Publication Regions China
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July 21, 2022 In

Bottled water quality and associated health outcomes: A systematic review and meta-analysis of 20 years of published data from China

Abstract/Summary: Bottled water is a rapidly growing yet relatively understudied source of drinking water globally. In addition to concerns about the safety of bottled water, the adverse environmental health and social impacts associated with bottled water production, distribution, consumption, and reliance are considerable. Our objective was to comprehensively review, analyze, and synthesize ∼20 years of publicly available data on bottled water quality and associated health outcomes in China. We conducted a systematic review and meta-analysis of publicly available studies of bottled water quality and associated health outcomes in China published between 1995 and early 2016 (in Chinese and English). We pre-specified and registered our study protocol, independently replicated key analyses, and followed standardized reporting guidelines. Our search identified 7059 potentially eligible records. Following screening, after full-text review of 476 publications, 216 (reporting results from 625 studies) met our eligibility criteria. Among many findings, 93.7% (SD = 10.1) of 24 585 samples tested for total coliforms (n = 241 studies), and 92.6% (SD = 12.7) of 7261 samples tested for nitrites (n = 85 studies), were in compliance with China’s relevant bottled water standards. Of the studies reporting concentration data for lead (n = 8), arsenic (n = 5), cadmium (n = 3), and mercury (n = 3), median concentrations were within China’s standards for all but one study of cadmium. Only nine publications reported health outcome data, eight of which were outbreak investigations. Overall, we observed evidence of stable or increasing trends in the proportions of samples in compliance over the ∼20 year period; after controlling for other variables via meta-regression, the association was significant for microbiological but not chemical outcomes (p = 0.017 and p = 0.115, respectively). Bottled water is typically marketed as being safe, yet in most countries it is less well-regulated than utility-supplied drinking water. Given the trend of increasing bottled water use in China and globally—and the associated environmental health impacts—we hope this work will help to inform policies and regulations for improving bottled water safety, while further highlighting the need for substantially expanding the provision of safe and affordable utility-supplied drinking water globally.

March 1, 2021 In

Water Supply Improvement & Health Promotion Campaigns in Rural Areas — China, 1949−2020

Abstract/Summary: In the 1950s, shortly after the founding of the People’s Republic of China (PRC), the central government created the Patriotic Health Campaign (PHC) in order to standardize and disseminate health focused educational materials intended to control and prevent infectious diseases (1). “Water improvement”, meaning measures aimed at providing safe drinking water for households in China, was an important part of the PHC. After 60 years of water improvement policies, programs, and investments, the rural water supply sanitation and hygiene in China has improved dramatically, and water-related diseases no longer negatively impact the rural population as they once did. In addition to improvements related to the quantity and quality of the rural water supply, water improvement programs also promoted improved hygiene, sanitation, and other health-related behaviors among rural households. Together, such initiatives have improved the quality of life and the health of hundreds of millions of rural residents, while also contributing to economic and social advancement across rural China (2). The purpose of this article is to describe how the PHC served as a foundation for the expansion and improvement of drinking water supply in rural China, and to summarize the key programs, projects, and initiatives that followed over the last 60 years.

March 1, 2021 In

Boiled or Bottled: Regional and Seasonal Exposures to Drinking Water Contamination and Household Air Pollution in Rural China

Abstract/Summary: We assessed the regional and seasonal prevalence of HWT practices (including bottled water use) in low-income rural areas in two Chinese provinces, evaluated the microbiological safety of drinking water and associated health outcomes, and estimated the air pollution burden associated with the use of solid fuels for boiling. Methods: We conducted cross-sectional surveys and collected drinking water samples from 1,033 rural households in Guangxi and Henan provinces. Temperature sensors affixed to pots and electric kettles were used to corroborate self-reported boiling frequencies and durations, which were used to model household air pollution (HAP) in terms of estimated particulate matter ≤2.5μm in aerodynamic diameter (PM2.5) concentrations. Results: Based on summer data collection in both provinces, after controlling for covariates, boiling with electric kettles was associated with the largest log reduction in thermotolerant coliforms (TTCs) (0.66log10 TTC most probable number/100mL), followed by boiling with pots (−0.58), and bottled water use (−0.39); all were statistically significant (p<0.001). Boiling with electric kettles was associated with a reduced risk of TTC contamination [risk ratio (RR)=0.25, p<0.001] and reported diarrhea (RR=0.80, p=0.672). TTCs were detected in 51% (n=136) of bottled water samples. For households boiling with biomass, modeled PM2.5 concentrations averaged 79 μg/m3 (standard deviation=21). Discussion: Our findings suggest that where boiling is already common and electricity access is widespread, the promotion of electricity-based boiling may represent a pragmatic stop-gap means of expanding safe water access until centralized, or decentralized, treated drinking water is available; displacing biomass use for water boiling could also reduce HAP concentrations and exposures. Our results also highlight the risks of increasing bottled water use in rural areas, and its potential to displace other sources of safe drinking water, which could in turn hamper efforts in China and other LMICs toward universal and affordable safe water access.

