) while the Post-hoc Scheffe test further revealed the series in which the effect existed. Similarly, the ANOVA tests revealed that the levels of the determinants between municipal versus borehole varied in pH, EC, Ca, Mg, Na, F, Cl, N, and SO₄ at a significant level of 5% (p < 0.05). The WQI showed that in all the series when combining the good and excellent category season 2 had the highest percentage of 80%, followed by season 3 with 79% and season 1 with 70%. Only borehole sampling sites were found in the poor, very poor and unsuitable categories. Similarly all the highest WQI values were found in borehole sampling sites. Conclusion: This study revealed that the water quality is of good quality in the Bainsvlei and Woodlands Hills Estate of the Mangaung metropolitan municipality in Bloemfontein, in the Free State, South Africa. The presence of E. coli, though found in a few sampling sites and the high levels of turbidity, nitrates and coliforms are of concern to public health.

The objective of this research is double: <p>1) to study the factors associated with the problems of quality with drinking water on the physicochemical and biological level in the municipality of Abomey-Calavi in Benin ;<p>2)to study its relationships with public health. <p>The goal is to bring on one hand, the tools of improvement to the quality of water and public health in this commune. In addition, to contribute to the reduction of the rate of morbidity and mortality generated by the diseases related to drinking water contamination in this locality<p><p>Methods:<p>For the purpase of this study, we made a preliminary investigation in the municipality (households 55898 and almost all the households have the traditional wells). In the same way the information provided by the National Society of Water in Benin gave the indications on the level koverage of drinkable water conveyance of the commune. This study carried out within a general logical framework of the durable development based on an DPSIR analysis in the municipality of Abomey-Calavi of the Atlantic district in Benin made it possible to provide information on the main sources of contamination of the drinking water. We also carried out a random sampling of 110 wells and 110 households by taking account into the geographical distribution of the households in the commune. We selected 60 taps and 60 households by random sampling for those using water drink distributed by the national Society of Water in Benin. In each zone or district, three households consuming either well water or tap water were drawn randomly. A retrospective study on the number of cases of the hydrous diseases and other symptoms of hydrous diseases was carried out by consultation of medical registers of the commune from 2007 to 2009. Cases of diarrhoeas used as basic variable of health were compared with the other cases of hydrous diseases available in the files. <p><p>Results:<p>The results show that: the most al the well water taken in the households has temperatures beyond the recommendation of the World Health Organization (25 °C) and 98.2 % have a pH below the normal which is 6.5 to 8.5. We note a strong mercury and cadmium, complete iron, aluminum, nitrate nitrite pollution of the sampled wells (n=110) which is respectively 32.73%, 11.82%,10%, 43.64%, 6.36% and 14.55%. The results of the bacteriological analysis of water revealed that the totality of the wells is contaminated. The germs identified during the analysis of the well water are: Escherichia coli, fecal streptococcus species, bacterial salmonella ,Shigella ,Clostridium perfringens, staphylococcus species,<p> Klebsiella pneumoniae and Pseudomonas aeruginosa Most frequent among these germs are: Escherichia coli (100%), Klebsiella pneumoniae (97.27%), bacterial salmonella and Shigella (96,36%) with regard to the coliformes and enterobacteries. As for the cocci with Gram (+) they are staphylococcus species (97.27%) and the fecal streptococcus (88.18%). It is useful to stress that all the wells are strongly contaminated by Clostridium perfringens (95.45%).<p> The differences between the respective prevalence of parasitic coprology, uroculture, diarrhoeas, pains abdominal and saddles bloody for exposed (45.4%, 71.8%, 76.4% and 59.1%) :those who consume the water of wells not exposed (8.3%, 1.7%,13.3%, 16.7): those who consume tap water, are statistically significant (p<0.001). For diarrhoeas according to the characteristics of the people reached of hydrous diseases and other symptoms of hydrous diseases we have: <p>•\<br>Doctorat en Sciences de la santé publique<br>info:eu-repo/semantics/nonPublished

Thesis (MTech (Environmental Health))--Cape Technikon, 2003<br>This study provides information on the provision of environmental health services to informal housing settlements by local authorities. A standard for Environmental Health Service delivery according to Government policies and legislation has been provided. Actual environmental health services delivered to Ducats informal settlement at the time (1992), have been compared to the services that should have been delivered by law. Baseline data have been compiled by means of questionnaires, in order to assist the different levels of government in addressing the housing and environmental health needs of the Ducat community. The nature of Environmental Health and the history of informal housing, more specific that of the Ducat informal housing settlement, have been determined. Limited environmental health services were rendered to informal housing settlements occupying land illegally during 1992. These environmental health services were limited to basic sanitation, water supply and refuse removal. Only pit latrines or bucket latrines were required as a means of sanitation, tanks for water supply and skips for the disposal of waste. Amatola Regional Services Council however rendered all the environmental health services required. Other environmental health aspects such as pest control, communicable disease control, air pollution control, radiation, occupational health issues, temperature extremes, lighting, ventilation, noise, social environment, food and meat hygiene were not required. This study has provided a set of Government policies and legislation, which should be considered in rendering environmental health services for housing in future. Uncertainty of the past decade, about rendering of Environmental Health services to people occupying land illegally, still persists. The Municipal Structures Act, 117 of 1998 requires the rendering of Environmental Health services by local authorities, but it does not state whether these services should be rendered to people occupying land illegally as well. Since this has been the biggest restriction in providing environmental health services in the past, it is recommended that Government address this uncertainty.

