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      Water Supply and Health

      discussion
      Author(s): 1 , * , 2 , 3
      Publication date (Electronic):
      Journal: PLoS Medicine
      Publisher: Public Library of Science

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          Abstract

          As one article in a four-part PLoS Medicine series on water and sanitation, Paul Hunter and colleagues argue that much more effort is needed to improve access to safe and sustainable water supplies.

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          Most cited references14

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          Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis.

          Ian Roberts, Tamer Rabie, Wolf Schmidt … (2007)
          To assess the effectiveness of interventions to improve the microbial quality of drinking water for preventing diarrhoea. Systematic review. Cochrane Infectious Diseases Group's trials register, CENTRAL, Medline, Embase, LILACS; hand searching; and correspondence with experts and relevant organisations. Randomised and quasirandomised controlled trials of interventions to improve the microbial quality of drinking water for preventing diarrhoea in adults and in children in settings with endemic disease. Allocation concealment, blinding, losses to follow-up, type of intervention, outcome measures, and measures of effect. Pooled effect estimates were calculated within the appropriate subgroups. 33 reports from 21 countries documenting 42 comparisons were included. Variations in design, setting, and type and point of intervention, and variations in defining, assessing, calculating, and reporting outcomes limited the comparability of study results and pooling of results by meta-analysis. In general, interventions to improve the microbial quality of drinking water are effective in preventing diarrhoea. Effectiveness was not conditioned on the presence of improved water supplies or sanitation in the study setting and was not enhanced by combining the intervention with instructions on basic hygiene, a water storage vessel, or improved sanitation or water supplies--other common environmental interventions intended to prevent diarrhoea. Interventions to improve water quality are generally effective for preventing diarrhoea in all ages and in under 5s. Significant heterogeneity among the trials suggests that the level of effectiveness may depend on a variety of conditions that research to date cannot fully explain.
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            Groundwater: the processes and global significance of aquifer degradation.

            P Chilton, Sheryl Foster (2003)
            The exploitation of groundwater resources for human use dates from the earliest civilizations, but massive resource development has been largely restricted to the past 50 years. Although global in scope, the emphasis of this paper is on groundwater-based economies in a developing nation context, where accelerated resource development has brought major social and economic benefits over the past 20 years. This results from groundwater's significant role in urban water supply and in rural livelihoods, including irrigated agriculture. However, little of the economic benefit of resource development has been reinvested in groundwater management, and concerns about aquifer degradation and resource sustainability began to arise. A general review, for a broad-based audience, is given of the mechanisms and significance of three semi-independent facets of aquifer degradation. These are (i) depletion of aquifer storage and its effects on groundwater availability, terrestrial and aquatic ecosystems; (ii) groundwater salinization arising from various different processes of induced hydraulic disturbance and soil fractionation; and (iii) vulnerability of aquifers to pollution from land-use and effluent discharge practices related to both urban development and agricultural intensification. Globally, data with which to assess the status of aquifer degradation are of questionable reliability, inadequate coverage and poor compilation. Recourse has to be made to 'type examples' and assumptions about the extension of similar hydrogeological settings likely to be experiencing similar conditions of groundwater demand and subsurface contaminant load. It is concluded that (i) aquifer degradation is much more than a localized problem because the sustainability of the resource base for much of the rapid socio-economic development of the second half of the twentieth century is threatened on quite a widespread geographical basis; and (ii) major (and long overdue) investments in groundwater resource and quality protection are urgently needed. These investments include appropriate institutional provisions, demand-side management, supply-side enhancement and pollution control.
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              Estimating the costs and health benefits of water and sanitation improvements at global level.

              Sherry L. Haller, Guy Hutton, Jamie Bartram (2007)
              The aim of this study was to estimate the costs and the health benefits of the following interventions: increasing access to improved water supply and sanitation facilities, increasing access to in house piped water and sewerage connection, and providing household water treatment, in ten WHO sub-regions. The cost-effectiveness of each intervention was assessed in terms of US dollars per disability adjusted life year (DALY) averted. This analysis found that almost all interventions were cost-effective, especially in developing countries with high mortality rates. The estimated cost-effectiveness ratio (CER) varied between US$20 per DALY averted for disinfection at point of use to US$13,000 per DALY averted for improved water and sanitation facilities. While increasing access to piped water supply and sewage connections on plot was the intervention that had the largest health impact across all sub-regions, household water treatment was found to be the most cost-effective intervention. A policy shift to include better household water quality management to complement the continuing expansion of coverage and upgrading of services would appear to be a cost-effective health intervention in many developing countries.
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                Author and article information

                Journal
                Journal ID (nlm-ta): PLoS Med
                Journal ID (publisher-id): PLoS
                Journal ID (pmc): plosmed
                Title: PLoS Medicine
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Print): 1549-1277
                ISSN (Electronic): 1549-1676
                Publication date Collection: November 2010
                Publication date (Print): November 2010
                Publication date (Electronic): 9 November 2010
                Volume: 7
                Issue: 11
                Electronic Location Identifier: e1000361
                Affiliations
                [1 ]School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, United Kingdom
                [2 ]British Geological Survey, Edinburgh, United Kingdom
                [3 ]WaterAid, London, United Kingdom
                Author notes

                ICMJE criteria for authorship read and met: PRH AMM RCC. Agree with the manuscript's results and conclusions: PRH AMM RCC. Analyzed the data: AMM. Wrote the first draft of the paper: PRH. Contributed to the writing of the paper: PRH AMM RCC. Participated in co-author meetings to agree on structure and content of paper; drafted sections of the paper under senior authorship of PRH.

                Article
                Publisher ID: 10-PLME-PF-4818R2
                DOI: 10.1371/journal.pmed.1000361
                PMC ID: 2976720
                PubMed ID: 21085692
                SO-VID: 258305b8-d579-4729-b058-663fd4afec1b
                Copyright © Hunter et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Page count
                Pages: 9
                Categories
                Subject: Policy Forum
                Subject: Infectious Diseases/Epidemiology and Control of Infectious Diseases
                Subject: Infectious Diseases/Tropical and Travel-Associated Diseases
                Subject: Pediatrics and Child Health
                Subject: Public Health and Epidemiology/Environmental Health

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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