Human Health Risk Assessment Applied to Rural Populations Dependent on Unregulated Drinking Water Sources: A Scoping Review
Abstract
:1. Introduction
2. Methods
2.1. Research Question
2.2. Data Sources and Search Strategy
2.3. Citation Management
2.4. Eligibility Criteria
2.5. Title and Abstract Relevance Screening
2.6. Data Characterization
2.7. Data Summary and Synthesis
3. Results
3.1. Search and Selection
3.2. Human Health Risk Assessment Characteristics
3.3. Literature Characteristics
3.4. Literature Gaps
4. Discussion
5. Strengths and Limitations
6. Conclusions
Recommendations
- Components of the HHRA (e.g., exposure population, source water, hazards, etc.) should be adequately described to improve the detection of potential relevant literature upon title and abstract searches, and the quality of research reporting. Consistent use of terminology and reporting associated with standardized HHRA frameworks is essential. Uncertainty and limitations should be clearly presented to allow for appropriate interpretation of the research.
- A holistic approach to HHRA should be considered when non-traditional factors are suspected of influencing the human health risk. This can be accomplished with alternative methods of risk assessment (e.g., Bayesian risk assessment) to characterize non-traditional factors and their influence on the human health risks. Gaps in the literature identify the need to consider the effects and uncertainty associated with non-traditional factors with respect to multiple hazards, exposures and pathways.
- Identification of gaps in research, management, community, and risk assessments is a necessary component of HHRA. Recognition of gaps in these areas drives research forward, paving the way for new research to better inform future approaches, frameworks, and decision-making.
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Inclusion Criteria |
---|
Peer-reviewed |
Identified applied HHRA |
Identified water use for human consumption |
Identified the water source as unregulated or unspecified a |
Characteristic | Number (n = 100) | Percentage (%) |
---|---|---|
Exposure Population | ||
Geographic Area of Population | ||
Rural (rural and unregulated) | 28 (7) | 28 (7) |
Urban (urban and rural) | 16 (4) | 16 (4) |
Remote (remote and rural) | 2 (0) | 2 (0) |
Unspecified | 54 | 54 |
Community a | ||
Geography | 86 | 86 |
Topography | 27 | 27 |
Cultural/Spiritual | 2 | 2 |
Unspecified | 20 | 20 |
Receptors a | ||
Adults | 66 | 66 |
Local Residents | 41 | 41 |
Child | 31 | 31 |
Toddler | 15 | 15 |
Teen | 15 | 15 |
Responsible for source water | 13 | 13 |
Seniors | 11 | 11 |
General Public | 10 | 10 |
Infants | 10 | 10 |
Local Farmers and Families | 5 | 5 |
Employees | 2 | 2 |
First Nation/Indigenous | 0 | 0 |
Age categories not defined | 39 | 39 |
Other (e.g., gender, visitors, etc.) | 6 | 6 |
Unspecified | 8 | 8 |
Exposure Pathway a | ||
Oral | 100 | 100 |
Dermal | 23 | 23 |
Inhalation | 4 | 4 |
Hazard Identification | ||
Status of drinking water | ||
Unregulated (unregulated and untreated) | 21 (14) | 21 (14) |
Unspecified (unspecified and untreated) | 79 (51) | 79 (51) |
Source of drinking water a | ||
Groundwater (unregulated groundwater) | 67 (14) | 67 (14) |
Surface water (unregulated surface water) | 39 (7) | 39 (7) |
Other (e.g., bottled, rain, cistern, etc.) | 21 | 21 |
Unspecified | 5 | 5 |
Type of drinking water | ||
Untreated | 56 | 56 |
Untreated and Treated | 9 | 9 |
Unspecified | 35 | 35 |
Hazard in drinking water | ||
Anthropogenic chemical | 35 | 35 |
Natural chemical | 22 | 22 |
Anthropogenic and natural chemical | 25 | 25 |
Microbiological/Pathogen (microbiological/pathogen and chemical) | 10 (2) | 10 (2) |
Radiological (radiological and chemical) | 1 (3) | 1 (3) |
Unspecified | 7 | 7 |
At least two hazards identified | 5 | 5 |
Data source a | ||
Source water sampled | 96 | 96 |
Historical data | 13 | 13 |
Predicted/Extrapolated | 11 | 11 |
Biomarkers (i.e., hair samples) | 3 | 3 |
Unspecified | 2 | 2 |
Applied Method | ||
Deterministic | 86 | 86 |
Probabilistic/Stochastic | 9 | 9 |
Deterministic and Probabilistic/Stochastic | 5 | 5 |
Scope a | ||
Human Health Risk Assessment | 100 | 100 |
Integrated (human and environmental) | 4 | 4 |
Holistic (integration of non-traditional data) | 0 | 0 |
Framework Used a | ||
US EPA | 75 | 75 |
World Health Organization | 6 | 6 |
