|
 
 |
| REVIEW ARTICLE |
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| Year : 2022 | Volume
: 17
| Issue : 4 | Page : 996-1004 |
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Health hazards of water contamination: An updated review among the COVID-19 pandemic
Atreyee Sarkar, Shantee Devi
Department of Environmental Science, Gitam University, Visakhapatnam, Andhra Pradesh, India
| Date of Submission | 21-Aug-2022 |
| Date of Acceptance | 12-Sep-2022 |
| Date of Web Publication | 10-Feb-2023 |
Correspondence Address:
Mrs. Atreyee Sarkar
Celeste-1302, Cadenza, Kudlu Gate, Bengaluru - 560 068, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_371_22
Water-borne diseases are on the rise all over the world. With the galloping progress of industrialization and urbanization, ground water which is the main source of drinking water is getting contaminated due to the various types of pollutants and is becoming scarce due to overconsumption. Consuming and using this contaminated water without any kind of treatment causes dangerous water-borne diseases. This is rampant not only in developing countries such as India but developed nations such as the USA as well. The prevalence of these water-borne diseases, its occurrence during the ongoing COVID-19 pandemic, effect of climate change on the occurrence of the diseases, adverse outcomes of water-related illnesses, possible treatment and precautionary methods should be reviewed. The types of pollutants, discussion of water-borne diseases, drugs used for treating the water-related diseases, treatments, and prevention measures have been covered in this literature-based review paper with a critical acclaim of literature sources available in the public domain. All references have been duly acknowledged in the references section of this paper.
Keywords: COVID-19, pollutants, prevention, treatment, water borne diseases
How to cite this article:
Sarkar A, Devi S. Health hazards of water contamination: An updated review among the COVID-19 pandemic. J Datta Meghe Inst Med Sci Univ 2022;17:996-1004 |
| Introduction | |  |
Water is a basic human need and primary natural resource. Access to proper water is required for good quality living and enhanced life expectancy. It is an essential ingredient for human advancement.[1]
Water is essential for animal husbandry, agriculture, industrial activities, and humans. The existence of humans is not possible without water. Everyone should have adequate amount of this which is clean and is not harmful upon consumption.[2]
Consuming safe drinking water prevents the occurrence of water-related diseases such as hepatitis, typhoid, and diarrhea.[3]
Safe water is free from harmful chemicals, pathogens, colorless, odorless and is pleasant to taste. Upon leaving the treatment plant, the quality of drinking water may be appropriate. Chemical, physical, and microbiological contaminations can occur through the distribution system. Diarrheal diseases such as typhoid, paratyphoid, amoebiasis, cholera, giardiasis, Salmonellosis More Details, bacillary dysentery, and cryptosporidiosis. Skin and mucous membrane contact with contaminated animal urine during bathing can cause Leptospira infection in humans.[4]
Seventy percent of the surface of the Earth is water. As per the WHO, 80% of diseases occurring are due to water contamination. Population growth, domestic and radioactive waste, too much usage of pesticides, fertilizers, and leak from water tanks are the major causes of water contamination. These negatively impact humans. Agriculture and domestic waste dumped without treatment cause this.[5]
Increase in anthropogenic actions and growing population over the world causes contamination of water sources. As per the WHO, 2.1 billion people which corresponds to 29% of the global population and one of 3 people in rural areas do not have access to safe drinking water. Approximately 159 million people collect drinking water from surface water directly. Surface water is contaminated by organic, inorganic, microbiological, and toxic contamination.[6]
As per the WHO, 578 infectious disease outbreaks occurred in 132 countries between the years 1998 and 2001. Cholera and acute diarrhea were the most frequent among them. Around 17 million cases occurred due to typhoid and paratyphoid fevers by Salmonella More Details typhi and Salmonella paratyphi, respectively.[7]
Diseases due to polluted water cause more than 5 million annual deaths. Lack of safe and adequate sanitation and water supply causes illness and morality in residents of developing countries. 250 million and 10–20 million people suffer from pathogen infection and deaths respectively. Improper water and sanitation is the major cause for high degree of illness in developing countries.[8]
| Search Strategy | | |
A systematic literature search was conducted to find appropriate published articles to be populated into this review paper. Various regulatory databases were searched such as PubMed, NCBI Bookshelf, Science direct, Cochrane Library, Medline, Embase, and general google search engine. Search terms included but were not limited to “health hazards of water pollution,” “risks of water-borne diseases.” “Effect of climate change on the occurrence of water-borne diseases,” “impact of COVID-19 on water diseases,” “environmental risks of water-borne diseases.” Seventy-five appropriate articles were identified to be included in this review. As far as possible, an attempt was made to cover recently published articles to make this review up to date. Predatory journals and articles that were irrelevant to this review were excluded. Papers having both positive and negative information about water contamination have been included in this review in order to make it nonbiased.
