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Background: The migration over the Mediterranean has become one of the deadliest sea voyages in last few years. The NGO Open Arms works in the area since 2015, with the objectives of protecting and reporting human rights at sea. This paper aims to give an overview on characteristics and health conditions of rescued people by the NGO in the Central Mediterranean. Methods: A descriptive retrospective population study was conducted, including people who were rescued from distress at sea by the NGO Open Arms from 1st July 2016 to 31st December 2018. Results: In this period of time 22,234 people were rescued from sea. Among them 2234 (22.7%) were minors, and 177 (0.8%) pregnant women. The most frequent countries of origin were Nigeria (1278–13.1%), Eritrea (1215–12.3%) and Bangladesh (981–9.9%). Among all people rescued, 4516 (20.3%) reported symptoms. Scabies was the most frequent pathology, being suspected in 1817 (8.2%) people. Other infectious diseases were diagnosed in 91 (0.4%). Thirty-five (0.16%) patients suffered some complication from their chronic diseases. Acute injuries due to trauma, burns, aggressions, and bullet or bladed weapon wound were reported in 135 (0.6%) cases. Seventy-four corpses were recovered. Conclusions: Main diagnoses on board were directly related to the precarious living conditions through migratory route, violence and complications of chronic diseases due to lack of care. The large number of people rescued highlights the catastrophic effect on migrants' health of European policies, which overlap the desire to restrict migratory movements on the humanitarian and health issues. An integrated information system and a coordinated response are basic to improve the situation in the area. [ABSTRACT FROM AUTHOR]

Deep tubewells are important sources of arsenic mitigation in rural Bangladesh. Compared to commonly available shallow tubewells, deep tubewells tap into deeper low-arsenic aquifers and greatly reduce exposure to arsenic in drinking-water. However, benefits from these more distant and expensive sources may be compromised by higher levels of microbial contamination at point-of-use (POU). This paper examines differences in microbial contamination levels at source and POU among households using deep tubewells and shallow tubewells, and investigates factors associated with POU microbial contamination among deep tubewell users. We assessed a prospective longitudinal cohort of 500 rural households in Matlab, Bangladesh, across 135 villages. Concentration of Escherichia coli (E. coli) in water samples at source and POU using Compartment Bag Tests (CBTs) was measured across rainy and dry seasons. We employed linear mixed-effect regression models to measure the effect of different factors on log E. coli concentrations among deep tubewell users. CBT results show that log E. coli concentrations are similar at source and at POU during the first dry and rainy season, but are significantly higher at POU among deep tubewell users during the second dry season. Log E. coli at POU among deep tubewell users is positively associated with both presence (exponentiated beta exp (b) = 2.52, 95% Confidence Interval (CI) = 1.70, 3.73) and concentration of E. coli (exp(b) = 1.36, 95% CI = 1.19, 1.54) at source, and walking time to the tubewell source (exp(b) = 1.39, 95% CI = 1.15, 1.69). Drinking-water during the second dry season is associated with reduced log E. coli (exp(b) = 0.33, 95% CI = 0.23, 0.57) compared to the rainy season. These results suggest that while households that use deep tubewells have lower arsenic exposure, they may be at higher risk of consuming microbially contaminated water compared to households that use shallow tubewells. [Display omitted] • Deep tubewell use may increase domestic drinking-water microbial contamination risk. • Deep tubewell (DTW) users often use non-private sources and walk longer to source. • Source contamination exacerbates point-of-use contamination among DTW users. • Rainy season and longer time to source increases contamination risk among DTW users. [ABSTRACT FROM AUTHOR]

Bangladesh is underlain by shallow aquifers in which millions of drinking water wells are emplaced without annular seals. Fecal contamination has been widely detected in private tubewells. To evaluate the impact of well construction on microbial water quality 35 private tubewells (11 with intact cement platforms, 19 without) and 17 monitoring wells (11 with the annulus sealed with cement, six unsealed) were monitored for culturable Escherichia coil over 18 months. Additionally, two 'snapshot' sampling events were performed on a subset of wells during late-dry and early-wet seasons, wherein the fecal indicator bacteria (FIB) E. coli, Bacteroidales and the pathogenicity gene eltA (enterotoxigenic E. coli; ETEC), ipaH (Shigella) and 40/41 hexon (adenovirus) were detected using quantitative polymerase chain reaction (qPCR). No difference in E. coli detection frequency was found between tubewells with and without platforms. Unsealed private wells, however, contained culturable E. coli more frequently and higher concentrations of FIB than sealed monitoring wells (p < 0.05), suggestive of rapid downward flow along unsealed annuli. As a group the pathogens ETEC, Shigella and adenovirus were detected more frequently (10/22) during the wet season than the dry season (2/20). This suggests proper sealing of private tubewell annuli may lead to substantial improvements in microbial drinking water quality. [ABSTRACT FROM AUTHOR]

