Climate Change, Water Quality and Water-Related Challenges: A Review with Focus on Pakistan

Wastewater surveillance for viral pathogens: A tool for public health

A focus on water quality has intensified globally, considering its critical role in sustaining life and ecosystems. Wastewater, reflecting societal development, profoundly impacts public health. Wastewater-based epidemiology (WBE) has emerged as a surveillance tool for detecting outbreaks early, monitoring infectious disease trends, and providing real-time insights, particularly in vulnerable communities. WBE aids in tracking pathogens, including viruses, in sewage, offering a comprehensive understanding of community health and lifestyle habits. With the rise in global COVID-19 cases, WBE has gained prominence, aiding in monitoring SARS-CoV-2 levels worldwide. Despite advancements in water treatment, poorly treated wastewater discharge remains a threat, amplifying the spread of water-, sanitation-, and hygiene (WaSH)-related diseases. WBE, serving as complementary surveillance, is pivotal for monitoring community-level viral infections. However, there is untapped potential for WBE to expand its role in public health surveillance. This review emphasizes the importance of WBE in understanding the link between viral surveillance in wastewater and public health, highlighting the need for its further integration into public health management.

Consumption of Tap Water and Sociodemographic-Associated Characteristics: A Nationwide Cross-Sectional Study

Safe water is a global public health concern amid increasing scarcity and pollution. Bottled water production and consumption contribute to these problems. This study examines tap water consumption in Italy, assessing associated sociodemographic factors and related health outcomes such as obesity and self-perceived health status. Data from the Italian National Statistics Institute's "Aspects of daily life" survey (N = 45,597) were analyzed. Covariates included education, age, gender, economic status, region, concerns about waste and climate change, consumption of carbonated drinks excluding water, alcohol consumption, consumption of vegetables, consumption of snacks, body mass index, and self-perceived health status. Bivariate analyses and mixed-effect logistic regression models explored the associations. People who drink tap water made up 19,674, with a higher prevalence in people aged 45 to 59 old, people with a graduate/post-graduate degree diploma, with optimal economic resources, people concerned about waste production and climate change, and those coming from the north-east regions of Italy. Underweight people showed a higher prevalence of TW consumption as well as those who less than occasionally drank carbonated drinks, drank alcohol, consumed vegetables more than once a day and snacks less than once a week, dairy products more than once a day, sweet less than once a week, cured meat less than once a week, and chicken meat less than once a week, those with no consumption of sheep meat, consumption of beef meat less than once a week and consumption of pork meat less than once a week, and those with a satisfactory level of perceived health status. Regressions showed that all other age classes are less likely to drink tap water than people younger than 20 years old. The category with "inadequate" economic resources is more likely to consume tap water. Low educational classes show a low likelihood of consuming tap water as well as islands. A concern about waste production and climate change is associated with an increased likelihood of consuming tap water. Tap water consumption was negatively associated with obesity but not with a satisfactory self-perceived health status. Insights from this study can inform public health strategies.

Tracing the barriers to decarbonising ophthalmology: A review

As climate change demands increasingly urgent mitigation of greenhouse gas emissions, the health sector needs to do its part to decarbonise. Ophthalmologists share concerns about climate change and seek opportunities to reduce their environmental impact. When measuring the footprint of ophthalmology, major contributions are from patient travel to clinics, and from the large amounts of single-use disposable materials that are consumed during surgeries and sterile procedures. Ophthalmic services in India have already demonstrated systems that consume far fewer of these products through efficient throughput of patients and the safe reuse of many items, while maintaining equivalent safety and quality outcomes. Choosing these low-cost low-emission options would seem obvious, but many ophthalmologists experience barriers that prevent them operating as Indian surgeons do. Understanding these barriers to change is a crucial step in the decarbonisation of ophthalmology and the health sector more broadly.

Evaluation of the physicochemical properties and bacterial loads of selected rivers in Ondo State, Nigeria

Background and Objectives

Water is crucial to human existence but may be contaminated with microorganisms, thus making it unfit for consumption. This study aimed to evaluate the physicochemical properties and bacterial loads of selected river waters in Ondo State, Nigeria.

Materials and Methods

Ten major rivers were sampled between April and August, 2021. The pH, temperature, total alkalinity, colour, turbidity, electrical conductivity, dissolved oxygen, ammonium, aluminium, organic matters, nitrate levels including the microbial loads were determined according to standard procedures. Confirmation of identified isolates was achieved by API 20E and API 20NE.

