{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:15:25Z","timestamp":1790817325163,"version":"4.1.0"},"reference-count":116,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2018,3,12]],"date-time":"2018-03-12T00:00:00Z","timestamp":1520812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Improved water, sanitation and hygiene (WASH) are significant in preventing diarrhea morbidity and mortality caused by protozoa in low- and middle-income countries. Due to the intimate and complex relationships between the different WASH components, it is often necessary to improve not just one but all of these components to have sustainable results. The objective of this paper was to review the current state of WASH-related health problems caused by parasitic protozoa by: giving an overview and classification of protozoa and their effect on people\u2019s health, discussing different ways to improve accessibility to safe drinking water, sanitation services and personal hygiene behavior; and suggesting an institutional approach to ensure improved WASH. The findings indicate that Giardia and Cryptosporidium are more often identified during waterborne or water-washed outbreaks and they are less sensitive than most of the bacteria and viruses to conventional drinking water and wastewater treatment methods. There are various institutions of control and prevention of water-related diseases caused by protozoa in developed countries. Unfortunately, the developing regions do not have comparable systems. Consequently, the institutional and systems approach to WASH is necessary in these countries.<\/jats:p>","DOI":"10.3390\/ijerph15030495","type":"journal-article","created":{"date-parts":[[2018,3,12]],"date-time":"2018-03-12T13:13:48Z","timestamp":1520860428000},"page":"495","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":198,"title":["Protozoan Parasites in Drinking Water: A System Approach for Improved Water, Sanitation and Hygiene in Developing Countries"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2087-3824","authenticated-orcid":false,"given":"Alua","family":"Omarova","sequence":"first","affiliation":[{"name":"Department of Nutrition and General Hygiene, Karaganda State Medical University, Gogol Street 40, Karaganda 100008, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamshat","family":"Tussupova","sequence":"additional","affiliation":[{"name":"Department of International Cooperation and Bologna Process, Karaganda State Medical University, Gogol Street 40, Karaganda 100008, Kazakhstan"},{"name":"Division of Water Resources Engineering &amp; Center for Middle Eastern Studies, Lund University, P.O. Box 118, SE-221 00 Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1473-0138","authenticated-orcid":false,"given":"Ronny","family":"Berndtsson","sequence":"additional","affiliation":[{"name":"Division of Water Resources Engineering &amp; Center for Middle Eastern Studies, Lund University, P.O. Box 118, SE-221 00 Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6693-8646","authenticated-orcid":false,"given":"Marat","family":"Kalishev","sequence":"additional","affiliation":[{"name":"Department of Nutrition and General Hygiene, Karaganda State Medical University, Gogol Street 40, Karaganda 100008, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kulyash","family":"Sharapatova","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gynecology and Pediatry, Semey State Medical University, Pavlodar Branch, Toraigyrov Street 72\/1, Pavlodar 140000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bartram, J., and Cairncross, S. (2010). Hygiene, sanitation, and water: Forgotten foundation of health. PLoS Med., 7.","DOI":"10.1371\/journal.pmed.1000367"},{"key":"ref_2","unstructured":"Pr\u00fcss-\u00dcst\u00fcn, A., Bos, R., Gore, F., and Bartram, J. (2008). Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, World Health Organization."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"710","DOI":"10.2471\/BLT.07.050054","article-title":"Estimating child mortality due to diarrhea in developing countries","volume":"86","author":"Velebit","year":"2008","journal-title":"Bull. World Health Org."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.watres.2017.01.036","article-title":"Waterborne transmission of protozoan parasites: Review of worldwide outbreaks\u2014An update 2011\u20132016","volume":"114","author":"Efstratiou","year":"2017","journal-title":"Water Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6603","DOI":"10.1016\/j.watres.2011.10.013","article-title":"Waterborne transmission of protozoan parasites: Review of worldwide outbreaks\u2014An update 2004\u20132010","volume":"45","author":"Baldursson","year":"2011","journal-title":"Water Res."