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A bibliometric analysis of global research on drinking water and health in low- and
lower-middle-income countries
Alexa Bennett a,*, Jeffrey Demaine b, Caetano Dorea cand Alexandra Cassivi d
a
Global Health, McMaster University, Hamilton, ON, Canada
b
Library, McMaster University, Hamilton, ON, Canada
c
Civil Engineering, University of Victoria, Victoria, BC, Canada
d
École supérieure d’aménagement du territoire et de développement regional Quebec, Université Laval, QC, Canada
*Corresponding author. E-mail: bennea19@mcmaster.ca
AB, 0000-0001-9756-8193; JD, 0000-0003-4586-1317; CD, 0000-0001-9367-0668;AC,0000-0001-8770-1296
ABSTRACT
Heightened interest in drinking water research in recent decades has been aimed at narrowing the knowledge gaps surrounding water and
health in a global pursuit to provide safely managed drinking water services to populations who continue to lack access. This study used
bibliometrics and network analysis to produce a global overview of publications and groups that have contributed to research on drinking
water and health in low- and lower-middle-income countries (LLMICs). The United States and the United Kingdom, which have historically
dominated the field based on the production and impact of scientific literature, remain at the center of international collaborative research
partnerships with emerging countries. However, in recent years, the volume of publications produced by India has surpassed that of the
United States while Bangladesh is ranked third for the strongest international collaborations. Iran and Pakistan are also emerging as
major producers of research, yet publications out of these countriesand India remain disproportionately restricted behind paywalls. Contami-
nation, diarrheal disease, and water resources are the themes that characterize the majority of research on water and health. These findings
may be used to accelerate equitable, inclusive research in the realm of water and health, thereby enabling gaps in global drinking water
inequalities to be filled.
Key words: bibliometric, health, sustainable development goals, water
HIGHLIGHTS
•A macroscopical overview of published literature on water and health in low and lower-middle-income countries using bibliometric data
•Critical insights into research gaps pertaining to the literature on water and health
•May inform future research priorities, facilitate collaboration, and identify where national research systems must be strengthened
•Search terms: bibliometric, water, health, SDG6, sustainable development
This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY-NC-ND 4.0), which permits copying and
redistribution for non-commercial purposes with no derivatives, provided the original work is properly cited (http://creativecommons.org/licenses/by-nc-nd/4.0/).
© 2023 The Authors Journal of Water and Health Vol 00 No 0, 1 doi: 10.2166/wh.2023.293
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GRAPHICAL ABSTRACT
INTRODUCTION
Access to safe drinking water is a fundamental human right and has been acknowledged as such by the United Nations Gen-
eral Assembly through the human right to water (United Nations General Assembly 2010). The provision of safe, affordable,
and reliable water is essential to human health, dignity, and indispensable to sustainable development. Nonetheless, in 2021,
two billion people around the globe continue to lack access to safely managed drinking water services, which is defined as an
improved water source that is located on premise, available when needed and free from contamination (UN Water 2021).
Most people who lack access to safe drinking water are situated in low- and lower-middle-income countries (LLMICs),
which are consequently the regions disproportionately affected by the health burdens associated with the inadequate pro-
vision of water (WHO & UNICEF 2021). Some of these conditions include infectious diseases caused by waterborne
pathogens, neglected tropical diseases, and adverse health outcomes such as stunting, wasting, and being underweight
(Deshpande et al. 2020). It is estimated that universal access to drinking water, together with guaranteeing sanitation and
hygiene services, would prevent 1.6 million deaths per year, accounting for 2.8% of global mortalities (Prüss-Ustün et al. 2019).
Lack of access to water also affects human health and development through several secondary mechanisms, making tar-
geted health interventions complex. The inadequate provision of safe and reliable water is associated with food insecurity
(Brewis et al. 2019) and reduced hygiene practices (Staddon et al. 2020), which can in turn lead to heightened rates of mal-
nutrition and infectious diseases, respectively. Moreover, the ramifications of drinking water insecurity extend beyond the
development of biological conditions and also involve potential consequences for mental health and well-being, including
increased levels of emotional/perceived stress, depression, and anxiety (Wutich et al. 2020). As women and girls are primarily
responsible for household water management in LLMICs, they bear the brunt of these mental health burdens (Hadley &
Wutich 2009) and often experience heightened vulnerability related to water insecurity during periods of menstruation, preg-
nancy, and personal or household illness (Stevenson et al. 2012;Collins et al. 2019;Adams et al. 2021). Moreover, evidence
suggests that the provision of on-site access to water is associated with an increase in educational and economic opportu-
nities, with these benefits skewing heavily toward women (WaterAid 2021). Thus, obtaining universal access to drinking
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water is not only a prerequisite for health but is also necessary for achieving progress toward eliminating hunger, advancing
women’s empowerment, and enabling greater opportunities for economic development.
In recent decades, heightened interest in drinking water research, maintained by supportive funding sources has narrowed
the gap in knowledge surrounding water and health. The volume of publications in the field has expanded as researchers
investigate diverse perspectives on drinking water, such as those related to quality, availability, and accessibility and a mul-
titude of themes, including major water-related diseases, contaminants of emerging concern, water and gender equality, and
water governance. Yet it remains unclear exactly which interests dominate the field of drinking water research in LLMICs.
Further, the globalization of research on global health topics has accelerated in recent decades, pointing to shifting collabora-
tive efforts that have become increasingly diverse both geographically and across socioeconomic parameters (Addo-Atuah
et al. 2020). However, research outputs from High-Income Countries (HICs) continue to dominate several fields of global
health research with less representation from LLMICs where the disease burden is disproportionately higher (Ghani et al.
2021). The distribution of global research on drinking water and health in LLMICs needs to be better understood to identify
whether these gaps exist with regard to drinking water research.
