Water, Sanitation and Chronic Kidney Diseases

Cost-Effective Solutions for Safe, Pure Drinking Water

Click here for full details about the water sanitation project currently underway to combat chronic kidney disease.

Although 73% of the world’s surface is covered by water, only 1% of the total water resources (fresh water) on earth is available for human use. In part because of over-exploitations and destruction of the environment, that 1% is now threatened. Population growth, rapid urbanization, expanding agriculture and industries continually increase the demand for fresh water. As a result, aging infrastructure and treatment plants and dams are under strain, and additional supplies and water preservation efforts are needed. Consequently, we lose approximately 1.7 trillion gallons of water worldwide each year.

Safe drinking water is a fundamental human right, but more than 2.0 billion people in the world still lack access to safe-clean drinking water and to sanitation; Sri Lanka is no exception. Contaminated water and poor sanitation claim more lives than any war or any single disease. Toxic chemicals or organisms affecting health cannot necessarily be seen, tasted, or smelled. Provision of clean water and sanitary facilities can save over 3 million lives globally and about 10,000 in Sri Lanka, annually.

The Blue Revolution

The Wimalawansa Foundation is committed to a Blue Revolution: a revolution that will make potable water available, affordable, and accessible on a wider scale than has been possible before.

The Blue Revolution is a mission to provide sustainable clean and safe water to all, including the poorest communities.

It is dedicated to providing innovative and affordable clean water and sanitation solutions to make lives healthier, prevent diseases, and make a positive difference in people's lives.

Consequence of Drinking Contaminated Water:

Five million people, most of them children, die every year of preventable waterborne diseases. Millions more experience diarrheal diseases, growth stunting, and poor physical and mental development.

Geographical and Other Issues Pertinent to Sri Lanka:

A dried water well in the North Central Province of Sri Lanka.

Safe drinking water is a precious asset. Despite plenty of rains in certain parts of the country and several large rivers, water scarcity is real in the North Western, North Central, Eastern and the Northern Provinces of Sri Lanka. However, water issues are local, as vividly observed in the NCP. Surmounting this challenge requires developing alliances and resilience among all stakeholders: the government, public and private sectors, and consumers.

Chronic Kidney disease (CKD) primarily affects middle-aged male farmers. The CKD in Sri Lanka is geographically demarcated, but is spreading to adjoining areas around the North Central Province (NCP) and elsewhere. The agricultural communities are predominantly affected; of which more than 90% live in rural areas with little access to medical facilities. Currently, the CKD-prone areas cover approximately 20,000 km2, and affecting about 2.8 million people. The occurrence of CKD is thought to be cause by the consumption of polluted water. Adverse environmental conditions, irrigation methods, agricultural habits, chemical fertilizer and agro-chemical use may play a role in causing this disease; but no causality is demonstrated. CKD in NCP is an environmental disease.

Causes and Incidence of CKD:

The water in the affected areas is contaminated with toxic heavy metals, cadmium, arsenic, as well as fluoride, nitrates and toxic agro-chemicals. Although the specific cause for the CKD is unknown, it is likely to be multi-factorial and due to a combination of chemicals or toxins widespread in this area. The exact incidence, prevalence, or the causes of CKD are unknown, but approximately 100,000 people seemed to be affected (up to 10% of people in certain villages) and the incidence is increasing. Thus, an urgent solution is necessary.

The Reality:

A centrally purified pipe-borne water supply would be the definitive solution, but this may take another three decades or more to materialize; by then, an estimated 200,000, predominantly middle-aged male farmers will be succumb to CKD, as there is no curative measure. Other than providing centrally purified pipe-borne water or clean water via reverse osmosis (RO) plants, there is no other sustainable way of providing clean water to the affected villages, most of which are remote. However, this must be done systematically and scientifically. A variety of commercial filters has been introduced, but none seems capable of removing the potential chemicals and toxins efficiently.