November 16, 2020 In

Water & poverty in rural China: Developing an instrument to assess the multiple dimensions of water & poverty

Abstract/Summary: This paper describes the theoretical foundations and development of a multidimensional, water-focused, thematic indicator of rural poverty: The Water, Economy, Investment and Learning Assessment Indicator (WEILAI). The WEILAI approach was specifically designed for application in rural China, to support poverty alleviation project planning, monitoring and evaluation, as well as targeting and prioritization. WEILAI builds primarily on the basic needs framework of poverty alleviation, and on the methodological structure of the Water Poverty Index, to provide a proxy measure of an area’s poverty by assessing eight key poverty sectors, with a strong focus on the components of water-poverty. The WEILAI approach was piloted and implemented in 534 households in China’s mountainous southwest. This paper describes the indicator construction, weighting schemes, methodology, field sites, and statistical validation of the results. In addition, we discuss the results, feedback from in-country project staff, and the likely utility of the tool for project planning, monitoring and evaluation support. The paper concludes with a discussion of WEILAI’s overall utility and ongoing development.

November 16, 2020 In

Microbiological evaluation of household drinking water treatment in rural China shows benefits of electric kettles: A cross-sectional study

Abstract: Background – In rural China ~607 million people drink boiled water, yet little is known about prevailing household water treatment (HWT) methods or their effectiveness. Boiling, the most common HWT method globally, is microbiologically effective, but household air pollution (HAP) from burning solid fuels causes cardiovascular and respiratory disease, and black carbon emissions exacerbate climate change. Boiled water is also easily re-contaminated. Our study was designed to identify the HWT methods used in rural China and to evaluate their effectiveness. Methods – We used a geographically stratified cross-sectional design in rural Guangxi Province to collect survey data from 450 households in the summer of 2013. Household drinking water samples were collected and assayed for Thermotolerant Coliforms (TTC), and physicochemical analyses were conducted for village drinking water sources. In the winter of 2013–2104, we surveyed 120 additional households and used remote sensors to corroborate selfreported boiling data. Findings – Our HWT prevalence estimates were: 27.1% boiling with electric kettles, 20.3% boiling with pots, 34.4% purchasing bottled water, and 18.2% drinking untreated water (for these analyses we treated bottled water as a HWT method). Households using electric kettles had the lowest concentrations of TTC (73% lower than households drinking untreated water). Multilevel mixed-effects regression analyses showed that electric kettles were associated with the largest Log10TTC reduction (-0.60, p<0.001), followed by bottled water (-0.45, p<0.001) and pots (-0.44, p<0.01). Compared to households drinking untreated water, electric kettle users also had the lowest risk of having TTC detected in their drinking water (risk ratio, RR = 0.49, 0.34–0.70, p<0.001), followed by bottled water users (RR = 0.70, 0.53–0.93, p<0.05) and households boiling with pots (RR = 0.74, 0.54–1.02, p = 0.06). Conclusion: As far as we are aware, this is the first HWT-focused study in China, and the first to quantify the comparative advantage of boiling with electric kettles over pots. Our results suggest that electric kettles could be used to rapidly expand safe drinking water access and reduce HAP exposure in rural China.

November 16, 2020 In

Predictors of drinking water boiling & bottled water consumption in rural China: A hierarchical modeling approach

Abstract/Summary: Approximately two billion people drink unsafe water. Boiling is the most commonly used household water treatment (HWT) method globally and in China. HWT can make water safer, but sustained adoption is rare and bottled water consumption is growing. To successfully promote HWT, an understanding of associated socioeconomic factors is critical. We collected survey data and water samples from 450 rural households in Guangxi Province, China. Covariates were grouped into blocks to hierarchically construct modified Poisson models and estimate risk ratios (RR) associated with boiling methods, bottled water, and untreated water. Female-headed households were most likely to boil (RR = 1.36, p < 0.01), and among boilers those using electric kettles rather than pots had higher income proxies (e.g., per capita TV ownership RR = 1.42, p < 0.01). Higher-income households with younger, literate, and male heads were more likely to purchase (frequently contaminated) bottled water, or use electric kettles if they boiled. Our findings show that boiling is not an undifferentiated practice, but one with different methods of varying effectiveness, environmental impact, and adoption across socioeconomic strata. Our results can inform programs to promote safer and more efficient boiling using electric kettles, and suggest that if rural China’s economy continues to grow then bottled water use will increase.

November 16, 2020 In

Implementation of Water Safety Plans in China: 2004-2018

Abstract/Summary:The application of Water Safety Plans (WSPs) in China varies throughout the country. Although pilot WSP projects in China were initiated shortly after WSP was introduced by the World Health Organization (WHO) in 2004, they have yet to be used for water supply facilities at a large scale. To better understand the evolution of WSP application in China, a systematic review was conducted to identify all published WSP related studies in China. Eighteen studies, which included 311 water systems, were included in the final analysis. Risk matrix, water supply risk factors, and other data were extracted and analyzed. Text mining methods were also used to better understand risks that can be addressed by WSPs (both potential and actual risks). This study revealed a number of noteworthy differences between and among urban and rural water systems in China. The primary risks associated with most urban water supply systems tended to be related to mechanical failure/s in the water treatment process. Rural water supply systems appear to suffer from similar problems, but insufficient overall management capacity was more prevalent in rural systems. Overall, the evidence suggests that, to date, the use of WSPs in China has been primarily limited to pilot studies, and full implementation of WSPs in China appears to still be in the early stages. The paper closes with a summary of the key obstacles identified as well as a discussion of policies and technical options which could increase the use of WSPs in both urban and rural China. Among other recommendations, the data indicate that there is strong need for the development and implementation of a simplified WSP approach designed specifically for small rural systems in China.