It is relevant to explore emerging trends in scientific activity to understand where research has been undertaken and by
whom. Past bibliometric studies have examined specific topics on drinking water (Hu et al. 2010;Abejon & Garea 2015;
Tang et al. 2020;Ekundayo et al. 2021) and concentrated on research out of specific geographical regions (Wambu & Ho
2016), or narrow time periods (Fu et al. 2013). Recent studies have also emerged to assess research on Sustainable Develop-
ment Goal (SDG) 6 (Basu et al. 2021;Dibbern et al. 2022;Roy et al. 2022), which include a wide range of water, sanitation,
and hygiene-related priorities and are again restricted to recent years. A comprehensive analysis examining research on drink-
ing water and health that highlights changing trends over time and analyses data from the perspective of country-level income
has yet to be conducted. Hence, the current study aims to assess research trends on water and health in LLMICs from 1980,
focusing on progress made in closing research disparities over time. It aims to explore possible pathways forward in the global
pursuit toward a more equitable scientific community, such as through initiatives that promote Open Access (OA) content. A
comprehensive overview of the field may be used to inform future research priorities and decision-making processes, facilitate
improved collaboration on research outputs, and identify where national research systems must be strengthened. In doing so,
the following questions would be addressed: What are the overall volume, type, and growth rate of all published documents
on drinking water and health in LLMICs? What countries, institutions, journals, or funding agencies have had the greatest
influence on research related to drinking water and health in LLMICs? What relationships are present between influential
groups? What percentage of global research on drinking water and health in LLMICs is universally accessible (i.e. OA)?
What are the most frequently studied topics on drinking water and health in LLMICs?
METHODS
A bibliometric analysis was conducted to produce an overview of publications and groups that have contributed to research
on drinking water and health in LLMICs since 1980. The Web of Science Core Collection (WOSCC), a leading bibliographic
source (Mongeon & Paul-Hus 2016), was used to extract data sets. The final search was performed on 28 June 2022.
Search strategy
The search strategy was developed to search title, abstract, author’s keywords, and ‘keywords-plus’(i.e. common words and
phrases from article titles) to retrieve publications since 1980 in all languages. As defined in Table 1, search terms related to:
(1) drinking or domestic water, including potable or household water; (2) health or disease; and (3) LLMICs.
LLMICs were determined based on the ‘list of ODA recipients effective for reporting on 2022 and 2023 flows,’published by
the Organisation for Economic Co-operation and Development (OECD) (DAC 2021). For inclusion in this study, only
research on low-income countries (LICs) and lower-middle-income countries (LMICs) was searched, which are defined as
nations with GNI per capita below $1,045 and between $1,046 and $4,095, respectively (Hamadeh et al. 2021). Literature
on upper-middle-income countries (UMICs) and HICs was not explicitly searched as a part of this study due to the consider-
ably higher rates of drinking water access in these regions. To retrieve relevant records, synonyms for LLMICs included now
outdated terms such as ‘third world,’as well as imprecise terms such as ‘global south’(Khan et al. 2022;Lencucha &
Neupane 2022). The use of this vocabulary, however, is not endorsed and henceforth will refer to LLMICs as a generic
term. In recognizing the role that language plays in perpetuating or minimizing the marginalization of certain groups, this
term was chosen for its comparatively objective connotation in this study and elsewhere. However, it should be
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acknowledged that any attempt to classify groups of people based on indicators, like national income status, will present
inherent shortcomings, as reflected by the drastic income inequalities that persist within nations.
A subset of the search queries was reviewed to ensure the search strategy produced results that fit within the scope of this
study. A total of 7,899 publications were retrieved from WOSCC and included in the analysis.
Analysis and science mapping
Analysis of the structure and dynamics of the research field was conducted using the functionality offered by Clarivate’s
InCites tool, in conjunction with the Bibliometrix R package. The leading institutions, countries, authors, and journals
were identified using publication-related metrics (indicating productivity) and citation-related metrics (indicating research
impact and academic influence). To minimize the likelihood that results were skewed by outliers, thresholds to limit the
search were established. For example, during impact analysis (i.e. examining Category Normalized Citation Impact
(CNCI)), publications were limited to those with up to 25 authors and from institutions/countries with a minimum of 25 pub-
lications contributing to the field. This is done to ensure that publications with an abnormally high number of co-authors, as
well as institutions/countries with minimal publications, do not have unduly influence on interpretation. To explore recent
trends, the time period was adjusted to the past five complete years (2016–2021).
By examining the records retrieved, the author affiliations and citations that link documents were leveraged to identify
relationships among researchers, institutions, and countries. Network analysis was performed to draw attention to the relative
importance of research groups to the field and the strength of relational ties between institutions/countries was measured.
The software tool VOSviewer 1.6.18 was used to generate, visualize, and analyze these bibliometric networks.
Bibliographic coupling was utilized to explore the topical research similarities at the institutional- and country-levels (Kess-
ler, 1963). Additionally, co-authorship analysis was utilized to illustrate regional contributions to the field and inter-country
collaboration patterns. Mapping such collaborations may be particularly relevant for highlighting countries or regions that
typically partner to produce research outputs, which may have the potential to spark new collaborative networks that inte-
grate underrepresented regions.
Table 1 |Search strategy used to retrieve relevant records from WOSCC (TS ¼topic)
Query Words searched
1TS¼(water NEAR/1 drink*) OR (water NEAR/1 domestic) OR (water NEAR/1 household) OR (water NEAR/1 potable)
2TS¼(health OR disease*)
3 #1 and #2
4TS¼(‘low* income countr*’OR ‘middle-income countr*’OR ‘LMIC’OR ‘low* income nation’OR ‘middle-income nation’OR
‘least developed countr*’OR ‘less developed countr*’OR ‘least developed nation’OR ‘least economically developed countr*’OR
‘less economically developed countr*’OR ‘least economically developed nation’OR ‘less economically developed nation’OR
‘less developed nation*’OR ‘underdeveloped countr*’OR ‘underdeveloped nation*’OR ‘underdeveloped world’OR ‘developing
countr*’OR ‘developing nation’OR ‘developing world’OR ‘third world’OR ‘global south’OR ‘poor* countr*’OR ‘poor*
nation’)
5TS¼(Afghanistan OR Angola OR Bangladesh OR Benin OR Bhutan OR ‘Burkina Faso’OR Burundi OR Cambodia OR ‘Central
African Republic’OR Chad OR Comoros OR (‘Democratic Republic Congo’OR DRC OR Zaire) OR Djibouti OR Eritrea OR
Ethiopia OR Gambia OR Guinea OR ‘Guinea-Bissau’OR Haiti OR Kiribati OR (‘Lao People’s Democratic Republic’OR Lao*)
OR Lesotho OR Liberia OR Madagascar OR Malawi OR Mali OR Mauritania OR Mozambique OR (Myanmar OR Burma) OR
Nepal OR Niger OR Rwanda OR Sao Tome OR Senegal OR ‘Sierra Leone’OR ‘Solomon Islands’OR Somalia OR ‘South Sudan’
OR Sudan OR (Tanzania OR Zanzibar) OR (‘Timor-Leste’OR ‘East Timor’) OR Togo OR Tuvalu OR Uganda OR Yemen OR
Zambia OR (‘Democratic People’s Republic Korea’OR DPRK OR ‘North Korea’OR ‘Korea Republic’) OR Belize OR
(Zimbabwe OR Rhodesia) OR Algeria OR Bolivia OR (‘Cabo Verde’OR ‘Cape Verde’) OR Cameroon OR Congo OR (‘Cote
d’Ivoire’OR ‘Ivory Coast’) OR Egypt OR ‘El Salvador’OR (Eswatini OR Swaziland) OR (Ghana OR ‘Gold Coast’) OR Honduras
OR India OR Indonesia OR Iran OR Kenya OR Kyrgyz* OR Micronesia OR Mongolia OR Morocco OR Nicaragua OR Nigeria
OR Pakistan OR ‘Papua New Guinea’OR Philippines OR ‘Sri Lanka’OR Syria* OR Tajikistan OR Tokelau OR Tunisia OR
Ukraine OR Uzbekistan OR Vanuatu OR Vietnam OR (‘West Bank’OR ‘Gaza’)OR(‘Sub-Saharan Africa’OR ‘East Africa’))
6#4OR#5
7 #3 and 6
Note: *Child/parent organizations are unified.