Results

The turbidity, colour, conductivity, ammonium, and aluminium ranged from 4.3 to 15.2 NTU, 4 to 20 NTU, 123.5 to 580.2 mgL-1, 0 to 3.5 mgL-1, and 0.05 to 1.7, respectively. Most physicochemical parameters showed no significant differences from the WHO permissible limits for drinking water (p > 0.05). The total viable bacterial count in the rivers ranged from 1.5 × 105 to 6.3 × 105 CFUmL-1, while the total coliform count ranged from 1.3 × 103 to 4.8 × 103 CFUmL-1. The predominant bacteria were Escherichia coli and Pseudomonas aeruginosa.

Conclusion

This study revealed that the physiochemical properties of the waters were majorly within the WHO permissible standards but with significantly higher bacterial loads.

Remote sensing-enabled machine learning for river water quality modeling under multidimensional uncertainty

Two fundamental problems have inhibited progress in the simulation of river water quality under climate (and other) uncertainty: 1) insufficient data, and 2) the inability of existing models to account for the complexity of factors (e.g., hydro-climatic, basin characteristics, land use features) affecting river water quality. To address these concerns this study presents a technique for augmenting limited ground-based observations of water quality variables with remote-sensed surface reflectance data by leveraging a machine learning model capable of accommodating the multidimensionality of water quality influences. Total Suspended Solids (TSS) can serve as a surrogate for chemical and biological pollutants of concern in surface water bodies. Historically, TSS data collection in the United States has been limited to the location of water treatment plants where state or federal agencies conduct regularly-scheduled water sampling. Mathematical models relating riverine TSS concentration to the explanatory factors have therefore been limited and the relationships between climate extremes and water contamination events have not been effectively diagnosed. This paper presents a method to identify these issues by utilizing a Long Short-Term Memory Network (LSTM) model trained on Moderate Resolution Imaging Spectroradiometer (MODIS) satellite reflectance data, which is calibrated to TSS data collected by the Ohio River Valley Water Sanitation Commission (ORSANCO). The methodology developed enables a thorough empirical analysis and data-driven algorithms able to account for spatial variability within the watershed and provide effective water quality prediction under uncertainty.

Global population surpasses eight billion: Are we ready for the next billion?

In November 2022, the global population had officially crossed eight billion. It has long been recognized that socioeconomic or health-related problems in the community always accompany an uncontrolled population expansion. International calls have been made regarding lack of universal health coverage, an insufficient supply of healthcare providers, the burden of noncommunicable disease, population aging and the difficulty in obtaining safe drinking water and food. The present health policy paper discusses how to conquer these crowded world issues, including (1) promoting government and international organization participation in providing appropriate infrastructure, funding and distribution to assist people's health and well-being; (2) shifting health program towards a more preventive approach and (3) reducing inequalities, particularly for the marginalized, isolated and underrepresented population. These fundamental principles of health policy delivery as a response to an increasingly crowded world and its challenges are crucial for reducing the burden associated with excessive healthcare costs, decreased productivity and deteriorating environmental quality.

Status of disinfection byproducts research in India

India faces high incidents of waterborne disease outbreaks owing to their limited access to safe drinking water. In many ways, the effort to improve the quality of drinking water is performed, and it has been keenly monitored. Among those, the disinfection of drinking water is considered a necessary and important step as it controls the microbial population. Chlorination is the most practiced (greater than 80%) disinfection process in India, and it is known to generate various disinfection byproducts (DBPs). Although the toxicity and trend of DBPs are regularly monitored and investigated in most countries, still in India, the research is at the toddler level. This review summarizes i) the status of drinking water disinfection in India, ii) types of disinfection processes in centralized water treatment plants, iii) concentrations and occurrence patterns of DBPs in a different region of India, iv) a literature survey on the toxicity of DBPs, and v) removal methodologies or alternative technologies to mitigate the DBPs formation. Overall, this review may act as a roadmap to understand the trend of disinfection practices in India and their impacts on securing the goal of safe drinking water for all.