The purpose of this dissertation was to identify factors that contribute to the sustainability of rural water supply facilities (WSFs). Twenty-four interviews were conducted: 16 from rural communities and 8 from water supply agencies. Key findings are that in order to achieve sustainability of WSFs, there is need to ensure that (1) there is an effective community organisation; (2) communities have the ability to operate and maintain WSFs; (3) communities are able to raise adequate user fees for purchasing spare parts; and (4) that there is a strong backup support at the district level to carry out major repairs. Major threats to the sustainability of WSFs include high poverty levels in communities, weak institutional framework and inability of communities to handle major breakdowns.<br>Social Work<br>M.A. (Social Work)

Water in 70 percent of the cities in the United States is hard enough that softening is either required or recommended. It is estimated that approximately 30 percent of all homes in the United States use water softeners. Water softeners, the cation exchange types suited for residential use, exchange sodium for the calcium and magnesium in water. The increase in sodium levels in the softened water caused by cation exchange softening is a direct function of the hardness level of the untreated water. For people who use groundwater, which has a relatively high level of naturally occurring sodium, magnesium and calcium, the additional sodium from cation exchange water softeners may create health hazards for the general population and could adversely affect those who are sensitive to salt or on low sodium diets. To prevent potential health hazards for the general population, no consumption of softened water by cation exchange water softeners should be recommended. If soft water is needed for some practical reasons, a "Separate Water Line System" should be recommended for homeowners.<br>Graduation date: 1991

This dissertation examines topics related to development, environment and health in developing countries using empirical methods. In the first chapter, I study how developing countries can increase enforcement to reduce subsidy leakage in public programs, by investing in the state capacity to target program beneficiaries. This chapter further attempts to understand how the formal sector and black market respond to a policy that reduces diversion of a subsidized commodity. I explore these questions using the case of a Unique ID-based direct fuel subsidy transfer policy in India. Second chapter focuses on the health and wealth trade off near mineral mining operations in developing countries. Using extensive data on mining, health outcomes and assets from 44 developing countries, this study quantifies the wealth gain and adverse health impact of mineral mining. With a number of empirical strategies, this study shows that, despite high wealth gains, how heavy metal mining significantly increases the level of anemia in women and stunting in children living near mines. In the third chapter, I estimate demand for a water quality diagnostic product -- arsenic testing, when it is offered at a price. I further look into various aspects related to selection, learning and households behavioral response to the information. This study is based on a field experiment in Bihar, India.

Reducing population exposure to inorganic arsenic (iAs), a known carcinogen and highly toxic metalloid of great public health concern, remains an ongoing challenge worldwide and in the United States (US). In the US, the Environmental Protection Agency (EPA) regulates the maximum contaminant level (MCL) for total arsenic in public drinking water supplies through the Safe Drinking Water Act. In 2001, the US EPA implemented the Final Arsenic Rule, which lowered the MCL for arsenic in public drinking water supplies from 50 to 10 µg/L. Reductions in iAs exposure and subsequent related disease associated with this important regulatory change have not been quantified. Currently, no national-level exposure estimates of iAs drinking water exposure are available for US residents reliant on public drinking water. There is a critical need to identify susceptible subgroups of the US population who remain at risk for elevated iAs drinking water exposure. This dissertation aimed to quantify the reduction in drinking water iAs exposure resulting from the US EPA MCL regulatory change, to estimate drinking water iAs exposure for US residents reliant on public drinking water, to identify susceptible subgroups across the US whose water iAs remains high, and to determine if iAs exposure was associated with heart disease mortality in the general US population. Chapter 1 provides background information necessary to contextualize the work contained in this dissertation. In Chapter 2, we conducted a cross-sectional analysis of dietary sources of iAs exposure in the Strong Heart Family Study, a cohort of American Indian adults followed primarily for cardiovascular disease, using a self-reported food frequency questionnaire and urinary iAs measurements. Self-reported intake of rice, organ meat, processed meat, and non-alcoholic drinks was associated with increased urinary iAs concentrations. Diet alone explained only 3% of total variability in urinary iAs concentrations, indicating that the majority of iAs exposure for SHFS participants occurs from drinking water. Second, (in Chapter 3), we explored trends in water iAs exposure in the general US population associated with the EPA’s MCL change using the National Health and Nutrition Examination Survey (NHANES) from 2003-2014, separately for participants reliant on public drinking water vs. private well water (which is not subject to US EPA regulation). We estimated that implementation of the new US EPA MCL was associated with a 17% reduction in drinking water iAs exposure for all participants reliant on public drinking water; the corresponding reduction was 32% for Mexican-American participants. No reduction was observed for participants reliant on private wells. Third (in Chapter 4), we estimated drinking water iAs exposure at the community water system and county-level across the entire US from 2006-2011 using the US EPA’s Six Year Review of Contaminant Occurrence database. We estimated that nationwide public drinking water iAs concentrations decreased by 8.5% and 21.6% at the 80th and 99th percentiles of the water iAs distribution in accordance with the MCL implementation, with significant differences across US subgroups. Greater decreases in iAs concentrations were reported for systems reliant on groundwater, systems serving smaller populations, and systems in the Northeast, Central Midwest, and Southwestern regions of the US. Susceptible subgroups whose public drinking water iAs exposure remains high include populations served by small community water systems reliant on groundwater, communities in the Southwestern US, Semi-Urban, Hispanic communities, and Rural, American Indian communities. Fourth (in Chapter 5), we assessed six-year average arsenic concentrations in community water systems exclusively serving correctional facilities in the US (e.g. prisons, jails, detention centers) compared to other community water systems. Average arsenic concentrations were twice as high in correctional facility community water systems located in the Southwest (6.41 µg/L, 95% CI 3.48, 9.34) compared to all other community water systems in the Southwest (3.11 µg/L, 95% CI 2.97, 3.24). Over a quarter of correctional facility systems in the Southwest reported a six-year average arsenic concentration exceeding the 10 µg/L MCL. Persons incarcerated in the Southwestern US were at disproportionate risk of drinking water arsenic exposure and related disease from 2006-2011. Fifth (in Chapter 6), we multiply imputed urinary arsenic concentrations below the limit of detection (LOD) in NHANES 2003-2016 using a Bayesian Tobit regression model. Epidemiological analyses of urinary arsenic data in NHANES are limited by the relatively high analytical LODs and large proportion of participants with undetectable values. Distributions of urinary arsenic originally reported in NHANES, which replace values below the LOD with the LOD divided by the square root of two, likely overestimate iAs exposure at the lowest exposure levels and may introduce significant bias. Bayesian-multiply imputed datasets may improve the assessment of iAs exposure in cohorts with high analytical LODs for arsenic species. Finally (in Chapter 7), we evaluated the association between urinary iAs concentrations (internal dose) and heart disease mortality as recorded in the National Death Index in NHANES 2003-2014 participants. We found a positive but non-significant prospective association between increasing iAs exposure and heart disease mortality for all participants (hazard ratio 1.15, 95% CI 0.77, 1.70), and a significant positive association for non-Hispanic white participants using flexible spline models. Geometric mean ratios of iAs exposure were higher among cases compared to non-cases, especially for Mexican-American participants (1.30, 95% CI 0.90, 1.88). These findings further support the potential association between low- to moderate- iAs exposure and cardiovascular disease in the US population, and indicate that further high-quality prospective studies of Hispanic and Latino Americans are needed to investigate the potential increased susceptibility of Mexican-Americans to iAs-related cardiovascular disease. Taken together, these studies suggest that while the implementation of the US EPA’s 10 µg/L MCL has reduced drinking water arsenic exposure for many Americans reliant on public drinking water systems, these reductions were not uniform across all US populations. Populations who remain at risk of elevated drinking water arsenic exposure include those reliant on domestic wells, those located in the Southwest, persons incarcerated in the Southwest, tribal communities, and Hispanic communities. Further high-quality epidemiologic research is needed to evaluate the association between low- to moderate iAs exposure and cardiovascular disease in these populations. Stronger federal regulations, targeted compliance enforcement and technical assistance, and other public health interventions are needed to reduce drinking water arsenic exposure in these communities.