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RESULTS
A total of 7,899 publications in 13 languages were retrieved from WOSCC, with the English language characterizing 99% of
publications. The most common document types are articles with 6,546 records, followed by 490 reviews and 297 proceed-
ings papers. Beginning with one article in 1981, the number of papers published on drinking water and health in LLMICs has
generally increased dramatically over the past 25 years (Figure 1). Significant growth in annual scientific production has
occurred from 2016 onwards, such that in 2021, the most recent completed year, a total of 894 documents were published.
Overall, the annual growth rate is measured at 15.95% for the last four decades.
Key players
Institutions
Since 1980, the greatest volume of publications has been produced by authors with affiliations from the University of London
(227, UK), the International Centre for Diarrhoeal Disease Research (ICDDR) (189, Bangladesh), the University of California
System (183, US), and Columbia University (175, US) (Figure 2). LLMIC-affiliated institutions have produced a growing
volume of research in the past 5 years (2016–2021), such that the Indian Institute of Technology (India) and Tehran Univer-
sity of Medical Sciences (Iran) tied for producing the greatest number of publications globally with 96 published documents
each, surpassing the University of London (94, UK) and the University of California System (89, US) that followed.
Since 1980, the top 10 institutions with the greatest CNCI, a metric used to measure citation impact by adjusting for field or
subject area, is illustrated in Table 2. Note that organizations in this table are unified, but data are displayed for both the
parent organization (i.e. University of London) and the child institution (i.e. London School of Hygiene and Tropical Medi-
cine). The leading institution is the University of California Berkley with a CNCI of 2.6, followed by the Swiss Federal
Institute of Aquatic Science and Technology (EAWAG) (2.2), and the London School of Hygiene and Tropical Medicine
(2.1). H-Index, a time-dependent measure of productivity and impact was also determined for organizations over the past
5 years (2016–2021). The following list presents the organizations with the highest H-index during this period; Tehran Uni-
versity of Medical Sciences (27), University of California System (22), COMSATS University, Islamabad (21), Indian Institute
of Technology System (20), University of London (20), Chang‘an University (19), Chinese Academy of Sciences (19), the
Figure 1 |Annual growth of scientific production on drinking water and health in LLMICs (1980–2021).
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ICDDR (18), Stanford University (17), and Shahid Beheshti University (17). With only three of the top 10 leading organiz-
ations representing HICs, this list is suggestive of the growing impact of publications from LLMIC-affiliated institutions in
recent years.
Countries/regions
Since 1980, the United States has produced 27.5% of global research (1,867 documents), followed by India with 22% (1,492
documents) and the United Kingdom with 10.5% (711 documents) (Figure 3(a)). The rate of growth of publications from India
has increased considerably since 2010, such that by 2021 India produced the greatest number of publications, surpassing the
United States, which also experienced significant growth during this time (Figure 3(b)).
Figure 2 |Top 10 institutions of published research on drinking water and health in LLMICs by publication volume (1980–2022).
Table 2 |Top 12 organizations having published more than 100 articles from 1980 to 2022, ranked by CNCI
Institution/Organization Documents Times cited CNCI % OA % in Q1 journals
University of California Berkeley 110 7,439 2.6 74.6 79.4
Swiss Federal Institute of Aquatic Science & Technology (EAWAG) 101 6,736 2.2 64.4 61.8
London School of Hygiene & Tropical Medicine 156 6,251 2.1 83.3 73.7
University of California System 183 9,589 2.0 71.6 70.1
Emory University 132 3,682 2.0 81.1 58.2
University of London 227 8,900 2.0 77.1 67.5
International Centre for Diarrhoeal Disease Research (ICDDR) 189 8,202 2.0 70.9 58.0
University of Dhaka 107 3,471 1.9 52.3 53.9
Columbia University 175 10,765 1.9 82.9 82.9
Johns Hopkins University 103 3,192 1.8 76.7 49.5
University of North Carolina Chapel Hill 129 5,677 1.8 70.5 69.9
Tehran University of Medical Sciences 137 3,637 1.8 35.0 21.6
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The countries with the highest citation impact by total citations are the United States (62,489 citations), India (37,709 cita-
tions), and the United Kingdom (29,764 citations). The past 5 years (2016–2021) mark the growing volume and impact of
research output from LLMICs. While the United States and the United Kingdom remain top producers of highly cited
research, only 3 of the top 10 countries constitute HICs (Table 3).
Figure 3 |Leading countries of published research on drinking water and health in LLMICs by publication volume (1980–2022): (a) Percent;
(b) Trend.
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Authors and publications
Since 1980, 9 of the top 10 most influential authors based on the H-index are affiliated with UMICs/HICs. On average,
LLMIC-affiliated publications have an Impact Relative to World indicator of 0.84, in contrast to 1.23 from UMICs/HICs.
This indicator is used to determine the relative research performance where the world average is equal to one.
Journals
For each article, InCites associates the Journal Impact Factor (JIF) of the journal in which it was published. As the ratio of
incoming citations to outgoing references, the JIF provides an index of the relative importance of a journal in the field. A
journal with a high JIF is widely read and contains articles that have attracted more citations than they themselves cite.
