Urban Health Updates — from the WASHplus Project

Annotated bibliography on household water treatment & safe storage, 2009

July 28, 2009 · 0 comments

Environmental Health at USAID has compiled an annotated bibliography of 21 journal articles on household water treatment and safe storage that were published from January-July 2009.

Link: http://www.ehproject.org/PDF/ehkm/bibliography-hwt_july2009.pdf (pdf, 70KB)

Below are 3 of the 21 studies from the bibliography:

1 – Am J Trop Med Hyg. 2009 May; 80(5):819-23.
Laboratory assessment of a gravity-fed ultra-filtration water treatment device designed for household use in low-income settings.

Clasen T, Naranjo J, Frauchiger D, Gerba C.

Interventions to improve water quality, particularly when deployed at the household level, are an effective means of preventing endemic diarrheal disease, a leading cause of mortality and morbidity in the developing world. We assessed the microbiologic performance of a novel water treatment device designed for household use in low-income settings. The device employs a backwashable hollow fiber ultrafiltration cartridge and is designed to mechanically remove enteric pathogenic bacteria, viruses, and protozoan cysts from drinking water without water pressure or electric power. In laboratory testing through 20,000 L (approximately 110% of design life) at moderate turbidity (15 nephelometric turbidity unit [NTU]), the device achieved log(10) reduction values of 6.9 for Escherichia coli, 4.7 for MS2 coliphage (proxy for enteric pathogenic viruses), and 3.6 for Cryptosporidium oocysts, thus exceeding levels established for microbiological water purifiers. With periodic cleaning and backwashing, the device produced treated water at an average rate of 143 mL/min (8.6 L/hour) (range 293 to 80 mL/min) over the course of the evaluation. If these results are validated in field trials, the deployment of the unit on a wide scale among vulnerable populations may make an important contribution to public health efforts to control intractable waterborne diseases.

4 – Environ Sci Technol. 2009 Feb 15; 43(4):986-92.
Household water treatment in poor populations: is there enough evidence for scaling up now?

Schmidt WP, Cairncross S.
Point-of-use water treatment (household water treatment, HWT) has been advocated as a means to substantially decrease the global burden of diarrhea and to contribute to the Millennium Development Goals. To determine whether HWT should be scaled up now, we reviewed the evidence on acceptability, scalability, adverse effects, and nonhealth benefits as the main criteria to establish how much evidence is needed before scaling up. These aspects are contrasted with the evidence on the effect of HWT on diarrhea. We found that the acceptability and scalability of HWT is still unclear, and that there are substantial barriers making it difficult to identify populations that would benefit most from a potential effect. The nonhealth benefits of HWT are negligible. Health outcome trials suggest that HWT may reduce diarrhea by 30-40%. The problem of bias is discussed. There is evidence that the estimates may be strongly biased. Current evidence does not exclude that the observed diarrhea reductions are largely or entirely due to bias. We conclude that widespread promotion of HWT is premature given the available evidence. Further acceptability studies and large blinded trials or trials with an objective health outcome are needed before HWT can be recommended to policy makers and implementers.

7 – Int J Epidemiol. 2009 Jul 2.

Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala.

Arnold B, Arana B, Mäusezahl D, Hubbard A, Colford JM Jr.

BACKGROUND: The promotion of household water treatment and handwashing with soap has led to large reductions in child diarrhoea in randomized efficacy trials. Currently, we know little about the health effectiveness of behaviour-based water and hygiene interventions after the conclusion of intervention activities.

METHODS: We present an extension of previously published design (propensity score matching) and analysis (targeted maximum likelihood estimation) methods to evaluate the behavioural and health impacts of a pre-existing but non-randomized intervention (a 3-year, combined household water treatment and handwashing campaign in rural Guatemala). Six months after the intervention, we conducted a cross-sectional cohort study in 30 villages (15 intervention and 15 control) that included 600 households, and 929 children <5 years of age.

RESULTS: The study design created a sample of intervention and control villages that were comparable across more than 30 potentially confounding characteristics. The intervention led to modest gains in confirmed water treatment behaviour [risk difference = 0.05, 95% confidence interval (CI) 0.02-0.09]. We found, however, no difference between the intervention and control villages in self-reported handwashing behaviour, spot-check hygiene conditions, or the prevalence of child diarrhoea, clinical acute lower respiratory infections or child growth.

