Water-related Infectious Diseases Research Articles

Climate variability and water-related infectious diseases in Pacific Island Countries and Territories, a systematic review

Background Climate induced changes in water-related infectious disease (WRID) transmission are a growing public health concern. The effects of climate on disease vary regionally, as do key socioeconomic modifiers. Regional syntheses are necessary to develop public health tools like risk maps and early warning systems at this scale. There is a high burden of WRID in the Pacific Island Countries and Territories (PICTs). There has been significant work on this topic in the PICTs, however, to date, there has been no regional systematic review of climate variability and WRID. Methods We searched the PubMed, Web of Science and Scopus scientific databases in September 2022 using a combination of disease, climate, and country terms. We included studies that evaluated the association between climate or weather variability and a WRID in the PICTs using a quantitative epidemiological design. We assessed risk of bias using validated tools. We analysed spatiotemporal publication patterns, synthesised the outcomes of studies in relation to the international literature and identified missing evidence. Results & discussion We identified 45 studies of climate and malaria, dengue, diarrhoea, leptospirosis, and typhoid, which represent major WRIDs of concern in the Pacific Islands. More than half of the studies were set in Papua New Guinea or Fiji. The number of studies published each year increased exponentially over time from the 1980s to present. We found few comparable outcomes per disease and setting across epidemiological studies which limited the potential for meta-analysis. However, we identified consistent increased incidence of diarrhoea, dengue, leptospirosis, and typhoid following extreme weather events, highlighting the necessity for adequate water, sanitation, and hygiene access across the PICTs. Additionally, there were consistent positive associations between temperature and dengue incidence in New Caledonia, highly seasonal malaria in PNG, increased diarrhoea incidence with high and low rainfall, and positive associations between leptospirosis and rainfall. These findings are biologically plausible and consistent with the international literature. Future work on this topic in the PICTs can take advantage of increasingly available health and climate data to consolidate the field across a greater diversity of settings and apply these findings to strengthening climate resilient health systems. Registration This review is registered with the international prospective register of systematic reviews (PROSPERO CRD42022353853), in accordance with PRISMA guidelines.

Advances in paper based isothermal nucleic acid amplification tests for water-related infectious diseases

Water-associated or water-related infectious disease outbreaks are caused by pathogens such as bacteria, viruses, and protozoa, which can be transmitted through contaminated water sources, poor sanitation practices, or insect vectors. Low- and middle-income countries bear the major burden of these infections due to inadequate hygiene and subpar laboratory facilities, making it challenging to monitor and detect infections in a timely manner. However, even developed countries are not immune to these diseases, as inadequate wastewater management and contaminated drinking water supplies can also contribute to disease outbreaks. Nucleic acid amplification tests have proven to be effective for early disease intervention and surveillance of both new and existing diseases. In recent years, paper-based diagnostic devices have made significant progress and become an essential tool in detecting and managing water-associated infectious diseases. In this review, we have highlighted the importance of paper and its variants as a diagnostic tool and discussed the properties, designs, modifications, and various paper-based device formats developed and used for detecting water-associated pathogens.

Twenty years of waterborne and related disease reports in Florida, USA

Florida represents a unique challenge for preventing and responding to infectious disease associated with water. This study cataloged the prevalence of reportable waterborne and water-related disease within Florida residents over the last twenty years and identified relationships between confirmed cases by location and additional risk factors. Data was collected through FLHealthCHARTS for confirmed cases between January 1, 1999 and December 31, 2019. Case records were compiled and analyzed by year, county, pathogen name and disease category, patient age, and where the infection was acquired. During this time, 218,707 cases of water-related disease were recorded with 214,745 due to waterborne disease, 3255 cases of water-related vector-borne disease, and 707 cases caused by a water-based toxin. Children aged 0–4 and the elderly demonstrated a higher proportion of waterborne disease while 45–49 year olds had increased rates of water-based toxins and water-related vector-borne disease. Most cases were reported in the southeast region. Across the state, opportunities for water contact have led to high rates of water-related infectious disease. Public health initiatives and response efforts should target the pathogens of greatest impact for each region, largely zoonotic waterborne diseases, using a One Health approach.