Other (i.e., studies, government) | 15 | 15 |
Unspecified | 12 | 12 |
HHRA Terminology | ||
Health (risk) Assessment | 47 | 47 |
Human Health Risk Assessment | 25 | 25 |
Risk Assessment | 24 | 24 |
Other (e.g., cancer risk, risk estimate, etc.) | 14 | 14 |
Factors and Uncertainty | ||
Non-Traditional Factors acknowledged a | ||
At least one non-traditional factor | 90 | 90 |
Geography | 76 | 76 |
Social | 23 | 23 |
Economic | 13 | 13 |
Risk Perception | 3 | 3 |
Cultural/Spiritual | 2 | 2 |
Other (e.g., behaviours, additional risks, temporal effects, etc.) | 22 | 22 |
Non-Traditional Factors applied a | ||
At least one non-traditional factor | 69 | 69 |
Geography | 56 | 56 |
Social | 4 | 4 |
Economic | 2 | 2 |
Risk Perception | 1 | 1 |
Cultural/Spiritual | 1 | 1 |
Other (e.g., behaviours, additional risks, temporal effects, etc.) | 16 | 16 |
Uncertainty acknowledged a | ||
At least one uncertainty acknowledged | 83 | 83 |
Dedicated section to uncertainty | 20 | 20 |
Quality Assurance/Quality Control | 47 | 47 |
Analytical detection limits | 38 | 38 |
Seasonal/Environment | 38 | 38 |
Data gaps | 30 | 30 |
Sufficiency of sampling | 28 | 28 |
Quality of historical data | 10 | 10 |
Other (e.g., exposures, toxicological factors, effects of unknown variables, etc.) | 18 | 18 |
Outcomes | ||
Result a | ||
Exposure Assessment | 96 | 96 |
Hazard Assessment | 95 | 95 |
Hazard Quotient/Index | 81 | 81 |
Epidemiological Assessment | 4 | 4 |
Other (i.e., quantitative microbial risk assessment and cancer risk) | 27 | 27 |
Conclusion by Authors | ||
Quantitative | 94 | 94 |
Quantitative and Qualitative | 4 | 4 |
Qualitative | 2 | 2 |
Characteristic | ||
---|---|---|
World Region | Number (n = 101 a) | Percentage (%) |
Asia | 58 | 57.4 |
West Africa | 9 | 8.9 |
Europe | 7 | 6.9 |
European Union | 8 | 7.9 |
North America | 7 | 6.9 |
South America | 4 | 4.0 |
South Africa | 3 | 3.0 |
Middle East | 2 | 2.0 |
Caribbean | 1 | 1.0 |
East Africa | 1 | 1.0 |
Oceania | 1 | 1.0 |
Publication Year | Number (n = 100) | Percentage (%) |
January 2010–May 2014 | 75 | 75 |
January 2005–December 2009 | 20 | 20 |
January 2000–December 2004 | 5 | 5 |
Gap Description | References |
---|---|
Research in HHRA | |
Use of biomonitoring | [78] |
Improved methods or application | [48,61,72,79,80] |
Sources of uncertainty | [37,47] |
Determining temporal exposures | [81] |
Determining future exposures | [42,74] |
Considering all pathways of exposure | [41,50,82,83,84,85] |
Exposure to additional hazard sources | [41,63,73,86] |
Exposure to mixtures | [34,53,58,83,87] |
Guides to direct researchers | [88] |
Gather more epidemiological evidence and toxicological data | [37,44,49,64,65,73,79,89] |
Risk Management | |
Collect data to inform management | [49,60,64,71] |
Knowledge of geochemistry and aquifers | [89,90] |
Monitoring | [58,79] |
Evaluation of exposures | [54,59,86] |
Establish national/regional HHRAs | [39,61,77,91] |
Standardize methods for mixtures | [47] |
Standardize regulations | [57,92] |
Improved communication, response and determination of risk | [53,62,64,72] |
Community Exposure | |
Inclusion of specific community (i.e., sensitive community members) | [42] |
Isolate risks specific to communities | [48,55,93] |
Consider quality of life, socioeconomic, and political factors | [75,90,94] |
Improve community involvement, engagement, education, and risk management | [49,53,95] |
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Share and Cite
Ford, L.; Bharadwaj, L.; McLeod, L.; Waldner, C. Human Health Risk Assessment Applied to Rural Populations Dependent on Unregulated Drinking Water Sources: A Scoping Review. Int. J. Environ. Res. Public Health 2017, 14, 846. https://doi.org/10.3390/ijerph14080846
Ford L, Bharadwaj L, McLeod L, Waldner C. Human Health Risk Assessment Applied to Rural Populations Dependent on Unregulated Drinking Water Sources: A Scoping Review. International Journal of Environmental Research and Public Health. 2017; 14(8):846. https://doi.org/10.3390/ijerph14080846
Chicago/Turabian StyleFord, Lorelei, Lalita Bharadwaj, Lianne McLeod, and Cheryl Waldner. 2017. "Human Health Risk Assessment Applied to Rural Populations Dependent on Unregulated Drinking Water Sources: A Scoping Review" International Journal of Environmental Research and Public Health 14, no. 8: 846. https://doi.org/10.3390/ijerph14080846