While this journal-level metric does not confer any level of significance to a given article, it serves as a marker of the general
quality of research found in that journal, as editors of a high JIF journal can be very selective of which manuscripts they
accept. Results show that 47% of publications generated by researchers affiliated with UMICs/HICs are published in journals
that have a JIF in the top quartile (i.e. attract more citations than 75% of all journals in the field), compared to 35% of pub-
lications produced by LLMIC-affiliated researchers. This indicates that as a percentage of the total published literature,
documents produced by LLMIC-affiliated researchers are less likely to be published in highly cited journals.
The most relevant sources were Science of the Total Environment (236 articles), Environmental Monitoring and Assess-
ment (172 articles), Environmental Science and Pollution Research (172 articles), International Journal of Environmental
Research and Public Health (154 articles), American Journal of Tropical Medicine and Hygiene (146 articles), Journal of
Water and Health (140 articles), Environmental Geochemistry and Health (133 articles), PLOS One (130 articles), Journal
of Water Sanitation and Hygiene for Development (120 articles), and Environmental Earth Sciences (119 articles).
Major global networks
International collaboration
To understand the collaborative structure of research in this field globally, co-authorships grouped at the country-level were
visualized using a threshold of 25 publications per country. Of the 168 countries in the dataset, 62 met this threshold. This
reveals a network containing a total of 4,350 collaborations across 358 country-to-country connections (Figure 4). In this visu-
alization, countries are represented as nodes, the size of which is determined by their total number of publications.
Collaborations are represented as edges (lines), the thickness of which reflects the total number of co-authorships between
the connected countries. Note that due to software constraints, network visualizations reference ‘England’instead of the
‘United Kingdom,’the latter of which is utilized elsewhere in the present study.
As a property of each node in the network, the sum of a country’s collaborations is given as total link strength. The United
States has the most collaborations (1,486 total link strength), followed by England (815), Bangladesh (745), and India (594),
indicating that these countries have the strongest collaborative research ties. England had a total of 57 country links, followed
by India (55), the United States (54), and Germany (49), which represent the countries with the most diverse range of
Table 3 |Top 10 countries producing published research on drinking water and health in LLMICs (past 5 years)
Country Web of science documents Times cited
USA 825 11,377
India 756 11,017
United Kingdom 338 6,355
Pakistan 316 5,019
Iran 311 6,478
Bangladesh 293 5,582
China 262 7,366
Nigeria 232 3,488
Ethiopia 206 3,350
Australia 173 4,827
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collaborative ties. The strongest bi-lateral connections are observed between the United States and the following countries:
Bangladesh (with link strength of 295), England (198), India (150), and Kenya (104). This was followed by connections
between Bangladesh and Japan (94 link strengths) and between Pakistan and China (93).
Thematic clusters
Bibliographic coupling, which illustrates similar relationships between documents using common references, was performed
to assess thematic clusters based on the assumption that such articles will address a similar thematic area. At the country-level
(Figure 5), the green cluster (lower-right) points to similar research interests among top-performing Asian countries, namely
India, China, and Pakistan in addition to Iran. The red cluster (left) depicts the United States, England, and Switzerland,
which share similar research themes as many other countries, particularly with several LLMICs. The third largest cluster
of countries is blue (upper-right), which shows Bangladesh sharing research themes with Australia, Japan, and Canada.
Bibliographic coupling was also used to arrange organizations with similar thematic priorities. In Figure 6, it is the fre-
quency of keywords shared by two countries that determine their visual proximity. Three distinct clusters appear with
blue (upper) and green (lower-left) groups depicting mostly organizations out of Europe and the United States. The red cluster
(lower-right) represents several leading organizations from India, Iran, and China. With a few exceptions, such as Bangladesh-
based organizations, these findings suggest a possible difference in research priorities along geographic lines.
Figure 4 |Co-authorships between countries. (Maximum of 25 countries per document, minimum of 100 publications per country. Minimum
25 co-authorships between countries).
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Research accessibility
Beyond comparing the volume of output and collaborations, this study also characterizes publications from the perspective of
their accessibility to potential readers. Academic journals were traditionally available only via an often very expensive sub-
scription. This model presents a barrier for researchers in LLMICs, whose institutional libraries often cannot afford the
journal subscriptions (Matheka et al. 2014). More recently, the OA model, funded primarily by publication and article pro-
cessing fees, has made an increasing proportion of academic literature free to read. OA refers to research that is accessible to
anyone for free online and grants permission to copy, use, or distribute such research with proper recognition (UNESCO,
2012). An OA journal can be further categorized by its chosen economic model, which is known as Gold, Hybrid, and
Bronze. An OA article can be both Green as well as any of the aforementioned types. Definitions of these types are provided
in Table 4.
While it is beyond the scope of this paper to investigate the relative proportion of these various types, Figure 7 lists the
countries that have published at least 100 articles in this field over the period from 2017 to 2021, ordered by the OA
output percentage. The United Kingdom, Ethiopia, Switzerland, and Kenya produce the greatest percentage of OA publi-
cations. At the other end of the spectrum, which represents countries with a lower proportion of OA publications are the
LLMICs, which have emerged as global leaders with respect to publication volume in the past 5 years: Iran, India, and Paki-
stan. Interestingly, 73% of Ethiopia’s research output in this field is found in Gold OA journals, higher than any other country
in this study. Uganda and Tanzania also had heightened OA rates (both with 86% of total publications) but are not depicted in
Figure 5 |Network visualization of bibliographic coupling of countries (minimum link strength of 1,000). Please refer to the online version of
this paper to see this figure in colour: http://dx.doi.org/10.2166/wh.2023.293.
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Figure 7 as they did not meet the minimum threshold having only published 51 and 65 publications during this period
respectively.
Since 1980, nearly half of all the publications (44%), a total of 3,437 records, are categorized as OA with the remainder of
documents requiring an access fee or subscription. Trend analysis suggests that across both country groups, the percentage of
OA publications is increasing, however as a whole, LLMIC-affiliated publications still lag behind UMICs/HICs (Figure 8).
