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India's burden of waterborne diseases is underestimated

BMJ 2003; 326 doi: (Published 12 June 2003) Cite this as: BMJ 2003;326:1284
  1. Ganapati Mudur
  1. New Delhi

    Major efforts to improve access to drinking water across India have not been matched by proportionate declines in deaths and illnesses from waterborne diseases, which remain grossly underestimated, a new government report has said.

    Today 85% of India's population is covered by water infrastructure, said the report, from India's planning commission, a top policy making body.

    Between 400 000 and 500 000 children aged under five years die each year from diarrhoea, the report said, citing a failure to improve personal and home hygiene as a factor.

    The report also cautioned that failure in epidemiological surveillance is leading public health authorities to record only a small fraction of cases of waterborne diseases.

    Reported data indicate that the incidence of viral hepatitis is 12 cases per 100 000 people. But at least two studies in urban communities studies have shown that the incidence might be around 100 per 100 000. The report also said that only a small proportion of diarrhoeal diseases are picked up through surveillance.

    The report, which was sponsored by the World Health Organization and Unicef, said that improvements in hygiene behaviour are not likely unless sanitation coverage improves dramatically. Without an adequate water supply children cannot wash often enough and so contract eye infections and skin conditions such as scabies.

    The report said that poor water quality and the lack of adequate disposal of human, animal, and household wastes are contributing to waterborne diseases. Just 30% of waste water from India's cities is treated before disposal. The rest flows into rivers, lakes, and groundwater, it said.

    Public health experts also say that the actual quality of water varies widely. “Quality assurance checks are lacking in cities and rural areas. What's passed off as drinking water often leaves much to be desired,” said Dr Chandrakant Pandav, a specialist in community medicine at the All India Institute of Medical Sciences.

    Figures from India's Central Bureau of Health Intelligence show that the incidence of diarrhoea, enteric fever, viral hepatitis, and cholera has stayed at the same level over the past decade.

    Fluoride contamination of fresh water also affects large parts of rural India, the report said. More than 25 million people across 17 states have to drink water with fluoride concentrations higher than the maximum permissible limit of 1.5 parts per million, it said. Excess fluoride can cause a condition called skeletal fluorosis.

    India Assessment 2002: Water Supply and Sanitation is available from the Water Resources Division, Government of India Planning Commission, Yojana Bhavan, Parliament Street, New Delhi 110 001, India.

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