Agrochemicals and Chronic Kidney Disease of Multi-Factorial Origin: Environmentally Induced Occupational Exposure An Occupational Exposure Disease
Abstract and Figures
Abstract
The contamination of food and water through waste and agricultural runoff poses serious threats to humans. Pollution with microbes causes noticeable diarrheal diseases, whereas agrochemicals, heavy metals, fluoride, and toxins cause insidious diseases and premature deaths. Chronic kidney disease of unknown origin (CKDuo) was first seen in dry-zonal agricultural regions in equatorial countries in the mid-1960s, and in Sri Lanka, in mid-1990s. A number of agents and toxins have been postulated as the cause of CKD of multifactorial origin (CKDmfo/CKDuo), including heavy metals, agrochemicals, fluoride, fungal and bacterial toxins, climate change; and a number of behavioral factors. Meanwhile, several other potential nephrotoxic causes have not been investigated, including the indiscriminate and excessive use of non-steroidal antiinflammatory drugs, illegal drugs and illicit alcohol, microbial agents (leptospirosis, Hanta virus etc.), chronic dehydration, and exposure to various combinations of these toxic agents in the presence of unhealthy habits. The incidence of CKDmfo is doubling every 4 to 5 years in Sri Lanka, leading to more than 5,000 deaths annually; excess of 150,000 people are currently affected. Although a number of agents have been postulated, no single offending agent has been identified as the cause of CKDmfo. To alleviate CKDmfo, it is essential to take a broader, holistic approach: carry out a massive awareness campaign, prevent environmental pollution, lessen malnutrition, correct unhealthy behaviors and habits acquired during recent past, and provide clean water completely devoid of nephrotoxins to all inhabitants in the affected communities. A sustained, coordinated, targeted, and effective approach is essential to decrease the disease incidence, prevention of premature deaths, and eradication of CKDmfo. This review explores pros and cons of agrochemicals as a potential cause of this deadly disease.
![The distribution of drinking water sources in the North Central Province (NCP) in Sri Lanka (after Chandrajith et al. [17]).](https://www.researchgate.net/profile/Sunil-Wimalawansa/publication/285546876/figure/fig1/AS:616354403061761@1523961749069/The-distribution-of-drinking-water-sources-in-the-North-Central-Province-NCP-in-Sri_Q320.jpg)
![The geographical distribution of patients with CKDmfo in relation to the climatic zones in Sri Lanka. (A) The three climatic zones, wet zone (pink), intermediate zone (red), and dry zone (orange) are illustrated, with the areas originally affected with CKDmfo shown in yellow. (B) A map of Sri Lanka illustrating the pattern of distribution and spread of the disease outside the NCP (NCP region is indicated in light green). Colour coding: The original CKDmfo hot spot areas (pink circles); the spread of the disease from 2008 through 2012 (blue circles), and the spread after 2012 (green circles). The climatic boundaries are super-imposed with broken black lines. Figure A was modified after Smedley and Kinniburgh, 2002 and Figure B was modified from existing data, public domain, and from Wimalawansa et al (2014) with added new data [21].](https://www.researchgate.net/profile/Sunil-Wimalawansa/publication/285546876/figure/fig3/AS:616354403057672@1523961749177/The-geographical-distribution-of-patients-with-CKDmfo-in-relation-to-the-climatic-zones_Q320.jpg)
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... To complicate matters, while the groundwater is very hard in areas, such as Puttalam and Jaffna districts, it has very low F − content and has a very low prevalence of CKDmfo. These data suggest that drinking hard water alone does not cause CKDmfo (Weeraratne and Wimalawansa, 2015;Wimalawansa, 2015a). Few other locations in the country have high F − (and iron) contents in water, but water is relatively soft, and people living in these areas also have a very low prevalence of CKDmfo. ...
... solubility product of Ca 2+ and PO 3− 4 exceeds the threshold, CaPO 4 nanoparticles are formed (Ho et al., 2018). This vicious cycle is facilitated by excess PO 3− 4 present in water (derived from waterways and reservoirs) and Ca 2+ in hard water (Wimalawansa and Dissanayake, 2019) in the affected regions secondary to the overuse of phosphate fertiliser in hilly areas of the country (Wimalawansa, 2015a). ...
