Household-specific feedback on the microbiological safety of drinking water may result in changes to water management practices that reduce exposure risks. We conducted a randomized, controlled trial in India to determine if information on household drinking water quality could change behavior and improve microbiological quality as indicated by Escherichia coli counts. We randomly assigned 589 participating households to one of three arms: (1) a messaging-only arm receiving messaging on safe water management ( n = 237); (2) a standard testing arm receiving the same messaging plus laboratory E. coli testing results specific to that household's drinking water ( n = 173); and (3) a test kit arm receiving messaging plus low-cost E. coli tests that could be used at the household's discretion ( n = 179). Self-reported water treatment increased significantly in both the standard testing arm and the test kit arm between baseline and follow-up one month later. Mean log E. coli counts per 100 mL in household stored drinking water increased in the messaging-only arm from 1.42 to 1.87, while decreasing in the standard testing arm (1.38 to 0.89, 65% relative reduction) and the test kit arm (1.08 to 0.65, 76% relative reduction). Findings indicate that household-specific water quality information can improve both behaviors and drinking water quality.

The objective of the present study was to determine the effect of nitrates on the incidence of gastrointestinal (GI) cancer development. Nitrate converted to nitrite under reducing conditions of gut results in the formation of N-nitrosamines which are linked to an increased gastric cancer risk. A population of 234 individuals with 78 cases of GI cancer and 156 controls residing at urban and rural settings in Nagpur and Bhandara districts of India were studied for 2 years using a case-control study. A detailed survey of 16 predictor variables using Formhub software was carried out. Nitrate concentrations in vegetables and primary drinking water supplies were measured. The logistic regression model showed that nitrate was statistically significant in predicting increasing risk of cancer when potential confounders were kept at base level (P value of 0.001 nitrate in drinking water; 0.003 for nitrate in vegetable) at P < 0.01. Exposure to nitrate in drinking water at >45 mg/L level of nitrate was associated with a higher risk of GI cancers. Analysis suggests that nitrate concentration in drinking water was found statistically significant in predicting cancer risk with an odds ratio of 1.20.

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Healthcare facilities are an under-characterized source of pharmaceuticals to municipal wastewaters. In this study, the composition and magnitude of sixteen cardiovascular active pharmaceutical ingredients (APIs) and two cardiovascular API metabolites in wastewater effluents from a hospital, nursing care, assisted living, and independent living facility are presented. Each cardiovascular API was detected in at least one facility's wastewater. The hospital's wastewater had the most detected cardiovascular APIs with thirteen of the eighteen measured compounds positively confirmed and quantified. Maximum mean analyte concentrations within each healthcare facility's wastewater were: 11.3 µg L(-1) atenolol for the independent living facility; 8.7 µg L(-1) valsartan for the assisted living facility; 2.7 µg L(-1) diltiazem for the nursing home facility; and 14.6 µg L(-1) valsartan for hospital facility. Daily wastewater flow was combined with individual concentrations to estimate the cardiovascular API mass loadings leaving each facility through wastewater discharges to the municipal sewer system. The estimated daily mass loading of all measured cardiovascular APIs ranged from 0.87 g per day at the assisted living facility to 12.5 g per day at the hospital. The combined loading for all four facilities was 16.2 g per day. This presented research informs the risk management process by providing source characterization data for healthcare facility wastewaters containing commonly prescribed cardiovascular APIs.