TFOS lifestyle: Impact of societal challenges on the ocular surface

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Climate change and its effect on groundwater quality

Knowing water quality at larger scales and related ground and surface water interactions impacted by land use and climate is essential to our future protection and restoration investments. Population growth has driven humankind into the Anthropocene where continuous water quality degradation is a global phenomenon as shown by extensive recalcitrant chemical contamination, increased eutrophication, hazardous algal blooms, and faecal contamination connected with microbial hazards antibiotic resistance. In this framework, climate change and related extreme events indeed exacerbate the negative trend in water quality. Notwithstanding the increasing concern in climate change and water security, research linking climate change and groundwater quality remain early. Additional research is required to improve our knowledge of climate and groundwater interactions and integrated groundwater management. Long-term monitoring of groundwater, surface water, vegetation, and land-use patterns must be supported and fortified to quantify baseline properties. Concerning the ways climate change affects water quality, limited literature data are available. This study investigates the link between climate change and groundwater quality aquifers by examining case studies of regional carbonate aquifers located in Central Italy. This study also highlights the need for strategic groundwater management policy and planning to decrease groundwater quality due to aquifer resource shortages and climate change factors. In this scenario, the role of the Society of Environmental Geochemistry is to work together within and across geochemical environments linked with the health of plants, animals, and humans to respond to multiple challenges and opportunities made by global warming.

The rise of diarrheal illnesses in the children of Pakistan amidst COVID-19: A narrative review

Background

In Pakistan, 74 children out of 1000 lose their lives annually due to diarrheal illness. This commentary addresses the contributing factors aggravating this growing dilemma and the effect of a simultaneous rise in COVID-19 cases in a healthcare system ready to collapse, along with providing recommendations to alleviate the problems causing this spike in diarrheal cases.

Methods

This narrative review has emphasized the causes of the spike in pediatric diarrheal illnesses in Pakistan as well as recommendations offered to lessen the burden by incorporating recent literature (n = 68). Tactics to tackle COVID-19 alongside diarrheal illnesses were also included. Pakistan was chosen to be assessed due to its high burden of child and infant mortality due to preventable causes.

Results

The provision of safe drinking water, the proper use of Integrated Management of Newborn and Childhood Illnesses (IMNCI), adequate awareness of the benefits of breastfeeding, the use of correct rehydration techniques such as Oral Rehydration Therapy, and the crucial implementation of the EPI vaccination schedule can curb this increase in diarrheal cases.

Conclusion

The increased prevalence of diarrheal diseases amongst the pediatric population of Pakistan can be attributed largely due to unsanitary drinking water. Emphasis must be put in the provision of safe drinking water. During the first years of life, children can be kept safe from deadly pathogens just by adequate breastfeeding. IMNCI and EPI must also be properly implemented.

Water sanitation problem in Pakistan: A review on disease prevalence, strategies for treatment and prevention

The global water crisis is expected to worsen if urgent action is not taken in making sustainable amends. This applies to Pakistan as the entire country suffers massively from poor water sanitation. Waterborne diseases are rising exponentially attributed to rise in microbial infestations, trace elements and drug toxicity in many water bodies of Pakistan. Treatment and prevention strategies must be implemented through national authorities and at the individual level. Awareness on use of clean water must be emphasized and proper administration on water management policies should be implemented. Immediate and active sustainability for water resources can ensure a safer future for Pakistan.

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Water Sanitation has been a problem all over Pakistan.

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The current situation has shown that most rural areas and some urban areas suffer due to the unclean water supply, which progresses in many diseases.

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This paper combines many methods of preventing waterborne diseases and treating the water bodies to make it free from contaminants.

One Health Paradigm to Confront Zoonotic Health Threats: A Pakistan Prospective

The emergence and re-emergence of zoonotic diseases significantly impact human health, particularly those who live in impoverished areas and have close contact with domestic or wild animals. Nearly 75% of zoonotic diseases are transmitted directly from animals to humans or indirectly via vector/agent interactions between animals and humans. Growing populations, globalization, urbanization, and the interaction of the environment with humans and livestock all play roles in the emergence and spread of zoonotic diseases. "One Health" is a multidisciplinary concept aimed at improving human, animal, and environmental health, but this concept is not widely accepted in developing countries. In Pakistan, environmental, human, and animal health are severely affected due to a lack of sufficient resources. This review article provides an overview of the most common zoonotic diseases found in Pakistan and emphasizes the importance of the "One Health" concept in managing these diseases. Given the current situation, interdisciplinary research efforts are required to implement and sustain effective and long-term control measures in animal, human, and environmental health surveillance and accurate diagnostic methods.