| Effect of Pollution on Sustainable Environment | | |
Food, water, and environment are interconnected and changeable due to human behavior on diseases. Water usage that supports human ability to flourish and endure in the indefinite future without disturbing the hydrologic ecosystem is called as sustainable use of water. Water related infectious diseases and water are major blocks for sustainable development.[9]
Pollution is the cause of approximately 9 million deaths every year. Deaths due to extreme poverty have been reduced although; however, no significant change has been noted for deaths due to chemicals like lead. Deaths owing to modern pollutants have risen to more than 66% after 2000. Climate change, pollution, and loss of biodiversity are directly linked.[10]
The goal of sustainable development has been encouraged in India; however, the effect of groundwater on health of humans has to be considered.[11]
Diseases related to water include communicable diseases which are associated with water, washed, and vector borne diseases and noncommunicable diseases caused by water pollution. Vectors, microbiological, and chemical pollution alter the state of water body which puts pressure on the environment. This along with health hazards impacts the state of human health. These incite responses of a disbalanced ecosystem and affected population.[12]
| Sources of Water Pollution | | |
Majority of the population is dependent on groundwater for drinking. Since this is the key to life's sustainability, it has to be managed well. Organic, inorganic, and microbial contamination occurs due to technical and industrial development, modernization, and industrialization. Aliphatic and aromatic hydrocarbons, pesticides, and aromatic hydrocarbons are organic pollutants. Heavy metals, sulfate, chloride, and arsenate or arsenite are inorganic contaminants. Microbial contaminants include bacteria, viruses, flatworms, and protozoans. Potable water should not contain toxic pollutants since health and nutritional status is dependent on this.[1]
Chloroorganic pesticides and polychlorinated biphenyls which are used on a large scale pose a massive health hazard to both animals and humans.[13]
The two main sources of drinking water are surface waters such as reservoirs and rivers and groundwater. Natural contaminants present in water include inorganic which is in the geological strata and anthropogenic sources due to chemicals and microorganisms. Groundwater has man made contaminants and is less prone to pollution compared to surface water. Pathogens causing diarrhea are a major quality issue for drinking water.[14]
Urbanization and industrial activities are sources of major contaminants. Heavy metals and Solvents like tri and tetra chloroethene found in groundwater; hydrocarbons present in petroleum oils are the prime contaminants.[14]
Hazardous pollutants produced by industries and urbanization is dumped in waste, marine and drinking water. The pollutants produced due to human actions impacts the whole environment. Pollutants in drinking water can be classified into chemical, physical like sediments, radiological and microbiological like viruses and bacteria.[15]
Heavy metals such as nickel, lead, chromium, zinc, copper, mercury, and cadmium are widely discharged from the industries as they are commonly found in industries such as paper, photographic, pesticide, mineral, and metallurgy.[16]
Wastewater effluents such as pesticides, heavy metals, dyes, personal care, and pharmaceutical products contaminate water. These waste products are classified as hazardous contaminants which mingle with water streams which are used for purposes such as irrigation and domestic work.[16]
The bacteria Escherichia More Details coli is found in mammalian feces. It can survive in drinking water for 4–12 weeks subject to environmental conditions such as microflora and temperature. It can survive for longer time in the water distribution system.[17]
Pesticides present in water pose a great risk to human health. Class 1A ones are extremely toxic having an LD50 value of <5 mg/kg; class 1B are highly toxic ones having and LD50 values between the range of 5 mg/kg and 50 mg/kg. Class II are moderately toxic ones having an LD50 value of 50–500 mg/kg; while class III are slightly toxic molecules having an LD50 value within the range of 500–2000 mg/kg body weight.[18]
Pesticides are a wise source of contaminant for drinking water. These cause abnormalities in endocrine and immunological systems apart from cancer. Ninety-seven percent of municipal have pesticides above the prescribed limit of 0.5 ppb by the European Union. Greater than 80% of cancer due to pesticides was caused due to diuron and mancozeb-ETU (Ethylene Thiourea). Breast cancer cases were correlated with glycophosphate-AMPA (Aminomethyl phosphonic Acid) and diuron.[19]
| Literature Review of Water Contamination All Over the World | | |