CONCLUSIONS: To our knowledge this is the first post-intervention follow-up study of a combined household water treatment and handwashing behaviour change intervention, and the first post-intervention follow-up of either intervention type to include child health measurement. The lack of child health impacts is consistent with unsustained behaviour adoption. Our findings highlight the difficulty of implementing behaviour-based household water treatment and handwashing outside of intensive efficacy trials.

Annotated bibliography on household water treatment

July 27, 2009 · 0 comments

Environmental Health at USAID has compiled an annotated bibliography of 19 journal articles on Household Water Treatment and Safe Storage that were published from January – July 2009.

Link: http://www.ehproject.org/PDF/ehkm/bibliography-hwt_july2009.pdf

Typhoid Vaccines Ready for Implementation

July 23, 2009 · 0 comments

Editorial – Typhoid Vaccines Ready for Implementation, IN: NEJM, Volume 361:403-405 July 23, 2009 Number 4

Myron M. Levine, M.D., D.T.P.H.

Enteric fevers encompass typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi) and paratyphoid fever caused by serotype Paratyphi A or B (S. Paratyphi). These human-restricted pathogens are acquired by ingesting contaminated water or food, and in the individual patient, one cannot differentiate clinically which agent is causing illness. S. Typhi expresses a capsular “Vi” (for virulence) polysaccharide, whereas S. Paratyphi A and B cannot synthesize Vi.

Before the use of antibiotics, typhoid fever had a case fatality rate of 10 to 20%. Transmission of enteric fever is minimized or eliminated if populations have access to treated water supplies and sanitation to remove human fecal matter. Where such amenities are unavailable, the risk of typhoid fever can be substantially diminished by immunization with typhoid vaccines.

Early typhoid vaccines (heat-inactivated whole S. Typhi organisms preserved in phenol) were developed in the 1890s. Six decades later, the World Health Organization (WHO) sponsored large-scale, randomized, controlled field trials, in which investigators found that similar killed whole-cell vaccines conferred substantial protection against typhoid.1 However, because these vaccines commonly elicited debilitating adverse reactions (fever and malaise), they were rarely used to control endemic typhoid fever.1

After a report in 1948 that chloramphenicol drastically ameliorated enteric fevers and reduced the case fatality rate to less than 1%, the treatment of patients with oral chloramphenicol became the mainstay of typhoid control in developing countries for the next quarter century. A rude awakening came in the 1970s, when epidemics of chloramphenicol-resistant typhoid occurred in Mexico and Vietnam. These outbreaks stimulated a search for alternative oral antibiotic therapies and accelerated efforts to develop a new generation of better-tolerated, efficacious typhoid vaccines. The efforts bore fruit when live oral S. Typhi vaccine strain Ty21a and parenteral Vi polysaccharide vaccine were licensed in the late 1980s and early 1990s. Despite extensive data documenting the safety, efficacy, and practicality of the Vi and Ty21a vaccines, they have not been widely applied programmatically in developing countries.

In the late 1980s, strains of S. Typhi that were resistant to multiple clinically relevant antibiotics began to emerge. In response, in 1999, the WHO recommended that typhoid vaccines be used for immunization of school-age children in areas where antibiotic-resistant typhoid was endemic. In 2008, the WHO and the Global Alliance for Vaccines and Immunization took more active steps to encourage programmatic use of these vaccines where typhoid is a health problem.

In most of the world, the incidence of enteric fever peaks among school-age children. However, in some South Asian urban slums, S. Typhi bacteremic infections peak in preschoolers, particularly when cases are detected by active household surveillance2,3; such infections are uncommon in infants. Since the WHO’s Expanded Program on Immunization does not typically include routine visits for toddlers or preschool children, protecting these age groups requires innovative strategies. One approach would be to administer typhoid vaccines in infancy, if efficacy could persist through the preschool and school years. Alternatively, preschool children could be targeted for mass campaigns. The current licensed typhoid vaccines are not compatible with infant immunization, since the unconjugated Vi vaccine is poorly immunogenic in infants, and the use of Ty21a in enteric-coated capsules is impractical.

In this issue of the Journal, Sur et al.4 report results of a well-executed field study showing that the Vi vaccine conferred an adjusted vaccine effectiveness of 80% in preschool children, thereby providing a biologic basis for including preschoolers in mass typhoid-immunization campaigns. However, organizing mass immunizations of so-called noncaptive populations such as preschoolers is more demanding than conducting campaigns among schoolchildren.