Research priorities
Themes
To measure relevant research areas within the field, the citation topics schema offered by Clarivate InCites was utilized, offer-
ing algorithmically determined clusters of citation topics at the macro, meso, and micro levels based on cited and citing
relationships between documents. A categorical analysis of citation topics at the meso-level reveals that contamination
and phytoremediation (1,854 documents), diarrheal disease (1,630 documents), and water resources (790 documents)
make up the top research areas and are also the most cited literature. The trend data in Figure 9 illustrate the steep increase
in research on contamination and diarrheal diseases since the early 2000s, as well as heightened scientific output on water
resources since 2016. The most-published micro-level research themes focused on microbial source tracking, arsenic, and
Figure 6 |Topical map of bibliographic coupling of institutions (minimum link strength of 1,000). Please refer to the online version of this
paper to see this figure in colour: http://dx.doi.org/10.2166/wh.2023.293.
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groundwater, with the former raising precipitously in the past two decades. The most relevant author keywords are ‘arsenic’
(768 articles), ‘drinking water’(740), ‘groundwater’(641), ‘water quality’(456), and ‘fluoride’(297). The most relevant key-
words-plus include ‘drinking water’(2,486 articles), ‘contamination’(965), ‘health’(737), ‘groundwater’(653), and ‘quality’
(608).
In the past 5 years (2016–2021), the publications targeting the SDGs have primarily focused on SDG 3: good health and
well-being (3,311 documents and 38,305 times cited), SDG 6: clean water and sanitation (2,171 documents and 27,089 times
cited), and SDG 14: life below water (1,555 documents and 18,996 times cited).
Funders
Table 5 illustrates the funding agencies dominating the field based on both productivity and impact. Funding agencies in
UMICs/HICs comprise 17 of the top 20 with India (2) and Pakistan (1) being the only countries representing LLMIC-
based agencies.
Table 4 |Definitions of OA journal types
OA Journal
type Definition
Gold Published in a fully open access journal upon payment of an Article Processing Charge (APC).
Bronze Freely available on the publisher’s website, but without an open license. No APC
Green Available in an open access repository (may be discipline specific, such as ArXiv or PubMed Central, or institutional
repositories). May be preprints or published articles (after publisher’s embargo expires). No APC.
Hybrid Published with an open license in a paid access journal through an APC.
Figure 7 |Percentage of publications that are OA by country (minimum 100 publications, 2017–2021).
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Figure 8 |Trend indicating the per cent of OA documents on drinking water and health in LLMICs, by country (1980–2022).
Figure 9 |Trend data of top five meso-level research areas of published research on drinking water and health in LLMICs.
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DISCUSSION
Of the global research on drinking water and health in LLMICs published since 1980, the United States and the United King-
dom have dominated the field based on the production and impact of scientific literature. India, Iran, Bangladesh, and
Pakistan are emerging as key players, yet, except for Bangladesh, publications out of these countries remain disproportio-
nately restricted behind paywalls. Contamination and phytoremediation, diarrheal disease, and water resources are the
themes that characterize most of the research on water and health with the latter emerging as a key priority only in
recent years.
The scientific literature on drinking water and health in LLMICs has grown, particularly since the start of the millennium,
with publication volume increasing steeply since 2016. The sustained and robust production of research shown in the present
study mirrors findings from similar investigations that evidence drinking water research as a developing field of study (Fu
et al. 2013;Wambu & Ho 2016) and is relevant to broader conclusions that previous scholars have established: health
and water, the combined focus of the present study, are among the most researched sustainable development priorities
(Meschede 2020).
Following successful efforts to meet the water-related Millennium Development Goal (MDG) target, to reduce by half the
proportion of the population without safe drinking water and sanitation, 2.6 billion people gained access to an improved
source of drinking water, i.e. one that adequately protects from outside contamination, between 1990 and 2015 through
supply programs and interventions (WHO & UNICEF 2015). In 2015, the United Nations extended far beyond the MDGs
through the adoption of the 2030 Agenda for Sustainable Development, a new global blueprint toward a more sustainable
future. Included in the agenda is SDG 6, which aims to ensure the availability and sustainable management of water and sani-
tation for all (UN DESA 2016). The universal clean water target (6.1) is particularly significant because it underscores several
other SDGs (Bhaduri et al. 2016). For example, an adequate supply of water is indispensable for and intricately connected to
achieving good health and well-being (SDG 3), no poverty (SDG 1), and gender equality (SDG 5) (UN-Water 2016). The
growth of published drinking water research observed in the past 20 years is reflective of efforts to reduce drinking water
Table 5 |Leading global funders of published research on drinking water and health in LLMICs
Funding Agency Country Documents Times cited
United States Department of Health & Human Services USA 478 23,914
National Institutes of Health (NIH - USA USA 450 23,363
NIH National Institute of Environmental Health Sciences (NIEHS USA 246 16,037
European Commission Belgium 173 9,137
UK Research & Innovation (UKRI) United Kingdom 160 10,286
National Natural Science Foundation of China (NSFC) China 138 3,870
National Science Foundation (NSF) USA 132 3,228
United States Agency for International Development (USAID) USA 124 3,938
Bill & Melinda Gates Foundation USA 113 3,710
CGIAR France 103 6,418
Ministry of Education, Culture, Sports, Science and Technology, Japan (MEXT) Japan 97 2,310
Department of Science & Technology (India) India 88 2,327
University Grants Commission, India India 85 2,218
Higher Education Commission of Pakistan Pakistan 82 2,034
NIH National Cancer Institute (NCI USA 80 5,126
Japan Society for the Promotion of Science Japan 74 1,752
NIH Fogarty International Center (FIC) USA 71 3,415
Natural Environment Research Council (NERC United Kingdom 66 2,331
NIH National Institute of Allergy & Infectious Diseases (NIAID USA 63 2,660
Wellcome Trust United Kingdom 59 1,832
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inequalities through the MDGs and similarly, the acceleration of such research outputs since 2016 is likely a consequence of
the international community’s doubling down on drinking water priorities through the commitments to universal access out-
lined in the SDGs. The growth of the field can likely also be attributed to the expansion of internet access and
telecommunications technologies, enhanced research capacity, and the improved ease of information sharing through digital
channels over time. However, these conveniences have not been distributed equally across the globe, as some are better able
to capitalize on technological tools and systems than others face barriers (Shumba & Lusambili 2021). As will be discussed in
the following sections, a necessary step in accelerating the production and application of water research is to reduce research
inequalities by addressing enduring barriers to participation that exist within underrepresented regions.
