Regional disparities in the burden of disease attributable to unsafe water and poor sanitation in China

Carlton, Elizabeth J.; Liang, Song; McDowell, Julia Z.; Li, Huazhong; Luo, Wei; Remais, Justin V.

doi:10.2471/blt.11.098343

Cited by 54 publications

(57 citation statements)

References 30 publications

(35 reference statements)

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“…In China, sanitary conditions vary markedly throughout the country, 3 as well as between rural and urban areas 4, 19. Moreover, in rural areas, disparities also exist in coverage rates of improved sanitation across socio-economic groups 20 .…”

Section: Discussionmentioning

confidence: 99%

Infectious diarrheal disease caused by contaminated well water in Chinese schools: A systematic review and meta-analysis

Ding

Zhai

et al. 2017

Journal of Epidemiology

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BackgroundIn China, waterborne outbreaks of infectious diarrheal disease mainly occur in schools, and contaminated well water is a common source of pathogens. The objective of this review was to present the attack rates, durations of outbreak, pathogens of infectious diarrheal disease, and sanitary conditions of wells in primary and secondary schools in China, and to analyze risk factors and susceptibility of school children.MethodsRelevant articles and reports were identified by searching PubMed, Web of Science, China National Knowledge Infrastructure, China Information System for Disease Control and Prevention, and the Chinese Field Epidemiology Training Program. Essential information, including urban/rural areas, school types, attack rates, pathogens, durations of outbreak, report intervals, and interventions were extracted from the eligible articles. Wilcoxon signed-rank test, Kruskal–Wallis H test, and Spearman correlation test were conducted in statistical analyses. Sex- and age-specific attack rate ratios were calculated as pooled effect sizes.ResultsWe screened 2188 articles and retrieved data of 85 outbreaks from 1987 to 2014. Attack rates of outbreaks in rural areas (median, 12.63 cases/100 persons) and in primary schools (median, 14.54 cases/100 persons) were higher than those in urban areas (median, 5.62 cases/100 persons) and in secondary schools (median, 8.74 cases/100 persons) (P = 0.004 and P = 0.013, respectively). Shigella, pathogenic Escherichia coli, and norovirus were the most common pathogens. Boys tended toward higher attack rates than girls (sex-specific attack rate ratio, 1.13; 95% CI, 1.00–1.29, P = 0.05). Unsanitary conditions of water wells were reported frequently, and unhealthy behavior habits were common in students.ConclusionSchool children were susceptible to waterborne disease in China. Chinese government should make efforts to improve access to safe water in schools. Health education promotion and conscientiousness of school leaders and teachers should be enhanced.

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Section: Discussionmentioning

confidence: 99%

Infectious diarrheal disease caused by contaminated well water in Chinese schools: A systematic review and meta-analysis

Ding

Zhai

et al. 2017

Journal of Epidemiology

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“…Most importantly, a food supply chain tracking system from field to fork should be established to make the information of food production, processing, transportation and storage open and transparent, and to take precautionary approaches to avoid the spread of contaminated food. Improving monitoring, regulatory oversight and more government transparency are needed to better estimate the potential risks of contaminated water, soil and poor sanitation and hygiene on human health (Wu et al, 1999;Carlton et al, 2012).…”