M.Sc.<br>The world is focusing on increasing the number of people who have access to safe drinking water due to the ascending numbers of drinking water related illnesses reported annually in rural areas where water is not treated before consumption. To meet this goal, household water treatment has to be introduced especially in places where homes are wide apart making centralised water treatment improbable. Most readily available household water treatment systems (HWTS) such as membrane filters may not be affordable in rural areas due to power requirements and degree of ability to use and maintain them. This study was therefore aimed at designing and constructing HWTS using readily available material such as sand, gravel, zeolites and clays. Five HWTS were designed, built, evaluated and compared based on their ability to remove chemical contaminants such as iron, arsenic and fluorides from drinking water. The types of filters that were used during this study are the biosand filter (BSF), a modified biosand filter with zeolites (BSFZ), a silver impregnated porous pot (SIPP) filter, a ceramic candle filter (CCF) and a bucket filter (BF). Effectiveness of the filters in reducing physical parameters such as turbidity and visual colour was also assessed. The water treatment devices had the following flow rates; 1.74 L/h – 19.20 L/h (BSFZ), 0.81 L/h – 6.84 L/h (BSF), 0.05 L/h – 2.49 L/h (SIPP) and 1.00 L/h – 4.00 L/h (CCF). The flow rates were high at the early stages of filter use and decreased with increase in the volume of water filtered through. The flow rates of the filters were affected by the turbidity of intake water which was between 1.74 NTU – 42.93 NTU and correlated to chlorophyll a concentrations. The household water treatment technologies reduced turbidity to levels less than 1 NTU (> 90% reduction) in the following order SIPP > BSFZ > BSF > CCF > BF. The filters achieved greater than 60% retention of calcium, magnesium, iron and arsenic. These contaminants with the exception of arsenic were reduced to acceptable levels of the South African National Standard of drinking water (SANS 241, 2004). Compared to the other filters, the BSFZ performed better in removing nitrates, phosphates and fluorides although the overall retention efficiency was low. Total organic carbon was removed greatly by the CCF (39%) and the least removal was by the BF. The overall performance of the filters in reducing contaminants from drinking water was in the order BSFZ > BSF > SIPP > CCF > BF. Filter washing vi resulted in an overall increase in the flow rates of the filters but negatively affected turbidity reduction. The filters still removed contaminants after total cumulative volumes of 1200 L (BSFZ, BSF, CCF and BF) and 300 L (SIPP) were filtered through the devices. The five evaluated filters have several advantages to the readily available technologies and the advantages include ease of construction, operation and maintenance. The filters are gravity driven and work independent of temperature. These HWTS incorporate safe storages fitted with spigots to eliminate recontamination of water when it is drawn for use. The filters can produce enough drinking and cooking water for a family of six members due to their high flow rates. The BSFZ, BSF, SIPP, CCF and BF may therefore be considered for treating contaminated water at household scale in places where water is taken directly from the source without treatment.

