In 2000, the United Nations Member States set eight different “Millennium Development Goals” (MDGs) to be accomplished by the target date of 2015. (From). All eight MDGs focused primarily on reducing poverty worldwide, however, the seventh goal focused on ensuring environmental sustainability via the improvement of the world’s population through “sustainable access to safe drinking water and basic sanitation.” Since the inception of these goals, significant improvements have been made in all facets of global poverty, including the improvement of sustainable water, but challenges continue to remain and impacts can still be seen, full force, in underdeveloped areas like India and Sub-Saharan Africa. To reflect these ongoing challenges, UN Water developed a “Post-2015” report regarding the future of global sustainable water and updated its Sustainable Development Goals (SDGs) for a new deadline of 2030 aiming to ensure “availability and sustainable management of water and sanitation for all.” To accomplish this new goal, underdeveloped and low-income areas will need to critically evaluate challenges and impacts of poor quality water. An example of the first steps of moving towards accomplishing this goal can be seen by breaking down India and Africa’s water challenges into three main topics: geogenic contamination, viruses and microbial pathogens, and general access and perceptions of these affected communities.
Geogenic contamination can be defined in many different ways, but generally refers to the naturally occurring chemical contaminants that can affect the health of millions of people wordwide if elevated. (Marks). These chemicals tend to fall into the parameters of arsenic, fluoride, salinity, iron and manganese, uranium, radon, strontium, selenium, and chromium. (Concept). Most common in relation to water quality and specifically for India and Sub-Saharan Africa, however, are arsenic, fluoride, nitrate and salinity. Both countries face impacts of all three chemical contaminants. In “Global water pollution and human health,” René Schwarzenbach reported high salt concentrations prevent the direct use as drinking water and can inhibit crop growth in agriculture, but according to the Government of India’s “Concept Note on Geogenic Contamination of Ground Water in India,” salinity has far less serious health impacts as compared to other geogenic contaminants like arsenic and fluoride. The same can be said for Sub-Saharan African communities, as well. Arsenic and fluoride can be considered one of the persistent organic pollutants (POPs) as referenced by Schwarzenbach for its impacts on water systems on a global scale.
Schwarzenbach claims that of all geogenic contaminants, arsenic has so far caused the greatest negative health effects. Health impacts due to arsenic exposure can include respiratory distress, pre-malignant skin lesions, high blood pressure, neural dysfunctions, and can increase potential for both lung and skin cancers. Arsenic exposure is prevalent in both India and Sub-Saharan Africa, but has its greatest effects in India. According to Yu Chen’s report, “Arsenic exposure at low-to-moderate levels and skin lesions, arsenic metabolism, neurological functions, and biomarkers for respiratory and cardiovascular diseases,” arsenic-contaminated groundwater is a major public health concern and affects between 35 and 75 million people in Bangladesh, alone. In 2007, it was reported that up to half of the estimated 10 million tubewells in Bangladesh might be contaminated with arsenic. (United Nations). This exposure is especially detrimental, given that over 95% of the population of Bangladesh exclusively drinks groundwater through wells and long-term arsenic exposure has been consistently linked to extremely hazardous health impacts. (Chen). The World Health Organization reported that arsenic is naturally present at high levels in groundwater of Argentina, Bangladesh, Chile, China, India, Mexico, and the United States of America, but the only way to improve currently affected communities is through prevention of further exposure via the “provision of a safe water supply.”
Though arsenic exposure isn’t as much of an issue for Sub-Saharan Africa, low-income African communities are far from safe from geogenic contamination. In Ghana, specifically, excess arsenic is typically less than .01 mg/l compared to excess and often significant impacts due to Iron, Manganese, Fluoride, and Iodine. (Adelana). Geogenic contamination of groundwater in African communities is especially detrimental given that, according to Michael Adelana’s report, “Groundwater and Health: Meeting Unmet Needs in Sub-Saharan Africa,” nearly 80% of the continent’s population using groundwater as its main source for drinking water. In the last few decades, global fluoride contamination has come to the forefront after many studies have reported fluoride-related health problems like dental and skeletal fluorosis. (Ali).