Sur et al. showed a trend for a lower adjusted Vi-vaccine effectiveness in older subjects (56% in children between the ages of 5 and 14 years and 46% in persons 15 years of age or older), although the differences in efficacy were not significant. These findings are the opposite of the trend observed in field trials of killed whole-cell parenteral vaccines and of the oral Ty21a vaccine, in which vaccine effectiveness was higher in older children.

A fascinating secondary analysis performed by Sur et al. indicated that control subjects who did not receive the Vi vaccine but lived in clusters with vaccinated subjects had substantial protection against typhoid fever. This is important new information. The indirect protection of nonvaccinated persons by the Vi vaccine further bolsters the case for school-based immunization to control endemic typhoid, since one might expect some indirect protection of preschool children as well. Indirect protection has also been observed with the oral Ty21a vaccine.1 Both Vi5 and Ty21a6 vaccines have been logistically practical and effective when administered to scores of thousands of schoolchildren through large-scale, school-based immunization projects.

An advantage of parenteral Vi vaccine is its single-dose regimen; unconjugated Vi does not elicit immunologic memory, so serum Vi titers are not boosted by additional doses. However, mass administration of the Vi vaccine by needle and syringe creates challenges for ensuring injection safety and for disposing of material that is potentially contaminated with bloodborne viruses. The use of needle-free injection devices could avert this problem. A drawback of the Ty21a vaccine is that it requires a three-dose regimen with an every-other-day interval. Nevertheless, oral immunization is logistically very practical in schoolchildren.

The Vi vaccine does not protect against S. Paratyphi A or B, since these strains do not express the Vi polysaccharide. Thus, countries with high rates of paratyphoid fever cannot expect reductions from the use of the Vi vaccine. The Ty21a vaccine confers substantial cross-protection (vaccine effectiveness, 49%) against S. Paratyphi B7 but not against S. Paratyphi A.8

In computer models, disease incidence and duration of protection greatly affect cost-effectiveness of typhoid vaccination in endemic settings. Field trials of the Vi vaccine have incorporated relatively short follow-up (17 months to 3 years),9,10 as compared with trials of the Ty21a vaccine (5 to 7 years).11 Klugman et al.10 reported a vaccine effectiveness of 55% during 3 years of follow-up. Investigation of a typhoid outbreak among Vi-immunized French soldiers in Africa showed that those who had received the vaccine more than 3 years before exposure had twice the risk of disease, as compared with those who had received the vaccine within the previous 3 years.12 Three doses of the Ty21a vaccine in enteric-coated capsules conferred a vaccine effectiveness of 62% during 7 years of follow-up.11

Two different “flavors” of licensed typhoid vaccine, parenteral unconjugated Vi and oral Ty21a, are available for use by public health practitioners. The time has come to implement use of these vaccines vigorously and monitor the effect of such intervention.

Urban Health Bulletin, May/June 2009

July 20, 2009 · 0 comments

The latest Urban Health Bulletin contains citations and abstracts to 20 recently published studies that were reviewed and selected by Anthony Kolb, USAID’s Urban Health Advisor,
Email: akolb@usaid.gov

Link – http://www.ehproject.org/PDF/ehkm/urban_health-may_jun09.pdf

Below are citations to the studies in this issue:

Urban Health Analysis

1 – Am J Hum Biol. 2009 Jun 16. Children’s work, earnings, and nutrition in urban Mexican shantytowns.

2 – Arch Dis Child. 2009 Jul 1. The effects of social variables on symptom-recognition and medical care-seeking behaviour for acute respiratory infections in infants in urban Mongolia.

3 – BMC Cardiovasc Disord. 2009 Jun 8; 9:23. The effect on cardiovascular risk factors of migration from rural to urban areas in Peru: PERU MIGRANT Study.

4 – BMC Public Health. 2009 May 22;9:149. Prevalence and correlates of smoking among urban adult men in Bangladesh: slum versus non-slum comparison.

5 – International Journal of Drug Policy, Volume 20, Issue 3, Risk Environment and Drug Harms, May 2009, Pages 237-243. The social context of initiation into injecting drugs in the slums of Makassar, Indonesia

6 – Int J Equity Health. 2009 Jun 5;8:21. Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai.