Piped water is not available to rural dwellers; hence, they are dependent surface waters which have faecal contamination. This along with improper hygiene and sanitation practices accounts for the increased cases of water-borne diseases among the rural residents. Improper environmental conditions encourage vectors and insect breeding which raises the chances of waterborne diseases. Consumption by the skin during bathing and direct consumption of untreated water pose risk to human health. As per the World Health Organization, 4.1% of daily global deaths corresponding to 1.8 million occurs due to unsafe water usage. Water-watershed diseases are impetigo, relapsing fever, skin ulcers, conjunctivitis, yaws, scabies, and typhus. Chlamydia trachomatis is a bacterium which causes inflammation of the eyes.[20]
Water present in a well in Maryland of the USA is reported to be frequently contaminated microbiologically by fecal indicators.[21]
Approximately 50% of all waterborne diseases in United States and Canada is caused due to noncommunity drinking water system.[22]
Change in the quality of water causes a huge number of deaths and illnesses which accounts for an estimated 50 million deaths annually over the world. Majority of these occurs in Asia and Africa. 75% of Chinese population do not have access to safe and clean drinking water as per China's report.[23]
A drastic decrease in the number of pesticides was noted for Ganga river after the formation of National Ganga River Basin Authority. However, certain organochlorines are more than that permitted for drinking water and microbiological contaminants have increased.[24]
The plains of rivers Chenab, Jhelum, Ravi, and Chaj doabs were found to be both saline and alkaline in the plains of Punjab of Pakistan.[25]
The synergistic effect of heavy metals of surface water of Houjing River in South Taiwan was found to be severe having the highest contribution from lead, copper, and nickel. At adverse effect level, copper had the highest carcinogenic risk. Chromium and Nickel had highest carcinogenic risk at unacceptable level.[26]
The effect of the heavy metals Cadmium, Zinc, Lead, and copper in sediment, water and the liver and fish of Nile Tilapia was studied in some sampling sites. Moreover, the heavy metal bioaccumulation in the aquatic ecosystem by means of sediment, water, and fish organs was also studied. The results indicated that the Lake water was safe for agricultural activities, sanitation of humans, and consumption by humans.[27]
The average temperature, mean turbidity, chloride value, sulfate, magnesium, sodium, potassium, and total coliform bacteria of water samples obtained from Wendo Genet Campus of Ethiopia were found to be acceptable for drinking as per the standards set by the World Health Organization.[28]
Usage of poor-quality water causes the spread and prevalence of water-borne diseases. Approximately 50% and 40% of diseases and deaths in Pakistan occurs due to improper drinking water quality. More than 80% of people in Khyber Pakhtunkhwa use drinking water which is clean and found underground and surface and in deepness. The resources in the northern part of this area are of poor quality due to improper treatment of water and old sanitation system in the urban regions.[29]
The major drinking water resource in Pakistan is groundwater which is extracted by motorized or hand operated pumps. Low recharge and heavy pumping causes decline of the available ground water.[3]
The groundwater of Pakistan is contaminated with fluoride which is hazardous to human health. A lot of samples have HQ >1 for children and adults due to high fluoride concentration in drinking water.[30]
Watershed in the United States serves a lot of water in the area. This water is minimally influenced by anthropogenic activities of agriculture, industry, or residential projects.[31]
The coastal water of Persian Gulf was analyzed for heavy metals iron, chromium, lead, copper, zinc, Selenium, Nickel, and cadmium. The concentrations of all the heavy metals were found to be higher compared to the permissible limit. The heavy metal pollution index and noncarcinogenic hazard quotient studied in fish species Scomberomorus guttatus, Lethrinus nebulosus, Brachirus orientalis, Pomadasys kaakan, and Scomberomorus commerson were found to be high. These fishes when consumed pose a risk to humans. Activity of petrochemical, oil and gas plants cause heavy metal pollution of marine animals in the area which is dangerous for the health of public.[32]
Insufficient health infrastructure for public in developing countries such as Asia face problems such as poor access to safe drinking water and sanitation. Urban residents have better sanitation and access to safe drinking water than the rural areas. Improper water quality is a concern in Uzbekistan as more than half of its population do not have piped water supply; hence dependent on other sources such as standpipes, water pumps, and taps. The eastern and western parts of Tashkent have high number of cases of enterobiasis and Hepatitis A. Rural area residents having children are vulnerable to water-borne illnesses compared to others staying in the area.[33]