In particular, countries such as India, China, Ethiopia, Kenya, and Argentina have faced serious impacts due to fluoride contamination, however, according to “Worldwide contamination of waster by fluoride,” fluoride contamination doesn’t necessarily have boundaries and in most countries, fluoride-related health hazards are under control. Shakir Ali reported in “Worldwide contamination of water by fluoride,” that almost all the states of India have fluoride contamination with Andhra Pradesh, Telangana, and Rajasthan highly effected. High fluoride levels have also been reported in multiple areas of Africa, particularly in Ethiopia, Tanzania, Kenya, Malawi, Cameroon, South Africa, Nigeria, and Ghana. Research has proven that groundwater in the “Rift Zone,” an area characterized by its active tectonic plate boundaries in East Africa, is influenced by geothermal waters and typically plagued by abnormally high concentrations of fluoride. (Adelana). When discussing potential solutions for these types of geogenic contaminations, Ali claimed, “Institutional intervention by way of identifying and isolating fluoride-contaminated sources may be an ideal measure. However, in case alternative drinking water sources are not available, proper treatment is mandatory.” In addition, Ali believes that the harvesting of rain water or the adoption of artificial recharge could potentially provide for dilution of fluoride-contaminated water and may be necessary in order to accomplish the long term goals of improving safe, sustainable water worldwide.
Outside of geogenic contamination impacts on the water quality in India and Sub-Saharan Africa, there are also viruses and microbial pathogens causing detrimental effects on people around the world. A pathogen is generally defined in microbiology as a micro-organism that has the potential to cause disease. (Microbes). Though published in 1998, Ashok Gadgil’s report, “Drinking water in developing countries,” claimed that safe drinking water remains inaccessible for about 1.1 billion people in the world and at any given time, about half the population in the developing world is suffering from Diarrhea, Ascaris, Dracunculisis, Hookworm, Schistosomiasis, and/or Trachoma due to lack of water supply or poor sanitation. Additionally, Gadgil cited the World Health Organization who stated that the “infectious diseases caused by pathogenic bacteria, viruses and protozoa or by parasites are the most common and widespread health risk associated with drinking water.” The major factors that will help reduction of significance and impact of diarrheal diseases, according to Gadgil, are quality sanitation, proper disposal of both human and animal excrement, public education on hygienic practices, and plentiful, available, and clean water. Though ambitious, by working with communities and investing in projects that improve the current status quo little by little, Gadgil’s suggestions have the ability to become reality.
Globally, lack of access to safe water and/or improved sanitation caused 1.6 million deaths per year with more than 99% of those deaths occurring in the “developing world.” (Schwarzenbach). These astounding statistics were what originally inspired the WHO’s MDGs set in 2000. Though small improvements were made through various programs and efforts, Katrina Jessoe’s report, “Improved source, improved quality? Demand for drinking water quality in rural India,” explained that though improved drinking water sources may have significantly reduced the occurrence of waterborne pathogens, “there is mixed evidence for whether source protection causes measurable reductions in waterborne disease.” Similar to geogenic contamination, neither India or Sub-Saharan Africa uniquely experience impacts of biological contamination via viruses and microbial pathogens. Though each face different consequences due to different community situations, 15% of the world’s population lives in areas of “water stress” with over 2.5 billion people having no access to improved sanitation, and more than 1.5 million children dying each day due to diarrheal disease. (Fenwick). A country can be deemed in “water stress” when the available amount’s use is restricted either due to a certain period impacting quantity or lack of quality.
For both India and Sub-Saharan Africa, many of these viruses and diseases are a direct result of poor sanitation as a result of fecal contamination. In India, it is estimated that up to 1.9 million people worldwide rely on water from either “unimproved” sources or ‘improved’ sources that are fecally contaminated. (Francis). Additionally, aside from the poor quality of the water, in rural communities of India and Sub-Saharan Africa, populations are often impacted in their procurement of water entirely. As reported by Mark Francis in “Perception of drinking water safety and factors influencing acceptance and sustainability of a water quality intervention in rural south India,” populations relying on unsafe and/or unreliable water sources are often exposed to water-associated pathogens, while also forced to also face the burden of collecting and transporting the water over long distances back to their homes. Limited access to water continues to be an issue in current society and is a true burden in the potential accomplishment of the WHO’s SDG set for 2030.