},{"key":"ref_6","unstructured":"Cotruva, J.A., Durfour, A., Rees, G., Bartram, J., Carr, R., Cliver, D.O., Craun, G.F., Fayer, R., and Gannon, V.P.J. (2004). Waterborne Zoonoses: Identification Causes and Control, World Health Organization, IWA Publishing."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1128\/CMR.05038-11","article-title":"Enteric protozoa in the developed world: A public health perspective","volume":"25","author":"Fletcher","year":"2012","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"86","DOI":"10.11599\/germs.2014.1061","article-title":"Human parasitic protozoa in drinking water sources in rural Zimbabwe and their link to HIV infection","volume":"4","author":"Ruhanya","year":"2014","journal-title":"Germs"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"753512","DOI":"10.1155\/2010\/753512","article-title":"Global Distribution, Public Health and Clinical Impact of the Protozoan Pathogen Cryptosporidium","volume":"2010","author":"Putignani","year":"2010","journal-title":"Interdiscip. Perspect. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Yang, K., LeJeune, J., Alsdorf, D., Lu, B., Shum, C.K., and Liang, S. (2012). Global Distribution of Outbreaks of Water-Associated Infectious Diseases. PLoS Negl. Trop. Dis., 6.","DOI":"10.1371\/journal.pntd.0001483"},{"key":"ref_11","unstructured":"Cairncross, S., and Feachem, R.G. (1983). Environmental Health Engineering in the Tropics: An Introductory Text, John & Wiley Sons. [2nd ed.]."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1128\/CMR.15.4.595-612.2002","article-title":"History of human parasitology","volume":"15","author":"Cox","year":"2002","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_13","unstructured":"Baron, S. (1996). Protozoa: Structure, Classification, Growth, and Development. Medical Microbiology, University of Texas Medical Branch at Galveston. [4th ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1080\/1040-840291046713","article-title":"Current trends in research into the waterborne parasite Giardia","volume":"28","author":"Lane","year":"2002","journal-title":"Crit. Rev. Microbiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1186\/s13071-017-2111-y","article-title":"Cryptosporidium and Giardia in Africa: Current and future challenges","volume":"10","author":"Squire","year":"2017","journal-title":"Parasites Vectors"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.gtc.2006.03.006","article-title":"An updated review on Cryptosporidium and Giardia","volume":"35","author":"Huang","year":"2006","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"106S","DOI":"10.1111\/j.1365-2672.2000.tb05338.x","article-title":"Escherichia coli: The best biological drinking water indicator for public health protection","volume":"88","author":"Edberg","year":"2000","journal-title":"J. Appl. Microbiol. Symp. Suppl."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1515\/REVEH.2001.16.2.117","article-title":"Direct exposure to animal enteric pathogens","volume":"16","author":"Enriquez","year":"2001","journal-title":"Rev. Environ. Health"},{"key":"ref_19","first-page":"23","article-title":"Reviewing efficacy of alternative water treatment techniques","volume":"55","author":"Hambidge","year":"2001","journal-title":"Health Estate"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4951","DOI":"10.1128\/AEM.68.10.4951-4955.2002","article-title":"Mechanisms of inactivation of hepatitis A virus by chlorine","volume":"68","author":"Li","year":"2002","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.tox.2004.01.030","article-title":"Microbial contamination of drinking water and disease outcomes in developing regions","volume":"198","author":"Ashbolt","year":"2004","journal-title":"Toxicology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"113S","DOI":"10.1017\/S0031182099004898","article-title":"Detection of parasites in the environment","volume":"117","author":"Smith","year":"1998","journal-title":"Parasitology"},{"key":"ref_23","unstructured":"(2017, December 16). Giardiasis and Cryptosporidiosis. Available online: http:\/\/wildlifedisease.unbc.ca\/giardia_cryptosporidium.htm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1128\/CMR.00067-12","article-title":"Transmission and Epidemiology of Zoonotic Protozoal Diseases of Companion Animals","volume":"26","author":"Esch","year":"2013","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_25","unstructured":"(2017, November 27). Centers for Disease Control and Prevention, Cryptosporidiosis, Available online: https:\/\/www.cdc.gov\/dpdx\/cryptosporidiosis\/index.html."