Background: Chronic arsenic (As) exposure in a global public health concern. Arsenic exposure through drinking water affects over 140 million people in at least 70 countries, including 40 million people in Bangladesh. In the United States (US), 2.4 million people rely on private wells or public water systems with As levels above the US maximum contaminant level. Ingested inorganic arsenic (InAs) is methylated to monomethyl (MMAs)- and dimethyl (DMAs)-arsenical species using the methyl donor S-adenosylmethionine (SAM). Full methylation of InAs to DMAs decreases As toxicity and facilitates urinary As excretion. Arsenic methylation capacity is influenced by nutrients involved in one-carbon metabolism (OCM), the biochemical pathway that synthesizes SAM. Folate recruits one-carbon units for the remethylation of homocysteine and the synthesis of SAM. The availability of one-carbon units is also impacted by nutrients including the alternative methyl donor betaine, its precursor choline, and possibly the cofactor vitamin B12. In addition, As methylation capacity may also be influenced by creatine; an estimated 50% of SAM is consumed by the final step of endogenous creatine synthesis. The adverse health outcomes associated with chronic As exposure include impaired intellectual function, cardiovascular disease, diabetes, inflammation, and cancers of the bladder, lung, kidney, liver, and skin. In utero As exposure is associated with adverse birth outcomes include decreased birth weight and gestational age. Elevated health risks persist after exposure has been reduced or ended, leading to the hypothesis that epigenetic dysregulation, including changes in DNA methylation, may be a biological mechanism linking As exposure to health outcomes. Objectives: This research has three main objectives: (1) to investigate the influence of OCM nutritional factors on As methylation by evaluating effects of folic acid (FA) and creatine supplementation on As methylation capacity, and effect modification by baseline status of OCM-related nutrients; (2) to examine associations between As exposure and loci-specific DNA methylation in an epigenome-wide association study (EWAS); and (3) to assess mediation of the association between in utero As exposure and birth outcomes (i.e., gestational age and birth weight) by DNA methylation of target genes identified in an EWAS, as well as the candidate gene DNA methyltransferase 3 alpha (DNMT3A), a protein-coding gene involved in de novo DNA methylation. Methods: This research used data from three studies of As-exposed individuals. To address the first objective, we used data from the Folic Acid and Creatine Trial (FACT), a 24-week randomized clinical trial of FA (400 or 800 μg/day) and/or creatine supplementation (3 g/day or 3 g creatine and 400 μg FA/day) among As-exposed adults in Bangladesh recruited independent of folate status (N = 622). We investigated overall FA and creatine treatment effects on mean within-person changes in As metabolite proportions in urine compared to the placebo group (weeks 0 to 12). Rebound of As methylation capacity following the cessation of FA supplementation was assessed from weeks 12 to 24. We also assessed effect modification by baseline choline, betaine, vitamin B12, and plasma folate of treatment effects on changes in homocysteine, guanidinoacetate (GAA) (biomarkers of OCM and endogenous creatine synthesis, respectively), total blood As, and urinary As metabolite proportions and indices. To address the second objective, we used data from the Strong Heart Study (SHS), a population-based prospective cohort of American Indians with low-moderate levels of As exposure. DNA methylation was measured in 2,325 participants using the Illumina MethylationEPIC array, which interrogates > 850,000 loci. We tested for differentially methylated positions (DMPs) and regions (DMRs), and conducted gene ontology (GO) enrichment analysis to understand functions of genes containing differential methylation. To address the third objective, we used data from a prospective birth cohort in Bangladesh. In a discovery phase, an EWAS was conducted to identify CpGs with methylation measured in cord blood that are associated with maternal water As levels and birth outcomes (N = 44). In a validation phase, DNA methylation in cord blood was measured using bisulfite pyrosequencing at three target CpGs annotated to miR124-3, MCC, and GNAL (N = 569). We applied structural equation models (SEMs) to assess mediation of the association between in utero As exposure and gestational age by DNA methylation. In addition, mediation of the association between in utero As exposure and birth outcomes by DNA methylation of the candidate gene DNA methyltransferase alpha (DNMT3A) was assessed. Results: In FACT, the mean within-person decreases %InAs and %MMAs and increase in %DMAs were greater among all groups receiving FA supplementation at weeks 6 and 12 compared to placebo (P < 0.05) (Chapter 3). Stratified by median choline and betaine concentrations at baseline, we observed a trend towards greater FA treatment effects among participants with levels below the median of both nutrients compared to participants above the median (Chapter 4). Among participants who discontinued FA supplementation, at week 24, %InAs and %DMAs were not significantly different than baseline levels, suggesting a rebound in As methylation capacity with cessation of FA supplementation. We observed a significantly greater mean within-person decreases in %MMAs with creatine supplementation compared to placebo at weeks 1, 6, and 12; mean within-person changes in %InAs and %DMAs did not differ significantly between the creatine and placebo groups (Chapter 3). The mean within-person decrease in urinary %MMAs at week 12 with creatine treatment was significantly greater than placebo among participants with baseline choline concentrations below the median, but did not differ from placebo among participants with choline concentrations above the median (Chapter 4). In an EWAS conducted in SHS, we identified 20 DMPs associated with urinary As levels at FDR < 0.05; five DMPs were significant at PBonferroni < 0.05 (Chapter 5). The top significant CpG, cg06690548, was located in solute carrier family 7 member 11 (SLC7A11 ), part of the amino-acid transporter cystine:glutamate antiporter system xc-, which is involved in biosynthesis of the endogenous antioxidant glutathione (GSH). Additional Bonferroni-significant CpGs were located in ANKS3, LINGO3, CSNK1D, and ADAMTSL4. We identified one FDR-significant DMR (chr11:2,322,050-2,323,247) including the open reading frame C11orf21 and tetraspanin 32 (TSPAN32 ). Mediation of the association between in utero As exposure and birth outcomes by cord blood DNA methylation was assessed in a Bangladeshi birth cohort. In the discovery phase (N = 44), the association between maternal water As levels and gestational age was fully mediated by DNA methylation of the top 10 CpGs associated with both variables. In a discovery phase (N = 569), there were significant indirect effects of maternal water As levels on gestational age through DNA methylation of miR124-3 and MCC ; the indirect effect through DNA methylation of GNAL was not significant (Chapter 6). In an adjusted SEM including miR124-3 and MCC, mediation of the association between in utero As exposure and gestational age by DNA methylation of miR124-3 was borderline significant (P = 0.06); DNA methylation of MCC did not act as a mediator. We also assessed mediation by DNA methylation of DNMT3A (Chapter 7). In an adjusted SEM including birth weight and gestational age, there was a significant indirect effect of maternal toenail As levels on gestational age through DNMT3A methylation, the indirect effect on birth weight was borderline significant (P = 0.082). However, the indirect effects of maternal toenail As levels on birth weight through all pathways including gestational age were statistically significant. A doubling in maternal toenail As concentrations had a total effect of a decrease in gestational age of 2.1 days and a decrease in birth weight of 28.9 g. Conclusions: Results from FACT (Chapters 3 and 4) provide evidence of the associations between OCM-related nutrients and As methylation capacity. Specifically, FA and creatine supplementation may increase As methylation capacity by increasing the availability of SAM, and treatment effects may be greater among individuals with low betaine and choline status, respectively. In addition, results reported in Chapters 5-7 support the hypotheses that chronic As exposure is associated with epigenetic dysregulation, and that changes in the epigenome may mediate the association between As exposure and adverse health effects. Findings from the research presented here may help inform public health interventions to reduce the adverse health effects of chronic As exposure. However, further research is needed to fully understand the biological mechanism that influence As methylation and that underlie the associations between chronic As exposure and adverse health outcomes.