November 16, 2020 In

Intermittent water supply management, household adaptation, & drinking water quality: A comparative study in two Chinese provinces

Abstract/Summary: Intermittent water supply (IWS) is a relatively common phenomenon across the world as well as in rural and peri-urban areas across China, though there has been little IWS-focused research from China published to date. IWS consumers typically adopt a range of strategies to cope with insufficient water supply, poor drinking water quality, and associated inconveniences. In this study, we collected a range of data from small-scale utilities and households in two IWS systems and two continuous water supply (CWS) systems, as well as from comparison groups, in Shandong and Hubei provinces. Data collection included water quality testing, interviews, and surveys on behavioral adaptations, coping strategies, water-related health perceptions, and other metrics of consumer satisfaction. Overall, we found that the IWS coping strategies employed in northern China (Shandong) were associated with generally safe, but inconvenient, water access, whereas adaptation strategies observed in southern China (Hubei) appeared to improve convenience, but not water quality. Compared to the CWS comparison groups, we did not observe significant differences in waterand sanitation-related behaviors in the IWS groups, suggesting interventions to increase adaptive and protective behaviors at the household level might further improve safe water access for households living with IWS. Overall, although the water supply infrastructure in these study areas appeared to be in relatively good condition, in contrast to reported data on IWS systems in other countries, we observed multiple risk factors associated with the water treatment and distribution processes in these IWS systems. Among policy recommendations, our results suggest that the implementation of Water Safety Plans in China would likely improve the management of drinking water treatment and, by extension, safe drinking water supply under conditions of IWS.

November 8, 2020 In

间歇式供水卫生风险及对农村家庭卫生行为影响的初步研究 [Intermittent water supply & associated impacts on drinking water & health-related behaviors in rural households]

Abstract/Summary: Objective: To understand the potential health risks associated with intermittent water supply（IWS） in rural area of China generally，and to evaluate the impact of IWS on water and sanitation-related behaviors in rural households specifically. Methods: Two villages with IWS were selected as the study group，one in Shandong province and one in Hubei province，and two neighboring villages with similar socioeconomic conditions and continuous water supply（CWS） were selected as the controls. A total of 600 households were randomly selected in the IWS and CWS groups. From August to November，2017，trained investigators conducted structured interviews to collect a variety of data related to general information of the investigated families，infrastructure of household water and environment，water and sanitation -related behaviors，etc. Data on basic information and operational situation of local drinking water treatment plants was also collected. Results: The primary reported reason for IWS was to decrease the electricity costs associated with water treatment and supply. Insufficient water production and poor clean water storage capacity were also the reasons for IWS. Under conditions of IWS，water was usually supplied one or three times per day during the peak period of water consumption，such as morning，noon and evening. The average duration of water supply in the IWS areas ranged from four hours to 15 hours. Households in the IWS group were much more likely to have water storage facilities （97.0%，194/200） compared with those in the CWS group （47.0%，188/400）. Compared with the CWS group，IWS households had worse measures of personal hygiene，indoor hygiene and household courtyard hygiene，and these differences were statistically significant （P<0.01）. The main types of water storage devices used in IWS households were roof mounted water tanks，water buckets and ceramic water tanks. The percentages of roof -mounted water tanks without mark of qualified quality，household water storage containers without hygienic administrative license for drinking water -related products，clean roof -mounted water tanks and storage containers were 44.6% ，41.5% ，17.9% and 29.7% respectively. Conclusion: Compared with CWS，IWS in rural areas is strongly associated with changes in water-related health behaviors，and unsafe household water storage is the most prominent problem for health risks. Additional attention should be paid to the water safety of rural residents living under conditions of IWS.

November 8, 2020 In

The impacts of socioeconomic development on rural drinking water safety in China: A provincial-level comparative analysis

Abstract/Summary:In China, achieving rural drinking water safety—meaning access to a safe, affordable, sufficient, and sustainable drinking water supply—remains a key challenge for government agencies and researchers. Using cross-sectional data at the provincial level, in this paper we examine the impacts of socioeconomic development on drinking water safety in rural China. Using a theoretical framework called Pressure-State-Response (PSR), existing data were organized into state and pressure indicators. Canonical Correlation Analysis was then used to analyze provincial-level relationships between the indicators. Significant drinking-water-safety-related differences were found across provinces. Our analyses suggest that, overall, China’s recent and rapid socioeconomic development yielded substantial benefits for China’s rural drinking water safety. However, this same development also negatively impacted rural drinking water safety via increased groundwater over-abstraction, reductions in water supply, and environmental contamination. The paper closes with a discussion of implications and options for improving drinking water policy, management, and regulation in rural China.