Methodologies:

The NC-Region (NCR) desperately needs a cost-effective way to provide safe and clean water for its populace. Our analysis indicates that the Reverse Osmosis (RO) is the most cost-effective system than can remove all toxic components from the brackish water in NCP. RO units come as capacity of 1,000 to 100,000 Litres of purified water, daily. However, not all RO units are the same. Thus, it is important to install the right RO unit in a given village, ideally with a built-in mode of delivery of clean water. Depending on the water quality/turbidity, a pre-filter is necessary in most villages. We are currently installing these units in the northern NCP, and planning to install a demonstration/pilot unit in a village closer to Anuradhapura for interested parties to visit and observe how the systems work.

Education, Awareness and Pollution Prevention Campaign:

Village-based and region-wide awareness and educational campaign on, (A) consequences of drinking contaminated water, (B) importance of using safe, and clean treated water, C) water conservations methods, prevention of pollution of water sources and environment, (D) utilization of locally available organic substances and compost for cultivation and for pest control. We have an on-going village level educational cum informative campaign on this since 2008, but this needs to be intensified.

Issues to Consider:

  1. Prioritization of villages & identifying optimal location within the village for RO installation of plants.
  2. Identification of the right RO units for the right village: as cost-effective, practical, and sustainable way to provide clean water – via water treatment technology (removing all potential pollutants).
  3. Sustainable sources of brackish-water; disposal of contaminated water; method for distribution.
  4. Infrastructure for the proper operation and long-term maintenance of RO plants.
  5. Widespread Awareness and Education Program on prevention of water pollution.
  6. Monitoring: water quality as an integral part of the operation and maintenance.
  7. Long-term data collation and systematic assessments to eliminate health problems in the region.
  8. Capital, operational, maintenance and distribution costs; and cost recovery method.

Cost of Installation of RO Plants:

On average, a Reverse Osmosis (RO) water purification plant cost $8,000 (range between $3,000 to $20,000). The Prepro foundation will be purchasing US-manufactured, high quality, RO unit, at a cost $8,500. This includes purchase, shipping, installing, and maintenance. Considering the durability and the lower maintenance costs (e.g., electricity savings), we have opted to purchase the "Advanced" models of this units, which costs $500 more than we previously budgeted and included in the flyer (thus, $8,500/unit). Entire region requires 600 of these RO units. These units would provide safe and clean water for between 1,500 and 2,000 people (i.e., one to three villages) in the north central province, and expected to save over 30 human lives over its life span.

Cost-Effectiveness

The number of deaths secondary to CKD in the affected regions currently approximates 5,000/year (statistics are under-estimated). Thus, each $650 spent on this project will prevent one CKD death per year. Therefore, over the expected life span of 30 years of an RO pant, prevention of one death would cost only US $23; less than a cost of one restaurant meal.

Another way to look at is the effects of reducing morbidity and mortality within one village following installation on one RO plant. With a rate of 1% current estimated CKD deaths (which is in fact, increasing), each RO plant would reduce ~10 deaths in an affected village, per year. Thus, over a 30-year period, each RO plant will save 300 lives with capital cost of $8,900. There is no medical or other intervention where one could offer a solution to this region that is even close to this cost-effectiveness in reducing burden of diseases and premature deaths.

Expectation:

The provision of clean water will significantly prevent the new occurrence of CKD in healthy people. It would also decrease other chronic diseases that are prevalent in the NCR (region). Thus, the clean water consumption prevents and reverses the trend of sicknesses and enables the continuation of productive lives.

Current Priorities: Commitments and Raising Funds

  1. Island-wide campaign on prevention of water contamination and environmental pollution.
  2. Provision of clean, safe potable water using RO systems to CKD-affected villages in Sri Lanka.
  3. Raising funds, and to develop collaborations and partnerships as appropriate with non-profit and the private sectors to implement the project and its longer-term maintenance in the NCR.

If the funds are granted, our organizations could provide expertise in professionally installing these 380 plants within the next 18 months to provide clean water to each affected village in the NCP.

Such a project must invariably link to the provision of safe, sanitary and toilet facilities in the region. We look forward to conducting a meaningful discussion with the view towards undertaking a firm and sustainable plan of action.

News and Articles

The following is a series of recent news articles regarding the epidemic of chronic kidney disease.