According to Alan Fenwick’s report, “Waterborne infectious diseases – could they be consigned to history?”, access to both clean water and sanitation is extremely rare and waterborne infections have become commonplace in many underdeveloped communities. As various development projects were launched in the second half of the 20th century, waterborne diseases became an “inevitable consequence,” as described by Fenwick. In addition, Fenwick further explained that, “The development of water resources, particularly in Africa, has changed the face of the continent, opening up land for agriculture, providing electric power, encouraging settlements adjacent to water bodies, and bringing prosperity to poor people. Unfortunately, the created or altered water bodies provide ideal conditions for the transmission of waterborne diseases and a favorable habitat for intermediate hots of tropical parasitic infections that cause disease and suffering.” Other diseases contracted as a result of these new developments include cholera, diarrhea, guinea worm infestation, snail-borne trematodes like schistosomiasis, malaria, and lymphatic filariasis through causes such as fecal contamination of water, parasite-contaminated waters, and vector-borne diseases due to increased open water sources. For example, the Gezira Scheme canals were completed in 1924, but as they matured, they became infested with weeds and became new homes for mosquitoes and snails thus ultimately causing vector control and treatment to suffer. (Fenwick).
As many of these similar development projects took off, treatment and prevention tactics weren’t necessarily familiar or attainable given the price of existing care. Though the reason behind the spreads of water-related diseases have shifted with time, the lack of affordability and access has stayed the same for underdeveloped communities, like those in India and Sub-Saharan Africa, have stayed the same.
Recently, however, multiple, affordable, water quality intervention strategies and treatments have been developed but there continues to be poor adoption and sustained use, specifically in rural areas. For example, in Kenya, a point-of-use chlorination tactic with a clay pot for storage was relatively low cost but lacked popularity due to “cultural factors and community preferences.” (Francis). Similarly, in Vellore, a southern India region, a low cost solar disinfection and domestic chlorination interventions were introduced to the community but were faced with extreme barriers of acceptance and suffered from little sustained use. (Francis). Many case studies have conducted in-depth interviews and surveys with communities in India and Sub-Saharan Africa regarding perceptions of water quality importance and interest in treatment. These studies generally expose the general understanding that sage water is beneficial for health of community members, children but lack the connection and knowledge of the magnitude of the issue. (Francis). Community members and head of households generally share the same consensual opinion that a water filtration intervention is unnecessary.
Through these case studies, it appears that perhaps the largest barrier to preventing transition from groundwater development to management is a general lack of information and understanding of the potential magnitude of the detrimental health impacts. “Many areas of Sub-Saharan Africa do not have any idea of how much groundwater is present and who withdraws how much groundwater and where. Indeed, even in countries where groundwater is important in all uses and where there is some knowledge about water resources, systematic monitoring of groundwater occurrence and abstraction is still lacking.” (Adelana). Furthermore, case studies regarding perceptions and current beliefs of water quality in respective communities provide further understanding of gaps in knowledge regarding the transmission pathways of waterborne diseases like diarrheal illnesses. (Francis). According to Francis, “Faulty perceptions of water treatment and a false sense of protection from water locally available not only place young children at the greatest risk of diarrheal diseases but mitigate the demand for water quality interventions.”
Though there’s been different strategies and tactics developed intended to improve both the water quality of specific regions and internationally, with broad initiatives, these strategies are rarely sustained long enough to create lasting change. Due to community differences and cultural norms, different aspects are required for consideration in different communities but most importantly, there needs to be “active and sincere” cooperation of the people. (Agrawal). In countries like India, cooperation is not possible in anything in which the government or the law are involved. (Agrawal). Similar barriers hold back other communities from adoption.
In rural communities in India and Sub-Saharan Africa, literature tends to suggest that word-of-mouth, do-it-yourself remedies tend to be more common and accepted than foreign suggestions and methods. Popular household water treatments include boiling, chlorination, and filtration. (Freeman). In rural India, specifically, Jessoe discusses the willingness of people in rural India to pay for better water quality through boiling water and in Matthew Freeman’s report, “Promoting Household Water Treatment through Women’s Self Help Groups in Rural India: Assessing Impact on Drinking Water Quality and Equity,” household water filters proved to be popular, as well, when introduced through the members of a women’s self-help group. The 18-month pilot program was able to achieve a 9.8% market penetration of the low-income, rural population, an impressive number for a typically unmarketable demographic. Unfortunately, regardless of the improved quality of water with the “better” filter, a substantial proportion of adopters continued to be exposed to high levels of fecal contamination in the water they reported drinking thus proving that possessing the tools for effectively treating water at home is not necessarily sufficient for ensuring safe drinking water. (Freeman). The only way to properly ensure that households are reaching optimal water quality with the given hardware is to use the tools correctly and consistently, something that is consistently a challenge regardless of the region. According to Freeman, in order to increase the maximum potential for health improvements, future programs must focus on increasing uptake among poor communities susceptible to disease/death and focus on continuing strategies to sustain users with correct and consistent methods.