Africa has interconnected rivers which serve as a reservoir for agricultural, industrial, and domestic wastes. Hence, there is a water scarcity. Value and implementation of water for quality management and ecosystem conservation is still under developed. This scenario has encouraged the direct consumption of untreated water and its discharge into rivers. This is observed in Ethiopia too where rivers are polluted due to urbanization, activities of industries, and agriculture.[34]
Drinking water samples collected from the areas of rural Bangladesh were analyzed for quality. They were slightly alkaline. Iron and Arsenic concentration was more than the acceptable limits as per the WHO for some areas. Salinity was more in samples collected from the coastal areas. Most of the household water samples had poor water quality.[35]
The household areas of coastal regions of Bangladesh have impacted water quality. The groundwater is saline due to the dissolution of toxic and trace metals and change in electric conductivity. Saline water consumption over the long-term causes diseases. One hundred percent of the water sources of aquifers were found to be unsuitable for drinking purpose.[36]
The United States is affected by improper water quality due to the lack of proper source and stressed finance of community. As per the Flint Crisis, around 98,000 of population were exposed to raised levels of disinfection by products, lead, Legionella and E. coli bacteria.[37]
Rapidly urbanizing sub-Saharan Africa lack quality piped water system. Rainwater usage in Bangladesh causes deficiencies of minerals which might cause cardiovascular diseases.[38]
| Effect of Climate Change on Occurrence of Water-Borne Diseases | | |
It has been reported that climate change alters the occurrences of water-borne diseases and diarrhea. The cases of diarrhea increase after heavy rain, high temperatures, and floods. Bacterial diarrhea cases rise but not viral diarrhea. E. coli-associated infections are the cause for this.[39]
Change in climatic condition alters the water cycles, water resources; hence causes high rainfall which increases the intensity and frequency of floods. High rainfall increases the pathogen movement from reserves such as animal waste and water-borne disease vectors which communicate the infections among humans and between fauna and human beings. Water diseases include infections due to water, pathogens in worms, viruses, protozoa, and bacteria. Neurological diseases, fever, diarrhea, and flu are the symptoms caused by these pathogens. Diseases such as cholera, gastrointestinal diseases, dengue fever, filaria, trypanosomiasis, and leishmaniasis are the waterborne diseases noted in tropical countries. Pathogens do not get decreased by sunlight and ultraviolet radiation. Survival, transition, and release of pathogens are dependent on hydrodynamics of water on the surface. Rainfall increases the number of oocytes in cryptosporidiosis which raises its pathogenicity.[40]
Heavy rainfall causes floods which increases the infection risk among humans in developing countries; however not in the Western nations provided water resources are not affected. Disease burden and mortality over the world due to water and sanitation is rampant. This is due to disease transmission by bacteria, viral, and parasites. Rainfall changes the water flow direction through channels in systems too. Heavy rain and borehole extraction caused one outbreak of cryptosporidiosis. Climate change caused the reintroduction of malaria in the UK which was nor much rampant before.[41]
Arsenic is present in the water of many parts of the World like India, Bangladesh, Far East, and South America. This causes cancer due to exposure via water.[14]
| Literature Review of Water Borne Diseases in India | | |
The sanitation problem of India is ranked second worst after China. Currently, just 28% of rural area residents of the country do not have access to toilet facilities. Variation in the prevalence of water-borne diseases in the states of the country is noted due to the difference in geographical location and climate factors. Water-borne diseases cause child mortality. Around 105 million children below 5 years die annually owing to water-borne diseases.[42]
Approximately 7000 of people in Pacific region and Asia do not have access to proper water supply. 70 percent of Pakistanis depend on ground water which causes extraction and decline in water table.[8]
Approximately 70% of the available water in Indian rivers is polluted due to unsafe disposal of industrial waste and untreated sewage which are directly dumped into streams and rivers. The contaminated water is a disease-causing source.[43]
Diarrhea is prevalent in India and is the fifth most happening disease in the world. The states of West Bengal and Andhra Pradesh suffer a lot from this communicable disease apart from other states. Some African and Arabian countries suffer from this disease like India. People of Kolkata suffer from Acute Watery Diarrhea during the rainy season due to the tropical climate and waterlogging.[44]