Section: Figure 5 Distribution Of Cancer Villages and Main Grain Yiementioning

confidence: 99%

Impacts of soil and water pollution on food safety and health risks in China

Lü

Shi

Wang

et al. 2015

Environment International

892

318

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Tieyu. 2015. Impacts of soil and water pollution on food safety and health risks in China. Copyright © 2015 Elsevier B.V.This version available http://nora.nerc.ac.uk/509736/ NERC has developed NORA to enable users to access research outputs wholly or partially funded by NERC. Copyright and other rights for material on this site are retained by the rights owners. Users should read the terms and conditions of use of this material at http://nora.nerc.ac.uk/policies.html#access NOTICE: this is the author's version of a work that was accepted for publication in Environment International. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Environment International, 77. 5-15. 10.1016International, 77. 5-15. 10. /j.envint.2014 www.elsevier.com/ Contact CEH NORA team at noraceh@ceh.ac.ukThe NERC and CEH trademarks and logos ('the Trademarks') are registered trademarks of NERC in the UK and other countries, and may not be used without the prior written consent of the Trademark owner. Impacts of Soil and Water Pollution on Food Safety and Health Risks in China AbstractEnvironmental pollution and food safety are two of the most important issues of our time. Soil and water pollution, in particular, have historically impacted on food safety which represents an important threat to human health. Nowhere has that situation been more complex and challenging than in China, where a combination of pollution and an increasing food safety risk have affected a large part of the population. Water scarcity, pesticide over-application, and chemical pollutants are considered to be the most important factors impacting on food safety in China. Inadequate quantity and quality of surface water resources in China have led to the long-term use of waste-water irrigation to fulfill the water requirements for agricultural production. In some regions this has caused serious agricultural land and food pollution, especially for heavy metals. It is important, therefore, that issues threatening food safety such as combined pesticide residues and heavy metal pollution are addressed to reduce risks to human health. The increasing negative effects on food safety from water and soil pollution have put more people at risk of carcinogenic diseases, potentially contributing to 'cancer villages' which appear to correlate strongly with the main food producing areas. Currently in China, food safety policies are not integrated with soil and water pollution management policies. Here, a comprehensive map of both soil and water pollution threats to food safety in China is presented and integrated policies addressing soil and water pollution for achieving food safety are suggested to provide a holistic approach.

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“…57 China is not alone in having outbreaks associated with contaminated water used in food production—outbreaks of E coli O157 in Sweden in 2005 linked to contaminated irrigation water, 58 and a viral gastroenteritis outbreak in the UK in 1994 associated with contaminated water used in food processing, are important examples from industrialised countries. 59 However, China’s water and sanitation infrastructure is at a much earlier stage of development, 60 and thus the risks to the food supply are much greater. In rural areas—the setting where most food production occurs—an estimated third of the population does not have access to improved sanitation, contributing, for instance, to the continuing transmission of important foodborne diseases such as trematodiases.…”

Section: Foodborne Disease and Food Safety Issues In Chinamentioning

confidence: 99%

“…In rural areas—the setting where most food production occurs—an estimated third of the population does not have access to improved sanitation, contributing, for instance, to the continuing transmission of important foodborne diseases such as trematodiases. 60–62 …”

Section: Foodborne Disease and Food Safety Issues In Chinamentioning

confidence: 99%

Food supply and food safety issues in China

et al. 2013

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Food supply and food safety are major global public health issues, and are particularly important in heavily populated countries such as China. Rapid industrialisation and modernisation in China are having profound effects on food supply and food safety. In this Review, we identified important factors limiting agricultural production in China, including conversion of agricultural land to other uses, freshwater deficits, and soil quality issues. Additionally, increased demand for some agricultural products is examined, particularly those needed to satisfy the increased consumption of animal products in the Chinese diet, which threatens to drive production towards crops used as animal feed. Major sources of food poisoning in China include pathogenic microorganisms, toxic animals and plants entering the food supply, and chemical contamination. Meanwhile, two growing food safety issues are illegal additives and contamination of the food supply by toxic industrial waste. China’s connections to global agricultural markets are also having important effects on food supply and food safety within the country. Although the Chinese Government has shown determination to reform laws, establish monitoring systems, and strengthen food safety regulation, weak links in implementation remain.

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Regional disparities in the burden of disease attributable to unsafe water and poor sanitation in China

Cited by 54 publications

References 30 publications

Infectious diarrheal disease caused by contaminated well water in Chinese schools: A systematic review and meta-analysis

Infectious diarrheal disease caused by contaminated well water in Chinese schools: A systematic review and meta-analysis

Impacts of soil and water pollution on food safety and health risks in China

Food supply and food safety issues in China

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