... mg/l, orthophosphate levels vary between 0.005 and 0.05 mg/l [4], but what is clinically meaningful is the total PO 3− 4 content. In CKDmfo-affected regions, the average PO 3− 4 concentration of reservoirs water is higher, between 0.8 and 1.4 mg/l (Dharma-Wardana et al., 2015;Wimalawansa, 2015a). Nevertheless, PO 3− 4 concentrations alone are not too high to cause health hazards. ...
Importance
More than forty million people from certain tropical countries are at risk of developing a non-conventional form of chronic kidney disease (CKD), CKD of multifactorial etiology (CKDmfo). This is also known as CKD of unknown etiology (CKDu). Worldwide, it kills more than 20,000 people annually.
Findings
CKDmfo is a chronic tubulointerstitial renal disease caused by groundwater-induced hydroxy- and fluorapatite nano-crystals and nano-tube formation in renal tubules and cortical tissues, in conjunction with chronic intravascular volume depletion, chronic renal anaemia, and ischemia. To manifest this gradually developing renal failure, consuming hard water having, higher concentrations of calcium, phosphates, and fluoride for more than 10 years is necessary. The disease progresses when the kidneys fail to repair or due to ongoing renal tissue damage in the presence of micronutrient deficiency, chronic dehydration, renal ischemia, chronic inflammation, and oxidative stress. These prevents regenerations of renal tissues.
Conclusion
Consumption of stagnant groundwater concentrated with ions, like Ca ²⁺ , PO 4 , and F ⁻ due to prolonged annual droughts over many years, in conjunction with lesser water intake and chronic dehydration, creates a conducive internal milieu for CaPO 4 crystallisation in renal tissues. This proposed primary etiology of the crystal-tubular-nephropathy (CTN) provides an insight into a deeper understanding of the use of cost-effective strategies for prevention, early intervention, and eradication of CKD-CTN. In addition to the nano-crystal/nano-tube concept, we provide supporting scientific evidence that Mg ²⁺ in water and the diet does not promote the disease; instead, it prevents crystal formation and developing CKDmfo, as with some other CKDs.
Relevance
We present novel CaPO 4 hydroxyapatite crystal formation concepts in a hyperosmolar fluid in renal tissues that causes CKDmfo. Besides, the protective (e.g., magnesium) and enhancing (e.g., dehydration, drinking stagnant hard water) mechanisms that cause CKD-CTN are explored. A new understanding of causative mechanisms paves a path for cost-effective targeted interventions to prevent and eliminate CKDmfo. These principles apply to all CKDmfo/CKDu-affected countries to protect the renal health of farm labourers and others who regularly engage in physical work in hot and dry environments. Providing affordable potable water, increasing water consumption, and avoiding harmful behaviours are critical measures for eliminating CKDmfo.
... To date, the disease is not well documented, and precise data on people affected by CKDu has been the subject of debate among researchers. Some have estimated that the affected population in Sri Lanka is as high as 400,000 (Perera 2012, cited in Silva 2019), while others suggest that around 150,000 people may be affected by the disease and that about 3% of those lose their lives annually (Wimalawansa 2015). Amarasiri de Silva (2019) notes that between 1991, when Sri Lanka's first ever CKDu patient was identified in Medawachchiya in Anuradhapura District, and 2010, the number of CKDu patients admitted to Anuradhapura Teaching Hospital rose by 274%. ...
... The author goes on to note that the perspective of villagers who believe that polluted water has a direct relationship with kidney disease has been strengthened by media reports on sociocultural, biomedical, and epidemiological research on the aetiology of CKDu (Idem.). Consequently, there is broad consensus within the CKDu research community in Sri Lanka that providing clean drinking water could be the most effective disease prevention strategy (Ranasinghe et al. 2015;Wimalawansa 2015;Wimalawansa and Wimalawansa 2016). It is worth noting that despite strong bodily evidence of the benefit of switching to filtered water, such as the cessation of a burning sensation when passing urine, people remain concerned about the possible side effects of consuming mineral-free filtered water (Senanayake 2020). ...
