Wastewater-based epidemiology empowered by o-DGT passive sampling: Quantifying pharmaceuticals consumption hotspots in rural China’s untreated watersheds

The lack of centralized sewage treatment in rural areas has led to severe underestimation of pharmaceutical pollution, posing significant risks to aquatic ecosystems and human health. While wastewater-based epidemiology (WBE) is widely used to estimate pharmaceutical consumption in urban settings, its dependence on sewage infrastructure leads to monitoring deficiencies in rural watersheds with direct wastewater discharges into rivers. Here, we pioneer the application of organic-diffusive gradients in thin-films (o-DGT) passive sampling to conduct WBE in a representative rural area of Hunan Province, China, which lacks sewage treatment facilities. By comparing o-DGT measurements with time-weighted average concentrations from 24-h composite automatic sampling, we demonstrate that o-DGT achieves comparable detection capability and consistency for pharmaceutical monitoring while excelling in capturing temporal fluctuations in dynamic river systems. In Tuojia River, 29 out of 74 pharmaceuticals were detected by o-DGT, with total concentrations ranging from 15.6 to 869 ng/L. The average pharmaceutical consumption of residents in this rural area was 11.3 g/d/1000inh, primarily driven by antibiotics (94 %). Azithromycin was the most prevalent pharmaceutical (32 ‰). Human-use antibiotic consumption in rural areas was 1-2 orders of magnitude higher than that in urban areas of China. This study is the first to use WBE for estimating pharmaceutical consumption in livestock farming, revealing average antibiotic consumption of 1.77 g/d/1000 swine, mainly sulfamethazine (52 %) and florfenicol (47 %). Our findings establish o-DGT as a cost-effective and reliable tool for WBE, enabling comprehensive pharmaceutical pollution surveillance and informing strategies for ecological risk mitigation and sustainable resource management in decentralized regions.