7 – Int J Health Geogr. 2009 Jun 8;8:32. The 2005 census and mapping of slums in Bangladesh: design, select results and application.

8 – Reprod Health. 2009 Jun 16;6(1):9. Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services?

Urban Environmental Health

9 – Cities, Volume 26, Issue 3, June 2009, Pages 125-132. Community-led infrastructure provision in low-income urban communities in developing countries: A study on Ohafia, Nigeria

10 – International Journal of Hygiene and Environmental Health, Volume 212, Issue 4, July 2009, Pages 387-397. Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia

11 – Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 103, Issue 5, May 2009, Pages 506-511. Improved sanitation and income are associated with decreased rates of hospitalization for diarrhoea in Brazilian infants

12 – Water Sci Technol. 2009;59(12):2341-50. Community-focused greywater management in two informal settlements in South Africa.

Urban Vector Disease

13 – Cad Saude Publica. 2009 Jul; 25(7):1543-51. Factors associated with the incidence of urban visceral leishmaniasis: an ecological study in Teresina, Piauí State, Brazil.

14 – Ethn Dis. 2009 Spring;19(1 Suppl 1):S1-37-41. Leptospirosis: a worldwide resurgent zoonosis and important cause of acute renal failure and death in developing nations.

15 – Geospat Health. 2009 May; 3(2):189-210. Urban agriculture and Anopheles habitats in Dar es Salaam, Tanzania.

16 – Malar J. 2009 Jun 24;8(1):138. Highly focused anopheline breeding sites and malaria transmission in Dakar.

17 – Malar J. 2009 May 14; 8:103. Development of vegetable farming: a cause of the emergence of insecticide resistance in populations of Anopheles gambiae in urban areas of Benin.

18 – Trop Med Int Health. 2009 Jun 28. Spatial distribution and risk factors of dengue and Japanese encephalitis virus infection in urban settings: the case of Vientiane, Lao PDR.

Urban HIV/AIDS

19 – AIDS Care. 2009 May;21(5):615-21. Factors influencing consent to HIV testing among wives of heavy drinkers in an urban slum in India.

20 – BMC Public Health. 2009 May 27;9:153. HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey.

Air pollution in womb linked to lower IQ

July 20, 2009 · 0 comments

(AP) Researchers for the first time have linked air pollution exposure before birth with lower IQ scores in childhood, bolstering evidence that smog may harm the developing brain.

The results are in a study of 249 children of New York City women who wore backpack air monitors for 48 hours during the last few months of pregnancy. They lived in mostly low-income neighborhoods in northern Manhattan and the South Bronx. They had varying levels of exposure to typical kinds of urban air pollution, mostly from car, bus and truck exhaust.

At age 5, before starting school, the children were given IQ tests. Those exposed to the most pollution before birth scored on average four to five points lower than children with less exposure.

That’s a big enough difference that it could affect children’s performance in school, said Frederica Perera, the study’s lead author and director of the Columbia Center for Children’s Environmental Health.

Dr. Michael Msall, a University of Chicago pediatrician not involved in the research, said the study doesn’t mean that children living in congested cities “aren’t going to learn to read and write and spell.”

But it does suggest that you don’t have to live right next door to a belching factory to face pollution health risks, and that there may be more dangers from typical urban air pollution than previously thought, he said.

“We are learning more and more about low-dose exposure and how things we take for granted may not be a free ride,” he said.

While future research is needed to confirm the new results, the findings suggest exposure to air pollution before birth could have the same harmful effects on the developing brain as exposure to lead, said Patrick Breysse, an environmental health specialist at Johns Hopkins’ school of public health.

And along with other environmental harms and disadvantages low-income children are exposed to, it could help explain why they often do worse academically than children from wealthier families, Breysse said.

“It’s a profound observation,” he said. “This paper is going to open a lot of eyes.”

The study in the August edition of Pediatrics was released Monday.

In earlier research, involving some of the same children and others, Perera linked prenatal exposure to air pollution with genetic abnormalities at birth that could increase risks for cancer; smaller newborn head size and reduced birth weight. Her research team also has linked it with developmental delays at age 3 and with children’s asthma.

The researchers studied pollutants that can cross the placenta and are known scientifically as polycyclic aromatic hydrocarbons. Main sources include vehicle exhaust and factory emissions. Tobacco smoke is another source, but mothers in the study were nonsmokers.