Over the last several decades, epidemics of chronic kidney disease of unknown aetiology (CKDu) have appeared in Mesoamerica, North Africa, and South Asia. Drawing on 14 months of ethnographic fieldwork in a CKDu-affected village in Sri Lanka, I explore how one CKDu ‘hotspot’ came into being following population screening interventions by a community development organisation, a philanthropic foundation, and a university research group. While the production of test results proved vital to the mobilisation of further research and public health resources for the community, this ethnography reveals philanthropy could be seen to have shaped by screening as much as screening was seen to have influenced by philanthropy. The example of medical screening and philanthropic interventions in Ginnoruwa illustrates how bioindicators of failing kidney function became a key metric for demarcating the community into populations of the deserving (or not so deserving) poorly, which in turn helped to create the pattern of disease prevalence and concentration that led to the community being designated a ‘hotspot’. In Ginnoruwa, philanthropy and screening did not operate independently but constituted a novel hybrid, which I refer to as ‘philanthropic science’.
... Another adverse consequence of chemical fertilizers is the promotion of algae bloom in water bodies. Excessive nutrients, particularly nitrogen and phosphorus from fertilizers, fuel the rapid growth of algae, resulting in algal blooms [38,39]. These blooms disrupt aquatic ecosystems, depleting oxygen levels in water bodies and causing harm to aquatic life. ...
The increasing need for sustainable agricultural practices due to the overuse of chemical fertilizers has prompted interest in microalgae as biofertilizers. This review investigates the potential of microalgae as biofertilizers and phycoremediators within sustainable agroecosystems, addressing both soil fertility and wastewater management. Microalgae provide a dual benefit by absorbing excess nutrients and contaminants from wastewater, generating nutrient-rich biomass that can replace chemical fertilizers and support plant growth. Implementation strategies include cultivating microalgae in wastewater to offset production costs, using closed photobioreactor systems to enhance growth efficiency, and applying microalgal biomass directly to soil or crops. Additionally, microalgae extracts provide essential bioactive compounds, such as phytohormones and amino acids, that enhance plant growth and resilience. While microalgae offer an eco-friendly solution for nutrient recycling and crop productivity, challenges in scalability, production cost, and regulatory frameworks hinder widespread adoption. This review highlights the potential pathways and technological advancements necessary for integrating microalgae into sustainable agriculture, emphasizing the need for interdisciplinary collaboration and innovative approaches to overcome these barriers. Ultimately, microalgae biofertilizers represent a promising approach to reducing environmental impact and advancing sustainable farming practices.
... The number of victims of CKDu, exceeded 30,500 by 2017 as diagnosed at 11 hospitals from 2003-2017 [3]. As estimated by some studies, the incidence of CKDu in Sri Lanka has been doubling every four to five years [4]. In turn, over 150,000 people have been affected by the disease by 2015 and about 3% of them lose their lives annually [5]. ...
Naturally occurring colloids, particles of diameter < 2 μm, are ubiquitous in geo environments and can potentially facilitate transport of numerous contaminants in soil via colloid-facilitated transport (CFT). Colloid mobilization, transport and CFT in various geo-media are highly sensitive to physico-chemical perturbations. This study investigated colloid, and colloid facilitated cadmium transport in saturated porous media with a series of column experiments. Soil colloids were extracted from soils belonging to two areas affected by chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. Colloid breakthrough curves were obtained from the column studies under different flow rates (0.50, 1.60, and 4.00 ± 0.05 cm³/s) and ionic strengths (0.01, 0.05, and 0.10 M NaCl). The CFT was studied using Cd(II) as a model contaminant together with colloidal suspension under selected scenarios for high colloidal deposition. Elevated colloid concentrations were observed in highly CKDu affected area. The experimental results were numerically simulated on an advection-diffusion/dispersion modelling framework coupled with first-order attachment, detachment and straining parameters inversely estimated using Hydrus 1D software. Experimental and simulated colloid breakthrough curves showed a good agreement and recognized colloid attachment as the key retention mechanism. Both colloids and CFT of Cd(II) showed pronounced deposition under low flow rates and high ionic strengths.
... The characteristic interstitial infiltrate comprises lymphocytes, macrophages, eosinophils, and plasma cells, which can rapidly transform into interstitial fibrosis leading to chronic kidney disease (CKD). The critical biochemical differential diagnosis aid is tubular-specific markers in urine, which is straightforward and not expensive [9,41,47]. Examples of tubular specific makers (when the primary damage is to renal tubules) include Cystatin C, Kidney injury molecule-1 (KIM-1), Monocyte chemotactic protein-1 (MCP-1) N-acetyl-β-Dglucosaminidase (NAG) Nephrin, Netrin-1, Neutrophil gelatinase-associated lipocalin (NGAL) Smooth Muscle alpha-Actin (α-SMA), Urinary Vitamin D binding protein (uVDBP), and Vascular endothelial growth factor (VEGF) [41,48,49]. ...