Influences of Land-Use Dynamics and Surface Water Systems Interactions on Water-Related Infectious Diseases—A Systematic Review

Human interactions with surface water systems, through land-use dynamics, can influence the transmission of infectious water-related diseases. As a result, the aim of our study was to explore and examine the state of scientific evidence on the influences of these interactions on water-related infectious disease outcomes from a global perspective. A systematic review was conducted, using 54 peer-reviewed research articles published between 1995 and August 2019. The study revealed that there has been an increase in the number of publications since 2009; however, few of these publications (n = 6) made explicit linkages to the topic. It was found that urban and agricultural land-use changes had relatively high adverse impacts on water quality, due to high concentrations of fecal matter, heavy metals, and nutrients in surface water systems. Water systems were found as the common “vehicle” for infectious disease transmission, which in turn had linkages to sanitation and hygiene conditions. The study found explicit linkages between human–surface water interaction patterns and the transmission of water-based disease. However, weak and complex linkages were found between land-use change and the transmission of water-borne disease, due to multiple pathways and the dynamics of the other determinants of the disease. Therefore, further research studies, using interdisciplinary and transdisciplinary approaches to investigate and enhance a deeper understanding of these complexities and linkages among land use, surface water quality, and water-related infectious diseases, is crucial in developing integrated measures for sustainable water quality monitoring and diseases prevention.

Hydro-epidemiological aspects of infectious agent indication in mollusks (review)

The article presents the rationale for the use of hydro-epidemiology in assessing the risk of spreading water-related in-fectious diseases of animals. The authors distinguish six hydro-epidemiological groups of diseases: 1) water is the medium of pathogen accumulation; 2) water is the medium for transmission of the infection pathogen without its biological accumula-tion; 3) the development cycle of the causative agent is directly related to water and aquatic organisms; 4) diseases transmitted by insects having water-related development cycle; 5) diseases transmitted by aquatic and near-water vertebrates; 6) diseases of reservoir inhabitants. At the same time, it is shown that the aquatic filter-feeding bivalves (mollusks) accumulate in them-selves various pathogenic microorganisms, which are the causative agents of infectious diseases of both man and animals. Thus, mollusks can serve as a test object for hydro-epidemiological study in assessing the risk of infectious diseases dissemi-nation in water area and near-water complex as well as in using them directly for food.

Drinking water accessibility and quantity in low and middle-income countries: A systematic review.

Increasing the quantity of water available for consumption and hygiene is recognized to be among the most efficient interventions to reduce the risk of water-related infectious diseases in low and middle-income countries. Such impacts are often associated with water supply accessibility (e.g. distance or collection time) and used to justify investment in improving access. To assess the relationship between the water source location and the quantity of water available in households from low and middle-income countries by identifying the effects of interventions aiming to improve access, and to compare the indicators and measures used to collect information. We systematically searched seven databases (i.e. Cairn, Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Women's Studies International) along with grey literature for articles reporting indicators and measures of accessibility and quantity. We found 6492 records, of which 20 studies were retained that met the review's inclusion criteria. Most studies were conducted in rural settings and provided suggestive findings to describe an inverse relationship between accessibility and quantity. Overall, a wide range of indicators and measures were used to assess water accessibility and quantity in the selected studies along with their association. The lack of consistency raised concerns regarding comparability and reliability of these methods. The review findings support the hypothesis that the quantity of water available in households is a function of the source location, but the inconsistency in study outcomes highlights the need to further investigate the strength and effects of the relationship.

