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The role of chemical exposures in reducing the effectiveness of water–sanitation–hygiene interventions in Bangladesh, Kenya, and Zimbabwe

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Abstract The sustainable success of water, sanitation, and hygiene (WASH) interventions to reduce waterborne disease and promote public health in low‐income regions is uncertain. Recent large randomized controlled trials in Bangladesh, Kenya, and Zimbabwe revealed that traditional household WASH interventions are unlikely to reduce diarrhea or improve linear growth (i.e., reduce stunting) in infants and children—two important indicators of the effectiveness of WASH interventions. A possible factor contributing to the null results is that traditional WASH interventions control microbial pathogens but do not remove chemical toxicants. Exposure to many organic and inorganic chemical toxicants is associated with diarrheal symptoms, as well as with preterm birth and stunting. Many chemical toxicants have deleterious effects on the immune system, impairing the body's response to infectious diseases, and reducing the effectiveness of vaccinations. Globalization has led to rapid and largely unregulated import, production, use, and disposal without adequate treatment of large quantities of hazardous chemicals throughout the developing world, with profound effects on the environment and human health. Literature evidence from the past 10 to 15 years on putative and demonstrated chemical exposures in Bangladesh, Kenya, and Zimbabwe and the regions within the countries where the large WASH trials took place supports potential contribution(s) from chemical toxicants in the failure of traditional WASH interventions to relieve diarrhea and stunting. Mitigating exposures to organic and inorganic chemical immunotoxins through drinking water and other routes is likely to be a necessary‐but‐insufficient criterion for the sustainable success of WASH interventions. This article is categorized under: Engineering Water > Water, Health, and Sanitation Engineering Water > Sustainable Engineering of Water
Chemical classifications used in this review paper. Legacy persistent organic pollutants (POPs) as identified by the Stockholm Convention. CEC stands for “contaminants of emerging concern.” PFAS stands for per‐ and poly‐fluoroalkyl substances. “Pharma” is short for pharmaceutically active compounds
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A possible proxy method for applying the persistent‐bioaccumulative‐toxic (PBT) approach to risk assessment in WASH. Inclusion in the Stockholm Convention list of legacy persistent organic pollutants (legacy POP) fulfills all three PBT criteria. Agricultural and industrial chemicals for which regulatory or guideline values have been established by EPA or WHO, or contaminant of emerging concern (CEC) designation imply criteria T is met. Bioconcentration is the accumulation of a chemical in or on an organism when the source of chemical is solely water. The bioconcentration factor (BCF) is the ratio of a chemical's concentration in an organism to its concentration in water. BCF can provide a proxy for the bioaccumulative (B) criterion. Biodegradation half‐life can provide a proxy for the environmentally persistent (P) criterion. BCF and biodegradation half‐life values were obtained from model predictions accessed through EPA's CompTox Dashboard
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Engineering Water > Sustainable Engineering of Water
Engineering Water > Water, Health, and Sanitation

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