Includes bibliographical references (leaves 232-247). Obtained information on dental caries and fluorosis among a representative sample of Vietnamese children. Also collected information on factors likely to influence caries experience and dental fluorosis and undertook statistical analyses to examine the relationship between fluoride in drinking water, dental caries and dental fluorosis

The Nanaimo Coalfield was a major coal producer between 1852 and 1968. During this time, coal was mined extensively in the area of South Wellington. The quality of groundwater in South Wellington may be adversely affected as mine site abandonment causes a deterioration of the hydrological system. This thesis employed a case-control study and examined the quality of drinking water and geographic variations in health of residents in two communities on Vancouver Island, South Wellington and Cinnabar, The control group, situated in Cinnabar, derives its water from the City of Nanaimo. However private groundwater wells supply drinking water to the study group, South Wellington. Abandoned coal mine workings degrade groundwater and in turn may affect the public through non-point source pollution. Disease and ill health are more common in South Wellington than in Cinnabar. The analyses of well water samples in South Wellington have revealed high levels of total dissolved solids and total conform, aluminum, antimony, arsenic, cadmium, iron, lead, selenium, sodium and thallium. Each of these elements has been linked to various diseases and disorders and may be predictive of ill health in South Wellington.

Background: Environmental exposure to inorganic arsenic (InAs) is a considerable worldwide problem, and over 57 million people in Bangladesh have been chronically exposed to arsenic-contaminated drinking water. Ingested inorganic arsenic (InAs) undergoes hepatic methylation generating monomethyl- (MMAs) and dimethyl- (DMAs) arsenic species in a process that facilitates urinary As (uAs) elimination. Of these three metabolites (InAs, MMA and DMA), MMA the most toxic, InAs is the second most toxic, and DMA is the least toxic. Consequently, increased MMAs is associated with increased risk of As-related adverse health outcomes. One-carbon metabolism (OCM), the biochemical pathway that provides methyl groups for As methylation, is influenced by folate and B12. A growing body of research, including cell-culture, animal-model, and epidemiological studies, have demonstrated the role of OCM-related micronutrients in As methylation. While folate supplementation is known to increase As methylation and lowers blood As (bAs) in adults, little data is available for adolescents. OCM also supports nucleotide and amino acid synthesis, particularly during periods of rapid growth, such as adolescence. In Bangladesh, deficiencies in folate and vitamin B12 are widespread. These micronutrients are essential for OCM and As methylation, and they are also critical for neural development, since they are necessary for the synthesis of neurotransmitters and myelin, and critical for generation of S-adenosyl-methionine (SAM) via OCM. Deficiencies in folate and B12 have been shown to negatively influence cognitive function in adults and children, but this has not been adequately characterized in adolescents. Individuals living in Bangladesh, facing As exposure and nutritional deficiency, also experience environmental exposure to elevated levels of cadmium (Cd), manganese (Mn), and lead (Pb). These metals have been linked to adverse neurocognitive outcomes in adults and children, though their effects on adolescents are not yet fully characterized. Additionally, previous studies have linked selenium (Se) levels to protective effects against toxicity of these other metals, as Se is an essential nutrient. Metal mixtures are also understudied in adolescents, and more research is needed. Objectives: Firstly, the research presented in this dissertation will examine the previously published evidence that nutritional status and nutritional interventions can influence the metabolism and toxicity of As, with a primary focus on folate. Secondly, the associations between OCM-related micronutrients and As methylation in Bangladeshi adolescents chronically exposed to As-contaminated drinking water will be studied. Thirdly, this dissertation will investigate the associations between folate and B12 nutritional status, homocysteine, and cognitive function as measured by two different test instruments in Bangladeshi adolescents. Finally, the associations between mixed metals exposure and cognitive function in Bangladeshi adolescents will be examined. Methods: The Metals, Arsenic, & Nutrition in Adolescents study (MANAs) is a cross-sectional study of 738 Bangladeshi adolescents aged 14-16 years, whose parents were enrolled in our group’s previous Health Effects of Arsenic Longitudinal Study (HEALS). Venous blood samples were collected from adolescent participants for measurement of plasma folate, red blood cell (RBC) folate, plasma B12, plasma homocysteine (Hcys), blood As (bAs), blood cadmium (bCd), blood manganese (bMn), blood lead (bPb), and blood selenium (bSe). Urine samples were collected for measurement of urinary arsenic and urinary arsenic metabolites (InAs, MMA, and DMA) expressed as a percentage of total urinary As: %InAs, %MMAs, %DMAs. Additionally, participants completed a modified version of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and an abbreviated version of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Associations between predictors and outcomes were assessed using linear regression analyses. Associations for the mixture of metals were also examined via Bayesian Kernel Machine Regression (BKMR), which assessed the effects of the metals mixture in addition to examining the effects each individual metal component. Results: In the linear regression analyses examining associations between nutritional status and arsenic methylation profiles controlling for water As and BMI, in girls we observed that RBC folate was inversely associated with bAs, plasma B12 was inversely associated with uAs, and, somewhat unexpectedly, plasma Hcys was inversely associated with %MMA. Among boys, we saw that plasma folate was inversely associated with %InAs and positively associated with %DMA, RBC folate was inversely associated with %InAs and positively associated with %MMA, while Hcys was positively associated with %InAs. In linear regression analyses examining the associations between nutritional status and cognitive function controlling for covariates, we found no significant associations between nutritional status and cognitive function as measured by WISC. For cognitive function as measured by CANTAB, we observed positive associations between plasma folate and spatial recognition memory, and between plasma B12 and spatial working memory. In our investigation of the associations between metal exposures and cognitive outcomes, linear regression analysis revealed negative associations between exposure to As and Mn and spatial working memory. Negative associations were also seen between bCd and Spatial Recognition Memory, and between bPb and Delayed Match to Sample. Finally, a positive association was seen between bSe and Spatial Span Length. Our BKMR results showed no overall effect of the mixture but further characterized the associations for individual metals within the mixture. BKMR analyses indicate that bPb has a negative association to Delayed Match to Sample, and that there are positive associations between bSe and Planning, Reaction Time, and Spatial Span. BKMR also showed higher concentrations of bCd to be negatively associated with Spatial Recognition Memory. Posterior inclusion probability consistently rated Se, which has a protective effect, as the most influential component of the mixture. Conclusions: These findings suggest that associations between OCM nutritional status, blood arsenic, and distribution of urinary As metabolites in adolescents are similar to previously reported observations in adults and in children. The inverse association between Hcys and %MMA in girls is unexpected since Hcys is known to be an indicator of impaired OCM and low folate/B12 in adults. These findings also suggest that associations between nutritional status and cognitive function in adolescents are consistent with previously reported associations in adults and children. The observation of positive associations between folate and spatial recognition memory and between B12 and spatial working memory are consistent with findings in animal models, children, and adults, all of which link deficiencies in these two micronutrients to memory deficits. The findings of the metals investigation are also consistent with previously reported observations in adults and children, and these results also suggest agreement between linear regression and BKMR analysis of the mixed metal exposure, with the BKMR further demonstrating associations seen in the linear regression analysis. Generally, Se had a protective effect for cognitive outcomes, whereas Mn and As were linked to poorer working memory, and Cd and Pb were linked to poorer visual recognition and memory. BKMR reinforced and further characterized results of the linear regression analyses. Overall, these results indicate that the associations between OCM-related micronutrients, arsenic methylation, metal exposure, and cognitive function in adolescents are generally similar to prior findings in adults and children. However, additional studies are needed to evaluate the impact of OCM and As methylation on As-related adverse health outcomes (such as cancer and cardiovascular disease) in people exposed to As during adolescence. These results also suggest that further investigation into the associations between nutritional status and measures of cognitive function in adolescents is merited, and that further exploration of homocysteine’s role in adolescent physiology is needed. Most importantly, these findings suggest that both nutritional interventions involving B12 and folate supplementation and metal exposure mitigation efforts may have a positive impact on overall health and well-being for individuals facing these environmental exposures. In the long term, interventions to reduce exposure to metals and nutritional deficiency, and interventions to attenuate the effects of these exposures have the potential to influence lifelong cognitive function, possibly influencing professional achievement and economic outcomes in regions having a high prevalence of nutritional deficiencies, arsenic exposure, and environmental exposure to metals mixtures.