In tropical countries, a mysterious tubulo-interstitial chronic renal disease (CKD), unrelated to diabetes, hypertension, and immunological causes, manifested four decades ago. Approximately 25,000 primarily middle-aged male farmers succumb annually to this crystal-tubular nephropathy (CTN). Without any known causative factors, it was identified as CKD of unknown aetiology (CKDu). Because multiple factors contribute to causing it later, was changed to CKD of multi-factorial (CKDmfo). Despite no evidence, it was hypothesised to cause by agrochemicals or heavy metals in food or drinking contaminated water. However, current data suggest that the CKD-CTN is due to natural geogenic water contamination. Consumption of concentrated stagnant groundwater from deep-dug wells and tube wells containing hard water and fluoride, overdecades is necessary for its clinical manifestations. In all affected countries have prolonged annual dry seasons that led to the evopo-concentration of ions and minerals in groundwater, making hard water even more unpalatable, thus, peasants consume lesser amounts of water. They develop chronic dehydration from daily exposure to hot climatic conditions aggravated by regular alcohol intake. These conditions provide a highly conducive environment—a perfect storm for calcium phosphate (CaPO4) crystal formation in renal tissues. Our recent histological and preliminary electron microscopic data reveal deposition of CaPO4 crystals and nano-tubes in kidneys. While CaPO4 nano-minerals are unstable, the presence of fluoride ions stabilises and allows their growth. This new concept paves the path for highly cost-effective, straightforward local solutions to protect farm workers and eliminate the disease, without embarking on expensive medications, interventions, or building hospitals. Chronic dehydration-associated CKD–CTN is preventable by increased consumption of potable water. Increasing clean water consumption reduces CKD–CTN incidence, and associated morbidities and premature deaths. However, the damage becomes irreversible when the disease advances beyond CKD stage IIIB. The incidence of this deadly renal failure can be prevented by its education, lifestyle changes, and increased water consumption, not by treating the renal disease or expanding dialysis centres/hospitals, or transplantation services. Eradication of CKD-CTN cost significantly less than the current approach of treating affected persons and unnecessarily expanding health infrastructure. Since the manifestation of CKD-CTN is due to consuming naturally contaminated drinking water (with calcium containing hard water and fluoride), it is not difficult to remove these to prevent CKD-CTN: thus, international assistance is unwarranted for its eradication. The straightforward approaches described here will prevent CKD–CTN and save thousands of lives in affected farming communities.
... For an instance, there is an assumption that water coming from the hill country brings many agrochemical residues viz. heavy metals, pesticides residues through the Mahaweli river to the reservoirs in the dry zone (Wanigasuriya, 2012;Wimalawansa, 2015), and therefore, those Mahaweli regions significantly shows CKDu respective to others areas. Furthermore, some researchers have identified that a small quantity of herbicide; propanil, and the insecticide; chlorpyrifos present in water sources in CKDu prevalent areas (Van Der Hoek and Konradsen, 2005). ...
The book consists of five main chapters. Chapters 01 & 02 consist of background information on the Uva Province and the background of the research study which has been conducted in the Uva Province in order to investigate etiological factors that contribute to the prevalence of CKDu. Chapter 02 explains the findings of the cross-sectional study carried out in order to identify the relationships between socioeconomic factors and the prevalence of CKDu. Furthermore, Chapter 03 is the most significant chapter which explains the geochemical assessment for groundwater in the study area to identify relationships between hydrogeochemical factors and the prevalence of CKDu. Moreover, Chapter 05 explains the findings of the soil erosion assessment that was carried out to identify the relationship between soil erosion and the prevalence of CKDu.
