High Population Density Greatest Risk Factor for Water-Linked Diseases
Water-associated infectious disease outbreaks are more likely to occur in areas where a region’s population density is growing, according to a new global analysis of economic and environmental conditions that influence the risk for these outbreaks.
Ohio State University scientists constructed a massive database containing information about 1,428 water-associated disease outbreaks that were reported between 1991 and 2008 around the world. By combining outbreak records with data on a variety of socio-environmental factors known about the affected regions, the researchers developed a model that can be used to predict risks for water-associated disease outbreaks anywhere in the world.
The research appears in PLoS Neglected Tropical Diseases, a journal published by the Public Library of Science.
There are five different categories of water-associated diseases, depending on the role water plays in the disease transmission process. Population density was a risk factor for all types of these diseases. Prolonged and excessive heat was shown to be a driver of water-related diseases that are transmitted to people by insect bites.
The study shows that clusters of reported outbreaks tended to occur in Western Europe, Central Africa, Northern India and Southeast Asia. These regions, as well as Latin America and eastern Brazil, were targeted as potential “hot spots” at highest risk for future water-associated disease outbreaks ranging from E. coli-related diarrhea to dengue fever.
World health experts conservatively estimate that 4 percent of deaths - almost 2 million annually - and 5.7 percent of illnesses around the world are caused by infectious diseases related to unsafe water and sanitation and hygiene problems. Getting a better handle on the socio-environmental factors that affect the risks for water-associated disease outbreaks is a first step toward guiding policymakers as they prioritize the distribution of health resources around the world, the researchers say.
“The safety of drinking and recreational water in developed countries will continue to be a concern, with WHO noting that ‘despite advances in diagnostic technology water related disease of unknown etiology remains a significant percentage of the total outbreaks of disease. Published statistics from the USA show that between 1991 and 2000, the etiological agent (precise cause) of around 40 percent of drinking water associated (disease) outbreaks was not identified’ ”
(WHO, 2003 Emerging Issues in Water and Infectious Diseases, p13)
“We know water is essential to life, but we also know that water is a vehicle that can carry hazards. If we understand the risk factors of disease better, we can inform policy decisions because resources are limited. Second, we can provide an early warning to certain places that are undergoing global environmental change because our model shows how those changes affect outbreak risks,” said Song Liang, senior author of the study and an assistant professor of environmental health sciences at Ohio State.
“We’re not going to address all of the questions in one study, but we hope to set the stage for studies that can move toward that goal.”
Most information on water-associated pathogens and infectious diseases in the Ohio State database came from the Global Infectious Disease and Epidemiology Network (GIDEON), a web-based database containing details on outbreaks for 337 recognized infectious diseases in 231 countries and regions. Liang and colleagues also collected extensive data from journal articles and health organization publications to supplement the GIDEON information.
Among the information included in the Ohio State database were disease-causing agents, such as bacteria or viruses, and their biological characteristics; water’s role in disease transmission; disease transmission routes; and details about whether the recorded outbreak represented an emergence or re-emergence of a water-associated disease for a given region. These details were crossed with a socio-environmental database that contained data on population density, global average accumulated temperature, surface area of water bodies, average annual rainfall and per-capita gross domestic product.
What is Diarrhoea?
Diarrhea is the passage of loose or watery stools occurring three or more times in a 24-hour period.
The three types of diarrhea are: acute diarrhea, persistent diarrhea, and dysentery.
If an episode of diarrhea lasts less than 14 days, it is acute diarrhea. Acute watery diarrhea causes dehydration and contributes to malnutrition. The death of a child with acute diarrhea is usually due to dehydration.
If the diarrhea lasts 14 days or more, it is persistent diarrhea. Up to 20% of episodes of diarrhea become persistent. Persistent diarrhea often causes nutritional problems, creating the risk of malnutrition and serious non-intestinal infection. Dehydration also occurs.
Diarrhea with blood in the stool – with or without mucus – is called dysentery. Dysentery is very dangerous because of its ability to lead to anorexia, rapid weight loss, and damage to the intestinal mucosa. Another danger is sepsis.
Though the global under-five mortality from acute diarrhea has decreased from 4.5 million to 1.8 million annually, acute diarrhea continues to take a huge toll on children’s health in developing countries. (WHO 2006) Diarrhea represents a significant burden on the health system, the household, and the nutritional status of children. (Bateman and McGahey 2001)
Diarrhea is the second leading killer of children under the age of five, accounting for approximately 15% of under-five child deaths worldwide, or almost two million deaths annually. (WHO 2003)
Although the means to prevent diarrhea through water supply, sanitation, and hygiene have been well documented, each year roughly one and one half billion episodes of acute diarrhea occur among children under the age of five.
Each disease tracked in the database was classified into one of five categories:
- water-borne (such as typhoid and cholera), caused by microorganisms that enter water through fecal contamination and cause infection when humans consume contaminated water. A subset of these, called “water-carried” diseases, result from accidental ingestion of contaminated water in a recreational setting;
- water-based (such as schistosomiasis), caused by parasites that spend part of their life in water;
- water-related (such as malaria and trypanosomiasis), which need water for breeding of insects that act as vectors in transmitting disease to humans;
- water-washed, caused by poor personal or domestic hygiene because no clean water is available; and
- water-dispersed (such as Legionella), caused by infectious agents that thrive in water and enter the body through the respiratory tract.