Water Journeys: Connecting Water Professionals to Third World Needs

http://waterjourneys.org/

Lankaweb: Article Series on Chronic Kidney Disease by Dr. Sunil J. Wimalawansa

http://www.lankaweb.com/news/items/category/professor-sunil-j-wimalawansa/

Daily Mirror: Water Pollution and Chronic Kidney Disease in Sri Lanka

http://www.dailymirror.lk/opinion/172-opinion/43526-water-pollution-and-chronic-kidney-disease-in-sri-lanka.html

Should Glyphosate be Banned Without Scientific Evidence? Chronic Kidney Disease of Multi-Factorial Origin (CKD-mfo)

http://www.island.lk/index.php?page_cat=article-details&page=article-details&code_title=100405

Agro-Chemicals and Chronic Kidney Disease: What Needs to be Done

http://www.island.lk/index.php?page_cat=article-details&page=article-details&code_title=98247

Knocking the Kidney Killer

http://www.dailynews.lk/features/knocking-kidney-killer

Chronic Kidney Disease in Rajarata, Worse Than Tsunami

http://www.sundayobserver.lk/2013/11/24/fea06.asp

Chronic Kidney Disease in Rajarata, Worse Than Tsunami

http://www.sundayobserver.lk/2013/11/24/fea06.asp

Olcott Oration 2013

http://www.anandacollege.net/document/14011809Olcott%20Oration%20Book.pdf

Tribal Leadership: Leveraging Natural Groups to Build a Thriving Organization

http://rsgonnering1.macmate.me/Emergent_Health/Health_Care.html

Scientific Papers

Impact of Changing Agricultural Practices on Human Health: Chronic Kidney Disease of Multi-Factorial Origin in Sri Lanka

http://www.wudpeckerresearchjournals.org/WJAR/pdf/2014/May/Wimalawansa%20and%20Wimalawansa.pdf

Chronic Kidney Disease of Uncertain Aetiology: Prevalence and Causative Factors in a Developing Country

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765913/

Epidemiology of Chronic Kidney Disease in a Sri Lankan Population

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772012/

Tubulointerstitial Damage as the Major Pathological Lesion in Endemic Chronic Kidney Disease Among Farmers in North Central Province of Sri Lanka

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348245/

Uncertain Etiologies of Proteinuric-Chronic Kidney Disease in Rural Sri Lanka.

http://www.ncbi.nlm.nih.gov/pubmed/21832982

Aetiological Factors of Chronic Kidney Disease in the North Central Province of Sri Lanka: A Review of Evidence To-Date

http://dh-web.org/health/ckdu/review-JCCGP.pdf

Chronic Renal Failure in Sri Lanka Caused by Elevated Dietary Cadmium: Trojan Horse of the Green Revolution.

http://www.ncbi.nlm.nih.gov/pubmed/20430069

Mycotoxin Detection in Urine Samples From Patients With Chronic Kidney Disease of Uncertain Etiology in Sri Lanka.

http://www.ncbi.nlm.nih.gov/pubmed/21553028

Dose-dependent Na and Ca in Fluoride-Rich Drinking Water--Another Major Cause of Chronic Renal Failure in Tropical Arid Regions.

http://www.ncbi.nlm.nih.gov/pubmed/21109289

Chronic Renal Failure in North Central Province of Sri Lanka: an Environmentally Induced Disease.

http://www.ncbi.nlm.nih.gov/pubmed/17643458

Pollution of River Mahaweli and Farmlands Under Irrigation by Cadmium from Agricultural Inputs Leading to a Chronic Renal Failure Epidemic Among Farmers in NCP, Sri Lanka.

http://www.ncbi.nlm.nih.gov/pubmed/20981564

Chronic Kidney Diseases of Uncertain Etiology (CKDue) in Sri Lanka: Geographic Distribution and Environmental Implications.

http://www.ncbi.nlm.nih.gov/pubmed/20853020

EPA Fact Sheet: Drinking Water Standard for Arsenic

http://water.epa.gov/lawsregs/rulesregs/sdwa/arsenic/regulations_factsheet.cfm

Setting Maximum Levels for Certain Contaminants in Foodstuffs (Commission Regulation (EC) No 1881/2006)

http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2006:364:0005:0024:EN:PDF