A total of 140 study children, 56 percent, were in the high exposure group. That means their mothers likely lived close to heavily congested streets, bus depots and other typical sources of city air pollution; the researchers are still examining data to confirm that, Perera said. The mothers were black or Dominican-American; the results likely apply to other groups, researchers said.

The researchers took into account other factors that could influence IQ, including secondhand smoke exposure, the home learning environment and air pollution exposure after birth, and still found a strong influence from prenatal exposure, Perera said.

Dr. Robert Geller, an Emory University pediatrician and toxicologist, said the study can’t completely rule out that pollution exposure during early childhood might have contributed. He also noted fewer mothers in the high exposure group had graduated from high school. While that might also have contributed to the high-dose children’s lower IQ scores, the study still provides compelling evidence implicating prenatal pollution exposure that should prompt additional studies, Geller said.

The researchers said they plan to continuing monitoring and testing the children to learn whether school performance is affected and if there are any additional long-term effects.

Source – CBS News

Bangladesh – Commercialization of improved cookstoves in urban slums

July 15, 2009 · 1 comment

Commercialization of Improved Cookstoves for Reduced Indoor Air Pollution in Urban Slums of Northwest Bangladesh, May 2009. (full-text, pdf, 2.86MB) USAID; Winrock.

Beginning in 2003, the energy team of USAID’s Bureau for Economic Growth, Agriculture, and Trade, and the environmental health team of the Bureau for Global Health jointly supported a cooperative agreement with Winrock International to develop models to reduce indoor air pollution by combining fuel-efficient cooking technologies with behavior change messages and market-based distribution mechanisms. Winrock developed two project models: a rural model piloted in the highlands of Peru for indigenous communities, and a peri-urban model piloted in Bangladesh for poor households.

The objective of the pilot project was to reduce indoor air pollution and fuel consumption via the dissemination and commercialization of efficient cookstoves among peri-urban communities through an integrated and sustainable household energy intervention. The project aimed to establish a sustainable market for improved and appropriate stoves to avoid the need for subsidies, either current or future.

Three models of fuel-efficient cookstoves, each significantly less polluting than traditional stoves, were selected and promoted in this project. Winrock coupled product promotion with a multi-faceted communication ampaign to raise awareness about the risks of indoor smoke and the benefits of behavior change and using improved stoves to reduce IAP exposure. The project team worked with existing local government institutions and health networks to disseminate behavior change messages, and teamed up with local entrepreneurs to disseminate stoves commercially. The project has strong potential for use as a model for incorporating IAP into child survival and health programming activities, particularly those implemented by donor agencies such as the USAID/Bangladesh Mission.

Urban poor and hungry burgeoning unnoticed

July 13, 2009 · 0 comments

JOHANNESBURG, 13 July 2009 (IRIN) – The number of poor and food-insecure people in developing countries is increasing more quickly in urban areas than in rural areas, and could be dropping off the policy radar, says new research by the US Department of Agriculture (USDA).

“Poverty is still viewed by many as a rural problem, as both governments and donors continue to allocate resources to rural development in order to reverse the bias of urban policies of the 1970s and 1980s,” Shahla Shapouri and Stacey Rosen, researchers in the department’s Economic Research Services, write in the USDA’s Food Security Assessment 2008-09.

In 2008, when the food crisis focused greater attention on agriculture and development in rural areas, for the first time in history more than half the world’s population lived in urban areas, the researchers said, citing UN Population Fund (UNFPA) statistics.

By 2030 the majority of people in all developing countries will live in urban areas, and UNFPA estimates that about 60 percent of the urban slum population will be under the age of 18. “This realization has not yet translated into policy action in most countries,” Shapouri and Rosen noted.

Sub-Saharan African countries have the world’s highest rates of urban growth and highest levels of urban poverty, according to the State of the World’s Cities Report 2006/07 by UN-Habitat, the UN human settlements programme. The slum population in these countries doubled from 1990 to 2005, when it reached 200 million.

The urban poor in Africa are more exposed to economic shocks – as the food price crisis in 2008 demonstrated – particularly in countries importing most of their food requirements.

