Water, Sanitation, and Hygiene (WASH) assessments twoyears after Nepal 2015 earthquake
2nd IDRC 2019, World Bosai Forum
November 12, 2019

Sital Uprety
Department of Civil and Environmental Engineering
University of Illinois at Urbana-Champaign

1Less than 50% Basic Water and Sanitation Coverage in many
placesBasic Drinking Water Coverage

Basic Sanitation Coverage

Source: WHO, 2015

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Severity of the situation: Why we need more work?

Water

Source: UNICFE, 2015

Sanitation3

What is being done? Sustainable Development
Goal 6 (SDG 6)• Ensure availability andsustainable management ofwater and sanitation for all.
• Increase the investments insanitation and drinking
water to meet the subtargets by 2030.

Source: UN Water, 20184

Challenges to meet SDGs?
• Increased number of natural
disasters linked to climatechange.1• Complications to meet SDG 6by 2030 with increased
number of natural disasters,
esp in Asia as Water andSanitation issues areworsening after any naturaldisaster.

1: Natural Disasters and Climate Change (2017)
Image Source: IDD, Belgium

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WASH Behavior and Diarrheal Diseases• Because of limited resources
and compromised livingsituation, natural disastervictims change their hygiene
behaviors to meet the basic
needs.1• This can result in a diarrheal
disease outbreak like in Haiti
after 2010 Earthquake.
1: Uprety et al. (2017)
Image Source: RefliefWeb & CDC

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Research Gap: What are we trying to address??
• How people adapt their WASH
behavior after natural disaster?

• Is the adapted behavior helping
or hurting their risks of getting
infected with diarrheal diseases?
• Although intervention works, howeffective is it in removing
pathogens from households(microbial analysis)?
Image Source: ENPHO

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Interrelation: WASH Behavior and Other Factors

Extreme Natural
EventsHuman Behavior Associatedwith WASH

WASH
Interventions

8Timeline of the Study

2015

NepalEarthquake

2015

WASH Relief
immediately
after theearthquake2017

E. coli testingin 2800 water
samplesthroughout
the country
postearthquake

WASH
Intervention

20172018 &2019

Water Quality
andSanitation
Study inTemporaryandPermanent
Settlements

Change inmicrobial
waterquality
during andafterintervention

Betterunderstandingof immediateand prolonged
effect ofnatural
disasters onWASHbehavior andits outcome

9Pathogen exposure pathways at temporary and permanent
settlements two years after the Nepal earthquake
Village 1: Permanent Settlements

10 Houses

Village 3: Temporary Settlements

10 Houses

10Sites: V1 and V3• Both villages are located in oneof the high risk districts fordiarrheal diseases.
• They have similar population
size and almost samehydroclimatic conditions.
• Water and sanitation samples
were taken in 2017 from thesetwo villages in triplicates for
microbial quantification.
• Approximately 30 samples foreach sample type for eachvillage (V1 and V3) adding up to~360 samples per samplingseason.

V1V311Sample Types: F- Diagram• 6 sample type collectedfrom each house in eachsampling round (3sampling rounds)• Drinking Water (DW)
• Cleaning Water (CW)
• Handwash Water (HW)
• Swab - Toilet Handle (TH)• Swab - Utensils (U)• Swab – Water Vessel (WV)

Graaf et al., 201712

Experimental Method
2 L Water

1.6 um2 filters per sample

DNA Extraction

DNA Extraction

Biomark

0.45 um

Swab13

Biomark System• Can simultaneously quantify up to 48
pathogens in the same sample.
• Faster, efficient and reliable quantificationas conventional qPCR.
• 24 assays (bacterial pathogenic genes)
were selected based on the primer validityand disease incidences in Nepal.
• 10 plates ran for total >300 samples
collected in 2017.

48x48 plate = 2,304 reactions
Less labor and less time thanconventional qPCR

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Results: Fluidigm ResultIAC••

Average assay
efficiency =93.4%
Only assays
greater than
90% and lessthan 110% areconsidered forthe analysis.

2x106 copies/uL

Standard

2x100 copies/uLNC16Results: Overall detection in all samples• Highest detection of Enterococcus
spp. in ~78% of the samples.
• 63% of samples were positive forLegionella pneumphila.
• 34% of total samples had one
gene of Salmonella typhimurium.

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Higher detection of pathogens from all sources in V3
compared to V1 but not statistically significant
V1V3
P-value: 0.82

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Enterococcus spp. significantly higher in toilet handle,utensils and water vessels in V3 compared to V1<0.001**0.01*<0.0001***

WilcoxonT-test

0.66

0.59

0.20

V1V319No statistical difference in detection of E. coli in different
samples between V1 and V3V1V3
E. Coli (uidA)

E. Coli (ftsz)

0.55

0.18

0.97

0.92

0.33

0.51

0.24

0.61

0.74

0.98

0.29

0.65

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Higher concentration of Salmonella was observed in V1for water samples
Salmonella typhimirium (ttrC)

0.04 *

0.027*

0.18

0.212
0.14

0.0018**
V1V321

Difference in Legionella pneumophila (miP) was onlyobserved in water vessel
0.96

0.002**
0.90

0.76

0.59
0.95

V1V322Statistical data between V1 and V3
Stat Summary:

V1Enterococcus
spp.

CWV3

E. coli(uidA)

Salmonella STEC
(ttrC)(stx2)

0.29

DW

0.66
0.59

0.65

0.18
0.042*

HW

0.20

0.98

TH

<0.001***0.51

U0.013**<0.001***WV

E. coli Legionella(ftsZ) (mip)
0.18
0.63
0.96
0.91

0.97

0.027*

0.30

0.92

0.90
0.76

0.14

0.19

0.55

0.95

0.21
0.61
0.74 0.0018**

0.66

0.33

0.59

0.43

0.24

0.002**
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Can microbial composition help us understand this in abetter way?
• 85 samples from both villages wererandomly selected for 16S rRNA
sequencing using MiSeq platform.
• Possible difference in bacterial profile
between different villages anddifferent samples were sought.
• Investigate the 16S profile to see if we
missed any important bacteria.
• Investigate whether or not, there is atransfer between water samples andhygiene samples.
Mohit et. al (2014)

Previous studies have also shown
different between attached and freeliving bacterial profile24

Microbes were evenly distributed between V1 and V3P-value = 0.103

Observed OTUs

Shannon Index

P-value = 0.433

V1V3

Species Diversity(How different?)

V1V3
Species Richness(How many?)25

Microbial composition different between sample type26

Relative Abundance: Class level

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Conclusions• Enterococcus spp. indicated a possible higher risk inthe village with temporary settlements compared tothe village with permanent settlements.
• Possible high risk of infection by Salmonella
typhirimium and Legionella penumophila from watervessel. QMRA will make this more clear.
• Sequencing results showed a very different bacterial
profile for sanitation samples compared to watersamples. Pathogenic family more dominant in swab
samples compared to water samples.
• Recovery affects microbial contamination.
Side note: Undergrads
contributed a lot to this projectImage Source: ENPHO, Nepal

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Thank you!

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