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.pt.2008.08.002","article-title":"Active invasion and\/or encapsulation? A reappraisal of host-cell parasitism by Cryptosporidium","volume":"24","author":"Borowski","year":"2008","journal-title":"Trends Parasitol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2166\/wh.2006.002","article-title":"Waterborne transmission of protozoan parasites: A worldwide review of outbreaks and lessons learnt","volume":"5","author":"Karanis","year":"2007","journal-title":"J. Water Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/S0043-1354(01)00279-2","article-title":"Prevalence of Cryptosporidium oocysts and Giardia cysts in the drinking water supply in Japan","volume":"36","author":"Hashimoto","year":"2002","journal-title":"Water Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2993","DOI":"10.1128\/AEM.67.7.2993-3001.2001","article-title":"Chlorine dioxide inactivation of Cryptosporidium parvum oocysts and bacterial spore indicators","volume":"67","author":"Chauret","year":"2001","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_30","first-page":"131","article-title":"Kriptosporidioz [Cryptosporidiosis]","volume":"2","author":"Chistenko","year":"2011","journal-title":"Voyennaya Med. [Milit. Med.]"},{"key":"ref_31","unstructured":"(2017, November 27). Giardia and Drinking Water from Private Wells, Available online: https:\/\/www.cdc.gov\/healthywater\/drinking\/private\/wells\/disease\/giardia.html."},{"key":"ref_32","unstructured":"Mazayev, V.T., Korolev, A.A., and Shlepnina, T.G. (2005). Kommunal\u2019naya Gigiyena (Municipal Hygiene), GEOTAR-MED Publication."},{"key":"ref_33","unstructured":"(2017, May 29). Waterborne Disease and Outbreak Surveillance System, Available online: https:\/\/www.cdc.gov\/healthywater\/surveillance."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.vetpar.2004.09.002","article-title":"Drinking water treatment processes for removal of Cryptosporidium and Giardia","volume":"126","author":"Betancourt","year":"2004","journal-title":"Vet. Parasitol."},{"key":"ref_35","unstructured":"Gregory, R., Zabel, T.F., and Edzwald, J.K. (1999). Sedimentation and flotation. Water Quality and Treatment, McGraw Hill."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1002\/j.1551-8833.1995.tb06425.x","article-title":"Removing Cryptosporidium by dissolved air-flotation","volume":"87","author":"Plummer","year":"1995","journal-title":"J. AWWA"},{"key":"ref_37","unstructured":"States, S.M., Sykora, J., Stadterman, K., Wright, D., Baldizar, J., and Conley, L. (1995, January 12\u201316). Sources, occurrence, and drinking water treatment removal of Cryptosporidium and Giardia in the Allegheny River. Proceedings of the 1995 Water Quality Technology Conference, New Orleans, LA, USA."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1021\/es60058a005","article-title":"Water and waste water filtration. Concepts and application","volume":"5","author":"Yao","year":"1971","journal-title":"Environ. Sci. Technol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/j.1551-8833.1999.tb08700.x","article-title":"Effect of filter media on cyst and oocyst removal","volume":"91","author":"Swertfeger","year":"1999","journal-title":"J. Am. Water Works Assoc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/j.1551-8833.1990.tb07069.x","article-title":"Diatomaceous earth filtration of cysts and other particulates using chemical additives","volume":"82","author":"Schuler","year":"1990","journal-title":"J. AWWA"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1002\/j.1551-8833.1997.tb08338.x","article-title":"DE filtration to remove Cryptosporidium","volume":"89","author":"Ongerth","year":"1997","journal-title":"J. AWWA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1002\/j.1551-8833.2001.tb09355.x","article-title":"Testing of diatomaceous earth filtration for removal of Cryptosporidium oocysts","volume":"93","author":"Ongerth","year":"2001","journal-title":"J. AWWA"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/S0011-9164(97)00120-3","article-title":"Role of membrane technology in drinking water treatment in the United States","volume":"113","author":"Jacangelo","year":"1997","journal-title":"Desalination"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1002\/ep.670220116","article-title":"A review of pressure-driven membrane processes in wastewater treatment and drinking water production","volume":"22","author":"Vandecasteele","year":"2003","journal-title":"Environ. Prog."},{"key":"ref_45","unstructured":"Thorsen, T., and Flogstad, H. (2006). Nanofiltration in Drinking Water Treatment, Techneau."