Thesis. (M. Tech (Biotechnology, Faculty of Applied and Computer Science))--Vaal University of Technology, 2011.<br>Bottled water like any drinking water used for human consumption should be safe and wholesome to ensure adequate public health protection. This is due to potential health effects of concern such as endocrine disruption, toxicity teratogenicity, mutagenicity and carcinogenicity. Despite the number of regulatory bodies, publications on bottled water and speculations on its public health significance, many questions remain to be answered. One of the questions is whether the shelf life of bottled water is a cause for concern. The aim of the study was to determine the shelf-life of various commercial bottled waters by monitoring the variation in microbiological, chemical and aesthetic qualities of bottled water. A total of five commercial bottled water brands (A, B, C, D, E) each containing bottles from the same batch consisting of spring water, mineral water and bottled tap water were purchased directly after being bottled from different distributors around Gauteng in South Africa. All samples were stored at room temperature with artificial lighting and controlled temperature for a year thus mimicking typical conditions in retail outlets, supermarkets and in homes. Analyses were conducted over a period of 12 months, at monthly intervals. Within days of being purchased, high Heterotrophic plate counts (HPC) bacteria exceeding drinking water alert level >5 000 cfu/ml was common in four bottled water brands. Growth succession occurred during the period of study as various algal species were growing and accumulating on all bottled water tested. Total coliforms (TC), faecal coliforms (FC) and E.coli were not detected in all the bottled water tested. Yeasts and moulds were also not detected in all the bottled water. There were insignificant variations during the period of study for turbidity, pH, TDS, conductivity, and colour. These did not indicate any potential impact on aesthetic quality of bottled water. Two bottled water brands had hardness measures as low as 11mg/ℓ as CaCO3 making the water too soft which has an effect on taste. Radioactive substances, trihalomethanes, heavy metals, pesticides and other chemical contaminants were not found at levels that can be detrimental to human health.

Excessive nitrates in drinking water pose a human health threat, especially to infants. Methemoglobinemia, or blue-baby syndrome, is a potentially fatal condition that inhibits the ability of red blood cells to bind and transport oxygen. Nitrates/nitrites have also been linked to such conditions as cancer, birth defects, and behavioral and developmental abnormalities. Nitrates are frequently found in wells in rural farming areas because synthetic fertilizers (containing nitrates) leach from the soil into the groundwater. The Lower Umatilla Basin (LUB) in Morrow and Umatilla counties of Oregon represents an intensively farmed and irrigated area in which relatively high amounts of nitrates are present in the groundwater and domestic well water. This study investigated population demographics for the rural Lower Umatilla Basin, comparing these data to identified well-water nitrate levels for the purpose of estimating nitrate exposures and potential risk of adverse health effects in the survey area. Results of the investigation revealed that 25 percent of the domestic-use wells in the survey area had nitrate levels that were in excess of the 10 ppm nN MCL for drinking water, as established by the U.S. Environmental Protection Agency. From access to these wells, 23 percent of the surveyed population was exposed to nitrate concentrations in excess of the MCL standard. However, resident infants were neither exposed to well-water nitrates in excess of the standard, nor were they exposed to illness that could have increased the risk of methemoglobinemia. The LUB survey population was generally older than the populations from cities in the LUB or the combined populations of rural areas of Morrow and Umatilla counties. The population included few women of childbearing age, and it was not subject to an appreciable increase in the proportion of younger to older families. These factors reduced the likelihood of a significant increase in the infant population, which also minimized the risk of methemoglobinemia to this population. Even though the risk of methemoglobinemia to infants was low in the LUB area, it is recommended that exposures to well-water nitrates be prevented, if possible even for adults, to reduce the potential for chronic, adverse health effects from excess nitrate ingestion. Continued monitoring of private wells by state agencies is recommended, with attention directed at domesticuse wells with nitrate levels in excess of 10 ppm nN. This information should be shared with local health departments for follow-up, investigation, and educational efforts as needed. Future studies by the Oregon DEQ, or other agencies which seek to document the sources of well-water nitrate contamination in the LUB, should include an investigation of the influence of local sources of nitrate contamination.<br>Graduation date: 1993

Inorganic arsenic exposure is a well-known toxicant of which we are still discovering harmful effects. People are exposed to inorganic arsenic in the environment through either drinking arsenic-contaminated groundwater or consuming arsenic-contaminated food. Regarding global public health, drinking water is still the most important source of inorganic arsenic exposure and is the main focus of this work. The overall goal of this dissertation is to answer some pointing epidemiological questions about exposure to inorganic arsenic: How much do we know about inorganic arsenic and non-malignant lung disease in the general population? To what extent are adolescents with lifetime arsenic exposure susceptible to the respiratory consequences seen in adults? And what actions can be taken to effectively reduce exposure from arsenic-contaminated drinking water? First, we conducted a systematic review of 29 peer-reviewed articles from various populations around the world. The review focused on the different ways in which arsenic is associated with respiratory health to help inform policy makers and public health researchers on the existing evidence. In short, associations between arsenic and respiratory health were noted throughout the lifespan: in infancy, there was growing evidence that in utero arsenic exposure was associated with increased frequency and severity of respiratory tract infections; in childhood, evidence of respiratory symptoms also began to appear; and in adulthood, there was consistent evidence that arsenic exposure was associated with deficits in lung function and increased reports of coughing and breathing problems. The review also uncovered some research gaps, including few studies with strong exposure history from early life and few studies examining respiratory effects during adolescence. Next, we used a life course epidemiological approach to create a more precise understanding of arsenic exposure and respiratory health during the teenage years. This study examined the relationship between lifetime arsenic exposure and lung function in 14-17 year olds, thus studying the period of maximal lung function before natural decline. Overall, higher arsenic exposure was associated with lower lung function levels; however, these associations were only observed in males. This study used a sensitive marker of lung function to investigate early signs of small airway disease. Incorporating this common marker of small airway disease and airflow limitation in future studies on arsenic and respiratory health may help clarify how inorganic arsenic contributes to the development of chronic respiratory disease. Lastly, we evaluated the effectiveness of arsenic removal filters at the household-level in rural Bangladesh. Identifying sustainable ways of reducing exposure to arsenic from naturally contaminated groundwater has been a major environmental health challenge. Although lab-approved arsenic removal water filters exist, there was limited evidence of their prolonged efficacy in the field. To our knowledge, this was the largest and longest deployment of filters accompanied by monitoring of urinary arsenic. Our results demonstrated that filters can temporarily reduce arsenic exposure for weeks to a few months, but should not be considered as a long-term arsenic mitigation option. This failed attempt to reduce exposure confirmed that alternative mitigation strategies need to be employed in Bangladesh, particularly among more vulnerable populations, including pregnant women and young children. This dissertation has important policy implications for future arsenic research and mitigation efforts and should be effectively communicated to policy makers, public health officials, and the general population. Given the pervasive nature of arsenic exposure and the growing evidence of health consequences at different stages throughout the life course, the continued integration of information on inorganic arsenic and research collaborations across disciplines is critical for the prevention and mitigation of arsenic-induced health consequences.

