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WHO issues revised drinking water guidelines to help prevent water-related outbreaks and disease


Annex

Africa

The latest edition of the GDWQ considers the application of household water treatment and safe storage technologies, which is becoming increasingly relevant with 1.1 billion people in rural and urban areas still relying on unsafe drinking water from rivers, lakes, and open wells. In Sub-Saharan Africa, underground water may have high mineral or chemical content, such as arsenic and particularly high fluoride levels. In some districts of Kenya, South Africa, Tanzania and Uganda, for example, fluoride levels in underground water ranged up to 25 mg/litre - far above the 1.5 mg/litre limit value recommended by the GDWQ. In those countries, populations suffer from dental and severe skeletal fluorosis.

Vulnerable populations cannot afford to wait for the ultimate goal of clean, piped water. Increasingly, water service providers are recognizing the value of, seeking guidance about, and implementing point-of-use interventions. In one example, a recent study conducted among 400 households in a Malawian refugee camp indicated that using a water container with a cover and a spout significantly decreased contamination of water and resulted in 31% fewer cases of diarrhoeal disease in children under five.

WHO Regional contact for Water and Sanitation in Africa: Dr Ahmed Nejjar, Environmental Health Officer, Tel: (+47) 241 39271, Email: nejjars@afro.who.int

North America

In recent years in Walkerton and North Battleford, Canada, disease outbreaks due to E.coli O157 and Campylobacter, or, in the United States, to Cryptosporidium have occurred. As recently as this month, contamination of drinking well water in the U.S state of Ohio by E.coli was being reported. In some cases there have been hundreds of thousands of cases of illness because of these microbes in drinking water, showing what can happen when there is not preventive management of drinking water quality. In response to these outbreaks, regulatory authorities have shifted towards a more preventive approach, instigating for example the surface water treatment rule in the USA.

WHO Regional contact for Water and Sanitation in North America: Mr Luiz Augusto Cassanha Galvão, Manager, Sustainable Development and Environmental Health Area, WHO Regional Office for the Americas of the World Health Organization, Tel:(+1)(202) 974 3156, Email: galvaolu@paho.org

Asia

Problems of naturally-occurring arsenic in drinking water in Bangladesh continue to attract much concern, especially because of the scale of the affected population. Some 35 million people in that country alone consume water containing elevated levels of arsenic. Other affected countries include India, China, Myanmar, Viet Nam, Laos and Cambodia.

In China, elevated fluoride in drinking water causes over 26 million people to suffer from dental fluorosis and is thought to cause one million people to suffer from skeletal fluorosis. In India, more than 66 million people consume drinking water with elevated fluoride.

The communities living in Pacific island countries confront severe logistical challenges in organizing safe drinking-water supply. A standard "sampling and analysis" approach to monitoring could never really ensure quality for these isolated populations. Preventive monitoring is more likely to work. Vulnerable fresh water lenses on island "atolls" demand holistic management and public participation if the precious resource is to be sustained.

WHO Regional contact in South East Asia: Mr Han Heijnen, Regional Advisor, Water, Sanitation & Health, Tel: (+91) (11) 2337 0804 26641/2, Email: heijnenh@whosea.org

WHO Regional contact in the Western Pacific: Mr Terrence Thompson, Regional Adviser, Tel: (+63) 2-528-9890, Email: thompsont@wpro.who.int

Eastern Mediterranean Region

The quality of water supplies in the WHO Eastern Mediterranean region (EMRO) countries does not always comply with national standards, with serious public health consequences, including disease outbreaks. Earlier this year, much publicized outbreak of diarrhoea occurred recently in Hyderabad, Pakistan; over 4000 patients suffering from acute watery diarrhoea were admitted in hospitals in May/June 2004.

