In the year 2015, the members of the UN General Assembly adopted the Sustainable Development Goals (SDGs), with their 6th goal being providing universal access to safe drinking water for all by 2030. However, despite a decade of efforts, a quarter of the world’s population still goes without access to safe drinking water. Around 1.7 million people worldwide are estimated to be using water contaminated with fecal matter, which is the root cause behind numerous waterborne diseases such as diarrhoea, cholera, typhoid, etc. Every year, almost 1.2 million people die prematurely due to the consumption of unsafe drinking water. According to the World Health Organisation (WHO), the majority of the victims of these diseases are children below the age of 5 years, particularly from Low-and Middle-Income Countries (LMICs). Waterborne diseases (WBD) refer to those diseases that spread through consumption of drinking water contaminated with pathogenic microbes. These water-borne pathogens can be viruses, bacteria, helminths, protozoa or intestinal parasites. The consequences of waterborne diseases are not just limited to incidences of morbidity and mortality, but they leave a longer lasting effect by affecting the physical and cognitive development of child survivors, thus deepening the social inequalities, imposing economic burden and aggravating the global health challenges, thereby pushing their victims in a vicious cycle of extreme poverty, malnutrition and poor socio-economic status. Achieving the goal of universal access to safe water by 2030 seems to be a daunting task, requiring a six-fold increase in current global rate of progress with three times the current investment. Here, Health Informatics, by integrating health information systems with data and technology can prove to be a powerful tool in the fight against waterborne diseases, which can provide data-driven solutions in surveillance, prevention, management and mitigation of these diseases. This blog explores the complex landscape of the management of waterborne diseases and the potential of innovative health informatics solutions in transforming response strategies.

Burden of Waterborne Disease

Globally, it is reported by the UN that 2.1 billion people lack access to clean and safe drinking water, resulting in 2.2 million deaths and 8.2 million disability-adjusted life years from waterborne diseases each year due to contaminated water, sanitation and hygiene. The severity is much higher in developing countries than developed countries.

In Malawi, one of the worst cholera outbreaks in its history occurred between 2022 and 2023, exacerbated by extreme weather events such as tropical cyclones. The outbreak resulted in 58,979 cases and 1,768 deaths, with a case fatality rate of 13.3%. The crisis was linked to inadequate access to clean water and sanitation facilities following flooding. Similarly, Pakistan faces a severe burden of diarrheal diseases, with an estimated 250,000 child deaths annually due to unsafe water and poor sanitation. Only 20% of the population has access to clean drinking water, and over 66% of households consume bacterially contaminated water, contributing to widespread illnesses such as diarrhea and cholera. Occurrence of diarrhoea was found to be positively associated with socioeconomic factors and WASH facilities were identified as risk factors in Lusaka, Zambia.

In India, about 3.7 million Indian people are affected by waterborne diseases every year and a staggering number of 73 million workdays are forfeited, resulting in significant economic repercussions. A World Resource reported that about 70% of India’s water supply is polluted with sewage discharge. Approximately 2439 people died due to waterborne diseases, i.e., acute diarrheal disease (ADD), typhoid, cholera, and viral hepatitis in 2018 in India; among these, 1,450 (60%) were children aged less than five years. Waterborne diseases that are continuously prevailing in India are cholera, ADD, typhoid, and viral hepatitis. These diseases have caused 10,738 deaths since 2017, and about 11,728 people died between the years 2014 and 2018 because of these diseases.

Bidirectional Relationship between Malnutrition and Waterborne Biseases

Malnutrition and infectious diseases are intricately linked in a bidirectional relationship, where each condition exacerbates the other, creating a vicious cycle detrimental to health. Inadequate nutrition impairs immune function, making individuals more susceptible to infections. For instance, deficiencies in essential nutrients such as proteins, vitamins, and minerals can weaken physical barriers like the skin and mucous membranes, as well as compromise cellular immune responses, thereby increasing vulnerability to pathogens.