Worldwide, approximately 1 billion people staying mostly in Africa and South Asia in countries like India lack access to sanitation and safe and clean drinking water. Open defecation and unsafe disposal of fecal matter contaminate drinking water which puts lives of public at risk. India had a huge population openly defecating before. This cause deteriorating health of public due to diseases such as diarrhea caused by consuming polluted groundwater. Construction of proper toilets and Clean India or Swachh Bharat initiatives have been initiated since 2014. However, the target of clean and fecal pollution free drinking water is still a far cry.[11]
As per a longitudinal study conducted between 2017 and 2018, it was reported that more elderly people in India suffered from water-borne diseases. States of Chattisgarh and Madhya Pradesh had more instances followed by the North India states. Occupational and educational status, rural or urban area, type of water resource, and toilet facility were the factors determining these occurrences. It was concluded that elderly people residing in urban pickets were not aware of basic hygiene practices; hence, these instances were more among them.[45]
Fecal coliform and E. coli bacteria contamination was found in water samples collected from house hold in an Indian southern state. People in the area were suffering from water-borne diseases such as hepatitis A, dysentery, and acute diarrhea.[46]
The presence of the thermotolerant bacteria E. coli in drinking water is a faecal indicator. As per the WHO, its presence in water renders it unfit for drinking. For sustainable development, 100 mL of water samples should not contain any culturable form of the bacteria. Droplet digital Polymerase Chain Reaction and dead-end ultrafiltration were used as culture-based methods to study the microbial contamination of urban water supply in Jaipur of India. The groundwater was found to be contaminated with the bacteria. However, the water supplied through distribution systems was not contaminated with the bacteria.[47]
Acute diarrheal disease and hepatitis were the most frequently causes of hospital admissions due to water-related illness in Medical College and Hospital Thiruvananthaputam of Central Kerala in India during a 5-year surveillance period. Diarrhea cases were more during the summer. However, diseases due to air borne infection were the highest.[48] The annual number of cases of diarrhea is represented schematically in below [Figure 1].
| Treatment and Prevention of Water-Borne Diseases | | |
Membrane filtration techniques are an effective method of removing microbiological contamination from the water.[20]
| Adverse Consequences of Contaminated Drinking Water | | |
A primary source of microbial pathogens in developing countries is drinking water. The outcomes of gastrointestinal infections are more severe considering lack of proper intervention, malnutrition, and under nutrition. Contagious diarrhea is the cause for approximately 1.7 million annual deaths over the world. Ninety percent of such deaths occur in children. Rotavirus, E. coli, Shigella sp., Vibrio cholerae, Clostrodium, difficile, Aeromonas sp., Campylobacter jejuni and Cryptosporidium parvum are some of the disease-causing agents in children. In adults, H. pylori and Clostridium jejuni cause gastrointestinal infections other than known pathogens such as Entameoeba histolytica, helminths, hepatitis A and E.[7]
Water-borne diseases are spread by human and animal fecal matter having bacteria, viruses and protozoans which are pathogenic microorganisms. These multiply in water, food, and surfaces. Diarrhea is a leading cause of morbidity and mortality in the world mostly affecting children. Other waterborne diseases include dysentery, cholera, giardiasis, typhoid, salmonellosis, cyclosporiasis, cryptosporidiosis, campylobacteriosis, diarrhea caused by adenivirus, rotavirus, astrovirus, calciviruses, enterovirus, and reovirus.[50]
Few millions of people in America and billions of people from other countries get diseased due to the pollution of surface and ground water. The examples of diseases caused by contaminated water include respiratory infection, typhoid, ulcer, hepatitis, dracunialisis, diarrhea, endocrine, and kidney damages. These diseases pose a risk to human health and can cause death. Harmful germs and microorganisms are responsible for these diseases.[51]
Wells in Bangladesh are reported to be contaminated with Arsenic.[52]
Groundwater in Bangladesh is contaminated with the toxic metalloid Arsenic. Chronic exposure to this causes arsenicosis, several types of cancer, cardiovascular, neurological, renal, respiratory, reproductive diseases, diabetes and multi-organ diseases. It also has adverse effects on child development and health. Spontaneous abortion, infant mortality, stillbirth, low weight at birth, delayed growth of child, lower IQ, improper immunity system, neurotoxicity and neurodevelopment have been observed when expectant mothers were exposure to Arsenic.[53]
Arsenic is classified as a Class A carcinogen to humans which is a reported groundwater contaminant. It affects more than 200 million people over the world in 105 countries.[53]