In most countries, water scarcity is the general rule, but at the same time, water wastage is widespread and the available water resources are threatened by salt water intrusion, pollution, and eutrophication. Hence, over 60% of the world’s installed desalination capacity is located in the region and the cost to extend and sustain water supply services is rising. EMRO is receiving requests for guidance on the minimum amounts of domestic water that should be supplied for domestic purposes as well as on issues unique to desalination operations and water quality. On the other hand, water supply systems operate intermittently in a number of countries, due to the severe shortages of freshwater, and inadequate maintenance and poor management. Closer drinking-water quality control is required, since water quality deterioration in the supply system and in household storage facilities occurs even where piped water supply is ensured.

WHO Regional contact in Eastern Mediterranean: Dr Houssain Abouzaid, Coordinator, Healthy Environment, Tel: +(202)6765028 (operator) and +(202)2795362(direct), Email: seh@emro.who.int

Western Europe

Disease outbreaks related to water continue to occur also in the most economically developed European countries. The main cause of outbreaks is often contamination of the raw water supply combined with missing or faulty disinfecting procedures.

  • In the fifteen years from 1988 - 2002, Norway recorded 72 outbreaks, affecting a total of 10 616 persons, due either to contamination and/or failed disinfection.
  • The United Kingdom reported 26 outbreaks of waterborne infectious intestinal diseases in England and Wales in the period 1992 - 1995 with the most important case affecting 575 people.
  • Important outbreaks occur, for example, in areas with small unchlorinated supplies (Finland, 463 cases of gastroenteritis in a population of 8,600; nationally 14 waterborne epidemics in the period 1998 - 1999 with 7 300 cases of illness), or in settings where people gather in considerable densities (Sweden, 500 people, ski resort; Italy, tourism area, 344 people).

WHO Regional contact for Water and Sanitation in Europe: Mr Roger Aertgeerts, Regional Adviser, Water and Sanitation, Tel: (+39) 06 4877528, Email: rae@who.it

Eastern Europe and the Commonwealth of Independent States

Although improvements are being made in some areas, the burden of water-related diseases remains significantly higher in the eastern, compared to the western, part of the European region. The Standardized Death Rate from diarrhoeal diseases for children under age five per 100 000 fell in the Commonwealth of Independent States (CIS) from 70.03 in 1993 to 21.58 in 2001 and in the Central Asian Republics from 176.26 to 44.63. Nevertheless, the burden remains much higher than in the 15 countries of the EU where the rate was 0.64 in 1993 and decreased to 0.36 in 2001. A similar picture is shown by viral hepatitis A incidence per 100 000. In the CIS it fell from 186.76 to 86.28 between 1993 and 2001, in the Central Asian Republics from 395.52 to 142.69. In the EU-15, the decrease was from 7.61 to 4.71 in the same period. Much, therefore, still needs to be done, especially in the eastern part of WHO's European Region, to achieve common, high standards of drinking-water quality.

WHO Regional contact for Water and Sanitation in Europe: Mr Roger Aertgeerts, Regional Adviser, Water and Sanitation, Tel: (+39) 06 4877528, Email: rae@who.it

Latin America and the Caribbean

Only 24% of the urban population of Latin America and the Caribbean has some water quality control surveillance system. In Honduras, Nicaragua, Haiti, Guyana and Bolivia, more than 50% of the population has access to piped drinking water less than 50% of the time. Moreover, the population covered with adequate surveillance systems and water quality control is very limited in the urban areas and insignificant in the rural areas. The fact that more than one-third of the deaths in Latin America and the Caribbean of children under five years old are due to communicable diseases highlights the critical role that provision of safe and reliable drinking water could play in reducing child mortality. It is envisaged that the new Guidelines for Drinking-water Quality will facilitate national and local authorities in the improvement of water quality at local level.

WHO Regional contact for Water and Sanitation in Latin America and the Caribbean: Mr Luiz Augusto Cassanha Galvão, Manager, Sustainable Development and Environmental Health Area, WHO Regional Office for the Americas of the World Health Organization, Tel:(+1)(202) 974 3156, Email: galvaolu@paho.org

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For more information contact:

Mr Gregory Hartl
Telephone: +41 (22) 791 4458
Mobile phone: +41 (79) 203 6715
E-mail: hartlg@who.int