... For an instance, there is an assumption that water coming from the hill country brings many agrochemical residues viz. heavy metals, pesticides residues through the Mahaweli river to the reservoirs in the dry zone (Wanigasuriya, 2012;Wimalawansa, 2015), and therefore, those Mahaweli regions significantly shows CKDu respective to others areas. Furthermore, some researchers have identified that a small quantity of herbicide; propanil, and the insecticide; chlorpyrifos present in water sources in CKDu prevalent areas (Van Der Hoek and Konradsen, 2005). ...
This study was aimed to investigate the major causative factors contribute to the prevalence of Chronic Kidney Disease of Uncertain Etiology (CKDu) in the Uva province of Sri Lanka. The study was carried out under three main objectives as questionnaire survey based socio-economical assessment for CKDu patients, geochemical assessment for groundwater and underlying rocks, and soil erosion assessment in order to identify relationships between socio-economical and geochemical factors with the prevalence of CKDu in the study area. The socio-economical assessment reveled that age, gender, education, type of water source, exposure to agrochemicals, the major method of obtaining foods are significant risk factors in terms of the prevalence of CKDu in the study area. The results of geochemical assessment suggests that out of the 260 groundwater samples analyzed, 21.5%, 21.2%, 20.0%, 10.0%, and 27.3% are categorized under excellent, good, poor, very poor, and unsuitable category respectively in terms of the WQI. Furthermore, the spatial and the correlation analysis revealed that the groundwater quality has a significant effect on the prevalence of CKDu in the study area. Moreover, according to the best fitted logistic regression model, F- level and PO4-3 levels of the groundwater were found to be the geochemical risk factors that were significantly associated with the progression of CKDu in the study area. The soil erosion assessment suggested that the soil erosion hazard is very high in the Badulla district under the existing land use scenario compared to Moneralaga district. Furthermore the areas with low soil erosion rates in the study area tend to have a higher number of CKDu patients. Mainly it can be speculate that the soil erosion is higher in uphill areas and these eroded materials may have affected the drinking water quality of the Uva Province of Sri Lanka. Moreover, the finding of the study can be effectively used by the Sri Lankan government and other health organizations in the control of the prevalence of CKDu in Sri Lanka.
Core ideas • Soil from highly CKDu affected area showed higher concentration of col-loids • Colloid deposition increases with the decreasing flow rate and with increasing ionic strength • Cd(II) attachment was pronounced at low flow rate and high ionic strength • Colloid attachment is the key mechanism on colloid retention in porous media Transport of colloids and colloid-facilitated heavy metals in agricultural soils: Could it be a potential causative factor for the chronic kidney disease with unknown etiology (CKDu) in Sri Lanka? Abbreviations: Abstract Naturally-occurring colloids, particles of diameter < 10m, are ubiquitous in Geo-environments and can potentially facilitate transport of numerous contaminants in soil including harmful heavy metals, pesticides, pathogens etc. via Colloid-Facilitated Transport (CFT). The CFT of contaminants to groundwater is still an underrepresented transport domain and may lead to significant environmental and health problems related to groundwater contamination. Colloid mobilization, transport and CFT in various geomedia are highly sensitive to physico-chemical perturbations. This study investigated colloid transport and colloid-facilitated heavy metal transport in saturated porous media with a series of column experiments using soil colloids extracted from two areas affected by Chronic Kidney Disease of Unknown Etiology (CKDu) in North Central Province of Sri Lanka. Colloid breakthrough curves were obtained from the column studies to observe the colloid transport under different flow rates (0.5±0.05, 1.65±0.05, 4.10±0.05 cm 3 /s) and ionic strengths (NaCl-0.01 M, 0.05 M, 0.1 M). The CFT was studied using Cadmium (Cd(II)) as a model contaminant together with colloidal suspension under selected scenarios for high colloid de-position. Elevated colloid concentrations were observed in high CKDu affected area compared to the low endemic area. The experimental results were numerically simulated on an advection-diffusion/dispersion modelling framework coupled with first-order attachment, detachment and straining parameters inversely estimated using HYDRUS 1D software. Experimental and simulated colloid breakthrough curves showed a good agreement, and recognized colloid 1 ESSOAr | https://doi.org/10.1002/essoar.10511273.1 | Non-exclusive | First posted online: Thu, 5 May 2022 06:06:23 | This content has not been peer reviewed. attachment as the key mechanism for colloid immobilization in selected soil. Both colloids and CFT of Cd(II) showed pronounced deposition under low flow rate and high ionic strength.