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2610","DOI":"10.1128\/aem.57.9.2610-2616.1991","article-title":"Giardia and Cryptosporidium spp. in filtered drinking water supplies","volume":"57","author":"LeChevallier","year":"1991","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2307\/4584715","article-title":"Influence of pH and temperature on the survival of coliforms and enteric pathogens when exposed to free chlorine","volume":"58","author":"Butterfield","year":"1943","journal-title":"Public Health Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"354","DOI":"10.4269\/ajtmh.2007.76.354","article-title":"Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: A systematic review and meta-analysis","volume":"76","author":"Arnold","year":"2007","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_49","unstructured":"(2018, January 30). Bringing Safe Water to Scale, Available online: https:\/\/nepis.epa.gov\/Exe\/ZyPDF.cgi\/200024OD.PDF?Dockey=200024OD.PDF."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"203","DOI":"10.4025\/actascitechnol.v37i2.24950","article-title":"Study of sequential disinfection for the inactivation of protozoa and indicator microorganisms in wastewater","volume":"37","author":"Medeiros","year":"2015","journal-title":"Acta Sci. Technol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1128\/aem.41.2.483-487.1981","article-title":"Effect of chlorine on Giardia lamblia cyst viability","volume":"41","author":"Jarroll","year":"1981","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"4636420","DOI":"10.1155\/2017\/4636420","article-title":"Detection of Cryptosporidium and Cyclospora oocysts from environmental water for drinking and recreational activities in Sarawak, Malaysia","volume":"2017","author":"Bilung","year":"2017","journal-title":"BioMed Res. Int."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1061\/(ASCE)0733-9372(1999)125:10(913)","article-title":"Modeling chlorine inactivation kinetics of Cryptosporidium parvum in phosphate buffer","volume":"125","author":"Gyurek","year":"1997","journal-title":"J. Environ. Eng."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1128\/aem.56.5.1423-1428.1990","article-title":"Effects of ozone, chlorine dioxide, chlorine and monochloramine on Cryptosporidium parvum oocyst viability","volume":"56","author":"Korich","year":"1990","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1128\/aem.55.6.1519-1522.1989","article-title":"Effect of disinfection of drinking water with ozone or chlorine dioxide on survival of Cryptosporidium parvum oocysts","volume":"55","author":"Peeters","year":"1989","journal-title":"J. Appl. Environ. Microbiol."},{"key":"ref_56","unstructured":"(2017, November 29). Disinfectants Chlorine Dioxide. Available online: https:\/\/www.lenntech.com\/processes\/disinfection\/chemical\/disinfectants-chlorine-dioxide.htm."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/S0926-3373(03)00326-6","article-title":"Catalytic ozonation and methods of enhancing molecular ozone reactions in water treatment","volume":"46","author":"Ziolek","year":"2003","journal-title":"Appl. Catal. B Environ."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1146\/annurev.energy.23.1.253","article-title":"Drinking water in developing countries","volume":"23","author":"Gadgil","year":"1998","journal-title":"Annu. Rev. Energy Environ."},{"key":"ref_59","unstructured":"Snicer, G.A., Malley, J.P., Margolin, A.B., and Hogan, S.P. (2000). UV Inactivation of Viruses in Natural Waters, AWWA Research Foundation and American Water Works Association."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3528","DOI":"10.1016\/j.watres.2008.05.001","article-title":"Contribution of treated wastewater to the contamination of recreational river areas with Cryptosporidium spp. and Giardia duodenalis","volume":"42","author":"Almeida","year":"2008","journal-title":"Water Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"3393","DOI":"10.1128\/AEM.69.6.3393-3398.2003","article-title":"Giardia cysts in wastewater treatment plants in Italy","volume":"69","author":"Caccio","year":"2003","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.vetpar.2004.09.004","article-title":"Cryptosporidium: A water-borne zoonotic parasite","volume":"126","author":"Fayer","year":"2004","journal-title":"Vet. Parasitol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1111\/j.1365-2672.2005.02737.x","article-title":"Occurrence of Cryptosporidium spp. oocysts in raw and treated sewage and river water in North-Eastern Spain","volume":"99","author":"Montemayor","year":"2005","journal-title":"J. Appl. Microbiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"5297","DOI":"10.1128\/AEM.00464-06","article-title":"Occurrence of Cryptosporidium oocysts and Giardia cysts