Groundwater Quality And Human Health: Sunderrajan Krishnan, CAREWATER

Groundwater quality and Human health Sunderrajan Krishnan CAREWATER INREM Foundation, Anand, Gujarat

Contents Introduction Main groundwater-health problems in India Biological Fluoride Salinity Nitrate Arsenic Iron Emerging problems Experiences in Fluorosis mitigation and learnings Some debates on RO Some thoughts on policy issues

Introduction • Water borne diseases are a massive burden on society • The impact of water borne diseases is higher on the poor who have poorer nutrition • Incidences of some water borne diseases are decreasing, whereas others are increasing • Most of these diseases are preventable by consumption of safe drinking water

Local picture of drinking water access and variable water quality Groundwater Drinking Piped water supply Cooking Tank/Pond Other uses Sources Domestic Uses

availability time Pond supply Sources Piped water Groundwater salinity availability fluoride availability Drinking coli form coli form coli form

Transport processes within the aquifer Fl Human, Animal waste TDS Fl Fertilizers, Pesticides TDS TDS Groundwater flow

Different contamination problems

Biological contamination • Child mortality in India is 57/1000 • 9.1% of 0-5 yr mortality due to Diarrhoel diseases • Overall DALY from Diarrhoel > 22 million years • Poor sanitation and flood conditions are the main causes • Several low cost filters are being developed now; yet propensity to spend among poor not so high

Nitrate contamination • Standards are for 45 mg/l • Studies support Methaemoglobinemia in infants • Suspicions for being carcinogenic, respiratory problems, Diabetes • Low cost solutions for Nitrate removal do not exist

Salinity • Ingress and inherent salinity in many parts of India • But what are the health symptoms from salinity? • Can kidney stones be attributed to salinity? Though lack of proper hydration is linked to Kidney stones, hardness by itself is not • Though there is high incidence of Kidney stone in coastal areas

Total costs due to Kidney stones In salinity affected villages, • Medical costs = Rs. 5790 per person per year • Wage loss costs = Rs. 2690 per person per year • Drinking water costs = Rs. 750 per household per year Social costs due to Kidney stones form a significant part of income

Source: ICAR Studies

Arsenic • Arsenic in eastern parts of country • Arsenicosis exposure to 16 million people (7 million > 50 ppb exposure) • New areas in Nepal Terai, Assam, Bihar • Linked closely to occurrence of Iron

Source: Jadavpur university

Iron • Safe limit of 1 mg/l • No health based guideline suggested by WHO • People report of gastro-enteritic problems, but not supported by medical studies • Iron overload, Hereditary Haemochromatosis, Liver Cirrhosis • Taste, odour, skin, hair, pipes, cooking • People resort to unsafe water due to taste of Iron • Link with Arsenic

Fluoride contamination • Hydro-Fluorosis causes by consumption of high Fluoride in water • Not just Dental and Skeletal Fluorosis, but variety of problems with brain, liver, kidney, heart diseases • Estimates vary from 10 to 65 million people exposed • DALY of 38.5 per 1000 population (NEERI, 2007)

Source: CGWB

Food (black tea, rock salt) Occupation (Mines, glass etching) Water Nutrition (Ca, Mg, Vitamins) Crops Fluorosis Metabolism Social, economic, cultural impacts (effect of medicines, wage loss, psychological setback) Society

Fluorosis mitigation programmes • More than 50% of Fluoride intake can be through food grown locally • Fluorosis is linked much with climatic and nutritive factors • Teaching of Fluorosis is not present in current Indian medicine or engineering literature • Fluorosis patients can incur high costs (wage + medicine losses)

Medical and Wage loss costs North Dausa Kolar North Gujarat (in 2005) (in 2005) Karnataka (in 2002) (in 2005) per capita Rs. 861 Rs. 1489 Rs. 2807 annual Rs. 1724 medical cost per capita Rs. 4593 Rs. 19741 Rs. 8719 Rs. 12857 annual wage loss afflicted 1.1 1.3 1.7 2.3 no/house hold cost/annual 26 % 6% 21 % 16 % income

Fluorosis mitigation programmes …. Cont’d • Most Fluorosis mitigation programmes have been water supply programmes • Mitigation and reversal of symptoms is very slow, so patients lose much hope after few years and resign to fate

Fluorosis mitigation programmes …. Cont’d • Started mainly as De-fluoridation programmes • Nalgonda filter (using Alum) in 1970s … NEERI • Activated Alumina (AA) as an advancement • Reverse Osmosis (RO) with proper membrane can remove Fluoride ions • New materials, … Resin, Chitin, Bio-polymer adsorbent, etc.