A chronic kidney disease (CKDu), independent of known causes, such as diabetes and hypertension, is emerging as an epidemic in certain agrarian regions of the developing world. Given the unprecedented incidence of the disease among farm households, in the North Central Province (NCP) of Sri Lanka, CKDu is considered a public health emergency. Ever since the disease was first reported over two and a half decades ago, both local and international research communities have taken significant efforts to reveal the aetiology of the disease. Although the causes of the disease still remain unrevealed, much of the research findings supports a set of environmental and behavioural risk factors that are deemed to be associated with the occurrence and progression of the disease. To encourage healthy behaviours such as consumption of safe, uncontaminated water that minimise the deemed risk factors, several health extension programs have been launched in the high-risk areas of the NCP. However, according to reports, the programs have not achieved the expected success due to non-compliance of the people of the target population. Under a context of uncertainty of proven facts, the effectiveness of such programs and compliance of people to risk reduction behaviour is brought into question by two interrelated socio-cognitive concerns. One concern raises the importance of knowing how the people living in epidemic areas perceive and interpret the disease in terms of causes and risk preventive methods. The second concern being the socio-cognitive determinants that may prevent people from adopting the expected risk reduction behaviour. Highlighting the importance of the above knowledge gap, this study attempts to understand how an agrarian population in Sri Lanka, vulnerable to CKDu, perceive the disease as a health risk. The study further explores, how their psycho-social beliefs structure preventive behaviour against the unknown disease under a context of uncertainty. To achieve the latter objective, the study refers to a theoretical framework based on an extended Protection Motivation Theory.
Abstract
INTRODUCTION:
In El Salvador, chronic kidney disease is a serious and growing public health problem. Chronic renal failure was the first cause of hospital deaths in men and the fifth in women in 2011.
OBJECTIVE:
Determine prevalence of CKD, CKD risk factors (traditional and nontraditional) and renal damage markers in the adult population of specific rural areas in El Salvador; measure population distribution of renal function; and identify associated risk factors in CKD patients detected.
METHODS:
A cross-sectional analytical epidemiological study was conducted based on active screening for chronic kidney disease and risk factors in persons aged ≥18 years during 2009-2011. Epidemiological and clinical data were gathered through personal history, as well as urinalysis for renal and vascular damage markers, determinations of serum creatinine and glucose, and estimation of glomerular filtration rates. Chronic kidney disease cases were confirmed at three months. Multiple logistical regression was used for statistical analysis.
RESULTS:
Prevalence of chronic kidney disease was 18% (23.9% for men and 13.9% for women) in 2388 persons: 976 men and 1412 women from 1306 families studied. Chronic kidney disease with neither diabetes nor hypertension nor proteinuria ≥1 g/L (51.9%) predominated. Prevalence of chronic renal failure was 11% (17.1% in men and 6.8% in women). Prevalence of renal damage markers was 12.5% (higher in men): microalbuminuria, 6.9%; proteinuria (0.3 g/L), 1.7%; proteinuria (1g/L), 0.6%; proteinuria (2 g/L), 0.4 %; and hematuria, 1.5%. Prevalence of chronic kidney disease risk factors was: diabetes mellitus, 9%; hypertension, 20.9%; family history of chronic kidney disease, 16.5%; family history of diabetes mellitus, 18.5%; family history of hypertension, 30.6%; obesity, 21%; central obesity, 24.9%; NSAID use, 84.2%; smoking, 9.9%; alcohol use, 15%; agricultural occupation, 31.2%; and contact with agrochemicals, 46.7%. Chronic kidney disease was significantly associated with male sex, older age, hypertension, agricultural occupation, family history of chronic kidney disease and contact with the agrochemical methyl parathion.
CONCLUSIONS:
The results of this study support suggestions from other research that we are facing a new form of kidney disease that could be called agricultural nephropathy.
