Sustainable Control of Water-Related Infectious Diseases: A Review and Proposal for Interdisciplinary Health-Based Systems Research

Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan 48109, USA.
Environmental Health Perspectives (Impact Factor: 7.98). 08/2009; 117(7):1023-32. DOI: 10.1289/ehp.0800423
Source: PubMed

ABSTRACT Even when initially successful, many interventions aimed at reducing the toll of water-related infectious disease have not been sustainable over longer periods of time. Here we review historical practices in water-related infectious disease research and propose an interdisciplinary public health oriented systems approach to research and intervention design.
On the basis of the literature and the authors' experiences, we summarize contributions from key disciplines and identify common problems and trends. Practices in developing countries, where the disease burden is the most severe, are emphasized.
We define waterborne and water-associated vectorborne diseases and identify disciplinary themes and conceptual needs by drawing from ecologic, anthropologic, engineering, political/economic, and public health fields. A case study examines one of the classes of water-related infectious disease.
The limited success in designing sustainable interventions is attributable to factors that include the complexity and interactions among the social, ecologic, engineering, political/economic, and public health domains; incomplete data; a lack of relevant indicators; and most important, an inadequate understanding of the proximal and distal factors that cause water-related infectious disease. Fundamental change is needed for research on water-related infectious diseases, and we advocate a systems approach framework using an ongoing evidence-based health outcomes focus with an extended time horizon. The examples and case study in the review show many opportunities for interdisciplinary collaborations, data fusion techniques, and other advances.
The proposed framework will facilitate research by addressing the complexity and divergent scales of problems and by engaging scientists in the disciplines needed to tackle these difficult problems. Such research can enhance the prevention and control of water-related infectious diseases in a manner that is sustainable and focused on public health outcomes.