Climate Change and Water-Related Infectious Diseases

Background: Water-related, including waterborne, diseases remain important sources of morbidity and mortality worldwide, but particularly in developing countries. The potential for changes in disease associated with predicted anthropogenic climate changes make water-related diseases a target for prevention. Methods: We provide an overview of evidence on potential future changes in water-related disease associated with climate change. Results: A number of pathogens are likely to present risks to public health, including cholera, typhoid, dysentery, leptospirosis, diarrhoeal diseases and harmful algal blooms (HABS). The risks are greatest where the climate effects drive population movements, conflict and disruption, and where drinking water supply infrastructure is poor. The quality of evidence for water-related disease has been documented. Conclusions: We highlight the need to maintain and develop timely surveillance and rapid epidemiological responses to outbreaks and emergence of new waterborne pathogens in all countries. While the main burden of waterborne diseases is in developing countries, there needs to be both technical and financial mechanisms to ensure adequate quantities of good quality water, sewage disposal and hygiene for all. This will be essential in preventing excess morbidity and mortality in areas that will suffer from substantial changes in climate in the future.

Health risk perceptions and local knowledge of water-related infectious disease exposure among Kenyan wetland communities.

Risk perceptions have the potential of motivating and shaping health-related behaviour, i.e. the application of protective health measures. They may reduce or accelerate the risk and exposure to diseases and are therefore valuable, particularly in environments such as wetlands that entail multiple risk factors exposing humans to disease-causing infectious agents. We assessed the risk perceptions towards infectious disease exposure in the Kenyan Ewaso Narok Swamp and evaluated whether the perceived risks reflect the actual risk factors. Data were collected from community members (target population, experts) by different methods (cross-sectional survey, in-depth interviews). The overall level of risk perception regarding the contraction of diseases in the wetland was high. Exposure to water-related infectious diseases was understood as being driven by users' physical contact to water during wetland use, characteristics of pathogens and vectors of disease, both in domestic and occupational environments. The risk factors mostly associated with diseases in wetlands included the limited access to basic water supply, sanitation and poor (environmental) hygiene (WaSH) (typhoid fever, diarrhoeal diseases, schistosomiasis), agricultural irrigation (malaria), the pastoralists' proximity to livestock (trachoma), the use of agrochemicals (skin and eye diseases), seasonal flooding (malaria, typhoid fever) and droughts (trachoma). Different user groups, i.e. farmers and nomadic pastoralists, perceived the use-related risks differently and different (occupational) risks were attributed to different groups. The understanding of disease exposure as due to the intense hydro-social interactions and change present in the fragile semiarid wetland was clear. By showing that the risk perceptions reflect the actual risks and shortcomings, this study underpins the vital role of wetland users as key informants. It demonstrates that risk perception studies and resulting recommendations from the grassroots level serve as helpful supportive tools for health-promoting wetland management which requires a sensitive, integrative approach that takes into consideration any and all of the humans, ecology, and animals affected (= One Health).

Water–Health Nexus: Modeling the Pathways and Barriers to Water-Related Diseases

Under pressure from climate change and other drivers, the risks of water-related infectious and chronic diseases seem poised to increase. Addressing these risks requires shared work in the fields of public health and water resources management. To help in risk assessment, the paper presents a comprehensive conceptual model of water-related health effects and the potential barriers that can be established by water management actions. The model does not indicate unique solution strategies because multiple water management factors cause multiple types of water-related diseases. It uses the water-health nexus to conceptualize the pathways to diseases and help clarify health-related responsibilities for water management and public health officials. Experiences of the U.S. are presented as an exemplar of the links between water management and disease incidence. However, parts of the water management system are not regulated effectively and many countries lack organized utilities and effective water governance.

Infectious diseases related to water in Peru

The growth of the world population has increased the demand for water. On the other hand, climate change shows us that the water sources that were previously safe are not anymore. There are inequalities between urban and rural areas, thus 96% of the urban world population uses drinking water sources compared to 84% of the rural population, while 82% of the urban population versus 51% of the rural population use sanitation facilities. In Peru, 80.4% of homes are supplied with water through a public network. In the urban area, this service covers 83.2%; while in the rural area 71.3% of homes have a toilet service connected to the public network. All the above conditions the presence of water-related infectious diseases, such as diarrhea, malaria, dengue, leptospirosis, viral hepatitis A, and E, whose classification is shown in this article. In the world, diarrhea is the third cause of death among children under five years of age and more than 340,000 children under the age of five die from diarrheal diseases due to poor sanitation. One of the goals of the SDGs is related to universal access drinking water, sanitation and hygiene, which cannot be achieved without due attention to the inequalities in access observed between different groups, avoiding the consequences of these deficiencies both in our country and in the world.