Globalization and industrialization have a marked effect on water and food security, with both beneficial and detrimental effects on water and air quality and living standards, especially in emerging economies. Air pollution is visible and relatively easier to control with enforcement of legislation, but water pollution is insidious and easily goes undetected. Contamination of food and water can have potentially deadly consequences, but many of these are preventable if proactive actions are taken. The availability of clean water depends on preservation of the watershed, which will not occur without proper planning, taking proactive measures, and enforcement of environmental laws. Governments have the fiduciary responsibility to make policies and implement and enforce legislations to preserve the environment, including watersheds. Administrations also must ensure all citizens have access to affordable, potable water and safe, sanitary facilities. Every nation needs to have and enforce a fair national water policy and legislations that ensures clean water and air; lacking such policies and legislation is suicidal. This article focuses on exploring the current understanding of the importance of preserving water quality and watersheds and practical ways to minimize anthropogenic water pollution by proactively preserving watersheds and the environment. Failure to take such actions will harm not only water quality, but also the environment, economy, and health of current and future generations.
An unpolluted environment is essential for optimum human health. Water polluted with microbes causes noticeable diarrheal diseases, whereas chemical and toxic contamination make people acutely or chronically sick and kill insidiously. Contamination of soil and water through human and industrial waste and agrochemicals is a universal problem and a major issue in developing countries, where the difficulties are attributable in part to lax environmental laws. Unrestrained industrial and domestic waste in urban and rural situations and pollution of reservoirs caused by agrochemical runoff are an increasing concern. Deforestation and consequent soil erosion further aggravate these issues. Massive contaminations such as oil spills are visible, and the deleterious effects are immediate, but microbial and chemical contamination of water in most circumstances is subtle, and it may be years before people realise their water supplies are contaminated and are adversely affecting human health. Misuse of agrochemicals is a key cause of pollution of potable water, reservoirs, and watersheds. The misuse is mostly attributable to irresponsible behaviour of farmers and agrochemical sellers, and large government fertiliser subsidies that incentivise fertiliser overuse; these are fully preventable. To prevent environmental pollution and occupational diseases, proactive preventative actions are needed, including preserving the environment and enforcing appropriate laws.
Approximately 25% of the world’s population has no access to clean and safe drinking water. Even though freshwater is available in most parts of the world, many of these water sources contaminated by natural means or through human activity. In addition to human consumption, industries need clean water for product development and machinery operation. With the population boom and industry expansion, the demand for potable water is ever increasing, and freshwater supplies are being contaminated and scarce.
In addition to human migrations, water contamination in modern farming societies is predominantly attributable to anthropogenic causes, such as the overutilization of subsidized agrochemicals― artificial chemical fertilizers, pesticides, fungicides, and herbicides. The use of such artificial chemicals continue to contaminate many of the precious water resources worldwide. In addition, other areas where the groundwater contaminated with fluorides, arsenic, and radioactive material occur naturally in the soil. Although the human body is able to detoxify and excrete toxic chemicals, once the inherent natural capacity exceeded, the liver or kidneys, or both organs may fail.
Following continual consumption of polluted water, when the conditions are unfavourable and the body’s thresholds are exceeded,
depending on the type of pollutants and toxin, liver, cardiac, brain, or renal failure may occur. Thus, clean and safe water provided at an affordable price is not only increasingly recognized, but also a human right and exceedingly important.
Most of the household filters and methods used for water purification remove only the particulate matter. The traditional methods, including domestic water filters and even some of the newer methods such as ultra-filtration, do not remove most of the heavy metals or toxic chemicals from water than can harm humans. The latter is achieved with the use of reverse osmosis technology and ion exchange methods.
Properly designed reverse osmosis methods remove more than
95% of all potential toxic contaminants in a one-step process. This review explains the reverse osmosis method in simple terms and summarizes the usefulness of this technology in specific situations in developing countries.