Background Millions of households throughout Bangladesh have been exposed to high levels of arsenic (As) causing various deadly diseases by drinking groundwater from shallow tubewells for the past 30 years. Well testing has been the most effective form of mitigation because it has induced massive switching from tubewells that are high (>50 μg/L) in As to neighboring wells that are low in As. A recent study has shown, however, that shallow low-As wells are more likely to be contaminated with the fecal indicator E. coli than shallow high-As wells, suggesting that well switching might lead to an increase in diarrheal disease. Methods Approximately 60,000 episodes of childhood diarrhea were collected monthly by community health workers between 2000 and 2006 in 142 villages of Matlab, Bangladesh. In this cross-sectional study, associations between childhood diarrhea and As levels in tubewell water were evaluated using logistic regression models. Results Adjusting for wealth, population density, and flood control by multivariate logistic regression, the model indicates an 11% (95% confidence intervals (CIs) of 4-19%) increase in the likelihood of diarrhea in children drinking from shallow wells with 10-50 μg/L As compared to shallow wells with >50 μg/L As. The same model indicates a 26% (95%CI: 9-42%) increase in diarrhea for children drinking from shallow wells with ≤10 μg/L As compared to shallow wells with >50 μg/L As. Conclusion Children drinking water from shallow low As wells had a higher prevalence of diarrhea than children drinking water from high As wells. This suggests that the health benefits of reducing As exposure may to some extent be countered by an increase in childhood diarrhea. [ABSTRACT FROM AUTHOR]

The goal of this study was to test hollow-fiber ultrafiltration as a method for concentrating in situ bacteria and viruses in groundwater samples. Water samples from nine wells tapping a shallow sandy aquifer in a densely populated village in Bangladesh were reduced in volume approximately 400-fold using ultrafiltration. Culture-based assays for total coliforms and Escherichia coli, as well as molecular-based assays for E. coli, Bacteroides, and adenovirus, were used as microbial markers before and after ultrafiltration to evaluate performance. Ultrafiltration increased the concentration of the microbial markers in 99% of cases. However, concentration factors (CF = post-filtration concentration/pre-filtration concentration) for each marker calculated from geometric means ranged from 52 to 1018 compared to the expected value of 400. The efficiency was difficult to quantify because concentrations of some of the markers, especially E. coli and total coliforms, in the well water (WW) collected before ultrafiltration varied by several orders of magnitude during the period of sampling. The potential influence of colloidal iron oxide precipitates in the groundwater was tested by adding EDTA to the pre-filtration water in half of the samples to prevent the formation of precipitates. The use of EDTA had no significant effect on the measurement of culturable or molecular markers across the 0.5 to 10 mg/L range of dissolved Fe concentrations observed in the groundwater, indicating that colloidal iron did not hinder or enhance recovery or detection of the microbial markers. Ultrafiltration appears to be effective for concentrating microorganisms in environmental water samples, but additional research is needed to quantify losses during filtration. [ABSTRACT FROM AUTHOR]

The health risks of As exposure due to the installation of millions of shallow tubewells in the Bengal Basin are known, but fecal contamination of shallow aquifers has not systematically been examined. This could be a source of concern in densely populated areas with poor sanitation because the hydraulic travel time from surface water bodies to shallow wells that are low in As was previously shown to be considerably shorter than for shallow wells that are high in As. In this study, 125 tubewells 6-36 m deep were sampled in duplicate for 18 months to quantify the presence of the fecal indicator Escherichia coli. On any given month, E. coli was detected at levels exceeding 1 most probable number per 100 mL in 19-64% of all shallow tubewells, with a higher proportion typically following periods of heavy rainfall. The frequency of E. coli detection averaged over a year was found to increase with population surrounding a well and decrease with the As content of a well, most likely because of downward transport of E. coli associated with local recharge. The health implications of higher fecal contamination of shallow tubewells, to which millions of households in Bangladesh have switched in order to reduce their exposure to As, need to be evaluated. [ABSTRACT FROM AUTHOR]