More than 6 mg/day intake of fluoride can cause bad effect on bones and 14 mg/day can cause bone fractures.[1]
As per studies, Atrzaine exposure was linked to lower weight at birth in Ohio. Drinking water contamination was associated with chronic kidney disease in Taiwan. Water was reported to be contaminated with Manganese in Quebec of Canada.[21]
Nitrate contamination in water due to agricultural runoff can cause methemoglobinemia or blue-baby syndrome in infants <3 months old who are bottle fed. This occurs if more than the WHO prescribed 50 mg/l amount of nitrate is present in water.[14]
Nitrate and nitrite contamination in drinking water is associated with colorectal and gastric cancer. The studies were mostly conducted in middle- and low-income countries of Taiwan, Europe, and USA.[54]
As per the WHO, poor quality water and improper sanitation causes 7, 60,000 annual deaths of children below 5 years. However, this number is better than the previous 2.2 million diarrhea-related deaths in children in 1998.[2]
Approximately 85% of the population of India is dependent on groundwater as per the WHO. High levels of fluoride in drinking water can cause health issues such as hypertension, infertility, skeletal cancer, neurotoxicology, damage to tissues of lungs, kidneys, liver, lungs, skeletal fluorosis, and hard tissue deformities. The presence of fluoride in water affects all age groups of people such as infants, children, adults, teenagers, and elderly people.[55]
Helicobacter pylori is a carcinogenic pathogen which forms colonies in more than 50% of humans. Water contamination is the prime cause for this as water might be a route for its transmission. This infection is more prevalent in developing countries. Water contamination, poor sanitation, and socioeconomic conditions are responsible for this. Due to the rising population globally combined with climate change the rate of increase is expected to be more in the years to come.[56]
| Effect of COVID-19 Pandemic on Water Borne Disease | | |
Water is required for almost all human activities such as cooking, drinking, and other recreations. The developed nations have succeeded in providing residents with adequate and clean water that is free of virus. However, the developing nations lack this which leads to deaths among the vulnerable people caused by the consumption of water contaminated by virus and other pathogens. The ongoing pandemic of COVID-19 is an eye opener to consider the importance of sanitation and usage of safe and clean water as it can be a prime driver for the spread of waterborne diseases and the virus. This is a challenge in developing countries which has poor socioeconomic development. The consumption of water contaminated with pathogens and improper hygiene and sanitation causes the water-borne diseases. The virus stays alive in the digestive tract of infected individuals even after 6–14 days of turning negative by respiratory sampling. Fcal transmission of virus also can happen.[34]
The microbiological and heavy metal characterization of 22 water samples of Thirumanimuthar River of South India was done prior and during the COVID-19 lockdown. Microbial population and heavy metals iron, Manganese, Zinc, Copper, Cadmium, Nickel, lead, and chromium were decreased during the lockdown. Hence, the health risk due to the metal index was quite different during the lockdown.[57]
Patients affected by COVID-19 were at a higher risk of being infected by diseases such as chikungunya, dengue, influenza, malaria, enteric fever, and leptospirosis. These are transmitted by vectors like insects mostly and caused by bacteria, viruses, and parasites. Rains aggravate this situation. These coexisting diseases with COVID-19 pose a greater challenge for clinical and laboratory diagnosis and treatment.[58]
Prevention and better hygiene practices can prevent the spread of water and vector borne diseases in Mumbai which was severely affected due to the COVID-19 pandemic.[59]
| Effect of Water Borne Diseases on Nation Economy | | |
Developing countries like India started the process of urbanization in mid-20th century. As per Government of India, 83.3 crore of the total 121 crore Indians live in rural area while 37.7 crore live in urban parts. Rural-urban differences, pull factor, and better economic condition in urban areas result in massive migration towards cities.[60]
Improper hygiene and sanitation cause water, sanitation and hygiene (WASH-) related diseases. 5.7% of outpatient department and 6.9% of admissions in hospitals of patients in India occurred in 2017. Seventy-four percent of rural Indians suffered from jaundice which is more than the per capita expenses. Hospital admission due to jaundice costs a lefty amount for patients. Hence there is a huge financial burden and prevalence of these WASH related diseases among people in India.[61]
The effects of drinking water on socio-economic and risk of illness was studied in a published literature. Family size, social status and income was positively related to the cost of illness. Source of drinking water like groundwater or others, education and awareness regarding safe drinkin water was negatively linked with the cost of illness. Conveyance and water usage is better among people living in urban areas.[3]
