Background Attention to women’s and girls’ menstrual needs is critical for global health and gender equality. The importance of this neglected experience has been elucidated by a growing body of qualitative research, which we systematically reviewed and synthesised. Methods and findings We undertook systematic searching to identify qualitative studies of women’s and girls’ experiences of menstruation in low- and middle-income countries (LMICs). Of 6,892 citations screened, 76 studies reported in 87 citations were included. Studies captured the experiences of over 6,000 participants from 35 countries. This included 45 studies from sub-Saharan Africa (with the greatest number of studies from Kenya [ n = 7], Uganda [ n = 6], and Ethiopia [ n = 5]), 21 from South Asia (including India [ n = 12] and Nepal [ n = 5]), 8 from East Asia and the Pacific, 5 from Latin America and the Caribbean, 5 from the Middle East and North Africa, and 1 study from Europe and Central Asia. Through synthesis, we identified overarching themes and their relationships to develop a directional model of menstrual experience. This model maps distal and proximal antecedents of menstrual experience through to the impacts of this experience on health and well-being. The sociocultural context, including menstrual stigma and gender norms, influenced experiences by limiting knowledge about menstruation, limiting social support, and shaping internalised and externally enforced behavioural expectations. Resource limitations underlay inadequate physical infrastructure to support menstruation, as well as an economic environment restricting access to affordable menstrual materials. Menstrual experience included multiple themes: menstrual practices, perceptions of practices and environments, confidence, shame and distress, and containment of bleeding and odour. These components of experience were interlinked and contributed to negative impacts on women’s and girls’ lives. Impacts included harms to physical and psychological health as well as education and social engagement. Our review is limited by the available studies. Study quality was varied, with 18 studies rated as high, 35 medium, and 23 low trustworthiness. Sampling and analysis tended to be untrustworthy in lower-quality studies. Studies focused on the experiences of adolescent girls were most strongly represented, and we achieved early saturation for this group. Reflecting the focus of menstrual health research globally, there was an absence of studies focused on adult women and those from certain geographical areas. Conclusions Through synthesis of extant qualitative studies of menstrual experience, we highlight consistent challenges and developed an integrated model of menstrual experience. This model hypothesises directional pathways that could be tested by future studies and may serve...

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Human noroviruses (NoVs) are a significant cause of nonbacterial gastroenteritis worldwide, with contaminated drinking water a potential transmission route. The absence of a cell culture infectivity model for NoV necessitates the use of molecular methods and/or viral surrogate models amenable to cell culture to predict NoV inactivation. The NoV surrogates murine NoV (MNV), feline calicivirus (FCV), poliovirus (PV), and male-specific coliphage MS2, in conjunction with Norwalk virus (NV), were spiked into surface water samples (n ‫؍‬ 9) and groundwater samples (n ‫؍‬ 6). Viral persistence was monitored at 25°C and 4°C by periodically analyzing virus infectivity (for all surrogate viruses) and nucleic acid (NA) for all tested viruses. FCV infectivity reduction rates were significantly higher than those of the other surrogate viruses. Infectivity reduction rates were significantly higher than NA reduction rates at 25°C (0.18 and 0.09 log 10 /day for FCV, 0.13 and 0.10 log 10 /day for PV, 0.12 and 0.06 log 10 /day for MS2, and 0.09 and 0.05 log 10 /day for MNV) but not significant at 4°C. According to a multiple linear regression model, the NV NA reduction rates (0.04 ؎ 0.01 log 10 /day) were not significantly different from the NA reduction rates of MS2 (0.05 ؎ 0.03 log 10 /day) and MNV (0.04 ؎ 0.03 log 10 /day) and were significantly different from those of FCV (0.08 ؎ 0.03 log 10 /day) and PV (0.09 ؎ 0.03 log 10 /day) at 25°C. In conclusion, MNV shows great promise as a human NoV surrogate due to its genetic similarity and environmental stability. FCV was much less stable and thus questionable as an adequate surrogate for human NoVs in surface water and groundwater.

The application of low pressure membranes (LPMs) to drinking water treatment and wastewater reuse has undergone accelerated development in the past decade. Integration of pretreatment with LPM filtration has been widely employed at full scale to reduce membrane fouling and/or increase the removal of certain aquatic contaminants. In principle, pretreatment of source water can impact membrane filtration in three ways: altering contaminant size distributions, changing mutual affinities of contaminants or their affinities to membrane surfaces, and suppressing undesirable microbial growth or removing biodegradable contaminants. The literature shows that, compared to the well-demonstrated enhancement of contaminant removal, impact of pretreatment to membrane fouling is often small or even negative, which isfurther complicated by variations in source water quality and membrane properties. Coagulation has been the most successful pretreatment for fouling reduction. Novel technologies are in immediate need for fouling control; ones which rely on a better understanding of the mechanisms of pretreatment and LPM filtration are warranted. This article provides a critical review of the state-of-the-art of pretreatment for LPMs, and discusses potential areas for future technical development and scientific studies.

Little is known about the extent or pattern of environmental fecal contamination among households using low-cost, on-site sanitation facilities, or what role environmental contamination plays in the transmission of diarrheal disease. A microbial survey of fecal contamination and selected diarrheal pathogens in soil (n = 200), surface (n = 120), and produce samples (n = 24) was conducted in peri-urban Bagamoyo, Tanzania, among 20 households using private pit latrines. All samples were analyzed for E. coli and enterococci. A subset was analyzed for enterovirus, rotavirus, norovirus GI, norovirus GII, diarrheagenic E. coli, and general and human-specific Bacteroidales fecal markers using molecular methods. Soil collected from the house floor had significantly higher concentrations of E. coli and enterococci than soil collected from the latrine floor. There was no significant difference in fecal indicator bacteria levels between households using pit latrines with a concrete slab (improved sanitation) versus those without a slab. These findings imply that the presence of a concrete slab does not affect the level of fecal contamination in the household environment in this setting. Human Bacteroidales, pathogenic E. coli, enterovirus, and rotavirus genes were detected in soil samples, suggesting that soil should be given more attention as a transmission pathway of diarrheal illness in low-income countries.