Fluorosis mitigation programmes …. Cont’d • Water treatment: AA and RO • Roof top rain water harvesting • Pipe water supply • Recharge

Fluorosis mitigation programmes …. Cont’d • Main options today are AA and RO • AA Minimum of 1mg/g adsorption. Requires regeneration every 4-5 months New materials with 8-9 mg/g adsorption Al-Fl complexes a health concern Has wide industry application, so is low-cost and available AA filters not available in market No electricity required Two main programs for AA are SWACH and Mytry

Fluorosis mitigation programmes …. Cont’d • SWACH and Mytry UNICEF and IITK tested the AA DDU filters and implemented in 2 locations Awareness programmes, village regeneration centres Mytry later transitioned into filter manufacturing company Currently some maintenance of filters happens in Rajasthan, but not widespread

Fluorosis mitigation programmes …. Cont’d Health based mitigation measures Studies say upto 80% bio-available Fluoride enters through food (Reddy R, 2008, AP) and 60% through food (Chakma, 2007, MP). Safe water can prevent Fluorosis, but can it mitigate? Calcium, Magnesium, Absorbic acid (Vitamin C) are suggested till now Successes have been achieved for few patients by Dr. AK Susheela, Dr. T. Chakma, Dr. Sunil Gupta and Dr. Raja Reddy But can these be achieved on a larger scale? Nutrition supplements through Atta, … other food items ?

Fluorosis mitigation programmes …. Cont’d Fluorosis mitigation: water and health perspectives • Understanding of Fluoride mobility and distribution • Fluorosis needs to be in medical and public health curriculum • Doctors should push patients towards need for safe water • Mitigation needs to be tried in mass trials and standardized • Options for safe water needs to be available: rain water storage, low cost treatment and services etc.

Debates with RO • Cost/litre • Effluent disposal • Does it really treat for required contaminants? • Maintenance • Is it safe for health? • Is it really required?

Successfully operating RO plants in south Gujarat Minimum Average Maximum- Capacity 250 lph 560 lph 1000 lph Storage 200 litres 2000 litres 6000 litres Plant cost 1.25 lakhs 2.32 lakhs 5 lakhs Cost/litre 0 Re 0.28 Re 0.6 Prod/day 300 litres 1200 litres 2500 litres Buyers in 30 86 325 village Reach 10% 42% 100% Suppliers of plant are varied (ISO, non-ISO) Reach within village shows wide variation, Off-shoot water suppliers cover surrounding villages, Non-users have very poor drinking water facilities Variability in size, cost/litre, % of reach and production

Treatment aspects of RO water • RO treats only according to the specific membrane capacity • Pre and post treatment is required • Although pure distilled water can be harmful for health, NRC, 1983 reports no health based guideline for RO water • Effluent for RO should be disposed properly, but currently no official safety standards exist in India

Monitoring of water quality • Network of govt agencies insufficient • NRDWQM program is in progress • Several tier of monitoring eg. Assam where field kits are employed along with 5 PHED labs and IIT G over seeing quality control • New low cost digital instrumentation are being developed eg. in IIT B

Issues with policy • Who is responsible for groundwater quality and health problems? • Do we have enough understanding of mobilization processes of contaminants?

Health department’s role • A framework on water quality should come from a concept of overall health • All water quality problems of a place need to be addressed eg. Assam (Iron + Fluoride + Arsenic filter) • Health agencies need to accept their responsibility

In summary • Better physical distribution needs to be known • Bringing people to be concerned on water quality and health is not an easy task • New treatment solutions coming up; but comprehensive local solutions to water treatment needs to be developed • Doctors can play a key role in disseminating water quality information

Groundwater Quality And Human Health: Sunderrajan Krishnan, CAREWATER

by India Water Portal on Jun 03, 2009

Accessibility

Categories

Upload Details

Usage Rights

2 Embeds 3

Statistics

Groundwater Quality And Human Health: Sunderrajan Krishnan, CAREWATER — Presentation Transcript

http://www.slideshare.net	2
http://webcache.googleusercontent.com	1