Climate Change Policy Coherence across Policies, Plans, and Strategies in Pakistan-Implications for the China-Pakistan Economic Corridor Plan

Climate Change (CC) adaptation and mitigation policy coherence (PC) across sectors is essential to effectively address CC challenges and support synergies. Pakistan is highly vulnerable to CC. In this paper, the extent to which Pakistan's national and provincial water, agriculture, and energy sector policies, development plans and strategies are aligned in a CC policy coherent manner is established. In this context, a qualitative content document analysis with associated scoring is used to assess government documents. Furthermore, implications of the China-Pakistan Economic Corridor Initiative (CPEC; 2017-2030), the biggest infrastructure investment program ever in Pakistan, are discussed. An important result is that sectoral policies are found to have different degrees of PC. Better coherence is found at federal than at provincial levels. Furthermore, CC policies are found to be more coherently addressed in water and agriculture policies than in energy policies. It is suggested that to achieve higher levels of CC PC, federal and provincial governments should establish mechanisms of intergovernmental consultation for policy-making and cross-sectoral planning, especially in the energy sector. Our findings can help the Government of Pakistan to transform CPEC into a model green Belt and Road Initiative (BRI) in the region. In this context, there are important implications with regards to e.g., reducing coal-based energy projects and environmentally damaging infrastructure activities in sensitive ecosystems. With this paper, the authors want to raise awareness of the key importance of CC PC, particular in context of the BRI. Many countries participating in the initiative have carbon reduction targets in place.

Climate Change Policy Coherence across Policies, Plans, and Strategies in Pakistan—Implications for the China–Pakistan Economic Corridor Plan

Climate Change (CC) adaptation and mitigation policy coherence (PC) across sectors is essential to effectively address CC challenges and support synergies. Pakistan is highly vulnerable to CC. In this paper, the extent to which Pakistan’s national and provincial water, agriculture, and energy sector policies, development plans and strategies are aligned in a CC policy coherent manner is established. In this context, a qualitative content document analysis with associated scoring is used to assess government documents. Furthermore, implications of the China–Pakistan Economic Corridor Initiative (CPEC; 2017–2030), the biggest infrastructure investment program ever in Pakistan, are discussed. An important result is that sectoral policies are found to have different degrees of PC. Better coherence is found at federal than at provincial levels. Furthermore, CC policies are found to be more coherently addressed in water and agriculture policies than in energy policies. It is suggested that to achieve higher levels of CC PC, federal and provincial governments should establish mechanisms of intergovernmental consultation for policy-making and cross-sectoral planning, especially in the energy sector. Our findings can help the Government of Pakistan to transform CPEC into a model green Belt and Road Initiative (BRI) in the region. In this context, there are important implications with regards to e.g., reducing coal-based energy projects and environmentally damaging infrastructure activities in sensitive ecosystems. With this paper, the authors want to raise awareness of the key importance of CC PC, particular in context of the BRI. Many countries participating in the initiative have carbon reduction targets in place.

Evaluation of contaminants removal by waste stabilization ponds: A case study of Siloam WSPs in Vhembe District, South Africa

Waste stabilization ponds (WSPs) are widely used for wastewater management owing to the simplicity of their design, low cost and the use of low-skilled operators. This study was carried out to assess the efficiency of a WSP system in reducing the levels of contaminants in hospital wastewater in a rural area of South Africa and to evaluate the current management of the WSP system. Sampling was conducted monthly from January to June 2014. Physicochemical and microbiological parameters were monitored using standard methods. The microbiological parameters (Escherichia coli and enterococci) in the effluent were higher than those in the influent in some sampling months. Also, low pathogen removal efficiency (<1 log reduction) was recorded. The chemical oxygen demand (COD) in the effluent (82-200 mg/L) exceeded the South African Department of Water Affairs for wastewater discharge guideline value of 75 mg/L although reduction efficiencies of 7.7%, 49.1% and 31.1% were observed for the months of February, April and June, respectively. The WSP system did not show a general trend of contaminant reduction except for Zn (5.5-94.8%). The Siloam WSP is not functioning properly and is releasing effluent of poor quality into the receiving river. It is recommended that the WSP system be expanded to cater for the extra load of wastewater it receives, also desludging should be performed as recommended for such systems. Continuous monitoring of the system for compliance to regulatory guideline should be routinely performed.