During the last two decades, Sri Lanka, located close to the equator, has experienced an escalating incidence of chronic kidney disease (CKD) of unknown aetiology (CKDue) in dry zonal areas. Similar incidences of unusual CKDs have been reported in the dry zonal, agricultural areas of several other equatorial countries. In Sri Lanka, the incidence of CKDue is highest in the North Central Province (NCP), where approximately 45 % of the country's paddy fields are located. However, in recent years, the disease has spread into areas adjacent to as well as distant from the NCP. The cause of CKD in Sri Lanka is unknown, and may likely due to interactions of different potential agents; thus, CKD is of multi-factorial origin (CKD-mfo). These factors include, the negative effects from overuse of agrochemicals. Nevertheless, the potential interactions and synergism between probable agents have not been studied. This systematic review discusses the proposed hypotheses and causes of CKD-mfo in Sri Lanka, and ways to decrease the incidence of this disease and to eradicate it, and provide some recommendations. During the past decade, a number of groups have investigated this disorder using different methodologies and reported various correlations, but failed to find a cause. Research has focussed on the contamination of water with heavy metals, agrochemicals, hard water, algae, ionicity, climate change, and so forth. Nevertheless, the levels of any of the pollutants or conditions reported in water in NPC are inconsistent not correlated with the prevalence of the disease, and are too low to be the sole cause of CKD-mfo. Meanwhile, several nephrotoxins prevalent in the region, including medications, leptospirosis, toxic herbs, illicit alcohol, locally grown tobacco, and petrochemicals, as well as the effects of changed habits occured over the past four decades have not been studied to date. Taken together, the geographical distribution and overall findings indicate that combinations of factors and/or their interactions are likely to precipitate CKD-mfo, which kills more than 5,000 people annually in Sri Lanka; most victims are middle-aged male farmers. Much anecdotal evidence from this region suggests that consumption of contaminated water is the most likely source of this deadly disease. Although the aetiology is unknown, prevention of this "environmentally acquired" disease seems relatively straightforward. Solutions include (a) preventing environmental pollution, (b) stopping the irresponsible use and decreasing the usage of agrochemicals, and encouraging the use of environmentally friendly agricultural methods, (c) taking proper precautions when using agrochemicals and safe disposal of their containers, (d) changing the risky behaviour of farmers and educating them to preserve the environment, and (e) providing clean potable water to all affected regions. Implementing a well-coordinated, in-depth, region-wide, broad-based research study together with a long-term effective surveillance programme across the country is essential to curbing this disease. Unless firm actions are taken promptly, more than three million healthy people in the country, live in agricultural regions, are at risk for contracting CKD-mfo and succumb to premature deaths, which are preventable.
Abstract
Sri Lanka provides an ideal opportunity for the study of the effect of geology on human health. The vast majority of the people of Sri Lanka still live in rural areas within areas termed geochemical provinces. Very broadly, one could say that a geochemical province has characteristic chemical composition in soil, water stream sediments and rocks, enabling their delineation from others. The chemical composition is presumed to be have an impact on the health of the inhabitants of the particular geochemical province, particularly because of the fact that their food and water are obtained mostly from the terrain itself. This leads to the concept of "diseases of geochemical origin". Among these are dental fluorosis, iodine deficiency disorders (IDDs) and selenium-based diseases. The Dry Zone of Sri Lanka has several areas rich in groundwater fluoride, the ingestion of which leads to dental fluorosis. Iodine deficiency diseases are more common in the Wet Zone, though their aetiologies are more complicated. Interestingly, it has also been observed that significant proportions of the female population of Sri Lanka are selenium-deficient, which could well be related to the geological environment. Chronic renal failure (CRF) has been observed in some areas of the Dry Zone of Sri Lanka, where there is a relationship of CRF with the mineral content of drinking water. This subject matter falls under the auspices of Medical Geology, a scientific discipline still in its infancy, and much more concerted studies are needed to attract the attention of medical research.
Examines the export of hazardous wastes to poor communities of color around the world and charts the global social movements that challenge them.
Every year, nations and corporations in the “global North” produce millions of tons of toxic waste. Too often this hazardous material—inked to high rates of illness and death and widespread ecosystem damage—is exported to poor communities of color around the world. In Resisting Global Toxics, David Naguib Pellow examines this practice and charts the emergence of transnational environmental justice movements to challenge and reverse it. Pellow argues that waste dumping across national boundaries from rich to poor communities is a form of transnational environmental inequality that reflects North/South divisions in a globalized world, and that it must be theorized in the context of race, class, nation, and environment. Building on environmental justice studies, environmental sociology, social movement theory, and race theory, and drawing on his own research, interviews, and participant observations, Pellow investigates the phenomenon of global environmental inequality and considers the work of activists, organizations, and networks resisting it. He traces the transnational waste trade from its beginnings in the 1980s to the present day, examining global garbage dumping, the toxic pesticides that are the legacy of the Green Revolution in agriculture, and today's scourge of dumping and remanufacturing high tech and electronics products. The rise of the transnational environmental movements described in Resisting Global Toxics charts a pragmatic path toward environmental justice, human rights, and sustainability.