Results of an Arctic Council survey on water and sanitation services in the Arctic

ABSTRACTAs part of a project endorsed by the Arctic Council’s Sustainable Development Working Group (SDWG), a survey was conducted to describe the current status of water, sanitation and hygiene (WASH) services in the Arctic region. The English language internet-based survey was open from April to September, 2016 and drew 142 respondents from seven Arctic nations. Respondents provided information on access to WASH services, notification requirements for water-related infectious diseases, and examples of environmental- or climate-change related events that impact the provision of WASH services. Many remote Arctic and sub-Arctic residents lack WASH services, and these disparities are often not reflected in national summary data. Environmental changes impacting WASH services were reported by respondents in every Arctic nation. Participants at an international conference co-sponsored by SDWG reviewed these results and provided suggestions for next steps to improve health of Arctic residents through improved access to water and sanitation services. Suggestions included ongoing reporting on WASH service availability in underserved populations to measure progress towards UN Sustainable Development Goal #6; evaluations of the health and economic consequences of disparities in WASH services; and Arctic-specific forums to share innovations in WASH technology, improved management and operations, and adaptation strategies for environmental or climate change.

Contracting infectious diseases in Sub-Saharan African wetlands: A question of use? A review.

Worldwide the pressure on water is increasing. In parts of Sub-Saharan Africa (SSA), natural wetlands constitute the only accessible water resources, providing water free of charge, agricultural potential and livelihoods in otherwise uninhabitable landscapes, which is why they are being used extensively. The degradation and contamination of water which result from the use of wetlands has the potential to spread disease-causing microorganisms and provide increased breeding habitats for disease vectors, Despite this importance, case studies are lacking and knowledge gaps remain about whether and how different kinds of wetland use influence the exposure to health risks and transmission of infectious diseases. This descriptive literature review aimed at identifying publications from peer-reviewed journals and book chapters that (i) address water-related infectious diseases in SSA wetlands and (ii) link those diseases to use-related exposures. The resulting overview includes 27 publications and shows that depending on the type of use, people in wetlands are exposed to different risk factors and water-related infectious diseases. Exposure to infectious agents depends on occupational characteristics, and time spent in wetlands. Disease transmission is driven by users' contact to water, characteristics of pathogens and vectors of disease. The amount of available literature varies significantly. Whereas several publications have linked crop production and the domestic use of wetland water to contraction of diseases, fewer are available on health risks identified with pastoralism in wetlands and other uses. Some risk factors are well researched, such as irrigation schemes favouring schistosomiasis prevalence. For others, including proximity of pastoralists to their livestock and the associated trachoma risk, knowledge remains limited. This review establishes connections of selected diseases with different transmission pathways that are linked to specific risk factors, transmission pathways and resulting diseases. All of these have been integrated into a detailed conceptual framework which simplifies the complexity of the relationships, while at the same time identifying missing links which might provide stimulus for future research tackling the potential research gaps. It concludes that socio-cultural and behavioural considerations regarding the wetland users are not sufficiently evaluated and should receive increased attention in future investigations.

Microbial Waterborne Pathogens

In the developed world, the connection between water, hygiene and health is taken for granted. However, for the less fortunate majority, access to potable water is non-existent and remains a daily struggle. Bacteria, viruses and parasites in contaminated water cause water borne disease. Of concern are the so-called new emerging pathogens, contributing to water borne disease, one of the biggest human tragedies, killing more than 5 million people each year. About 2.3 billion people suffer from diseases linked to contaminated water and some 6,000 people die daily as a result of this. Some 60% of all infant mortality worldwide is linked to water-related infectious and parasitic diseases. Treating water before use can eliminate most of these waterborne pathogens. The essential starting point is knowledge of the disease-causing organisms, the detection techniques, and the epidemiology, which is the focus of this book. Microbial Waterborne Pathogens provides up-to-date coverage of waterborne microbial pathogens including traditional and emerging pathogens and the latest molecular detection techniques. The link between climate and disease is covered in the book and indicates future approaches to dealing with this important area as we face the effects of global climate change. All the existing and emerging pathogens including bacteria, viruses and protozoa are reviewed. The characteristics of each organism are discussed in detail as well as their epidemiology. Methods for the detection of these pathogens, traditional and new are presented. Microbial Waterborne Pathogens provides students, academics and practitioners with a complete reference book on the microbiological quality and safety of potable water. ISBN: 9781843390558 (Print) ISBN: 9781780402826 (eBook)