Poor and food-insecure people will account for a large share of urban growth because of both rural migration and natural growth, since fertility rates are higher among the poor than among higher income populations
In lower-income Latin American and Caribbean countries, 45 percent of total grain supplies between 2004 and 2006 were imported, compared to 31 percent in sub-Saharan Africa, and 12 percent in lower-income Asian countries.

“Poor and food-insecure people will account for a large share of urban growth because of both rural migration and natural growth, since fertility rates are higher among the poor than among higher income populations,” the researchers pointed out.

“These developments will translate to higher poverty and more food insecurity in urban versus rural areas, and present a challenge to create employment opportunities for the urban poor.”

Trying to find a solution

Countries like India and China are trying to implement programmes to slow the pace of urbanization; in sub-Saharan Africa, “governments have increased investment in rural development with the expectation that this will slow the pace of urban migration, but so far there is no evidence to suggest that this will happen,” Shapouri and Rosen warned.

“Can the experience of the developed countries that adjusted and accommodated high urban growth rates be replicated by developing countries? The answer is not simple because of the differences in public attention and investment.”

In days gone by, the wealthy urban population in developed countries forced the authorities to devote attention to poor living conditions in local slums.

However, the rich in developing countries can now afford water pumps and generators for electricity, “thereby protecting themselves from the unhealthy conditions of the urban poor. That schism reduces pressure on developing country governments to invest in urban public services, of which the poor are the main beneficiaries.”

Improved safety-net systems to help cope with food insecurity and economic shocks are likely to become more important as the urban population increases.

Some countries are promoting urban gardening, but limited access to clean water and high population density pose the risk of contamination, the researchers cautioned.

Health hazards emanating from food in urban areas are a critical concern: buying pre-cooked food from street vendors, close contact between humans and poultry and other domestic animals for slaughter, and generally unhygienic conditions in urban markets can have significant health consequences, as has become apparent in China and various countries in Southeast Asia in recent years.

Shapouri and Rosen said quality control and urban agriculture could contribute to a healthier, safer living environment, and recommended improvements in infrastructure that would allow the efficient flow of food into cities from the countryside and via imports.

Source – http://www.irinnews.org/Report.aspx?ReportId=85265

WEDC Conference 2008 – Selected papers on urban water/sanitation

July 13, 2009 · 0 comments

Below are links to selected presentations on urban water and/or sanitation from the 33rd WEDC Conference in Ghana on Access to Sanitation and Safe Water: Global Partnerships and Local Actions, April 2008. All presentations are in pdf format.

Meeting the hygiene, safe water and sanitation needs of people living with HIV/Aids (PLWHA)

Use now, pay later: An innovative approach to increasing access to improved latrine facilities in Ghana

Water supply systems in selected urban poor areas of Addis Ababa, Ethiopia

A new global sanitary revolution: lessons from the past

Addressing the water and sanitation needs of primary schools: Experiences from East Africa

An investigation into linkages between tenure and urban sanitation development

Approaching community-level greywater management in non-sewered settlements in South Africa

Demand management for sustainable urban water services in cities of developing countries

Domestic water supply in Accra: How physical and social constraints to planning have greater consequences for the poor

HCES: A new approach to environmental sanitation planning for urban areas

Performance of private companies involved in urban solid waste management: Evidence from three cities in Ghana

Prejudices and attitudes toward reuse of nutrients from urine diversion toilets in South Africa

Bhopal – water supply is now a deadly issue

July 13, 2009 · 0 comments

India prays for rain as water wars break out

The monsoon is late, the wells are running dry and in the teeming city of Bhopal, water supply is now a deadly issue.

It was a little after 8pm when the water started flowing through the pipe running beneath the dirt streets of Bhopal’s Sanjay Nagar slum. After days without a drop of water, the Malviya family were the first to reach the hole they had drilled in the pipe, filling what containers they had as quickly as they could. Within minutes, three of them were dead, hacked to death by angry neighbours who accused them of stealing water.

In Bhopal, and across much of northern India, a late monsoon and the driest June for 83 years are exacerbating the effects of a widespread drought and setting neighbour against neighbour in a desperate fight for survival.

India’s vast farming economy is on the verge of crisis. The lack of rain has hit northern areas most, but even in Mumbai, which has experienced heavy rainfall and flooding, authorities were forced to cut the water supply by 30% last week as levels in the lakes serving the city ran perilously low.