At-home treatments are also popular in Sub-Saharan Africa due to the general affordability and popularity. In a report titled “Understanding why women adopt and sustain home water treatment: Insights from the Malawi antenatal care program” by Siri Wood, Wood explains that the Ministry of Health (MOH) has taken a new approach in Malawi for improving water quality through the promotion of household water treatments, improvement of general sanitation, and hand washing. Through the promotion of individual decisions and behaviors the end-goal is to ultimately change community-wide social norms and ultimately improve the overall sustained use of sanitation products, specifically for improving water quality. Wood’s case study of the impacts in Malawi confirm “the power of interpersonal communication from a trusted source,” the possibility of overcoming temporary cost barriers through free product trials, and the importance of social reinforcement from multiple sources (family, friends, relatives, neighbors, health workers, etc.)
With decades of water quality lagging behind in rural, underdeveloped communities like India and Sub-Saharan Africa, improving overall sanitation and health is incredibly important, especially as the UN states work towards the SDGs deadlined at 2030. Sub-Saharan Africa continues to “lag far behind” its fellow counterparts because of its slow progress, low coverage, and significant disparities between urban and rural areas. (Ray). It’s common knowledge that clean drinking water and safe sanitation facilities are important for the day-to-day functions for human health and well-being, but, in Africa there is a direct correlation between water quality and the nutritional welfare and education of a child. (Waggoner). Kimberly Waggoner’s analysis in “Evaluating the impact of water and sanitation quality on child malnutrition in Sub-Saharan Africa” concluded that, “a child living in a household with a flush toilet or water-based sanitation into a piped sewer system, septic tank, or pit latrine is less likely to be chronically malnourished than a child living in a household with unimproved sanitation and that this relationship holds true even when controlling for household wealth, maternal education, and child age, among other confounding variables.”
Similar to Africa, Natasha Ledlie’s thesis, “Integrated child development services scheme: Impact of water quality on child malnutrition in India,” concludes that quality of water is more important than feeding programs put in place for reducing malnutrition in developing countries like India. Her findings ultimately determine that the investment of water, sanitation, and hygiene education for the general public is the most important investment for bettering a child’s future. (Ledlie).
In terms of perception of each community, in 2008, a Gallup poll was conducted of 145 countries on their perceptual satisfaction of water quality. Overall, respondents in the sub-Saharan region are the least likely of any region Gallup polled to express satisfaction with the water quality in their communities with a regional median satisfaction was 48%. Within Sub-Saharan Africa, satisfaction varied from Chad (21%) and Nigeria (29%) to South Africa (81%) and Namibia (82%). (Ray). In comparison, the Gallup poll revealed that the regional median satisfaction with water quality for India was at 68%, equal to the median satisfaction of overall water quality across Asia. (Ray). Though both India and Sub-Saharan Africa struggle with water quality and sanitation, the two could differ in satisfaction percentages due to size vs square foot. In 2015, the population of India was 1.311 billion and Sub-Saharan Africa was at 1.001 billion. India is considered to be the seventh largest country in the world with a total area of 3,287,263 square kilometers whereas Sub-Saharan Africa is believed to have an area of 22 million square kilometers. (India).
In conclusion, water quality in India and Sub-Saharan Africa face a series of challenges due to geogenic contamination, biological viruses including water and vector-borne diseases, and general access, perceptions, and social norms. Extensive research, strategies, and tactics have been formulated to accurately represent the importance of sanitation and improved water quality, rural communities lack interest in sustaining correct and consistent methods of improvement for long-term benefits. Although many households and community members see the benefits and understand the connection between clean water to an improved society and future of children of the community, the only way the SDG set by WHO will be reached by 2030 is if underdeveloped communities buy-in and start small with changing their independent behaviors. As Gadgil mentioned, it is “worthwile” to work towards a global shift from an “old view” to a “new view” in order to improve overall quality of life. Starting with hand washing, improving personal hygiene, investing in sanitation, and utilizing free resources, communities in both Sub-Saharan Africa and India have the ability to improve the livelihoods of not only their own society, but for future generations to come.