A Survey of Dutch Expert Opinion on Climatic Drivers of Infectious Disease Risk in Western Europe

Climate change is considered to be a significant influence for infectious disease risk in Western Europe. Climatic and non-climatic developments act together resulting in current and future infectious disease risk. This study uses a survey to explore Dutch expert perspectives on climate change induced infectious disease risk. The results show that the experts consider temperature change, precipitation change, humidity change, and climate change induced habitat change to be relatively important for water-related infectious disease risk, vector-borne disease risk excluding zoonoses, and the risk of zoonoses. The climatic drivers are seen as relatively less important for food-related infectious disease risk. The experts rate many non-climatic drivers to be highly important for infectious disease risk. Comparatively, the majority of the non-climatic drivers assessed are seen as more important than climate change drivers. The degree of uncertainty in the future development of climatic drivers is viewed as moderate to high, and for non-climatic drivers mostly as moderate. An analysis of subsamples based on professional backgrounds reveals differences in experts’ opinions for e.g., socio-cultural drivers, and similarities. Diversity and consensus amongst expert perspectives on climate change and infectious diseases can have implications for policy. Further research to uncover and compare prevailing perspectives is necessary.

Delays reducing waterborne and water-related infectious diseases in China under climate change.

Despite China’s rapid progress improving water, sanitation and hygiene (WSH) access, in 2011, 471 million people lacked access to improved sanitation and 401 million to household piped water. Because certain infectious diseases are sensitive to changes in both climate and WSH conditions, we projected impacts of climate change on WSH-attributable diseases in China in 2020 and 2030 by coupling estimates of the temperature sensitivity of diarrheal diseases and three vector-borne diseases, temperature projections from global climate models, WSH-infrastructure development scenarios, and projected demographic changes. By 2030, climate change is projected to delay China’s rapid progress toward reducing WSH-attributable infectious disease burden by 8–85 months. This development delay summarizes the adverse impact of climate change on WSH-attributable infectious diseases in China, and can be used in other settings where a significant health burden may accompany future changes in climate even as the total burden of disease falls due to non-climate reasons.

Water Quality: Guidelines, Standards and Health: Assessment of Risk and Risk Management for Water-Related Infectious Disease

The quality of water, whether it is used for drinking, irrigation or recreational purposes, is significant for health in both developing and developed countries worldwide. In responding to this challenge, countries develop standards intended to protect public health. Recognising this, the World Health Organization (WHO) develops ‘guidelines’ that present an authoritative assessment of the health risks associated with hazards through water and of the effectiveness of approaches to their control. To date, the various WHO guidelines concerned with water ( Guidelines for drinking-water quality; Guidelines for the safe use of wastewater and excreta in agriculture and aquaculture; Guidelines for safe recreational water environments ) have been developed in isolation from one another. However, their common primary concern is for health hazards derived from excreta. Addressing their specific areas of concern together will tend to support better health protection and highlight the value of interventions closer to sources of pollution, which may otherwise be under-valued. The potential to increase consistency in approaches to assessment and management of water-related microbial hazards was discussed by an international group of experts between 1999 and 2001. These discussions led to the development of a harmonised framework, which was intended to inform the process of development of guidelines and standards. Subsequently, a series of reviews was developed and refined, which addressed the principle issues of concern linking water and health to the establishment and implementation of effective, affordable and efficient guidelines and standards. The book is based on these reviews and the harmonised framework. This book will prove invaluable to all those concerned with issues relating to microbial water quality and health, including environmental and public health scientists, water scientists, policy makers and those responsible for developing standards and regulations. This title belongs to WHO Water Series . ISBN: 9781780405889 (eBook) ISBN: 9781900222280 (Print)

