Article

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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    • "We evaluate our process as successful using a variety of metrics recently developed for ID research. This success supports the findings of prior research into successful ID scientific teamwork (Batie 2008; Batterman et al. 2009; Falkenmark and Rockström 2004; Freeman 2000; Jury and Vaux 2005; Lach et al. 2005; Nowak et al. 2006). Our team demonstrated a unique approach to facilitating international ID team success through specific leadership techniques, intensive workshops, and group exercises. "
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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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    • "Isolating excreta to a consolidated area is a positive step but is minimally effective in lowering water-related disease rates (Bolaane & Ikgopoleng, 2011). Batterman et al. (2009) notes that isolated pit latrines in Africa, which technically indicate " access to sanitation, " often serve over 200 people and frequently overflow during rainy season. Integrated sanitation infrastructure is the most promising hope for sustainable waste management. "

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