Designing a monitoring plan for microbial water quality and waterborne antimicrobial resistance in the Akaki catchment, Ethiopia

The Akaki River, in Ethiopia, becomes a source of antimicrobial-resistant (AMR) pathogens and genes that are spreading to receiving water. Water quality monitoring (WQM) is limited in Akaki, and the available evidence is based on short-term monitoring of inconsistent sampling sites and water quality parameters. Therefore, we designed a suitable WQM plan for the Big Akaki River receiving wastewater from rural, urban, and peri-urban areas. WQM plan was designed by employing multiple approaches including literature review, field observations, spatial analysis, and pollutant “hotspot” identification. Information was extracted through a systematic review of 48 articles, selected through a screening process, to guide the selection of suitable monitoring sites. Field observation was used to inspect previously sampled sites and identify pollution sources and exposure routes to antibiotic-resistant bacteria and zoonotic pathogens. For validation, water samples were collected from 40 sites identified from the literature review and field observation, and results were refined during a stakeholder consultation workshop. Hotspots were identified based on chemical oxygen demand, dissolved oxygen, ammonia, and extended-spectrum βeta-lactamase (ESβL)-producing Escherichia coli and Salmonella enteritidis/Shigella flexneri data. Cluster analysis of the water quality data categorized the 40 sites into three groups, and the number of sites for future monitoring to 20, including possible pollutant hotspots, reference sites, known pollution sources, exposure routes, and availability of river discharge data. The WQM plan will help AMR and zoonotic pathogens monitoring and mitigation in the study sites. Our approach can be replicated to design WQM plans for other rivers.