Sustainable Control of Water-Related Infectious Diseases: A Review and Proposal for Interdisciplinary Health-Based Systems Research

ObjectiveEven when initially successful, many interventions aimed at reducing the toll of water-related infectious disease have not been sustainable over longer periods of time. Here we review historical practices in water-related infectious disease research and propose an interdisciplinary public health oriented systems approach to research and intervention design.Data sourcesOn the basis of the literature and the authors’ experiences, we summarize contributions from key disciplines and identify common problems and trends. Practices in developing countries, where the disease burden is the most severe, are emphasized.Data extractionWe define waterborne and water-associated vectorborne diseases and identify disciplinary themes and conceptual needs by drawing from ecologic, anthropologic, engineering, political/economic, and public health fields. A case study examines one of the classes of water-related infectious disease.Data synthesisThe limited success in designing sustainable interventions is attributable to factors that include the complexity and interactions among the social, ecologic, engineering, political/economic, and public health domains; incomplete data; a lack of relevant indicators; and most important, an inadequate understanding of the proximal and distal factors that cause water-related infectious disease. Fundamental change is needed for research on water-related infectious diseases, and we advocate a systems approach framework using an ongoing evidence-based health outcomes focus with an extended time horizon. The examples and case study in the review show many opportunities for interdisciplinary collaborations, data fusion techniques, and other advances.ConclusionsThe proposed framework will facilitate research by addressing the complexity and divergent scales of problems and by engaging scientists in the disciplines needed to tackle these difficult problems. Such research can enhance the prevention and control of water-related infectious diseases in a manner that is sustainable and focused on public health outcomes.

A global picture of the diverse links between water and health.

Over the past decades, the picture of water-related human health issues has become increasingly comprehensive, with a greater recognition of the complex nature of these links, the emergence of new water-related infectious diseases and a re-emergence of ones already known, and with a greater awareness and insight of the detrimental impact of water-related diseases on social and economic development. Today, we have strong evidence that water-, sanitationand hygiene-related diseases (i.e. the classical safe drinking water and sanitation, or water-borne and water-washed diseases) account for some 2 213 000 deaths annually and an annual loss of 82 196 000 Disability Adjusted Life Years (DALYs). This does not take into account water-related diseases such as malaria, schistosomiasis and other vector-borne diseases, or the more modern infections such as legionellosis. For these diseases, the analyses remain to be done, and, in many cases, the detailed attribution to aquatic environments is not yet completed. The most recent of emerging water-related diseases is that caused by the SARS CoV infections, with a number of well-documented cases of aerosol transmission in specific sanitary domestic or hospital situations. The global picture of water and health has a strong local dimension with some 1.1 billion people still lacking access to improved drinking water sources (and