in sewage in Norway","volume":"72","author":"Robertson","year":"2006","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"3945","DOI":"10.1128\/AEM.02788-06","article-title":"Tracking host sources of Cryptosporidium spp. in raw water for improved health risk assessment","volume":"73","author":"Rueker","year":"2007","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_66","first-page":"670","article-title":"Giardia in wastewater\u2014Effect of treatment","volume":"62","author":"Casson","year":"1990","journal-title":"Water Pollut. Control Fed. Res. J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2310","DOI":"10.1016\/S0043-1354(99)00408-X","article-title":"Giardia cysts and Cryptosporidium oocysts at sewage treatment works in Scotland, UK","volume":"34","author":"Robertson","year":"2000","journal-title":"Water Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1289\/ehp.1206028","article-title":"Pit Latrines and Their Impacts on Groundwater Quality: A Systematic Review","volume":"121","author":"Graham","year":"2013","journal-title":"Environ. Health Perspect."},{"key":"ref_69","first-page":"279","article-title":"A strategy for evaluating the environmental impact of on-site sanitation systems","volume":"23","author":"Fourie","year":"1997","journal-title":"Water SA"},{"key":"ref_70","unstructured":"Feachem, R.G., Bradley, D.J., Garelick, H., and Mara, D.D. (1983). Sanitation and Disease: Health Aspects of Wastewater and Excreta Management, John & Wiley Sons."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.pce.2006.08.031","article-title":"Assessment of the impacts of pit latrines on groundwater quality in rural areas: A case study from Marondera district, Zimbabwe","volume":"31","author":"Dzwairo","year":"2006","journal-title":"Phys. Chem. Earth"},{"key":"ref_72","unstructured":"Reed, B. (2010). Emergency Excreta Disposal Standards and Options for Haiti, DINEPA (Direction Nationale de l\u2019Eau Potable et de l\u2019Assainissement) and Global WASH Cluster."},{"key":"ref_73","unstructured":"Still, D.A., and Nash, S.R. (2002, January 19\u201323). Groundwater contamination due to pit latrines located in a sandy aquifer: A case study from Maputaland. Proceedings of the Water Institute of Southern Africa Biennial Conference, Durban, South Africa."},{"key":"ref_74","unstructured":"Franceys, R., Pickford, J., and Reed, R. (1992). A Guide to the Development of On-Site Sanitation, World Health Organization. Available online: http:\/\/www.who.int\/water_sanitation_health\/hygiene\/envsan\/onsitesan.pdf."},{"key":"ref_75","unstructured":"WaterAid (2017, November 30). Technology Notes. Available online: http:\/\/www.wateraid.org\/documents\/plugin_documents\/technology_notes_2011.pdf."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Sphere Project (2011). Minimum standards in water supply, sanitation and hygiene promotion. Humanitarian Charter and Minimum Standards in Disaster Response, Sphere Project. Available online: http:\/\/www.ifrc.org\/PageFiles\/95530\/The-Sphere-Project-Handbook-20111.pdf.","DOI":"10.3362\/9781908176202"},{"key":"ref_77","unstructured":"WHO (World Health Organization)\/UNICEF (2012). Progress on Drinking Water and Sanitation: 2012 Update, WHO and UNICEF. Available online: http:\/\/www.unicef.org\/media\/files\/JMPreport2012.pdf."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Newson, R.S., Lion, R., Crawford, R.J., Curtis, V., Elmadfa, I., Feunekes, G.I., Hicks, C., van Liere, M., Lowe, C.F., and Meijer, G.W. (2013). Behavior change for better health: Nutrition, hygiene and sustainability. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-S1-S1"},{"key":"ref_79","unstructured":"(2017, March 30). A Guide to Drinking Water Treatment Technologies for Household Use, Available online: https:\/\/www.cdc.gov\/healthywater\/drinking\/home-water-treatment\/household_water_treatment.html."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"501","DOI":"10.4269\/ajtmh.14-0802","article-title":"\u201cImproved\u201d but not Necessarily Safe: An Assessment of Fecal Contamination of Household Drinking Water in Rural Peru","volume":"93","author":"Heitzinger","year":"2015","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1289\/ehp.1409002","article-title":"Association of Supply Type with Fecal Contamination of Source Water and Household Stored Drinking Water in Developing Countries: A Bivariate Meta-analysis","volume":"123","author":"Shields","year":"2015","journal-title":"Environ. Health Perspect."},{"key":"ref_82","unstructured":"Bloomfield, S.F., and Nath, K.J. (2017, December 20). Home Hygiene in Developing Countries Prevention of Infection in the Home and the Peri-Domestic Setting. Available online: http:\/\/wsscc.org\/wp-content\/uploads\/2016\/03\/ifh_wsscc_home_hygiene_training_resource_eng.pdf."