Furthermore, it is relevant to evaluate recent progress on drinking water targets and assess current global events to predict
whether research in this field will continue to expand in the future. Worldwide, progress toward the use of safely managed
drinking water, which was set as the new indicator, has progressed at a rate of 0.63% per year between 2015 and 2020 (WHO
& UNICEF 2021). Yet, the world is not currently on track to achieve universal and equitable access to affordable drinking
water by 2030 (UN Water 2021). LLMICs continue to confront challenges in closing the gap in drinking water disparities,
such as reaching rural communities, transitioning existing facilities (i.e. from wells to piped), and ensuring consistent moni-
toring (WHO & UNICEF 2021). Likely to further challenge global progress on drinking water are emerging global threats
associated with rapid population growth, viral pandemics, climate change, and conflict (Hannah et al. 2020). These pressures
have the capacity to place additional stress on global water supplies and potentially interrupt efforts toward achieving uni-
versal access. Modern-day challenges, combined with the new evidence needed to advance SDG 6, are the likely catalysts
for the marked expansion of research outputs highlighted by the present study and are predicted to drive the continued expan-
sion of the research field in years to come.
Key players
The present study assessed the key players in drinking water research, highlighting emerging influences at the institutional-
and country-level. The results suggest that the United States and the United Kingdom have historically driven research, a find-
ing that has been supported by similar literature analyzing the areas of drinking water and SDG 6 (Basu et al. 2021;Roy et al.
2022). Although the United States and the United Kingdom presently remain important contributors, heightened LLMIC-
affiliated research in recent years out of India and to a lesser extent, Pakistan, Iran, and Bangladesh are shifting the landscape
of research production on drinking water and health in LLMICs. The growing influence of LLMIC-based research highlighted
by the present study is at variance with other studies on SDG 6, such as one conducted by Dibbern et al. (2022) that did not
determine a significant contribution from these regions on the field. This may, in part, be due to the explicit use of ‘health’and
‘LLMICs’in the present study’s search strategy instead of ‘SDG 6,’the latter of which may be utilized less often by LLMIC-
based researchers despite similar driving research agendas (i.e. regarding the complexities surrounding what is considered
global health versus public health (Bozorgmehr 2010)). Moreover, the present study revealed that the impact of publications
out of LLMICs relative to the world and the proportion of research published in Q1 journals were notably lower than
UMICs/HICs, pointing to a possible undervaluing of this scientific literature.
The United States and the United Kingdom are consistently evidenced as frontrunners in the production of global health
research (Cash-Gibson et al. 2018) and are among the top producers of research in several other scientificfields (Sumathipala
et al. 2004;Sweileh 2020). It is therefore unsurprising that these countries have contributed significantly to the literature on
drinking water and health in LLMICs. Part of this dominance may be due to supportive national commitments to reducing
drinking water inequalities and connected funding priorities. For example, the United Kingdom’s Department for Inter-
national Development (DFID) –now known as the Foreign, Commonwealth and Development Office (FCDO) –has
supported numerous research initiatives and interventions to target drinking water in LLMICs in recent decades, with evi-
dence pointing to 80 million people who gained access to WASH services from DFID projects between 2011 and 2019
(Blaszczyk 2019). A push for greater assistance from governments and funding agencies in HICs to support global health
research on drinking water, in addition to empowering LLMICs to participate in this research and drive agenda-setting,
may facilitate the enhanced generation of impactful research in the coming years.
The growing representation of LLMICs in drinking water research in the past 5 years is promising, as India, Pakistan, Iran,
and Bangladesh are now among the global leaders, while Nigeria and Ethiopia are also represented in the top 10 producers of
literature. While other scholars have pointed India as the top LMIC contributor to health inequalities research in general
(Cash-Gibson et al. 2018), the present study reveals that India is now the new global leader in research on drinking water
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and health in LLMICs, recently surpassing the United States on scientific production. Despite this, evidence suggests that
significant disparities exist within countries, such as India, suggesting that research capacity may be developing unevenly
(Kalita et al. 2015). For example, one study suggests that a heightened proportion of health research is produced by insti-
tutions in just four states in India, whereas the regions with the highest disease burdens are only minimally represented
(Kalita et al. 2015). As such, it is crucial that priority-setting highlights opportunities for underserved populations to
become involved in research so that inequalities within countries do not escalate as global inequalities in research are
reduced.
Although the increased representation of LLMICs on the list of the top 10 producers of research is encouraging, this does
not represent the minuscule production and underrepresentation of many other LLMICs that face barriers to establishing
research capacity. In the present study, for example, LICs are significantly less represented as producers of drinking water
research than LMICs, meaning that while new research systems are strengthening in some regions, countries that possess
the least resources remain at the periphery of global drinking water research, at times with more problems and without a
voice to drive the research agenda. This implies that greater effort is needed to ensure the field of drinking water research
becomes more representative of the LICs that are likely the ‘subjects’or ‘recipients’of the implications of such research.
This speculation is consistent with a study conducted by Dimitris et al. (2021) that evidences uneven progress in the represen-
tation of authors from LMICs in global health research, despite greater representation as a whole. With this understanding,
capacity-building and improved authentic partnering to encourage research out of low-resource settings should be prioritized
to strengthen national research systems.
The continued presence of water-related diseases in the modern era is indicative of the complexities that underpin efforts to
achieve universal access to clean drinking water. As solutions to drinking water challenges are often based on complex sys-
tems of unique, contextual factors, ‘silver bullet’solutions fail to consider the changing landscapes that surround people’s
relationships with water in local settings. This is why it is important for drinking water research to include regional investi-
gations, for example through implementation science, that are driven by principles of co-creation, local decision-making, and
strengthened local research capacity (Haque & Freeman 2021). Many scholars convey that barriers to reaching water and
sanitation targets stem from a lack of local water governance, not simply a lack of funding, technology, or infrastructure
(Herrera 2019). Local researchers from LMICs are needed to guide context-specific research investigations and enhance con-
siderations of organizational, political, social, and infrastructural circumstances that define the specific WASH needs of the
community under study. Local involvement also facilitates the production of health research that aligns with processes that
facilitate the greatest impact. The field of global health is predicated on eliminating health disparities between people, par-
ticularly focusing on empowering low-resource and marginalized groups through access to fundamental health
opportunities. Similarly, there is a need for the field of global health to encourage research out of low-resource settings,
which will not only foster publication equity but also empower actors who are better positioned to identify unique factors
that may disrupt interventions from actually improving health outcomes.