Thesis (M. Com. (Economics))--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Economic & Business Sciences, 2017<br>This study establishes the causal impact of piped water access on child health in rural South Africa (2008 – 2015) through the use of a panel dataset and a quasi-experimental sample space. By employing an ordinal measure of child health as the dependent variable within ordinal probit, fixed and random effects, propensity-score matched difference-in-difference and system-GMM estimators, it is demonstrated that positive health benefits for children with access to piped water are observed if and only if the minimum level of educational attainment of the primary-caregiver is equal to or greater than 7 years. This finding of complementarity is demonstrated to be a function of an individual’s (in)capacity to evaluate water quality: people below this threshold suffer from a piped water bias, place insufficient weight on the observable characteristics of water when determining water quality and are subsequently less likely to treat piped water preceding consumption. The interactional effect estimates are statistically significant at the 5% level with the impact ranging from 1.617 to 2.008 levels.<br>GR2018

The removal of microbial populations from potable water has been a practice with great importance towards public health, as it has resulted in the reduction of literally millions of cases of infectious disease. In the United States, pathogenic organisms are most commonly removed from drinking water through the application of chlorine. Ninety-nine per cent of all U.S. potable water treatment facilities that disinfect, rely on chlorine as their sole or primary disinfectant, and over 175,000,000 Americans regularly consume chlorinated water. In 1974, Rook and Bellar et al. published studies which indicated that chlorine reacted with organic matter in water during treatment to produce a wide-range of halogenated by-products. Since that time, numerous analyses have been performed to isolate and identify the by-products of chlorination. Toxicologic and epidemiologic studies have been performed, some of which suggest that the use of chlorine as a disinfectant may be contributing to the incidence of chronic disease in the United States. Because of the concern that the use of chlorine for potable water disinfection may be contributing to chronic disease, Amendments to the Safe Drinking Water Act (SDWA) have been promulgated which strictly regulate disinfectants and disinfection by-products. Future disinfectant and disinfectant by-product regulations (1992) will have a major impact on the purveyors of potable water in the U.S.. Probably the largest challenge U.S. water treatment utilities now face is in the attempt to control for disinfectants and disinfectant by-products while maintaining the microbiological integrity of the water supply. The SDWA Amendments and their supporting regulations will result in major changes in the way water quality parameters are measured, and the way disinfection and treatment strategies are practiced. This thesis looks closely at the role of chlorine as a disinfectant, the by-products arising from chlorine reacting with organic matter, as well as the rationale behind the disinfectant and disinfectant by-product regulations. After examining the chemical, toxicologic and epidemiologic evidence which fueled the new SDWA regulations, available treatment strategies for meeting the new regulations will be detailed and examined. A water treatment strategy which best appears to maximize the reduction of waterborne disease and minimize the risk of chronic disease will then be offered.<br>Graduation date: 1992

The Safe Drinking Water Act ensures that public systems provide water that meets health standards. However, no such protection exists for millions of Americans who obtain water from private wells. Concern for safety is warranted as most wells draw from underground aquifers, and studies demonstrate that groundwater is affected by a range of contaminants, most often nitrate. Oregon's Domestic Well Testing Act (DWTA) links well testing to property sales, enabling continuous data collection by the State. This research addresses a need for identifying datasets for characterizing exposure to private well contaminants by evaluating DWTA data for use in a sentinel surveillance system. Validation of DWTA data was accomplished by developing a land use regression (LUR) model based on agricultural nitrogen inputs and soil leachability to predict nitrate concentrations in well water. Geographic information systems (GIS) were used to advance methods for high resolution spatial modeling of fertilizer and manure nitrogen with statewide coverage. Hazard mapping with these datasets suggests that nearly half of recently drilled wells are susceptible to nitrate contamination. Spearman's rank correlation demonstrated a significant correlation between LUR-predicted nitrate levels and levels reported in the DWTA dataset. These results suggest that DWTA data is valid for use in a sentinel surveillance system, such that evidence of nitrate contamination in a single well may indicate an area-wide health hazard. However, a low fraction of variance explained by the LUR model highlighted the need for specific improvements to datasets crucial for understanding nitrate contamination in well water, including the DWTA.<br>Graduation date: 2012

This dissertation discusses three questions of development and environmental economics. First, it assesses the impact of mineral mining on the health and wealth of households in local communities across 44 developing countries, using micro data. Secondly, it presents evidence from a randomized controlled trial on the cost-shared provision of well-water tests for arsenic. Finally, it analyzes measurement error in a satellite night light data product widely used in development research, and investigates the scope for using the data in very high spatial resolution.