},{"key":"ref_83","unstructured":"U.S. Environmental Protection Agency Office of Ground Water and Drinking Water (2018, January 28). Drinking Water from Household Wells, Available online: https:\/\/nepis.epa.gov\/Exe\/ZyPDF.cgi\/200024OD.PDF?Dockey=200024OD.PDF."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"11352","DOI":"10.1021\/es301842u","article-title":"Use of Household Water Treatment and Safe Storage Methods in Acute Emergency Response: Case Study Results from Nepal, Indonesia, Kenya, and Haiti","volume":"46","author":"Lantagne","year":"2012","journal-title":"Environ. Sci. Technol."},{"key":"ref_85","unstructured":"(2017, March 30). Cryptosporidium (Crypto) and Drinking Water from Private Wells, Available online: https:\/\/www.cdc.gov\/healthywater\/drinking\/private\/wells\/disease\/cryptosporidium.html."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1046\/j.1365-3156.2000.00512.x","article-title":"Domestic hygiene and diarrhea\u2014Pinpointing the problem","volume":"5","author":"Curtis","year":"2000","journal-title":"Trop. Med. Int. Health"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/S1473-3099(04)01253-8","article-title":"Water, sanitation, and hygiene interventions to reduce diarrhea in less developed countries: A systematic review and meta-analysis","volume":"5","author":"Fewtrell","year":"2005","journal-title":"Lancet Infect. Dis."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Osman, M., El Safadi, D., Cian, A., Benamrouz, S., Nourrisson, C., Poirier, P., Pereira, B., Razakandrainibe, R., Pinon, A., and Lambert, C. (2016). Prevalence and risk factors for intestinal protozoan infections with Cryptosporidium, Giardia, Blastocystis and Dientamoeba among schoolchildren in Tripoli, Lebanon. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004643"},{"key":"ref_89","unstructured":"O\u2019Connell, K. (2015). Management of Child Feces: Study Design and Measurement Tips, WSP Sanitation Marketing Toolkit. Available online: http:\/\/www.wsp.org\/sites\/wsp.org\/files\/publications\/Child-Feces-Formative-Research-Study-Design.pdf."},{"key":"ref_90","unstructured":"(2017, December 09). Sustainable Development Goals. Available online: http:\/\/www.undp.org\/content\/undp\/en\/home\/sustainable-development-goals.html."},{"key":"ref_91","unstructured":"(2017, December 09). Goal 6: Clean Water and Sanitation. Available online: http:\/\/www.undp.org\/content\/undp\/en\/home\/sustainable-development-goals\/goal-6-clean-water-and-sanitation.html."},{"key":"ref_92","unstructured":"World Health Organization (2011). Guidelines for Drinking-Water Quality, WHO. [4th ed.]. Available online: http:\/\/apps.who.int\/iris\/bitstream\/10665\/44584\/1\/9789241548151_eng.pdf."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Hunter, P.R., Waite, M., and Ronchi, E. (2003). National surveillance systems. Drinking Water and Infectious Disease: Establishing the Links, CRC Press.","DOI":"10.1201\/9781420040524"},{"key":"ref_94","unstructured":"(2017, December 08). United States Environmental Agency, Available online: https:\/\/www.epa.gov."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1111\/j.1574-6976.2002.tb00604.x","article-title":"Risk and control of waterborne cryptosporidiosis","volume":"26","author":"Rose","year":"2002","journal-title":"FEMS Microbiol. Rev."},{"key":"ref_96","unstructured":"US Environmental Protection Agency (2012). Method 1623.1: Cryptosporidium and Giardia in Water by Filtration\/IMS\/FA."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1128\/AEM.65.4.1578-1583.1999","article-title":"Phylogenetic analysis of Cryptosporidium parasites based on the small-subunit rRNA gene locus","volume":"65","author":"Xiao","year":"1999","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1128\/AEM.65.8.3427-3432.1999","article-title":"Detection of infectious Cryptosporidium parvum oocysts in surface and filter backwash water samples by immunomagnetic separation and integrated cell culture-PCR","volume":"65","author":"Hashemi","year":"1999","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"3936","DOI":"10.1128\/AEM.65.9.3936-3941.1999","article-title":"A most probable number assay for enumeration of infectious Cryptosporidium parvum oocysts","volume":"65","author":"Slifko","year":"1999","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1128\/AEM.67.3.1097-1101.2001","article-title":"Molecular characterization of Cryptosporidium oocysts in samples of raw surface water and wastewater","volume":"67","author":"Xiao","year":"2001","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"5380","DOI":"10.1128\/AEM.69.8.4983-4984.2003","article-title":"Assessment of methods for detection of infectious Cryptosporidium oocysts and Giardia cysts in reclaimed effluents","volume":"69","author":"Gennacaro","year":"2003","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0167-7012(02)00007-6","article-title":"Cryptosporidium parvum and Cyclospora cayetanensis: A review of laboratory methods for detection of these waterborne parasites","volume":"49","author":"Peele","year":"2002","journal-title":"J. Microbiol. Meth."