Major global networks
The present study analyzed co-authorship to determine which countries have the strongest collaborative research ties and
used bibliographic coupling to determine whether similar thematic areas emerge among organizations/countries. The visu-
alizations in the present study suggest that the United States, England, Bangladesh, and India had the strongest
international research collaborations. Partnerships were also strong between Bangladesh and Japan, and between Pakistan
and China; however, these links were not as strong as connections between the United States and the following countries:
Bangladesh, England, India, and Kenya. Heightened collaborative ties observed for the United States and England are con-
sistent with previous findings by Basu et al. (2021); however, the strong international networks shown for Bangladesh and
India are perhaps under-recognized in the literature. Moreover, findings suggest that similar research themes are pursued
among European and American organizations, whereas Asian and Middle Eastern organizations tend to cluster together
more.
In general, the network analysis in the present study depicts a rather robust map of international partnerships with several
collaborative hubs. In particular, the well-established research partnerships between the United States and England and sev-
eral other countries illustrate the continued role these two countries play in driving research in this field. The comparatively
stronger ties between the United States/United Kingdom and certain LLMICs may have developed based on linguistic and
historical happenings. As a large portion of global health research is driven by English-speaking HICs (Cash-Gibson et al.
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2018), it is likely that partnerships that were previously established based on the similar language spoken may have fostered
collaborative research on drinking water as well. For example, strong ties between the United States/United Kingdom and
English-speaking East African countries are particularly high. Bangladesh and India, also English-speaking LLMICs, are
strong centers for international collaboration in their own right, which may further be explained by the heightened pro-
duction of research out of these countries in general.
The strong collaborative ties between Japan and Bangladesh as well as China and Pakistan are notable. This is mirrored in
the bibliographic coupling networks, which indicate Asian/Middle Eastern countries produce literature on different thematic
areas than the rest of the world. This separation may be indicative of differing regional needs for drinking water research,
apart from advancements in basic WASH that drive a significant amount of research on SDG 6. For example, China,
India, Bangladesh, and Pakistan are among the leading producers of research on heavy metals, such as arsenic, in drinking
water (Abejon & Garea 2015;Han et al. 2020), which aligns with heightened concerns over contaminated waterways in
populated Asian nations. Countries in the Middle East have differing agendas for advancing drinking water development,
which requires research related to water scarcity and security (World Bank 2018). Thus, it is speculated that clusters of
co-authorship, in addition to bibliometric coupling networks are reflective of the pervasive research needs unique to each
region.
Despite the well-established networks displayed in the present study, partnerships between LICs appear to be much fewer,
with weaker link strengths. This highlights possible entry points for enhanced collaborative partnerships. International col-
laborations play a pivotal role in facilitating information sharing, enabling the transfer of technology, and widening the reach
of research to affect global health outcomes (Addo-Atuah et al. 2020). Such partnerships, however, must involve authentic
partnering, inclusion, and shared benefits to ensure that power imbalances are not propagated in the process (Plamondon
& Bisung 2019).
Strengthening meaningful international partnerships across income groups and also between LLMICs can facilitate the
advancement of drinking water targets through improved knowledge generation. The 2030 Agenda for Sustainable Develop-
ment explicitly calls for expanded international co-operation and capacity-building to support low-resource settings with
water and sanitation-related activities and programs (6.a) as well as supporting the participation of local communities in
water management (6.b) (UN DESA 2016). Not only is there a need to improve inter-country partnerships, but also, there
is a growing call for water researchers to collaborate with actors in related sectors and partner with those working on con-
nected development goals (Bhaduri et al. 2016). In the face of contemporary global issues tied to rapid population growth and
climate change, it is likely that inter-regional and inter-sectoral collaborations on water research will grow to explore the
myriad of water-related challenges that flow through a range of development priorities. In the coming decade, collaborative
research partnerships that transcend national borders will be crucial to attaining drinking water equity and minimizing the
elevated water-related disease burden that weighs heavily on LLMICs.
Research accessibility
The findings on OA trends in the present study are consistent with other studies, which point to publications becoming
increasingly OA over time (Kurata et al. 2013;Bosman & Kramer 2018). In the present study, UMICs/HICs exhibit a
higher percentage of OA publications, with the United Kingdom demonstrating the highest rates across all years, likely
due to funder mandates. Interestingly, in the past 5 years, East African countries had among the highest levels of OA content
globally. Despite the progress realized in this region, several other LLMICs continue to lag behind the global average on OA
indicators, particularly those emerging as leaders in the field, namely India, Iran, and Pakistan. These findings are consistent
with conclusions by Iyandemye & Thomas (2019) that point to sub-Saharan Africa as having the highest rates of OA biome-
dical publications, with the Middle East and South Asia displaying among the lowest. Importantly, several countries with
limited research capacity were left out of the analysis as they did not meet the minimum threshold of 100 publications in
the field to be evaluated.
Since 2003, when the OA movement was declared a global priority at the UN’s World Summit on Information Technology
(King & Tamber 2004), OA has been advocated as a tool to support the expansion of an equitable scientific knowledge base
for social and economic development. The present study reveals a marked increase in OA content in the years following the
announcement of the OA movement, which may illustrate the influence of international commitments to equitable infor-
mation sharing on changing the nature of how research is accessed. Moreover, there are several possible explanations for
the heightened rates of OA content in East Africa, and other low-income regions that the present study highlights. It is
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speculated that the role of OA fee waivers for low-income countries may be one possible reason. Further, heightened collab-
oration with countries with strong OA policies (i.e. UK) may have enabled a greater percentage of OA-published research to
come out of LLMICs since publications with international and inter-regional collaboration tend to have considerably higher
OA rates compared to single-country outputs (Chan 2019). High OA rates in East Africa may also be explained by the heigh-
tened production of research into topics that are overrepresented in OA literature, such as poverty-related diseases
(Breugelmans et al. 2018). Finally, the expansion of OA repositories in countries such as Kenya, Tanzania, and Uganda in
recent years, may have also contributed to heightened rates of OA publications (Otando 2015).
In the present study, it is notable that India, Pakistan, and Iran have among the lowest percentages of OA publications,
despite producing a large volume of literature on water and health. These findings may provide evidence of regions that
can be better supported in the transition to OA research. There are numerous reasons why some countries and institutions
are slow to adopt OA frameworks and practices. As Bosman & Kramer (2018) suggest, funder/publisher policies, institutional
mandates, and repository infrastructure play influential roles in determining whether research will shift in the direction of
OA. Further research into barriers that are restricting OA progress may be key to supporting regions slow to adopt OA pri-
orities. Advocates of the OA movement suggest that it is a necessary mechanism for leveling the playing field between those
who can afford to produce and access fee-based scientific literature and those who cannot (Tennant et al. 2016).