Risky Trade-offs: Bangladeshi Quest for Safe Water

Vol. 112, No. 11 EnvironewsOpen AccessRisky Trade-offs: Bangladeshi Quest for Safe Wateris accompanied byThe Effect of Arsenic Mitigation Interventions on Disease Burden in Bangladesh M. Nathaniel Mead M. Nathaniel Mead Search for more papers by this author Published:1 August 2004https://doi.org/10.1289/ehp.112-a636bAboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit In an attempt to eliminate epidemic levels of diarrhea and other infectious diseases associated with the use of surface waters, millions of shallow tube wells were drilled into the Ganges Delta alluvium in Bangladesh beginning in the early 1970s. This process reduced the rates of water-related infectious diseases but created a new public health dilemma: a surge in diseases such as skin ailments, diabetes mellitus, and various cancers, all resulting from habitual consumption of groundwater naturally high in arsenic.A number of interventions have been proposed to help remedy the widespread arsenic exposure, but these interventions may only be bringing the catastrophic water situation in Bangladesh full circle. A new study by epidemiologists led by Kamalini Lokuge of the Australian National University suggests that, while these interventions will eventually result in less disease overall, they may initially cause a steady and considerable increase in diarrheal disease [EHP 112:1172–1177]. The study indicates that any large-scale transition away from household tube wells as a source of drinking water, without proper evaluation of the risks, may be premature.In attempting to quantify the disease burden resulting both from arsenic exposure and from the potential side effects of widely available arsenic mitigation interventions, Lokuge and her colleagues used previously published information to estimate mortality rates and disability-adjusted life years (DALYs). Simply put, a DALY is a measure of the burden of disease; it reflects how much a person’s expectancy of healthy life is reduced by premature death as well as by disability caused by disease.The Australian team used World Health Organization data to estimate the DALYs lost per year to arsenic-related effects including diabetes, ischemic heart disease, and a number of cancers. They calculated that arsenic exposure causes the loss of 174,174 DALYs per year in Bangladeshis exposed to arsenic concentrations above 50 micrograms per liter (μg/L), the nation’s cut-off point for safe drinking water.Then they calculated the DALYs that would be lost to infectious disease, provided Bangladeshis adopted certain arsenic mitigation options currently advocated by the federal Bangladesh Arsenic Mitigation and Water Supply Project and immediately accessible to the majority of the Bangladeshi population year-round. These include surface water supplies, uncontaminated community tube wells, and low-cost filtration systems. These alternative options carry the potential for increased water-related infections, compared with household tube wells.Assuming that mitigation efforts were undertaken only in those areas where the arsenic concentration of drinking water is highest (100–300 μg/L), the team found that the long-range benefits of arsenic mitigation in terms of DALYs gained and deaths avoided would outweigh any initial decline in public health due to water-related infectious diseases. However, there would initially be a period of some years (the number of which is still unknown) before any benefit would accrue, and some additional years until the total benefit outweighed the cost of the water-related infectious disease increase. The investigators also conclude, moreover, that if the Bangladeshi people gradually stop using the alternative water sources and processes (for example, because of the inconvenience of maintenance or complacency as disease drops off), the initial DALY-based cost of water-related infectious diseases would remain while the long-range benefits would disappear.The study demonstrates that implementation of any arsenic-mitigating intervention must take into account not only the strategy’s effectiveness in reducing arsenic exposure but also its safety in terms of water-related infectious diseases, the likelihood of population-wide compliance, and different exposure levels within the population. The investigators contend that such information is vital to developing appropriate policies toward resolving the drinking water crisis in Bangladesh.FiguresReferencesRelatedDetailsRelated articlesThe Effect of Arsenic Mitigation Interventions on Disease Burden in Bangladesh17 June 2004Environmental Health Perspectives Vol. 112, No. 11 August 2004Metrics About Article Metrics Publication History Originally published1 August 2004Published in print1 August 2004 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

The effect of arsenic mitigation interventions on disease burden in Bangladesh.

Many interventions have been advocated to mitigate the impact of arsenic contamination of drinking water in Bangladesh. However, there are few data on the true magnitude of arsenic-related disease in Bangladesh nationally. There has also been little consideration given to possible adverse effects of such interventions, in particular, diarrheal disease. The purpose of this study was to estimate and compare the likely impacts of arsenic mitigation interventions on both arsenic-related disease and water-borne infectious disease. We found that arsenic-related disease currently results in 9,136 deaths per year and 174,174 disability-adjusted life years (DALYs; undiscounted) lost per year in those exposed to arsenic concentrations > 50 μg/L. This constitutes 0.3% of the total disease burden in Bangladesh in terms of undiscounted DALYs. We found intervention to be of overall benefit in reducing disease burden in most scenarios examined, but the concomitant increase in water-related infectious disease significantly reduced the potential benefits gained from intervention. A minimum reduction in arsenic-related DALYs of 77% was necessary before intervention achieved any reduction in net disease burden. This is assuming that interventions were provided to those exposed to > 50 μg/L and would concomitantly result in a 20% increase in water-related infectious disease in those without access to adequate sanitation. Intervention appears to be justified for those populations exposed to high levels of arsenic, but it must be based on exposure levels and on the effectiveness of interventions not only in reducing arsenic but in minimizing risk of water-related infections.