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"5178","DOI":"10.1128\/AEM.69.9.5178-5185.2003","article-title":"Real-time PCR for quantification of Giardia and Cryptosporidium in environmental water samples and sewage","volume":"69","author":"Guy","year":"2003","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2166\/wh.2009.056","article-title":"Household characteristics associated with home water treatment: An analysis of the Egyptian demographic and health survey","volume":"7","author":"Wright","year":"2009","journal-title":"J. Water Health"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"175S","DOI":"10.1080\/0960312031000102921","article-title":"Studies of food hygiene and diarrheal disease","volume":"13","author":"Lanata","year":"2003","journal-title":"Int. J. Environ. Health Res."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1128\/CMR.4.3.325","article-title":"Cryptosporidiosis","volume":"4","author":"Current","year":"1991","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_107","first-page":"39","article-title":"Important zoonotic intestinal protozoan parasites in Asia","volume":"21","author":"Mak","year":"2004","journal-title":"Trop. Biomed."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1016\/j.ijpara.2004.08.009","article-title":"Meta-analysis in assessment of the prevalence and annual incidence of Giardia spp. and Cryptosporidium spp. infections in humans in the Nordic countries","volume":"34","author":"Hormann","year":"2004","journal-title":"Int. J. Parasitol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1080\/09603120500155716","article-title":"Outbreaks associated with recreational water in the United States","volume":"15","author":"Craun","year":"2005","journal-title":"Int. J. Environ. Health Res."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"794","DOI":"10.4269\/ajtmh.2002.66.794","article-title":"Hyperendemic Cryptosporidium and Giardia in Households Lacking Municipal Sewer and Water on the United States\u2014Mexico Border","volume":"66","author":"Redlinger","year":"2002","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1128\/aem.55.5.1223-1229.1989","article-title":"Viability of Giardia cysts suspended in lake, river, and tap water","volume":"55","author":"DeRegnier","year":"1989","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"3494","DOI":"10.1128\/aem.58.11.3494-3500.1992","article-title":"Survival of Cryptosporidium parvum oocysts under various environmental pressures","volume":"58","author":"Robertson","year":"1992","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1128\/aem.62.6.2081-2085.1996","article-title":"Evaluation of PCR, Nested PCR, and Fluorescent Antibodies for Detection of Giardia and Cryptosporidium Species in Wastewater","volume":"62","author":"Mayer","year":"1996","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_114","first-page":"1","article-title":"Surveillance for waterborne-disease outbreaks associated with recreational water\u2014United States, 2001\u20132002","volume":"53","author":"Yoder","year":"2004","journal-title":"MMWR Surveill. Summ."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"3483","DOI":"10.1016\/j.watres.2007.05.009","article-title":"Impact of bathers on levels of Cryptosporidium parvum oocysts and Giardia lamblia cysts in recreational beach waters","volume":"41","author":"Sunderland","year":"2007","journal-title":"Water Res."},{"key":"ref_116","unstructured":"Indest, K. (2017, December 20). Interim Guidance on Assessing the Risk Posed by Pathogens Associated with Dredged Material. Available online: https:\/\/dots.el.erdc.dren.mil\/elpubs\/pdf\/eedp01-49.pdf."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/3\/495\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:56:40Z","timestamp":1760194600000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/3\/495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,12]]},"references-count":116,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2018,3]]}},"alternative-id":["ijerph15030495"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15030495","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,12]]}}}