Research priorities
The sustained production of research on both contamination and diarrheal disease is an indication of the global challenges
that have driven long-term priorities in global water research. Chemical pollution from industrial discharge and untreated
sewage remains a heightened area of concern in the modern, industrialized era since evidence points to a range of chronic
diseases from exposure to contaminants found in water (Villanueva et al. 2014;Hutton & Chase 2016). Moreover, diarrheal
disease is consistently targeted as a research priority as it accounts for 829,000 deaths per year, representing one of the lead-
ing causes of death in children under five (Prüss-Ustün et al. 2019). Scientific monitoring of contaminants in water and
improved knowledge generation on diarrheal disease have the capacity to greatly reduce the associated health burdens,
hence the continued effort to develop scientific literature on these topics.
In the present study, it is unsurprising that the greatest number of publications and most cited literature are associated with
SDG 3 (good health and well-being) and SDG 6 (clean water and sanitation), since the search strategy explicitly included
‘health’and ‘drinking water,’both of which respectively represent these goals. Notably, SDG 14 (life below water) is the
third most-published SDG in this study, aligning also with the increase in literature on the topic of ‘water resources’in
recent years. Such evidence may point to planetary health, a field dedicated to the relationships between human health
and the earth’s natural systems, as a growing global priority. The extension of the SDGs to incorporate efficient water
resource allocation alongside environmental protection, rather than as a separate agenda item, is a likely explanation for
the popular keywords ‘groundwater’and ‘contamination’highlighted in the searched health literature. The rise in publi-
cations related to water resources in the wake of announcements for the 2030 Agenda for Sustainable Development may
therefore be reflective of a broader movement in the drinking water sector toward a more holistic, cross-sectoral integration
of priorities on social and environmental development.
Interventions, policies, and research agendas are becoming increasingly multifaceted because of the recognition of how
fundamental and interdependent water resources are for so many sectors. In 2016, water insecurity was named the greatest
long-term risk facing society by the World Economic Forum (WEF 2018). It was later evidenced that among other intercon-
nected consequences, the growing strain on water supply would put global GDP and grain production at serious risk by 2050
(UNESCO, 2016). As such, drinking water research has expanded to examine the interconnections between development
goals and across targets listed within goals. Evidence from surveys of WASH professionals across 36 countries suggests
that water research must further engage in multisectoral coordination to meet contemporary global needs (Setty et al.
2020). It is predicted that collaborative approaches to water-related sustainable development, rather than fragmented ones,
will continue to facilitate partnerships between actors across research fields and levels of society, which may lead to
topics that reflect interdisciplinary priorities.
The patterns in publications that address social determinants of health, implementation science, or qualitative methods
remain unexplored by the present study. There is growing recognition by health researchers, including those studying drink-
ing water, of the relevance of social science perspectives to better understand how thoughts, attitudes, beliefs, and social
norms shape behavior (Lilje & Mosler 2017). For example, critical WASH technologies are rendered ineffective if
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psychosocial factors impede the rate of adoption by the receiving communities, such as beliefs among women that using
latrines is strange or scary, compared to practicing open defecation (Aiemjoy et al. 2017). Understanding how and why drink-
ing water programs benefit communities or fail to reach intended outcomes is critical to reaching vulnerable populations most
burdened by inadequate drinking water services (Loevinsohn et al. 2015). Considerations of social determinants in drinking
water research may therefore result in a more comprehensive understanding of the barriers associated with universal drinking
water and lead to more effective interventions (Dreibelbis et al. 2013). The possible movement toward the integration of
social science perspectives in drinking water research is not captured by the present study; however, such investigations
may make an interesting extension as it would further define the nature of research on drinking water and health in LLMICs.
Limitations
Although most of the literature on drinking water and health in LLMICs was captured in this review, this study has several
limitations. First, only articles published in WOSCC were included, thereby excluding potentially relevant publications from
local journals that are not indexed in this database. Moreover, papers from predatory journals may inevitably be indexed in
reputable databases and due to the large number of papers included in this study, it was not feasible to screen out such papers.
Thus, countries/institutions with a heightened volume of papers published in predatory journals may be inflated. Second, the
search strategy does not include research on UMICs or low-resource settings within HICs, which may also contain disadvan-
taged groups that lack access to adequate drinking water but were not captured here. The search was also conducted in
English, thereby missing records that were cataloged in different languages. This may have resulted in the underrepresenta-
tion of certain regions, such as China, that likely have contributed more to the field. Moreover, the search strategy included
imprecise terms related to the ‘developing world,’whose membership has changed throughout history or can be redefined
based on different classifications. Third, there are numerous bibliometric indicators that can be utilized to evaluate a given
field of research, and this study is limited by the indicators and visualization tools selected by the authors. For instance, Vos-
Viewer references ‘England’, without having the functionality to analyze the ‘United Kingdom,’whereas data generated from
Clarivate InCites are generally analyzed using ‘United Kingdom.’Thus, international partnerships out of this particular region
were likely underrepresented in network maps, as the ‘United Kingdom’would have yielded greater international collabora-
tive links. Finally, this study used citation-based metrics to examine the impact of publications in the field of drinking water
research. However, a strong bibliometric impact may not always align with publications that yield the greatest societal impact,
the latter of which may be better understood by evaluating policies and programs that were established as a result of published
research articles. Despite these limitations, the current study provides a useful overview of global research on water and
health in LLMICs.
CONCLUSIONS
As sustainable development priorities drive the continued expansion and globalization of research on drinking water and
health, special efforts are needed to support the participation of low-resource and underrepresented researchers, particularly
from LICs. Local voices and perspectives may be particularly significant for facilitating the translation of research into con-
text-specific solutions and producing evidence-informed decisions that advance both policy and implementation efforts. In
recognizing that information sharing is critically important to building research capacity, the OA movement, and policies
that support low-resource researchers to access and publish accessible drinking water research may also play an important
role in developing a more equitable scientific community. The present study may be used to inform future research priorities
and decision-making processes, facilitate improved collaboration on research outputs, and identify where national research
systems must be strengthened. This will enable gaps in global drinking water inequalities to be filled, while at the same time
accelerating equitable, inclusive research in the realm of water and health.
DATA AVAILABILITY STATEMENT
All relevant data are available from an online repository or repositories.
CONFLICT OF INTEREST
The authors declare there is no conflict.
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