Diseases caused by water pollution and contamination causes mortality and morbidity which requires a huge cost for the prevention and treatment. These directly causes environmental pollution and degradation. Pathogens causing water borne diseases should be assessed properly and decisions should be made regarding the proper infrastructure of distribution system, the best possible treatment and prevention of water borne disease outbreaks. 12 billion US dollars are spent every year to treat these diseases. 780 million and 2.5 billion people over the world don't have access to pure water and lack proper sanitation respectively.[62] [Figure 2] represents the causes and consequences of water contamination | Figure 2: Represents the annual cases of Water borne diseases in India[49]
Click here to view |
| Drugs Used for the Treatment of Water Borne Diseases | | |
Cases of diarrhea in India are generally treated with oral rehydrating solution and intravenous drips till the condition of patient stabilizes. Treatments are also given using antidiarrheals and other antibiotics.[63]
Albendazole, ampicillin, chloramphenicol, metronidazole, ornidazole, Ciprofloxacin, Doxycycline, and Tinidazole are some of the generics and over-the-counter drugs available for the treatment of water borne diseases.[64]
| Scenario of Water Borne Diseases in the Current Pandemic | | |
Published articles reporting the effect of water borne illnesses during the current ongoing COVID-19 pandemic is not adequately available.
In order to contain the spread and severity of the pandemic, vaccines have been introduced. Vaccine provides direct and personal protection on a population level which has the ability to incorporate herd immunity. These can prevent other diseases which are not targeted; for example, pathogenic infections by viruses can also prevent the disposition of bacterial infections.[65]
| Methods of Purifying Drinking Water Before Consumption | | |
Water derived from sources like dug well, standpipe, pipe system, rainwater and spring-should be clean and safe. Sanitation should be proper which has connection to septic system, pit latrine, sewer or water seal. Chemical disinfection, filtration and exposure to ultraviolet radiations may be applied to purify water. Outbreaks of water borne diseases should be intimated to healthcare officials. Water based diseases associated with harmful toxic agents and algae should also be notified.[4]
Fecal contaminated water can be disinfected chemically to reduce the risk of diseases.[66]
There are several methods of purifying water before usage like coagulation and precipitation, softening of water, distillation, adsorption, ion exchange resins reverse osmosis.[67]
| Prevention of Water Contamination | | |
Maintaining proper hygiene and sanitation can prevent the transmission of Helicobacter pylori by water.[56]
Enhanced filtered drinking water reduces the incidence of cryptosporidiosis. Vaccination with polysaccharide vaccines reduced the incidences of S. typhi and S. paratyphi.
Proper management of water resources, preventing from contamination by chemical and microbial contaminants can make water acceptable to public. Proper management in catchment area can produce quality water downstream and in aquifers. This will better the treatment process required to provide safe and clean water.[66]
| Discussion | | |
As per WHO, safe drinking water is water that does not pose any significant health risk after a lifetime consumption, including different life stages and their corresponding sensitivities. Billions of people over the world do not have access to safe drinking water. This culminates into a huge burden of waterborne diseases like typhoid, cholera and diarrhea. More than 3.4 million people annually die due to water borne diseases and thus is a leading cause of mortality and morbidity. Microorganisms that live in raw sewage cause the Illnesses mostly in small children.[68]
| Conclusion | | |
It may be concluded that, water borne diseases is a world-wide problem affecting both developed and developing nations. Consumption and usage of contaminated water risks the lives of infants, children, teenager, adults and elderly. Hospitalization, deaths, drugs and illnesses due to water pollution pose a huge burden on the finance and economic condition of countries. Since prevention is better than cure, proper hygiene and sanitation should be maintained to prevent water borne illnesses. The Indian government has taken initiatives like Swach Bharat, toilet construction to prevent the practice of open defecation. Health camps and awareness sessions should be conducted to educate the rural population about the importance of hygiene, sanitation and need for consuming water only after treatment. The current pandemic situation teaches us yet another lesson about the importance of cleanliness and hygiene.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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