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    • "Risk models are advantageous because they can inform early warning systems which attempt to predict outbreaks, but generally focus on a limited range of variables [28]. Researchers have argued for an expanded transdisciplinary approach to combat water-associated disease, as a large number of factors such as climate patterns, land use and socioeconomic determinants are often examined separately and with limited successes [10], [29]–[31]. For instance, using only the Aedes mosquito index based on larval surveys has been ineffective in predicting dengue incidence in many regions including Malaysia, Taiwan and Trinidad [24], [32], [33]. "
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    ABSTRACT: The Water-associated Disease Index (WADI) was developed to identify and visualize vulnerability to different water-associated diseases by integrating a range of social and biophysical determinants in map format. In this study vulnerability is used to encompass conditions of exposure, susceptibility, and differential coping capacity to a water-associated health hazard. By assessing these conditions, the tool is designed to provide stakeholders with an integrated and long-term understanding of subnational vulnerabilities to water-associated disease and contribute to intervention strategies to reduce the burden of illness. The objective of this paper is to describe and validate the WADI tool by applying it to dengue. A systemic ecohealth framework that considers links between people, the environment and health was applied to identify secondary datasets, populating the index with components including climate conditions, land cover, education status and water use practices. Data were aggregated to create composite indicators of exposure and of susceptibility in a Geographic Information System (GIS). These indicators were weighted by their contribution to dengue vulnerability, and the output consisted of an overall index visualized in map format. The WADI was validated in this Malaysia case study, demonstrating a significant association with dengue rates at a sub-national level, and illustrating a range of factors that drive vulnerability to the disease within the country. The index output indicated high vulnerability to dengue in urban areas, especially in the capital Kuala Lumpur and surrounding region. However, in other regions, vulnerability to dengue varied throughout the year due to the influence of seasonal climate conditions, such as monsoon patterns. The WADI tool complements early warning models for water-associated disease by providing upstream information for planning prevention and control approaches, which increasingly require a comprehensive and geographically broad understanding of vulnerability for implementation.
    PLoS ONE 05/2013; 8(5):e63584. DOI:10.1371/journal.pone.0063584 · 3.23 Impact Factor
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    • "For example, to disrupt disease cycles, the Tennessee Valley Authority (TVA) modified their reservoir operations to raise or lower water levels by 0.3 m over about a week [Keiser, 2005b; Porter, 1938]. While the development of chemicals such as DDT fostered a transition away from environmental control measures in the 1950s, a growing number of public health experts have begun to recommend reintegrating environmental methods into disease control strategies [Batterman et al., 2009; Utzinger, 2001; World Health Organization (WHO), 2004], and some engineers have begun developing environmental control methods [Bomblies et al., 2008; Gianotti et al., 2009]. However, there has been very little contemporary consideration of modifying dam operation to contribute to malaria control. "
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    ABSTRACT: This paper investigates the water resources implications of using a method of hydrological control to reduce malaria around the Koka reservoir in central Ethiopia. This method is based on recent findings that malaria is transmitted from the shoreline of the Koka reservoir, and on a similar method that was used to control malaria some 80 yr ago in the United States. To assess the feasibility of implementing hydrological control at Koka, we considered the potential impact of the modified management regime on the benefits derived from current uses of the reservoir water (i.e., hydropower, irrigation, flood control, water supply, and downstream environmental flows). We used the HEC-ResSim model to simulate lowering the reservoir by a rate designed to disrupt larval development, which is expected to reduce the abundance of adult mosquito vectors and therefore reduce malaria transmission during the season in which transmission of the disease peaks. A comparison was made of major reservoir uses with and without the malaria control measure. In the 26-yr simulation, application of the malaria control measure increased total average annual electricity generation from 87.6 GWh × y -1 to 92.2 GWh × y -1 (i.e., a 5.3% increase) but resulted in a small decline in firm power generation (i.e., guaranteed at 99.5% reliability) from 4.16 MW to 4.15 MW (i.e., a 0.2% decrease). Application of the malaria control measure did not impact the ability of the reservoir to meet downstream irrigation demand and reduced the number of days of downstream flooding from 28 to 24 d. These results indicate that targeted use of hydrological control for malaria vector management could be undertaken without sacrificing the key benefits of reservoir operation.
    Water Resources Research 09/2011; 47(9). DOI:10.1029/2010WR010166 · 3.55 Impact Factor
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    • "It is critical to build a data infrastructure and conduct such research in India so that region-specific models based on climate and health can be developed. A systems approach focusing on health outcomes is critical to the success of future research in this area (Batterman et al. 2009). As prediction models evolve, region-specific action plans and adaptation strategies can be developed. "
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    ABSTRACT: Climate change and associated increases in climate variability will likely further exacerbate global health disparities. More research is needed, particularly in developing countries, to accurately predict the anticipated impacts and inform effective interventions. Building on the information presented at the 2009 Joint Indo-U.S. Workshop on Climate Change and Health in Goa, India, we reviewed relevant literature and data, addressed gaps in knowledge, and identified priorities and strategies for future research in India. The scope of the problem in India is enormous, based on the potential for climate change and variability to exacerbate endemic malaria, dengue, yellow fever, cholera, and chikungunya, as well as chronic diseases, particularly among the millions of people who already experience poor sanitation, pollution, malnutrition, and a shortage of drinking water. Ongoing efforts to study these risks were discussed but remain scant. A universal theme of the recommendations developed was the importance of improving the surveillance, monitoring, and integration of meteorological, environmental, geospatial, and health data while working in parallel to implement adaptation strategies. It will be critical for India to invest in improvements in information infrastructure that are innovative and that promote interdisciplinary collaborations while embarking on adaptation strategies. This will require unprecedented levels of collaboration across diverse institutions in India and abroad. The data can be used in research on the likely impacts of climate change on health that reflect India's diverse climates and populations. Local human and technical capacities for risk communication and promoting adaptive behavior must also be enhanced.
    Environmental Health Perspectives 01/2011; 119(6):765-70. DOI:10.1289/ehp.1003000 · 7.98 Impact Factor
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