Conversely, infectious diseases can further deteriorate nutritional status through several mechanisms. Gastrointestinal infections, for example, can lead to diarrhea, resulting in significant nutrient loss and malabsorption. Additionally, infections often suppress appetite and elevate metabolic demands, leading to a depletion of nutrient reserves . This cyclical interaction underscores the necessity for integrated interventions that address both nutritional support and infection control to effectively break the cycle of malnutrition and disease.​

Programs for Management of Waterborne Diseases in India

Curbing the menace of water-borne diseases requires a multipronged approach. Providing access to safe water and sanitation, investment in public health and water supply infrastructure, regular monitoring of water quality along with community awareness on hygiene practices are some of the key aspects to control the outbreaks of such diseases.

Atal Mission for Rejuvenation and Urban Transformation (AMRUT) 2.0 scheme was launched in 2021 to enable cities to become self-reliant and water secure along with ensuring universal coverage of sewerage & septage management with the help of government investments in large infrastructural projects and technology enabled monitoring and supervision of the scheme.

Jal Jeevan Mission (JJM-Har Ghar Jal) was launched in 2019 to provide adequate quantities of appropriate quality water through tap water connection in all rural areas of the country (PIB, 2021). Robust monitoring and surveillance systems have been established under this scheme to ensure quality of the water being supplied. Testing of water samples with the help of field testing kits by trained members of the “Paani Samiti” and at laboratories established at Block and District levels enables community participation and surveillance in the process. A real-time dashboard has also been created that provides updated status of the water quality monitoring and the action taken by the respective governments. The Department of Drinking Water and Sanitation (DDWS) has developed an integrated management information system for mapping the operational and financial progress made under this scheme.

Pradhan Mantri Ayushman Bharat Infrastructure Mission (PM-ABHIM) was another initiative by GoI launched in 2021 for improving the public health infrastructure of the country. Establishment of Block Public Health Units (BPHUs) and Integrated Public Health Laboratories (IPHL) under this scheme can ensure improved surveillance and early detection of the waterborne disease outbreaks along with enhancing timely response.

Potential of Health Informatics in Combating the Issue

Health informatics provides a transformative perspective to enhance public health surveillance systems, particularly in addressing waterborne diseases. By leveraging data-driven technologies, health informatics can improve the effectiveness of each of the seven key elements of public health surveillance: planning and system design, data collection, data management, analysis, interpretation, dissemination, and application to public health programs. For instance, systems like the Centers for Disease Control and Prevention (CDC’s) Waterborne Disease and Outbreak Surveillance System (WBDOSS) integrate data from drinking water, recreational water, and environmental exposures to track outbreaks effectively. The WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply, Sanitation, and Hygiene generates estimates of progress on drinking water, sanitation, and hygiene that are comparable across countries. The World Health Organisation (WHO) conducts the UN-Water Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS). In order to maintain and expand WASH services for everyone, particularly the most vulnerable population groups, it keeps an eye on the governance, monitoring, financial, and human resources components of WASH systems.

In India, the “Integrated Disease Surveillance Programme (IDSP)” is the primary system used for surveillance of waterborne diseases, allowing for early detection and response to outbreaks of diseases like cholera, typhoid fever, acute diarrheal disease, and hepatitis A/E , which are transmitted through contaminated water by monitoring disease trends and initiating rapid response actions when necessary.
Advanced technologies like IoT devices, biosensors, and mobile applications streamline the collection of water quality data in real time. For example, IoT-based systems equipped with sensors for pH levels, turbidity, and temperature can detect water contamination early, reducing the risk of outbreaks. Health informatics enables seamless integration of new data with legacy systems while ensuring data privacy and security. For example, platforms like the Environmental Health Specialists Network Information System (EHSNIS) provide standardized reporting tools for waterborne illness assessments.

Mobile applications and digital platforms can be utilised for awareness campaigns on a large scale. Use of digital health systems, and analysis of data from multiple sources can enable early outbreak detection and mitigation of risks, thereby lowering the cost and burden on the healthcare systems. By leveraging real-time monitoring and predictive analytics, health informatics can help identify hotspots of waterborne disease outbreaks, thus enabling real-time tracking of the cases and targeted response efforts.

References

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