Across the country, from Gujarat to Hyderabad, in Andhra Pradesh, the state that claims to be “the rice bowl of India”, special prayers have been held for more rain after cumulative monsoon season figures fell 43% below average.

On Friday, India’s agriculture minister, Sharad Pawar, said the country was facing a drought-like situation that was a “matter for concern”, with serious problems developing in states such as Punjab, Uttar Pradesh and Bihar.

In Bhopal, which bills itself as the City of Lakes, patience is already at breaking point. The largest lake, the 1,000-year-old, man-made Upper Lake, had reduced in size from 38 sq km to 5 sq km by the start of last week.

The population of 1.8 million has been rationed to 30 minutes of water supply every other day since October. That became one day in three as the monsoon failed to materialise. In nearby Indore the ration is half an hour’s supply every seven days.

The UN has warned for many years that water shortages will become one of the most pressing problems on the planet over the coming decades, with one report estimating that four billion people will be affected by 2050. What is happening in India, which has too many people in places where there is not enough water, is a foretaste of what is to come.

In Bhopal, where 100,000 people rely solely on the water tankers that shuttle across the city, fights break out regularly. In the Pushpa Nagar slum, the arrival of the first tanker for two days prompted a frantic scramble, with men jostling women and children in their determination to get to the precious liquid first.

Young men scrambled on to the back of the tanker, jamming green plastic pipes through the hole on the top, passing them down to their wives or mothers waiting on the ground to siphon the water off into whatever they had managed to find: old cooking oil containers were popular, but even paint pots were pressed into service. A few children crawled beneath the tanker in the hope of catching the spillage.

In the Durga Dham slum, where the tanker stops about 100 metres away from a giant water tower built to provide a supply for a more upmarket area nearby, Chand Miya, the local committee chairman, watched a similar scene. There was not enough water to go around, he said. “In the last six years it has been raining much less. The population has increased, but the water supply is the same.”

Every family needed 100 litres a day for drinking, cooking and washing, he said, and people had no idea when the tanker would come again.

Not everyone gets a tanker delivery. The city has 380 registered slums, but there are numerous other shanties where people have to find their own methods. Some, like the Malviyas, tap into the main supply. Others cluster around the ventilation valves for the main pipelines that stick up out of the ground from place to place, trying to catch the small amounts of water leaking out. In the Balveer Nagar slum, 250 families have no supply at all. The women get up in the middle of the night to walk 2km to the nearest pumping station, where someone has removed a couple of bricks from the base to allow a steady flow of water to pour out.

A few communities have received help from non-governmental organisations. In the Arjun Nagar slum, a borewell has been drilled down 115 metres by Water Aid to provide water for 100 families, each paying 40 rupees (50p) a month.

Until the well was drilled, Shaheen Anjum, a mother of four, got up at 2.30am each day to fetch water, wheeling a bike with five or six containers strapped to it to the nearest public pipe in the hope of beating the queues. “Often we would get there and the water would not be running,” she said. “It was so tiring: the children were suffering and getting ill because they had to come too. The tankers used to come, but there were so many fights that the driver used to run away.”

Water Aid is working in 17 of the city’s 380 registered slums, providing water and sanitation. “It’s not just Bhopal. This has been a drought year for many districts,” said Suresh Chandra Jaiswal, the technical officer. “Now it has reached a critical stage. We just don’t know any more how long the water will last.”

Fifty years ago, Bhopal had a population of 100,000; today it is 1.8 million and rising. In a good year the city might get more than a metre of rain between July and September, but last year the figure was only 700mm.

Neighbours of the Malviyas cluster around the hole in the street outside the house where Jeevan Malviya lived with his wife, Gyarasi, their son, Raju, 18, and their four other children. It was the evening of 13 May, said Sunita Bai, a female relative: a local man, Dinu, thought that the family had blocked the pipe to stop the water flowing further down the hill.

He and a group of friends slapped Gyarasi, 35; Raju tried to stop him. Someone produced a sword and, a few minutes later, the Malviyas lay dying. “We were too afraid to do anything,” said a woman who gave her name as Shanno. “Dinu didn’t want them to take any water. He wanted it for himself.”

Everyone stood around, looking down at the hole in the ground. The pipe is dry. “It is a terrible thing, that people should be fighting over water,” said Shanno.

Source – http://www.guardian.co.uk/world/2009/jul/12/india-water-supply-bhopal